RE: medical interpreter and non compliant pt.

[Guest guest]

So, does this mean that if someone has insurance through which you are

contracted you would refuse to see them if they requested a sign language

interpreter when they're deaf?

Before you answer, you may want to be careful about your formal reply in

written word. I am not a lawyer but from things I have heard I could

imagine a formal written statement of that sort could very easily be

admissible in a court case for discrimination based on a handicap.

And when we say " a good fit " , could a white, upperclass doctor refuse to

accept a new patient who is black, unemployed and under educated because

they say they can not " relate " and believe that ultimately the patient

would be problematic? I pose this question to provoke thoughts and do not

mean to challenge anyone personally.

The question of prejudice and discrimination in our country is a huge

challenge. And I for one think all of us must be careful how we act, not

for legal reasons but rather, for appropriateness.

Refusing a patient care when they have an insurance we're contracted with

when they have done nothing officially wrong, to me is worth profound

contemplation of what is medical professionalism.

We must address the business-side of our offices. No margin, no mission.

But I agree with some other sentiments recently stated that being a

physician, at least part of the time, is much more than a business both

for the patient and the doctor. This field of medicine, which we asked to

the part of, like it or not, holds a special place in our society and it

has a level of professionalism not expected of most other fields.

Again, I do not mean to offend. But I do mean to challenge all of our

thinking. I do not recommend we make decisions which will lead to ruin

financially. But I do recommend we make some decisions at a different

level than the accountants of the insurance companies.

Respectfully,

Tim

> Good summary on your part. But I am in fact following my contractual

> language exactly. As I mentioned, I just signed one yesterday & it said

> " will provide interpretor services to deaf patients at no charge or make

> reasonable accomodations if indicated. " In the final analysis though,

> it has minimal to no impact on my personal practice because I have yet

> to be asked to see a deaf patient. I can tell you though my bottom

> line: I will not be forced to take on any new patient that I do not feel

> comfortable seeing or that would not be a good fit. One of the biggest

> mistakes (in my opinion) I still colleagues in private practice making

> is not running a things like a business; rather, they try to look at it

> as a " save the world " venture. True, we are different than say, a

> hairdresser, but it is still a business first and I just will not be

> forced to see patients at a loss. Now, if you are seeing these patients

> for free out of the goodness of your heart or have a particular i!

> nterest in it, then that is a bit different I guess. But if you are

> just seeing them for free because you feel obligated to by law, then

> count me out on that one.

>

>

>>

>>

>> Date: 2006/03/25 Sat PM 12:47:00 EST

>> To: < >

>> Subject: Re: Re: medical interpreter and non

>> compliant pt.

>>

>> I wanted to remain quiet on this, but I think I have to step in now.

>> This is very close to my area of expertise. I know sign language and

>> work with a few hundred deaf patients here in Rochester, New York. I

>> have served as an expert witness in legal cases, and presented both

>> locally and nationally on the issue and have served on panels for HCFA

>> (now called CMS) regarding services for the deaf.

>>

>> First off, I will make clear that my personal preference would be that

>> interpreters could bill directly to insurance companies. My second

>> preference would be that doctors could pay interpreters and then have

>> a code to receive payment (at least partial) through the insurance

>> companies with the in regular charges. This would respect the extra

>> work that is inherently needed for the great majority of deaf patients

>> we see.

>>

>> Regarding the discussion so far I want to make a clear there really is

>> no " urban legend " about the requirements for interpreters for the deaf

>> in medical care. Just because not many cases are brought before the

>> courts does not mean that this is not a reality.

>>

>> Also, understand there are cases that have made it through the courts

>> but most often these are settled out-of-court. I believe most of the

>> challenges to ADA have been regarding the jurisdiction of the law and

>> whether they apply to state hospitals or other subtle situations.

>>

>> Whether we think it's fair or not we are obligated to follow laws of

>> the land and the contracts we sign with the insurance companies.

>>

>> Also, when considering the need for interpreters for the deaf we must

>> understand how medical professionalism is interpreted by our society

>> as well as the limited English skills of most deaf patients and the

>> difference of American sign language from English.

>>

>> Whether we feel we are simply running a business are not, the truth is

>> our society has established high standards for our behaviors and

>> expects us to live up to them. This has been supported for many

>> decades by professional organizations outlining medical ethics and

>> professionalism. These are so ingrained in our society that they have

>> a legal standing. Our actions cannot be considered the same as

>> hairdressers, auto mechanics or other laborers. We have an obligation

>> to our society, our patients and our colleagues to maintain a

>> professionalism when providing care.

>>

>> Also, financially the ADA is clear in stating the overall financial

>> burden is not judged by an individual event but on our total financial

>> status. The ADA has many parts to it and each must be considered in

>> relationship to the others. Be careful in pulling on single sections

>> or clauses. See below regarding certain sections of the law than

>> cover the financial issues.

>>

>> Most deaf patients have far weaker English skills than hearing

>> patients. Trying to communicate with them with written English in

>> most situations could be argued as close to malpractice as we are

>> potentially jeopardizing our ability to gather the medical information

>> needed to make proper decisions and to be sure the information we

>> communicate may be understood.

>>

>> I will offer one example. If we write, " your test was negative for

>> anemia " that could be understood by a sign language user as meaning,

>> " your test was bad. You have anemia. " Now, I recommend we do not

>> speak that way but the truth is we physicians often do. What is

>> written in English by using the word " negative " suggests the absence

>> of anemia. But the sign for " negative " is not used in that way.

>> Rather, it suggests a " bad " condition. Thus, by depending on the

>> written English we may be

>> communicating the exact opposite of what is intended.

>>

>> I know of many, many situations where doctors communication with

>> patients has been misunderstood because of the lack of interpretation.

>> Often, I need to re-explain to my patients what the specialist

>> believed had been communicate at an appointment.

>>

>> Finally, please see below for an excerpt of something I have written

>> regarding the ADA and the use of sign language interpreters.

>>

>> Thank you for considering this issue. I do beg you to use

>> interpreters when working with deaf patients.

>> Tim

>> .... excerpt from my writing...

>>

>> To safeguard the rights of American citizens with disabilities to

>> access services throughout our society on as equal terms as possible

>> with non-disabled citizens, the United States Congress passed, and

>> President Bush signed into law, the Americans With Disabilities Act of

>> 1990 (commonly referred to as the ADA). The ADA addresses the issue

>> of accessibility for our citizens with disabilities in all aspects of

>> our society. There are pertinent details in the ADA as it relates to

>> an initial doctor-patient consultation when a Deaf person requests an

>> ASL interpreter but then must use pen-and-paper for communication.

>>

>> Section 2 of ADA finds that “discrimination against individuals with

>> disabilities persists in such critical areas as ... health services”

>> and that “the Nation's proper goals regarding individuals with

>> disabilities are to assure equality of opportunity, full

>> participation, independent living, and economic self-sufficiency for

>> such individuals.”

>>

>> Section 3 of ADA includes within its definition of an auxiliary aid

>> and service “qualified interpreters or other effective methods of

>> making aurally delivered materials available to individuals with

>> hearing impairments.”

>>

>> Section 301 of ADA states “the following private entities are

>> considered public accommodations for purposes of this title, if the

>> operations of such entities affect commerce ... professional office of

>> a health care provider, hospital, or other service establishment.” It

>> also defines “commercial facilities (as) facilities (which) ... are

>> intended for nonresidential use; and ... whose operations will affect

>> commerce.

>>

>>

>> The same section also states “the term " readily achievable " means

>> easily accomplishable and able to be carried out without much

>> difficulty or expense. In determining whether an action is readily

>> achievable, factors to be considered include-- (A) the nature and cost

>> of the action needed under this Act; ( the overall financial

>> resources of the facility or facilities involved in the action...”

>>

>> Section 302 of ADA states, “Goods, services, facilities, privileges,

>> advantages, and accommodations shall be afforded to an individual with

>> a disability in the most integrated setting appropriate to the needs

>> of the individual.”

>>

>> Also, Section 302 of ADA includes in the definition of discrimination

>> “a failure to take such steps as may be necessary to ensure that no

>> individual with a disability is excluded, denied services, segregated

>> or otherwise treated differently than other individuals because of the

>> absence of auxiliary aids and services, unless the entity can

>> demonstrate that taking such steps would fundamentally alter the

>> nature of the good, service, facility, privilege, advantage, or

>> accommodation being offered or would result in an undue burden.”

>>

>>

>>

>>

>>

>>

>>

>> > Yes, I think you are correct. The whole ADA interprtor thing

>> persists in " urbal legend " form despite no such law.

>> >

>> >

>> >>

>> >>

>> >> Date: 2006/03/25 Sat AM 08:17:47 EST

>> >> To:

>> >> Subject: Re: medical interpreter and non

>> compliant pt.

>> >>

>> >> There may be such a law in Washington, I am sure there is none in

>> Indiana and I will check about Illinois. The federal law they are

>> talking about applies to state agencies or " receivers of federal

>> funding " , which we are not.

>> >>

>> >>

>> >>

>> >> >

>> >> > My information came from my malpractice insurance company.  Here

>> is

>> >> the link:

>> >> >

>> >> >  

>> >> >

>> >> > http://www.phyins.com/pi/risk/faq.html

>> >> >

>> >> >  

>> >> >

>> >> > It specifically addresses requiring people to bring their own

>> >> interpreter, and suggests against it.

>> >> >

>> >> >  

>> >> >

>> >> > We also find our patients that require interpreters (about 7) are

>> >> pleasant to deal with, even if we don?t make money on their

>> visits. 

>> >> Don?t get me wrong, I think the law is stupid and that it should

>> >> provide funds and a limited time for those who do not speak English

>> but do speak other languages (so they are forced to learn the

>> language of the country they live in).  Sign language does not

>> include articles, which makes it difficult to have an appointment

>> with a note pad.  It is hard to read and difficult for them to

>> understand.  It also seems to be difficult have a detailed

>> >> conversation about managing diabetes through gesturing.  But I

>> have called our legislators about it as well as crummy Medicare

>> >> reimbursement, but they haven?t changed the law yet.  I keep

>> holding my breath.

>> >> >

>> >> >  

>> >> >

>> >> > And I hate to say it, but if your defense is you?re a doctor and

>> >> can?t afford a $60 bill for an interpreter, I wish you luck.  I

>> don?t think you would fare well in open court.

>> >> >

>> >> >  

>> >> >

>> >> > Ernie

>> >> >

>> >> >  

>> >> >

>> >> >  

>> >> >

>> >> >

>> >> > From:

>> >> > [mailto: ] On Behalf Of

>> >> Brock DO

>> >> > Sent: Thursday, March 23, 2006 7:17 AM

>> >> > To:

>> >> > Subject: RE: medical interpreter and non

>> >> compliant pt.

>> >> >

>> >> >  

>> >> >

>> >> > Good info.  And chances are that if a potential patient is going

>> to

>> >> be that adamant about following the letter of the ADA law right

>> from the start by waving the requirements in your face, then most

>> likely they will not be a good fit anyways & will not last long

>> (will be dismissed for other reasons probably).

>> >> >

>> >> >  

>> >> >

>> >> >

>> >> >

>> >> >  

>> >> >

>> >> > Re: medical interpreter and non

>> >> compliant pt.

>> >> >

>> >> >  

>> >> >

>> >> > The ADA does not mandate the use of interpreters in every

>> instance.

>> >> The health care professional can choose alternatives to

>> interpreters

>> >> as long as the result is effective communication. Alternatives to

>> >> interpreters should be discussed with hearing impaired patients,

>> especially those not aware that such alternatives are permissible

>> under the Act. Acceptable alternatives may include: note taking;

>> written materials; or, if viable, lip reading. A health care

>> >> > professional or facility is not required to provide an

>> interpreter

>> >> when:

>> >> >

>> >> > ·         it would present an undue burden. An undue burden is a

>> >> significant expense or difficulty to the operation of the facility.

>> Factors courts use to determine whether providing an interpreter

>> would present an undue burden include the practice or facility's

>> operating income and eligibility for tax credits, and whether it

>> has sources of outside funding or a parent company. Courts also

>> consider the frequency of visits that would require the services

>> of an interpreter. However, the single factor of the cost of an

>> interpreter exceeding the cost of a medical consultation generally

>> has not been found by the courts to be an undue burden.

>> >> >

>> >> > Source:  http://www.ama-assn.org/ama/pub/category/4616.html

>> >> >

>> >> >  

>> >> >

>> >> > Brett

>> >> >> medical interpreter and non

>> >> compliant pt.

>> >> >>

>> >> >>  

>> >> >>

>> >> >> Hi group

>> >> >>

>> >> >> I would like to know if as physician we are obligated to

>> provide

>> >> and

>> >> >> pay fro interpreter or patient has to do it? and the second

>> >> question is what is the best way to document or track or get the

>> pt. to follow up and what is the best way to protect the practice

>> from the legal consequences? Thanks

>> >> >>

>> >> >> Mandana

>> >> >>

>> >> >>  

>> >> >>

>> >> >> -------------- Original message --------------

>> >> >>

>> >> >>

>> >> >> > Health care is a basic human need, depends on how you define

>> it.

>> >> Certain christian sects would say wrong. It is not food and

>> >> water. It is not shelter from the elements. How far do you take it?

>> >> >> >

>> >> >> > We are all in this to help people be the best they can be.

>> You

>> >> have to be careful of how you define the patient relationship

>> nowadays also. Much is being done in chiropractor offices, mall

>> clinics , and in the Emergency Room.

>> >> >> >

>> >> >> > Just stirring the pot a little to see what floats to the top.

>> >> Brent

>> >> >> >

>> >> >> > >

>> >> >> > > i've been reading about the social burden of being a doctor

>> >> and

>> >> >> > how it relates to low overhead practice with great interest.

>> >> >> > >

>> >> >> > > there are some underlying fundamental precepts i like to

>> keep

>> >> in

>> >> >> > mind when discussing these things.

>> >> >> > >

>> >> >> > > they are:

>> >> >> > >

>> >> >> > > health care is not a right or privilege; it is a basic

>> human

>> >> >> > need, just like food, clothing and shelter. everybody needs

>> it.

>> >> >> > >

>> >> >> > > good health care arises from a healthy doctor-patient

>> >> >> > relationship. the relationship facilitates healthy choices

>> >> resulting in good outcomes.

>> >> >> > >

>> >> >> > > any framework surrounding the doctor-patient relationship

>> must

>> >> >> > be defined by the needs of the doctor-patient relationship.

>> form

>> >> follows function.

>> >> >> > >

>> >> >> > > just my thoughts.

>> >> >> > >

>> >> >> > > LL

>> >> >> > >

>> >> >> > >

>> >> >> > > ---------------------------------

>> >> >> > > Yahoo! Travel

>> >> >> > > Find great deals to the top 10 hottest destinations!

>> >> >> > >

>> >> >> >

>> >> >> >

>> >> >> >

>> >> >> >

>> >> >> >

>> >> >> >

>> >> >> >

>> >> >> >

[Guest guest]

RE Medicare NOT ADA related?

How would participation in Medicare NOT apply to an ADA case, if the govt is

footing the bill? Thought you'd have to be more in compliance?

Or, is ADA paramount, as an unfunded mandate, for ALL physicians to provide

care using a translator?

Where does this end? What if a pt without english skills shows up at my

solo office, am I required to find an Icelandic translator for them?

Think I'll just take my chances....

medical interpreter and non

>> compliant pt.

>>

>>

>>

>> Hi group

>>

>> I would like to know if as physician we are obligated to

>> provide and pay fro interpreter or patient has to do it? and

>> the second question is what is the best way to document or

>> track or get the pt. to follow up and what is the best way to

>> protect the practice from the legal consequences? Thanks

>>

>> Mandana

>>

>>

>>

>> -------------- Original message --------------

>>

>>

>> > Health care is a basic human need, depends on how you define

>> it. Certain christian sects would say wrong. It is not food

>> and water. It is not shelter from the elements. How far do

>> you take it?

>> >

>> > We are all in this to help people be the best they can be.

>> You have to be careful of how you define the patient

>> relationship nowadays also. Much is being done in

>> chiropractor offices, mall clinics , and in the Emergency

>> Room.

>> >

>> > Just stirring the pot a little to see what floats to the

>> top. Brent

>> >

>> > >

>> > > i've been reading about the social burden of being a

>> doctor and

>> > how it relates to low overhead practice with great interest.

>> > >

>> > > there are some underlying fundamental precepts i like to

>> keep in

>> > mind when discussing these things.

>> > >

>> > > they are:

>> > >

>> > > health care is not a right or privilege; it is a basic

>> human

>> > need, just like food, clothing and shelter. everybody needs

>> it.

>> > >

>> > > good health care arises from a healthy doctor-patient

>> > relationship. the relationship facilitates healthy choices

>> resulting in good outcomes.

>> > >

>> > > any framework surrounding the doctor-patient relationship

>> must

>> > be defined by the needs of the doctor-patient relationship.

>> form follows function.

>> > >

>> > > just my thoughts.

>> > >

>> > > LL

>> > >

>> > >

>> > > ---------------------------------

>> > > Yahoo! Travel

>> > > Find great deals to the top 10 hottest destinations!

>> > >

>> >

>> >

>> >

>> >

>> >

>> >

>> >

>> >

[Guest guest]

No, I would not refuse to see them based on anything like that. However, it is

perfectly acceptable to screen patients before deciding if they are accepted as

a new patient. For example, if a potential patient is on Oxycontin & Percocet

is seeking to transfer from " that horrible doctor down the street that did not

understand my pain " , then I'm not likely to accept them, regardless of their

insurance, deaf status, whatever. That is the type of thing I was referring to.

Of course I would not just refuse to see someone simply because they require an

interpretor. Still I can not imagine how that scenario could ever come to be

in my practice(a deaf pt, alone with no companion to assist). If they are deaf

& can't speak then how did they schedule the appt? A friend called? Then why

can't that same friend come in with them? How does the deaf patient get along

outside the doctor's office setting? What makes this office visit so unique

compared to the other 23 hours in thei!

r day that they need an interpretor for this but nowhere else? I can not

recall a single episode from day one of medical school until now (2 years into

practice) that I've ever had to obtain the services of an interpretor in the

course of learning or providing medical care. So for me it is really a

non-issue. I guess I just get my feathers ruffled when someone says " doctor,

you MUST see this patient and you MUST provide an interpretor and you MUST pay

for it out of pocket and, so sorry, but you WILL lose money on the visit, but

you are a doctor & this is the only profession that would allow such non-sense

laws. " Believe me, I have nothing against deaf people, just such silly " rules " .

>

>

> Date: 2006/03/25 Sat PM 06:10:43 EST

> To: < >

> Subject: Re: Re: medical interpreter and non compliant

pt.

>

> So, does this mean that if someone has insurance through which you are

> contracted you would refuse to see them if they requested a sign language

> interpreter when they're deaf?

>

> Before you answer, you may want to be careful about your formal reply in

> written word. I am not a lawyer but from things I have heard I could

> imagine a formal written statement of that sort could very easily be

> admissible in a court case for discrimination based on a handicap.

>

> And when we say " a good fit " , could a white, upperclass doctor refuse to

> accept a new patient who is black, unemployed and under educated because

> they say they can not " relate " and believe that ultimately the patient

> would be problematic? I pose this question to provoke thoughts and do not

> mean to challenge anyone personally.

>

> The question of prejudice and discrimination in our country is a huge

> challenge. And I for one think all of us must be careful how we act, not

> for legal reasons but rather, for appropriateness.

>

> Refusing a patient care when they have an insurance we're contracted with

> when they have done nothing officially wrong, to me is worth profound

> contemplation of what is medical professionalism.

>

> We must address the business-side of our offices. No margin, no mission.

> But I agree with some other sentiments recently stated that being a

> physician, at least part of the time, is much more than a business both

> for the patient and the doctor. This field of medicine, which we asked to

> the part of, like it or not, holds a special place in our society and it

> has a level of professionalism not expected of most other fields.

>

> Again, I do not mean to offend. But I do mean to challenge all of our

> thinking. I do not recommend we make decisions which will lead to ruin

> financially. But I do recommend we make some decisions at a different

> level than the accountants of the insurance companies.

>

> Respectfully,

> Tim

>

> > Good summary on your part. But I am in fact following my contractual

> > language exactly. As I mentioned, I just signed one yesterday & it said

> > " will provide interpretor services to deaf patients at no charge or make

> > reasonable accomodations if indicated. " In the final analysis though,

> > it has minimal to no impact on my personal practice because I have yet

> > to be asked to see a deaf patient. I can tell you though my bottom

> > line: I will not be forced to take on any new patient that I do not feel

> > comfortable seeing or that would not be a good fit. One of the biggest

> > mistakes (in my opinion) I still colleagues in private practice making

> > is not running a things like a business; rather, they try to look at it

> > as a " save the world " venture. True, we are different than say, a

> > hairdresser, but it is still a business first and I just will not be

> > forced to see patients at a loss. Now, if you are seeing these patients

> > for free out of the goodness of your heart or have a particular i!

> > nterest in it, then that is a bit different I guess. But if you are

> > just seeing them for free because you feel obligated to by law, then

> > count me out on that one.

> >

> >

> >>

> >>

> >> Date: 2006/03/25 Sat PM 12:47:00 EST

> >> To: < >

> >> Subject: Re: Re: medical interpreter and non

> >> compliant pt.

> >>

> >> I wanted to remain quiet on this, but I think I have to step in now.

> >> This is very close to my area of expertise. I know sign language and

> >> work with a few hundred deaf patients here in Rochester, New York. I

> >> have served as an expert witness in legal cases, and presented both

> >> locally and nationally on the issue and have served on panels for HCFA

> >> (now called CMS) regarding services for the deaf.

> >>

> >> First off, I will make clear that my personal preference would be that

> >> interpreters could bill directly to insurance companies. My second

> >> preference would be that doctors could pay interpreters and then have

> >> a code to receive payment (at least partial) through the insurance

> >> companies with the in regular charges. This would respect the extra

> >> work that is inherently needed for the great majority of deaf patients

> >> we see.

> >>

> >> Regarding the discussion so far I want to make a clear there really is

> >> no " urban legend " about the requirements for interpreters for the deaf

> >> in medical care. Just because not many cases are brought before the

> >> courts does not mean that this is not a reality.

> >>

> >> Also, understand there are cases that have made it through the courts

> >> but most often these are settled out-of-court. I believe most of the

> >> challenges to ADA have been regarding the jurisdiction of the law and

> >> whether they apply to state hospitals or other subtle situations.

> >>

> >> Whether we think it's fair or not we are obligated to follow laws of

> >> the land and the contracts we sign with the insurance companies.

> >>

> >> Also, when considering the need for interpreters for the deaf we must

> >> understand how medical professionalism is interpreted by our society

> >> as well as the limited English skills of most deaf patients and the

> >> difference of American sign language from English.

> >>

> >> Whether we feel we are simply running a business are not, the truth is

> >> our society has established high standards for our behaviors and

> >> expects us to live up to them. This has been supported for many

> >> decades by professional organizations outlining medical ethics and

> >> professionalism. These are so ingrained in our society that they have

> >> a legal standing. Our actions cannot be considered the same as

> >> hairdressers, auto mechanics or other laborers. We have an obligation

> >> to our society, our patients and our colleagues to maintain a

> >> professionalism when providing care.

> >>

> >> Also, financially the ADA is clear in stating the overall financial

> >> burden is not judged by an individual event but on our total financial

> >> status. The ADA has many parts to it and each must be considered in

> >> relationship to the others. Be careful in pulling on single sections

> >> or clauses. See below regarding certain sections of the law than

> >> cover the financial issues.

> >>

> >> Most deaf patients have far weaker English skills than hearing

> >> patients. Trying to communicate with them with written English in

> >> most situations could be argued as close to malpractice as we are

> >> potentially jeopardizing our ability to gather the medical information

> >> needed to make proper decisions and to be sure the information we

> >> communicate may be understood.

> >>

> >> I will offer one example. If we write, " your test was negative for

> >> anemia " that could be understood by a sign language user as meaning,

> >> " your test was bad. You have anemia. " Now, I recommend we do not

> >> speak that way but the truth is we physicians often do. What is

> >> written in English by using the word " negative " suggests the absence

> >> of anemia. But the sign for " negative " is not used in that way.

> >> Rather, it suggests a " bad " condition. Thus, by depending on the

> >> written English we may be

> >> communicating the exact opposite of what is intended.

> >>

> >> I know of many, many situations where doctors communication with

> >> patients has been misunderstood because of the lack of interpretation.

> >> Often, I need to re-explain to my patients what the specialist

> >> believed had been communicate at an appointment.

> >>

> >> Finally, please see below for an excerpt of something I have written

> >> regarding the ADA and the use of sign language interpreters.

> >>

> >> Thank you for considering this issue. I do beg you to use

> >> interpreters when working with deaf patients.

> >> Tim

> >> .... excerpt from my writing...

> >>

> >> To safeguard the rights of American citizens with disabilities to

> >> access services throughout our society on as equal terms as possible

> >> with non-disabled citizens, the United States Congress passed, and

> >> President Bush signed into law, the Americans With Disabilities Act of

> >> 1990 (commonly referred to as the ADA). The ADA addresses the issue

> >> of accessibility for our citizens with disabilities in all aspects of

> >> our society. There are pertinent details in the ADA as it relates to

> >> an initial doctor-patient consultation when a Deaf person requests an

> >> ASL interpreter but then must use pen-and-paper for communication.

> >>

> >> Section 2 of ADA finds that “discrimination against individuals with

> >> disabilities persists in such critical areas as ... health services”

> >> and that “the Nation's proper goals regarding individuals with

> >> disabilities are to assure equality of opportunity, full

> >> participation, independent living, and economic self-sufficiency for

> >> such individuals.”

> >>

> >> Section 3 of ADA includes within its definition of an auxiliary aid

> >> and service “qualified interpreters or other effective methods of

> >> making aurally delivered materials available to individuals with

> >> hearing impairments.”

> >>

> >> Section 301 of ADA states “the following private entities are

> >> considered public accommodations for purposes of this title, if the

> >> operations of such entities affect commerce ... professional office of

> >> a health care provider, hospital, or other service establishment.” It

> >> also defines “commercial facilities (as) facilities (which) ... are

> >> intended for nonresidential use; and ... whose operations will affect

> >> commerce.

> >>

> >>

> >> The same section also states “the term " readily achievable " means

> >> easily accomplishable and able to be carried out without much

> >> difficulty or expense. In determining whether an action is readily

> >> achievable, factors to be considered include-- (A) the nature and cost

> >> of the action needed under this Act; ( the overall financial

> >> resources of the facility or facilities involved in the action...”

> >>

> >> Section 302 of ADA states, “Goods, services, facilities, privileges,

> >> advantages, and accommodations shall be afforded to an individual with

> >> a disability in the most integrated setting appropriate to the needs

> >> of the individual.”

> >>

> >> Also, Section 302 of ADA includes in the definition of discrimination

> >> “a failure to take such steps as may be necessary to ensure that no

> >> individual with a disability is excluded, denied services, segregated

> >> or otherwise treated differently than other individuals because of the

> >> absence of auxiliary aids and services, unless the entity can

> >> demonstrate that taking such steps would fundamentally alter the

> >> nature of the good, service, facility, privilege, advantage, or

> >> accommodation being offered or would result in an undue burden.”

> >>

> >>

> >>

> >>

> >>

> >>

> >>

> >> > Yes, I think you are correct. The whole ADA interprtor thing

> >> persists in " urbal legend " form despite no such law.

> >> >

> >> >

> >> >>

> >> >>

> >> >> Date: 2006/03/25 Sat AM 08:17:47 EST

> >> >> To:

> >> >> Subject: Re: medical interpreter and non

> >> compliant pt.

> >> >>

> >> >> There may be such a law in Washington, I am sure there is none in

> >> Indiana and I will check about Illinois. The federal law they are

> >> talking about applies to state agencies or " receivers of federal

> >> funding " , which we are not.

> >> >>

> >> >>

> >> >>

> >> >> >

> >> >> > My information came from my malpractice insurance company.  Here

> >> is

> >> >> the link:

> >> >> >

> >> >> >  

> >> >> >

> >> >> > http://www.phyins.com/pi/risk/faq.html

> >> >> >

> >> >> >  

> >> >> >

> >> >> > It specifically addresses requiring people to bring their own

> >> >> interpreter, and suggests against it.

> >> >> >

> >> >> >  

> >> >> >

> >> >> > We also find our patients that require interpreters (about 7) are

> >> >> pleasant to deal with, even if we don?t make money on their

> >> visits. 

> >> >> Don?t get me wrong, I think the law is stupid and that it should

> >> >> provide funds and a limited time for those who do not speak English

> >> but do speak other languages (so they are forced to learn the

> >> language of the country they live in).  Sign language does not

> >> include articles, which makes it difficult to have an appointment

> >> with a note pad.  It is hard to read and difficult for them to

> >> understand.  It also seems to be difficult have a detailed

> >> >> conversation about managing diabetes through gesturing.  But I

> >> have called our legislators about it as well as crummy Medicare

> >> >> reimbursement, but they haven?t changed the law yet.  I keep

> >> holding my breath.

> >> >> >

> >> >> >  

> >> >> >

> >> >> > And I hate to say it, but if your defense is you?re a doctor and

> >> >> can?t afford a $60 bill for an interpreter, I wish you luck.  I

> >> don?t think you would fare well in open court.

> >> >> >

> >> >> >  

> >> >> >

> >> >> > Ernie

> >> >> >

> >> >> >  

> >> >> >

> >> >> >  

> >> >> >

> >> >> >

> >> >> > From:

> >> >> > [mailto: ] On Behalf Of

> >> >> Brock DO

> >> >> > Sent: Thursday, March 23, 2006 7:17 AM

> >> >> > To:

> >> >> > Subject: RE: medical interpreter and non

> >> >> compliant pt.

> >> >> >

> >> >> >  

> >> >> >

> >> >> > Good info.  And chances are that if a potential patient is going

> >> to

> >> >> be that adamant about following the letter of the ADA law right

> >> from the start by waving the requirements in your face, then most

> >> likely they will not be a good fit anyways & will not last long

> >> (will be dismissed for other reasons probably).

> >> >> >

> >> >> >  

> >> >> >

> >> >> >

> >> >> >

> >> >> >  

> >> >> >

> >> >> > Re: medical interpreter and non

> >> >> compliant pt.

> >> >> >

> >> >> >  

> >> >> >

> >> >> > The ADA does not mandate the use of interpreters in every

> >> instance.

> >> >> The health care professional can choose alternatives to

> >> interpreters

> >> >> as long as the result is effective communication. Alternatives to

> >> >> interpreters should be discussed with hearing impaired patients,

> >> especially those not aware that such alternatives are permissible

> >> under the Act. Acceptable alternatives may include: note taking;

> >> written materials; or, if viable, lip reading. A health care

> >> >> > professional or facility is not required to provide an

> >> interpreter

> >> >> when:

> >> >> >

> >> >> > ·         it would present an undue burden. An undue burden is a

> >> >> significant expense or difficulty to the operation of the facility.

> >> Factors courts use to determine whether providing an interpreter

> >> would present an undue burden include the practice or facility's

> >> operating income and eligibility for tax credits, and whether it

> >> has sources of outside funding or a parent company. Courts also

> >> consider the frequency of visits that would require the services

> >> of an interpreter. However, the single factor of the cost of an

> >> interpreter exceeding the cost of a medical consultation generally

> >> has not been found by the courts to be an undue burden.

> >> >> >

> >> >> > Source:  http://www.ama-assn.org/ama/pub/category/4616.html

> >> >> >

> >> >> >  

> >> >> >

> >> >> > Brett

> >> >> >> medical interpreter and non

> >> >> compliant pt.

> >> >> >>

> >> >> >>  

> >> >> >>

> >> >> >> Hi group

> >> >> >>

> >> >> >> I would like to know if as physician we are obligated to

> >> provide

> >> >> and

> >> >> >> pay fro interpreter or patient has to do it? and the second

> >> >> question is what is the best way to document or track or get the

> >> pt. to follow up and what is the best way to protect the practice

> >> from the legal consequences? Thanks

> >> >> >>

> >> >> >> Mandana

> >> >> >>

> >> >> >>  

> >> >> >>

> >> >> >> -------------- Original message --------------

> >> >> >>

> >> >> >>

> >> >> >> > Health care is a basic human need, depends on how you define

> >> it.

> >> >> Certain christian sects would say wrong. It is not food and

> >> >> water. It is not shelter from the elements. How far do you take it?

> >> >> >> >

> >> >> >> > We are all in this to help people be the best they can be.

> >> You

> >> >> have to be careful of how you define the patient relationship

> >> nowadays also. Much is being done in chiropractor offices, mall

> >> clinics , and in the Emergency Room.

> >> >> >> >

> >> >> >> > Just stirring the pot a little to see what floats to the top.

> >> >> Brent

> >> >> >> >

> >> >> >> > >

> >> >> >> > > i've been reading about the social burden of being a doctor

> >> >> and

> >> >> >> > how it relates to low overhead practice with great interest.

> >> >> >> > >

> >> >> >> > > there are some underlying fundamental precepts i like to

> >> keep

> >> >> in

> >> >> >> > mind when discussing these things.

> >> >> >> > >

> >> >> >> > > they are:

> >> >> >> > >

> >> >> >> > > health care is not a right or privilege; it is a basic

> >> human

> >> >> >> > need, just like food, clothing and shelter. everybody needs

> >> it.

> >> >> >> > >

> >> >> >> > > good health care arises from a healthy doctor-patient

> >> >> >> > relationship. the relationship facilitates healthy choices

> >> >> resulting in good outcomes.

> >> >> >> > >

> >> >> >> > > any framework surrounding the doctor-patient relationship

> >> must

> >> >> >> > be defined by the needs of the doctor-patient relationship.

> >> form

> >> >> follows function.

> >> >> >> > >

> >> >> >> > > just my thoughts.

> >> >> >> > >

> >> >> >> > > LL

> >> >> >> > >

> >> >> >> > >

> >> >> >> > > ---------------------------------

> >> >> >> > > Yahoo! Travel

> >> >> >> > > Find great deals to the top 10 hottest destinations!

> >> >> >> > >

> >> >> >> >

> >> >> >> >

> >> >> >> >

> >> >> >> >

> >> >> >> >

> >> >> >> >

> >> >> >> >

> >> >> >> >

[Guest guest]

Me too. This whole " what if " scenario relating to ADA reminds me of the whole

HIPPA chaos when it first came out. There were all of these bizarre

hypothetical scenarios being thrown around. " What happens if someone is outside

my office & I forgot the window was open & a construction worker hears us, &

that worker is related to the patient. " You know, lots of discussion about

things that obviously will rarely if ever happen. Like for me, the whole

scenario of a deaf patient with no interpretor of their own insisting that I

have to see them & that I must provide an interpretor and, no handwriting will

not work. This just is not going to occur but once every 10 years for me.

Again, it goes back to lower volume practices: fewer total patients means fewer

chances of these very rare occurrences.

>

>

> Date: 2006/03/25 Sat PM 07:12:13 EST

> To: < >

> Subject: Re: medical interpreter and non compliant pt.

>

> RE Medicare NOT ADA related?

>

> How would participation in Medicare NOT apply to an ADA case, if the govt is

> footing the bill? Thought you'd have to be more in compliance?

>

> Or, is ADA paramount, as an unfunded mandate, for ALL physicians to provide

> care using a translator?

>

> Where does this end? What if a pt without english skills shows up at my

> solo office, am I required to find an Icelandic translator for them?

>

> Think I'll just take my chances....

>

> medical interpreter and non

> >> compliant pt.

> >>

> >>

> >>

> >> Hi group

> >>

> >> I would like to know if as physician we are obligated to

> >> provide and pay fro interpreter or patient has to do it? and

> >> the second question is what is the best way to document or

> >> track or get the pt. to follow up and what is the best way to

> >> protect the practice from the legal consequences? Thanks

> >>

> >> Mandana

> >>

> >>

> >>

> >> -------------- Original message --------------

> >>

> >>

> >> > Health care is a basic human need, depends on how you define

> >> it. Certain christian sects would say wrong. It is not food

> >> and water. It is not shelter from the elements. How far do

> >> you take it?

> >> >

> >> > We are all in this to help people be the best they can be.

> >> You have to be careful of how you define the patient

> >> relationship nowadays also. Much is being done in

> >> chiropractor offices, mall clinics , and in the Emergency

> >> Room.

> >> >

> >> > Just stirring the pot a little to see what floats to the

> >> top. Brent

> >> >

> >> > >

> >> > > i've been reading about the social burden of being a

> >> doctor and

> >> > how it relates to low overhead practice with great interest.

> >> > >

> >> > > there are some underlying fundamental precepts i like to

> >> keep in

> >> > mind when discussing these things.

> >> > >

> >> > > they are:

> >> > >

> >> > > health care is not a right or privilege; it is a basic

> >> human

> >> > need, just like food, clothing and shelter. everybody needs

> >> it.

> >> > >

> >> > > good health care arises from a healthy doctor-patient

> >> > relationship. the relationship facilitates healthy choices

> >> resulting in good outcomes.

> >> > >

> >> > > any framework surrounding the doctor-patient relationship

> >> must

> >> > be defined by the needs of the doctor-patient relationship.

> >> form follows function.

> >> > >

> >> > > just my thoughts.

> >> > >

> >> > > LL

> >> > >

> >> > >

> >> > > ---------------------------------

> >> > > Yahoo! Travel

> >> > > Find great deals to the top 10 hottest destinations!

> >> > >

> >> >

> >> >

> >> >

> >> >

> >> >

> >> >

> >> >

> >> >

[Guest guest]

Look what the CMS website says :

" Q. What is Federal financial assistance?

• A. Examples of Federal financial assistance as defined by our

regulations include Medicaid, Medicare Hospital Insurance (Part A),

Public Health Service grants, Aid to Families with Dependent Children.

These funds are given to a facility (such as a hospital, social

service agency) or an individual service provider (such as a doctor,

dentist) by the government for services provided or to provide a

service. Social security benefits, Supplemental Security Income,

Medicare Supplemental Medical Insurance (Part are not considered

Federal financial assistance when applying the civil rights laws OCR

enforces. Generally speaking, the reason for this is that these

sources of funding are paid directly to an individual beneficiary by

the government. "

The web address http://www.hhs.gov/ocr/newfaq.html

So, a physician taking medicare part B does not receive federal

financial assistance, a hospital has to comply because it takes

medicare part A.

The ADA definition of disability :

" Disability means, with respect to an individual, a physical or mental

impairment that substantially limits one or more of the major life

activities of such individual; a record of such an impairment; or being

regarded as having such animpairment.

(1) The phrase physical or mental impairment means --

(i) Any physiological disorder or condition, cosmetic disfigurement, or

anatomical loss affecting one or more of the following body systems:

neurological; musculoskeletal; special sense organs; respiratory,

including speech organs; cardiovascular; reproductive; digestive;

genitourinary; hemic and lymphatic; skin; and endocrine;

(ii) Any mental or psychological disorder such as mental retardation,

organic brain syndrome, emotional or mental illness, and specific

learning disabilities;

(iii) The phrase physical or mental impairment includes, but is not

limited to, such contagious and noncontagious diseases and conditions

as orthopedic, visual, speech, and hearing impairments, cerebral palsy,

epilepsy, muscular dystrophy, multiple sclerosis, cancer, heart

disease, diabetes, mental retardation, emotional illness, specific

learning disabilities, HIV disease (whether symptomatic or

asymptomatic), tuberculosis, drug addiction, and alcoholism;

(iv) The phrase physical or mental impairment does not include

homosexuality or bisexuality.

(2) The phrase major life activities means functions such as caring for

one's self, performing manual tasks, walking, seeing, hearing,

speaking, breathing, learning, and working.

(3) The phrase has a record of such an impairment means has a history

of, or has been misclassified as having, a mental or physical

impairment that substantially limits one or more major life activities.

(4) The phrase is regarded as having an impairment means --

(i) Has a physical or mental impairment that does not substantially

limit major life activities but that is treated by a private entity as

constituting such a limitation;

(ii) Has a physical or mental impairment that substantially limits

major life activities only as a result of the attitudes of others

toward such impairment; or

(iii) Has none of the impairments defined in paragraph (1) of this

definition but is treated by a private entity as having such an

impairment. "

Since when is not speaking english a disability ? Does it mean that any

store has to provide interpreters ? No, they have to be handicapped

accessible, remove barriers... but they don't have to provide

interpreters. I agree that deaf people are disabled and you need to try

to accommodate them, but non-english speaking people do not fall into

the same category.

Even if you consider Title VI of the Civil Rights Act of 1964 :

" Title VI allows persons to file administrative complaints with federal

departments and agencies alleging discrimination based on race, color,

or national origin by recipients of federal funds (e.g., states,

universities, local governments). "

" Recipient means, for the purposes of this regulation, any state or its

political subdivision, any instrumentality of a state or its political

subdivision, any public or private agency, institution, organization,

or other entity, or any person to which Federal financial assistance is

extended directly or through another recipient, including any

successor, assignee, or transferee of a recipient, but excluding the

ultimate beneficiary of the assistance. "

And also http://www.hhs.gov/ocr/lep/summaryguidance.html clarifies

even more.

>

> RE You are a client of the Fed

>  

> If you take Medicare, you have to comply with THEIR rules.

>  

> I don't make the rules.

>  

> Legal opinions don't always make sense.  Wish they did-- wouldn't have

> needed a lawyer to set up practice.

>  

> I'm not a lawyer, though, so you'll need to decide on getting one-- I

> do not offer legal opinions.

>>

>>   medical interpreter and non

>>>>>> compliant pt.

>>>>>>

>>>>>>  

>>>>>>

>>>>>> Hi group

>>>>>>

>>>>>> I would like to know if as physician we are obligated to provide

>>>>>> and pay fro interpreter or patient has to do it? and the second

>>>>>> question is what is the best way to document or track or get the

>>>>>> pt. to follow up and what is the best way to protect the practice

>>>>>> from the legal consequences? Thanks

>>>>>>

>>>>>> Mandana

>>>>>>

>>>>>>  

>>>>>>

>>>>>> -------------- Original message --------------

>>>>>>

>>>>>>

>>>>>> > Health care is a basic human need, depends on how you define it.

>>>>>> > Certain christian sects would say wrong. It is not food and

>>>>>> water.

>>>>>> > It is not shelter from the elements. How far do you take it?

>>>>>> >

>>>>>> > We are all in this to help people be the best they can be. You

>>>>>> have

>>>>>> > to be careful of how you define the patient relationship

>>>>>> nowadays

>>>>>> > also. Much is being done in chiropractor offices, mall clinics ,

>>>>>> > and in the Emergency Room.

>>>>>> >

>>>>>> > Just stirring the pot a little to see what floats to the top.

>>>>>> > Brent

>>>>>> >

>>>>>> > >

>>>>>> > > i've been reading about the social burden of being a doctor

>>>>>> and

>>>>>> > how it relates to low overhead practice with great interest.

>>>>>> > >

>>>>>> > > there are some underlying fundamental precepts i like to keep

>>>>>> in

>>>>>> > mind when discussing these things.

>>>>>> > >

>>>>>> > > they are:

>>>>>> > >

>>>>>> > > health care is not a right or privilege; it is a basic human

>>>>>> > need, just like food, clothing and shelter. everybody needs it.

>>>>>> > >

>>>>>> > > good health care arises from a healthy doctor-patient

>>>>>> > relationship. the relationship facilitates healthy choices

>>>>>> > resulting in good outcomes.

>>>>>> > >

>>>>>> > > any framework surrounding the doctor-patient relationship must

>>>>>> > be defined by the needs of the doctor-patient relationship. form

>>>>>> > follows function.

>>>>>> > >

>>>>>> > > just my thoughts.

>>>>>> > >

>>>>>> > > LL

>>>>>> > >

>>>>>> > >

>>>>>> > > ---------------------------------

>>>>>> > > Yahoo! Travel

>>>>>> > > Find great deals to the top 10 hottest destinations!

>>>>>> > >

>>>>>> >

>>>>>> >

>>>>>> >

>>>>>> >

>>>>>> >

>>>>>> >

>>>>>> >

>>>>>> >

[Guest guest]

Oh, no problem, I agree with you that I have to make some

accommodations for some patients and I will, as soon as I can pull

myself from the whole.

> My apologies if I offended. That was not my intent. I was presenting

> the

> perspective of how a lawyer might approach the idea that a doc refuses

> to

> provide an interpreter and says it's because of cost. I meant for

> example

> sake only. This has been part of the approach used in legal

> discussions

> and even in court cases related to this issue.

>

> As I started out saying, I'd much prefer that insurance companies would

> pay for the services as I think it is basic to allowing us to provide

> care. Some insurers in the country are trialing such efforts. But,

> what

> I wish for doesn't match the reality of ADA.

>

> Again, I meant no offense. I wish you success and hope you are far in

> the

> red very soon (and I'm praying the same for myself too)!

>

> By the way, I pay for interpreters 1-2 times a month even though I know

> sign language. Why? Because some of my patients have minimal language

> skills and are deaf. I get a certified deaf interpreter. That is a

> deaf

> person who is skilled in sign language linguistics and can take the

> formalized language of ASL and transform it to gestural communication.

> It

> is remarkable to see the comprehension of the patients soar when the

> communication method is changed from my sign language to the certified

> deaf interpreter.

>

> Tim

>

>> Tim, I started 4 months ago from zero patients. I do not " decorate "

>> my

>> office, nor can I afford a lawyer for such advice. I do locum

>> tenens

>> to pay my rent and malpractice.

>>> Realistically, if such a small fee will delay you

>>> from getting in the red, your business plan may well fail anyway

>> No, it will delay me to pull a salary and feed my three children.

>>

>>

>>

>>> A physician operating in the black is actually a very rare thing.

>>> So it

>>> would be a special situation I imagine when considering a legal

>>> issue.

>>>

>>> However, I imagine any half decent lawyer would clarify how long you

>>> project to remain in the black and whether a " small fee " to pay for

>>> an

>>> interpreter that allows you to offer appropriate care will prevent

>>> you

>>> from getting there. Realistically, if such a small fee will delay

>>> you

>>> from getting in the red, your business plan may well fail anyway.

>>> And, if

>>> you look at all your financial books you would need to demonstrate

>>> there

>>> are no other " extra fees " paid here or there. For example, have

>>> you

>>> spent

>>> any extra money for decorating the walls of the office? Do those

>>> allow

>>> you to improve the quality of your service for the patients' sake?

>>>

>>> Thus, the question of our paying for interpreters finances when put

>>> in

>>> context of professionalism and the total financial picture becomes

>>> very

>>> cloudy. This is not cut and dry whether you are currently in the

>>> black,

>>> in the red or believe that every decision you make is based on

>>> " running a

>>> business " .

>>>

>>> Tim

>>>

>>>> " or accommodation being offered or

>>>> would result in an undue burden.”

>>>> As a solo-solo physician office, still operating in black, I can

>>>> prove

>>>> that this would be an undue burden for my office.

>>>>

>>>>

>>>>

>>>>> or accommodation being offered or

>>>>> would result in an undue burden.”

>>>

>>>

>>>

>>>

>>>

>>>

>>>

[Guest guest]

the whole mess, I mean I may need an interpreter

> My apologies if I offended. That was not my intent. I was presenting

> the

> perspective of how a lawyer might approach the idea that a doc refuses

> to

> provide an interpreter and says it's because of cost. I meant for

> example

> sake only. This has been part of the approach used in legal

> discussions

> and even in court cases related to this issue.

>

> As I started out saying, I'd much prefer that insurance companies would

> pay for the services as I think it is basic to allowing us to provide

> care. Some insurers in the country are trialing such efforts. But,

> what

> I wish for doesn't match the reality of ADA.

>

> Again, I meant no offense. I wish you success and hope you are far in

> the

> red very soon (and I'm praying the same for myself too)!

>

> By the way, I pay for interpreters 1-2 times a month even though I know

> sign language. Why? Because some of my patients have minimal language

> skills and are deaf. I get a certified deaf interpreter. That is a

> deaf

> person who is skilled in sign language linguistics and can take the

> formalized language of ASL and transform it to gestural communication.

> It

> is remarkable to see the comprehension of the patients soar when the

> communication method is changed from my sign language to the certified

> deaf interpreter.

>

> Tim

>

>> Tim, I started 4 months ago from zero patients. I do not " decorate "

>> my

>> office, nor can I afford a lawyer for such advice. I do locum

>> tenens

>> to pay my rent and malpractice.

>>> Realistically, if such a small fee will delay you

>>> from getting in the red, your business plan may well fail anyway

>> No, it will delay me to pull a salary and feed my three children.

>>

>>

>>

>>> A physician operating in the black is actually a very rare thing.

>>> So it

>>> would be a special situation I imagine when considering a legal

>>> issue.

>>>

>>> However, I imagine any half decent lawyer would clarify how long you

>>> project to remain in the black and whether a " small fee " to pay for

>>> an

>>> interpreter that allows you to offer appropriate care will prevent

>>> you

>>> from getting there. Realistically, if such a small fee will delay

>>> you

>>> from getting in the red, your business plan may well fail anyway.

>>> And, if

>>> you look at all your financial books you would need to demonstrate

>>> there

>>> are no other " extra fees " paid here or there. For example, have

>>> you

>>> spent

>>> any extra money for decorating the walls of the office? Do those

>>> allow

>>> you to improve the quality of your service for the patients' sake?

>>>

>>> Thus, the question of our paying for interpreters finances when put

>>> in

>>> context of professionalism and the total financial picture becomes

>>> very

>>> cloudy. This is not cut and dry whether you are currently in the

>>> black,

>>> in the red or believe that every decision you make is based on

>>> " running a

>>> business " .

>>>

>>> Tim

>>>

>>>> " or accommodation being offered or

>>>> would result in an undue burden.”

>>>> As a solo-solo physician office, still operating in black, I can

>>>> prove

>>>> that this would be an undue burden for my office.

>>>>

>>>>

>>>>

>>>>> or accommodation being offered or

>>>>> would result in an undue burden.”

>>>

>>>

>>>

>>>

>>>

>>>

>>>

[Guest guest]

Tim, I am curious what you have to

pay. I have only one deaf patient,

and she usually shows up with no appointment and brings someone with her to

interpret and we make do the best we can. But several years ago, I did have a

patient who insisted on an interpreter and at that time we found one that

charged $45/hour and required a minimum 2 hour booking. So with $51 reimbursement for a 99213, we

lost $40 without even covering any overhead, and getting $70 for a 99214 means

we only lose $20. Seems like more

than a little loss to me…..

Annie

Re:

medical interpreter and non compliant pt.

My apologies if I offended. That was not my

intent. I was presenting the

perspective of how a lawyer might approach the

idea that a doc refuses to

provide an interpreter and says it's because of

cost. I meant for example

sake only. This has been part of the

approach used in legal discussions

and even in court cases related to this issue.

As I started out saying, I'd much prefer that

insurance companies would

pay for the services as I think it is basic to

allowing us to provide

care. Some insurers in the country are

trialing such efforts. But, what

I wish for doesn't match the reality of ADA.

Again, I meant no offense. I wish you

success and hope you are far in the

red very soon (and I'm praying the same for myself

too)!

By the way, I pay for interpreters 1-2 times a

month even though I know

sign language. Why? Because some of my

patients have minimal language

skills and are deaf. I get a certified deaf

interpreter. That is a deaf

person who is skilled in sign language linguistics

and can take the

formalized language of ASL and transform it to

gestural communication. It

is remarkable to see the comprehension of the

patients soar when the

communication method is changed from my sign

language to the certified

deaf interpreter.

Tim

> Tim, I started 4 months ago from zero

patients. I do not " decorate " my

> office, nor can I afford a lawyer for such

advice. I do locum tenens

> to pay my rent and malpractice.

>> Realistically, if such a small fee will

delay you

>> from getting in the red, your business

plan may well fail anyway

> No, it will delay me to pull a salary and

feed my three children.

>

> On Mar 25, 2006, at 12:12 PM, Malia,

MD wrote:

>

>> A physician operating in the black is

actually a very rare thing.

>> So it

>> would be a special situation I imagine

when considering a legal issue.

>>

>> However, I imagine any half decent lawyer

would clarify how long you

>> project to remain in the black and

whether a " small fee " to pay for an

>> interpreter that allows you to offer

appropriate care will prevent you

>> from getting there. Realistically,

if such a small fee will delay you

>> from getting in the red, your business

plan may well fail anyway.

>> And, if

>> you look at all your financial books you

would need to demonstrate

>> there

>> are no other " extra fees " paid

here or there. For example, have you

>> spent

>> any extra money for decorating the walls

of the office? Do those

>> allow

>> you to improve the quality of your

service for the patients' sake?

>>

>> Thus, the question of our paying for

interpreters finances when put in

>> context of professionalism and the total

financial picture becomes

>> very

>> cloudy. This is not cut and dry

whether you are currently in the

>> black,

>> in the red or believe that every decision

you make is based on

>> " running a

>> business " .

>>

>> Tim

>>

>>> " or accommodation being offered

or

>>> would result in an undue

burden.”

>>> As a solo-solo physician office,

still operating in black, I can

>>> prove

>>> that this would be an undue burden

for my office.

>>>

>>> On Mar 25, 2006, at 11:47 AM,

Malia, MD wrote:

>>>

>>>> or accommodation being

offered or

>>>> would result in an undue

burden.”

>>

>>

>>

>>

>>

>>

>>

[Guest guest]

Tim, I am curious what you have to

pay. I have only one deaf patient,

and she usually shows up with no appointment and brings someone with her to

interpret and we make do the best we can. But several years ago, I did have a

patient who insisted on an interpreter and at that time we found one that

charged $45/hour and required a minimum 2 hour booking. So with $51 reimbursement for a 99213, we

lost $40 without even covering any overhead, and getting $70 for a 99214 means

we only lose $20. Seems like more

than a little loss to me…..

Annie

Re:

medical interpreter and non compliant pt.

My apologies if I offended. That was not my

intent. I was presenting the

perspective of how a lawyer might approach the

idea that a doc refuses to

provide an interpreter and says it's because of

cost. I meant for example

sake only. This has been part of the

approach used in legal discussions

and even in court cases related to this issue.

As I started out saying, I'd much prefer that

insurance companies would

pay for the services as I think it is basic to

allowing us to provide

care. Some insurers in the country are

trialing such efforts. But, what

I wish for doesn't match the reality of ADA.

Again, I meant no offense. I wish you

success and hope you are far in the

red very soon (and I'm praying the same for myself

too)!

By the way, I pay for interpreters 1-2 times a

month even though I know

sign language. Why? Because some of my

patients have minimal language

skills and are deaf. I get a certified deaf

interpreter. That is a deaf

person who is skilled in sign language linguistics

and can take the

formalized language of ASL and transform it to

gestural communication. It

is remarkable to see the comprehension of the

patients soar when the

communication method is changed from my sign

language to the certified

deaf interpreter.

Tim

> Tim, I started 4 months ago from zero

patients. I do not " decorate " my

> office, nor can I afford a lawyer for such

advice. I do locum tenens

> to pay my rent and malpractice.

>> Realistically, if such a small fee will

delay you

>> from getting in the red, your business

plan may well fail anyway

> No, it will delay me to pull a salary and

feed my three children.

>

> On Mar 25, 2006, at 12:12 PM, Malia,

MD wrote:

>

>> A physician operating in the black is

actually a very rare thing.

>> So it

>> would be a special situation I imagine

when considering a legal issue.

>>

>> However, I imagine any half decent lawyer

would clarify how long you

>> project to remain in the black and

whether a " small fee " to pay for an

>> interpreter that allows you to offer

appropriate care will prevent you

>> from getting there. Realistically,

if such a small fee will delay you

>> from getting in the red, your business

plan may well fail anyway.

>> And, if

>> you look at all your financial books you

would need to demonstrate

>> there

>> are no other " extra fees " paid

here or there. For example, have you

>> spent

>> any extra money for decorating the walls

of the office? Do those

>> allow

>> you to improve the quality of your

service for the patients' sake?

>>

>> Thus, the question of our paying for

interpreters finances when put in

>> context of professionalism and the total

financial picture becomes

>> very

>> cloudy. This is not cut and dry

whether you are currently in the

>> black,

>> in the red or believe that every decision

you make is based on

>> " running a

>> business " .

>>

>> Tim

>>

>>> " or accommodation being offered

or

>>> would result in an undue

burden.”

>>> As a solo-solo physician office,

still operating in black, I can

>>> prove

>>> that this would be an undue burden

for my office.

>>>

>>> On Mar 25, 2006, at 11:47 AM,

Malia, MD wrote:

>>>

>>>> or accommodation being

offered or

>>>> would result in an undue

burden.”

>>

>>

>>

>>

>>

>>

>>

[Guest guest]

--

You are likely in a area without many deaf. But, I'd be willing to bet

there are deaf there. But they ain't going to the doctor. That is what

research suggests. This is especially true for older deaf people. Care is

ignored due to past experience and limited knowledge of why it may be

reasonable to see a doc.

A huge portion of their time is spent with other deaf isolated from the

larger world due to communication limitations.

The learning of English, both in spoken and written form, can be

remarkably difficult due to limited early language deficits. Especially

older deaf were often discovered to be deaf quite late and had lived a few

years with almost no language. In the same amount of time, hearing

children would have a strong foundation of English words and structure. A

time when language acquisition and patterning is most plastic.

Then, many deaf remain quite apart from their family and never gain from

" overhearing " family discussions or other people or the radio, etc...

things I like to call " ambient knowledge " , that is, things we learn

incidentally.

Point is, many deaf are using sign language and are not able to " learn "

English. They can't suddenly appreciate the phonics of the language, and

the grammer must be memorized as they have never listened to conversations

and obtained an inherent understanding of the language structure.

Subtleties of the words make it hard enough for us hearing folks who have

listened to thousands of hours of conversations.

That is why they are handicapped. This is a problem they can't " fix " by

trying harder.

Tim

> No, I would not refuse to see them based on anything like that.

> However, it is perfectly acceptable to screen patients before deciding

> if they are accepted as a new patient. For example, if a potential

> patient is on Oxycontin & Percocet is seeking to transfer from " that

> horrible doctor down the street that did not understand my pain " , then

> I'm not likely to accept them, regardless of their insurance, deaf

> status, whatever. That is the type of thing I was referring to. Of

> course I would not just refuse to see someone simply because they

> require an interpretor. Still I can not imagine how that scenario

> could ever come to be in my practice(a deaf pt, alone with no companion

> to assist). If they are deaf & can't speak then how did they schedule

> the appt? A friend called? Then why can't that same friend come in

> with them? How does the deaf patient get along outside the doctor's

> office setting? What makes this office visit so unique compared to the

> other 23 hours in thei!

> r day that they need an interpretor for this but nowhere else? I can

> not recall a single episode from day one of medical school until now (2

> years into practice) that I've ever had to obtain the services of an

> interpretor in the course of learning or providing medical care. So

> for me it is really a non-issue. I guess I just get my feathers

> ruffled when someone says " doctor, you MUST see this patient and you

> MUST provide an interpretor and you MUST pay for it out of pocket and,

> so sorry, but you WILL lose money on the visit, but you are a doctor &

> this is the only profession that would allow such non-sense laws. "

> Believe me, I have nothing against deaf people, just such silly

> " rules " .

>

>

>>

>>

>> Date: 2006/03/25 Sat PM 06:10:43 EST

>> To: < >

>> Subject: Re: Re: medical interpreter and non

>> compliant pt.

>>

>> So, does this mean that if someone has insurance through which you are

>> contracted you would refuse to see them if they requested a sign

>> language interpreter when they're deaf?

>>

>> Before you answer, you may want to be careful about your formal reply

>> in written word. I am not a lawyer but from things I have heard I

>> could imagine a formal written statement of that sort could very

>> easily be admissible in a court case for discrimination based on a

>> handicap.

>>

>> And when we say " a good fit " , could a white, upperclass doctor refuse

>> to accept a new patient who is black, unemployed and under educated

>> because they say they can not " relate " and believe that ultimately the

>> patient would be problematic? I pose this question to provoke

>> thoughts and do not mean to challenge anyone personally.

>>

>> The question of prejudice and discrimination in our country is a huge

>> challenge. And I for one think all of us must be careful how we act,

>> not for legal reasons but rather, for appropriateness.

>>

>> Refusing a patient care when they have an insurance we're contracted

>> with when they have done nothing officially wrong, to me is worth

>> profound contemplation of what is medical professionalism.

>>

>> We must address the business-side of our offices. No margin, no

>> mission. But I agree with some other sentiments recently stated that

>> being a physician, at least part of the time, is much more than a

>> business both for the patient and the doctor. This field of medicine,

>> which we asked to the part of, like it or not, holds a special place

>> in our society and it has a level of professionalism not expected of

>> most other fields.

>>

>> Again, I do not mean to offend. But I do mean to challenge all of our

>> thinking. I do not recommend we make decisions which will lead to

>> ruin financially. But I do recommend we make some decisions at a

>> different level than the accountants of the insurance companies.

>>

>> Respectfully,

>> Tim

>>

>> > Good summary on your part. But I am in fact following my

>> contractual language exactly. As I mentioned, I just signed one

>> yesterday & it said " will provide interpretor services to deaf

>> patients at no charge or make reasonable accomodations if

>> indicated. " In the final analysis though, it has minimal to no

>> impact on my personal practice because I have yet to be asked to see

>> a deaf patient. I can tell you though my bottom line: I will not be

>> forced to take on any new patient that I do not feel comfortable

>> seeing or that would not be a good fit. One of the biggest

>> mistakes (in my opinion) I still colleagues in private practice

>> making is not running a things like a business; rather, they try to

>> look at it as a " save the world " venture. True, we are different

>> than say, a hairdresser, but it is still a business first and I just

>> will not be forced to see patients at a loss. Now, if you are

>> seeing these patients for free out of the goodness of your heart or

>> have a particular i!

>> > nterest in it, then that is a bit different I guess. But if you

>> are

>> > just seeing them for free because you feel obligated to by law, then

>> count me out on that one.

>> >

>> >

>> >>

>> >>

>> >> Date: 2006/03/25 Sat PM 12:47:00 EST

>> >> To: < >

>> >> Subject: Re: Re: medical interpreter and non

>> compliant pt.

>> >>

>> >> I wanted to remain quiet on this, but I think I have to step in

>> now. This is very close to my area of expertise. I know sign

>> language and work with a few hundred deaf patients here in

>> Rochester, New York. I have served as an expert witness in legal

>> cases, and presented both locally and nationally on the issue and

>> have served on panels for HCFA (now called CMS) regarding services

>> for the deaf.

>> >>

>> >> First off, I will make clear that my personal preference would be

>> that interpreters could bill directly to insurance companies. My

>> second preference would be that doctors could pay interpreters and

>> then have a code to receive payment (at least partial) through the

>> insurance companies with the in regular charges. This would

>> respect the extra work that is inherently needed for the great

>> majority of deaf patients we see.

>> >>

>> >> Regarding the discussion so far I want to make a clear there really

>> is no " urban legend " about the requirements for interpreters for

>> the deaf in medical care. Just because not many cases are brought

>> before the courts does not mean that this is not a reality.

>> >>

>> >> Also, understand there are cases that have made it through the

>> courts but most often these are settled out-of-court. I believe

>> most of the challenges to ADA have been regarding the jurisdiction

>> of the law and whether they apply to state hospitals or other

>> subtle situations.

>> >>

>> >> Whether we think it's fair or not we are obligated to follow laws

>> of the land and the contracts we sign with the insurance companies.

>> >>

>> >> Also, when considering the need for interpreters for the deaf we

>> must understand how medical professionalism is interpreted by our

>> society as well as the limited English skills of most deaf patients

>> and the difference of American sign language from English.

>> >>

>> >> Whether we feel we are simply running a business are not, the truth

>> is our society has established high standards for our behaviors and

>> expects us to live up to them. This has been supported for many

>> decades by professional organizations outlining medical ethics and

>> professionalism. These are so ingrained in our society that they

>> have a legal standing. Our actions cannot be considered the same

>> as hairdressers, auto mechanics or other laborers. We have an

>> obligation to our society, our patients and our colleagues to

>> maintain a professionalism when providing care.

>> >>

>> >> Also, financially the ADA is clear in stating the overall financial

>> burden is not judged by an individual event but on our total

>> financial status. The ADA has many parts to it and each must be

>> considered in relationship to the others. Be careful in pulling on

>> single sections or clauses. See below regarding certain sections

>> of the law than cover the financial issues.

>> >>

>> >> Most deaf patients have far weaker English skills than hearing

>> patients. Trying to communicate with them with written English in

>> most situations could be argued as close to malpractice as we are

>> potentially jeopardizing our ability to gather the medical

>> information needed to make proper decisions and to be sure the

>> information we communicate may be understood.

>> >>

>> >> I will offer one example. If we write, " your test was negative for

>> anemia " that could be understood by a sign language user as

>> meaning, " your test was bad. You have anemia. " Now, I recommend

>> we do not speak that way but the truth is we physicians often do.

>> What is written in English by using the word " negative " suggests

>> the absence of anemia. But the sign for " negative " is not used in

>> that way. Rather, it suggests a " bad " condition. Thus, by

>> depending on the written English we may be

>> >> communicating the exact opposite of what is intended.

>> >>

>> >> I know of many, many situations where doctors communication with

>> patients has been misunderstood because of the lack of

>> interpretation.

>> >> Often, I need to re-explain to my patients what the specialist

>> >> believed had been communicate at an appointment.

>> >>

>> >> Finally, please see below for an excerpt of something I have

>> written regarding the ADA and the use of sign language

>> interpreters.

>> >>

>> >> Thank you for considering this issue. I do beg you to use

>> >> interpreters when working with deaf patients.

>> >> Tim

>> >> .... excerpt from my writing...

>> >>

>> >> To safeguard the rights of American citizens with disabilities to

>> access services throughout our society on as equal terms as

>> possible with non-disabled citizens, the United States Congress

>> passed, and President Bush signed into law, the Americans With

>> Disabilities Act of 1990 (commonly referred to as the ADA). The

>> ADA addresses the issue of accessibility for our citizens with

>> disabilities in all aspects of our society. There are pertinent

>> details in the ADA as it relates to an initial doctor-patient

>> consultation when a Deaf person requests an ASL interpreter but

>> then must use pen-and-paper for communication.

>> >>

>> >> Section 2 of ADA finds that “discrimination against individuals

>> with disabilities persists in such critical areas as ... health

>> services” and that “the Nation's proper goals regarding individuals

>> with disabilities are to assure equality of opportunity, full

>> >> participation, independent living, and economic self-sufficiency

>> for such individuals.”

>> >>

>> >> Section 3 of ADA includes within its definition of an auxiliary aid

>> and service “qualified interpreters or other effective methods of

>> making aurally delivered materials available to individuals with

>> hearing impairments.”

>> >>

>> >> Section 301 of ADA states “the following private entities are

>> considered public accommodations for purposes of this title, if the

>> operations of such entities affect commerce ... professional office

>> of a health care provider, hospital, or other service

>> establishment.” It also defines “commercial facilities (as)

>> facilities (which) ... are intended for nonresidential use; and

>> ... whose operations will affect commerce.

>> >>

>> >>

>> >> The same section also states “the term " readily achievable " means

>> easily accomplishable and able to be carried out without much

>> difficulty or expense. In determining whether an action is readily

>> achievable, factors to be considered include-- (A) the nature and

>> cost of the action needed under this Act; ( the overall financial

>> resources of the facility or facilities involved in the action...”

>> >>

>> >> Section 302 of ADA states, “Goods, services, facilities,

>> privileges, advantages, and accommodations shall be afforded to an

>> individual with a disability in the most integrated setting

>> appropriate to the needs of the individual.”

>> >>

>> >> Also, Section 302 of ADA includes in the definition of

>> discrimination “a failure to take such steps as may be necessary to

>> ensure that no individual with a disability is excluded, denied

>> services, segregated or otherwise treated differently than other

>> individuals because of the absence of auxiliary aids and services,

>> unless the entity can demonstrate that taking such steps would

>> fundamentally alter the nature of the good, service, facility,

>> privilege, advantage, or accommodation being offered or would

>> result in an undue burden.”

>> >>

>> >>

>> >>

>> >>

>> >>

>> >>

>> >>

>> >> > Yes, I think you are correct. The whole ADA interprtor thing

>> >> persists in " urbal legend " form despite no such law.

>> >> >

>> >> >

>> >> >>

>> >> >>

>> >> >> Date: 2006/03/25 Sat AM 08:17:47 EST

>> >> >> To:

>> >> >> Subject: Re: medical interpreter and non

>> >> compliant pt.

>> >> >>

>> >> >> There may be such a law in Washington, I am sure there is none

>> in

>> >> Indiana and I will check about Illinois. The federal law they are

>> talking about applies to state agencies or " receivers of federal

>> funding " , which we are not.

>> >> >>

>> >> >>

>> >> >>

>> >> >> >

>> >> >> > My information came from my malpractice insurance company. 

>> Here

>> >> is

>> >> >> the link:

>> >> >> >

>> >> >> >  

>> >> >> >

>> >> >> > http://www.phyins.com/pi/risk/faq.html

>> >> >> >

>> >> >> >  

>> >> >> >

>> >> >> > It specifically addresses requiring people to bring their own

>> >> >> interpreter, and suggests against it.

>> >> >> >

>> >> >> >  

>> >> >> >

>> >> >> > We also find our patients that require interpreters (about 7)

>> are

>> >> >> pleasant to deal with, even if we don?t make money on their

>> >> visits. 

>> >> >> Don?t get me wrong, I think the law is stupid and that it

>> should

>> >> >> provide funds and a limited time for those who do not speak

>> English

>> >> but do speak other languages (so they are forced to learn the

>> language of the country they live in).  Sign language does not

>> include articles, which makes it difficult to have an appointment

>> with a note pad.  It is hard to read and difficult for them to

>> understand.  It also seems to be difficult have a detailed

>> >> >> conversation about managing diabetes through gesturing.  But I

>> >> have called our legislators about it as well as crummy Medicare

>> >> >> reimbursement, but they haven?t changed the law yet.  I keep

>> >> holding my breath.

>> >> >> >

>> >> >> >  

>> >> >> >

>> >> >> > And I hate to say it, but if your defense is you?re a doctor

>> and

>> >> >> can?t afford a $60 bill for an interpreter, I wish you luck.  I

>> >> don?t think you would fare well in open court.

>> >> >> >

>> >> >> >  

>> >> >> >

>> >> >> > Ernie

>> >> >> >

>> >> >> >  

>> >> >> >

>> >> >> >  

>> >> >> >

>> >> >> >

>> >> >> > From:

>> >> >> > [mailto: ] On Behalf Of

>>

>> >> >> Brock DO

>> >> >> > Sent: Thursday, March 23, 2006 7:17 AM

>> >> >> > To:

>> >> >> > Subject: RE: medical interpreter and

>> non

>> >> >> compliant pt.

>> >> >> >

>> >> >> >  

>> >> >> >

>> >> >> > Good info.  And chances are that if a potential patient is

>> going

>> >> to

>> >> >> be that adamant about following the letter of the ADA law right

>> >> from the start by waving the requirements in your face, then most

>> likely they will not be a good fit anyways & will not last long

>> (will be dismissed for other reasons probably).

>> >> >> >

>> >> >> >  

>> >> >> >

>> >> >> >

>> >> >> >

>> >> >> >  

>> >> >> >

>> >> >> > Re: medical interpreter and

>> non

>> >> >> compliant pt.

>> >> >> >

>> >> >> >  

>> >> >> >

>> >> >> > The ADA does not mandate the use of interpreters in every

>> >> instance.

>> >> >> The health care professional can choose alternatives to

>> >> interpreters

>> >> >> as long as the result is effective communication. Alternatives

>> to

>> >> >> interpreters should be discussed with hearing impaired patients,

>> >> especially those not aware that such alternatives are permissible

>> under the Act. Acceptable alternatives may include: note taking;

>> written materials; or, if viable, lip reading. A health care

>> >> >> > professional or facility is not required to provide an

>> >> interpreter

>> >> >> when:

>> >> >> >

>> >> >> > ·         it would present an undue burden. An undue burden is

>> a

>> >> >> significant expense or difficulty to the operation of the

>> facility.

>> >> Factors courts use to determine whether providing an interpreter

>> would present an undue burden include the practice or facility's

>> operating income and eligibility for tax credits, and whether it

>> has sources of outside funding or a parent company. Courts also

>> consider the frequency of visits that would require the services

>> of an interpreter. However, the single factor of the cost of an

>> interpreter exceeding the cost of a medical consultation generally

>> has not been found by the courts to be an undue burden.

>> >> >> >

>> >> >> > Source:  http://www.ama-assn.org/ama/pub/category/4616.html

>> >> >> >

>> >> >> >  

>> >> >> >

>> >> >> > Brett

>> >> >> >> medical interpreter and non

>> >> >> compliant pt.

>> >> >> >>

>> >> >> >>  

>> >> >> >>

>> >> >> >> Hi group

>> >> >> >>

>> >> >> >> I would like to know if as physician we are obligated to

>> >> provide

>> >> >> and

>> >> >> >> pay fro interpreter or patient has to do it? and the second

>> >> >> question is what is the best way to document or track or get

>> the

>> >> pt. to follow up and what is the best way to protect the practice

>> from the legal consequences? Thanks

>> >> >> >>

>> >> >> >> Mandana

>> >> >> >>

>> >> >> >>  

>> >> >> >>

>> >> >> >> -------------- Original message --------------

>> >> >> >>

>> >> >> >>

>> >> >> >> > Health care is a basic human need, depends on how you

>> define

>> >> it.

>> >> >> Certain christian sects would say wrong. It is not food and

>> water. It is not shelter from the elements. How far do you take

>> it?

>> >> >> >> >

>> >> >> >> > We are all in this to help people be the best they can be.

>> >> You

>> >> >> have to be careful of how you define the patient relationship

>> >> nowadays also. Much is being done in chiropractor offices, mall

>> clinics , and in the Emergency Room.

>> >> >> >> >

>> >> >> >> > Just stirring the pot a little to see what floats to the

>> top.

>> >> >> Brent

>> >> >> >> >

>> >> >> >> > >

>> >> >> >> > > i've been reading about the social burden of being a

>> doctor

>> >> >> and

>> >> >> >> > how it relates to low overhead practice with great

>> interest.

>> >> >> >> > >

>> >> >> >> > > there are some underlying fundamental precepts i like to

>> >> keep

>> >> >> in

>> >> >> >> > mind when discussing these things.

>> >> >> >> > >

>> >> >> >> > > they are:

>> >> >> >> > >

>> >> >> >> > > health care is not a right or privilege; it is a basic

>> >> human

>> >> >> >> > need, just like food, clothing and shelter. everybody

>> needs

>> >> it.

>> >> >> >> > >

>> >> >> >> > > good health care arises from a healthy doctor-patient

>> >> >> >> > relationship. the relationship facilitates healthy choices

>> >> >> resulting in good outcomes.

>> >> >> >> > >

>> >> >> >> > > any framework surrounding the doctor-patient

>> relationship

>> >> must

>> >> >> >> > be defined by the needs of the doctor-patient

>> relationship.

>> >> form

>> >> >> follows function.

>> >> >> >> > >

>> >> >> >> > > just my thoughts.

>> >> >> >> > >

>> >> >> >> > > LL

>> >> >> >> > >

>> >> >> >> > >

>> >> >> >> > > ---------------------------------

>> >> >> >> > > Yahoo! Travel

>> >> >> >> > > Find great deals to the top 10 hottest destinations!

>> >> >> >> > >

>> >> >> >> >

>> >> >> >> >

>> >> >> >> >

>> >> >> >> >

>> >> >> >> >

>> >> >> >> >

>> >> >> >> >

>> >> >> >> >

[Guest guest]

--

You are likely in a area without many deaf. But, I'd be willing to bet

there are deaf there. But they ain't going to the doctor. That is what

research suggests. This is especially true for older deaf people. Care is

ignored due to past experience and limited knowledge of why it may be

reasonable to see a doc.

A huge portion of their time is spent with other deaf isolated from the

larger world due to communication limitations.

The learning of English, both in spoken and written form, can be

remarkably difficult due to limited early language deficits. Especially

older deaf were often discovered to be deaf quite late and had lived a few

years with almost no language. In the same amount of time, hearing

children would have a strong foundation of English words and structure. A

time when language acquisition and patterning is most plastic.

Then, many deaf remain quite apart from their family and never gain from

" overhearing " family discussions or other people or the radio, etc...

things I like to call " ambient knowledge " , that is, things we learn

incidentally.

Point is, many deaf are using sign language and are not able to " learn "

English. They can't suddenly appreciate the phonics of the language, and

the grammer must be memorized as they have never listened to conversations

and obtained an inherent understanding of the language structure.

Subtleties of the words make it hard enough for us hearing folks who have

listened to thousands of hours of conversations.

That is why they are handicapped. This is a problem they can't " fix " by

trying harder.

Tim

> No, I would not refuse to see them based on anything like that.

> However, it is perfectly acceptable to screen patients before deciding

> if they are accepted as a new patient. For example, if a potential

> patient is on Oxycontin & Percocet is seeking to transfer from " that

> horrible doctor down the street that did not understand my pain " , then

> I'm not likely to accept them, regardless of their insurance, deaf

> status, whatever. That is the type of thing I was referring to. Of

> course I would not just refuse to see someone simply because they

> require an interpretor. Still I can not imagine how that scenario

> could ever come to be in my practice(a deaf pt, alone with no companion

> to assist). If they are deaf & can't speak then how did they schedule

> the appt? A friend called? Then why can't that same friend come in

> with them? How does the deaf patient get along outside the doctor's

> office setting? What makes this office visit so unique compared to the

> other 23 hours in thei!

> r day that they need an interpretor for this but nowhere else? I can

> not recall a single episode from day one of medical school until now (2

> years into practice) that I've ever had to obtain the services of an

> interpretor in the course of learning or providing medical care. So

> for me it is really a non-issue. I guess I just get my feathers

> ruffled when someone says " doctor, you MUST see this patient and you

> MUST provide an interpretor and you MUST pay for it out of pocket and,

> so sorry, but you WILL lose money on the visit, but you are a doctor &

> this is the only profession that would allow such non-sense laws. "

> Believe me, I have nothing against deaf people, just such silly

> " rules " .

>

>

>>

>>

>> Date: 2006/03/25 Sat PM 06:10:43 EST

>> To: < >

>> Subject: Re: Re: medical interpreter and non

>> compliant pt.

>>

>> So, does this mean that if someone has insurance through which you are

>> contracted you would refuse to see them if they requested a sign

>> language interpreter when they're deaf?

>>

>> Before you answer, you may want to be careful about your formal reply

>> in written word. I am not a lawyer but from things I have heard I

>> could imagine a formal written statement of that sort could very

>> easily be admissible in a court case for discrimination based on a

>> handicap.

>>

>> And when we say " a good fit " , could a white, upperclass doctor refuse

>> to accept a new patient who is black, unemployed and under educated

>> because they say they can not " relate " and believe that ultimately the

>> patient would be problematic? I pose this question to provoke

>> thoughts and do not mean to challenge anyone personally.

>>

>> The question of prejudice and discrimination in our country is a huge

>> challenge. And I for one think all of us must be careful how we act,

>> not for legal reasons but rather, for appropriateness.

>>

>> Refusing a patient care when they have an insurance we're contracted

>> with when they have done nothing officially wrong, to me is worth

>> profound contemplation of what is medical professionalism.

>>

>> We must address the business-side of our offices. No margin, no

>> mission. But I agree with some other sentiments recently stated that

>> being a physician, at least part of the time, is much more than a

>> business both for the patient and the doctor. This field of medicine,

>> which we asked to the part of, like it or not, holds a special place

>> in our society and it has a level of professionalism not expected of

>> most other fields.

>>

>> Again, I do not mean to offend. But I do mean to challenge all of our

>> thinking. I do not recommend we make decisions which will lead to

>> ruin financially. But I do recommend we make some decisions at a

>> different level than the accountants of the insurance companies.

>>

>> Respectfully,

>> Tim

>>

>> > Good summary on your part. But I am in fact following my

>> contractual language exactly. As I mentioned, I just signed one

>> yesterday & it said " will provide interpretor services to deaf

>> patients at no charge or make reasonable accomodations if

>> indicated. " In the final analysis though, it has minimal to no

>> impact on my personal practice because I have yet to be asked to see

>> a deaf patient. I can tell you though my bottom line: I will not be

>> forced to take on any new patient that I do not feel comfortable

>> seeing or that would not be a good fit. One of the biggest

>> mistakes (in my opinion) I still colleagues in private practice

>> making is not running a things like a business; rather, they try to

>> look at it as a " save the world " venture. True, we are different

>> than say, a hairdresser, but it is still a business first and I just

>> will not be forced to see patients at a loss. Now, if you are

>> seeing these patients for free out of the goodness of your heart or

>> have a particular i!

>> > nterest in it, then that is a bit different I guess. But if you

>> are

>> > just seeing them for free because you feel obligated to by law, then

>> count me out on that one.

>> >

>> >

>> >>

>> >>

>> >> Date: 2006/03/25 Sat PM 12:47:00 EST

>> >> To: < >

>> >> Subject: Re: Re: medical interpreter and non

>> compliant pt.

>> >>

>> >> I wanted to remain quiet on this, but I think I have to step in

>> now. This is very close to my area of expertise. I know sign

>> language and work with a few hundred deaf patients here in

>> Rochester, New York. I have served as an expert witness in legal

>> cases, and presented both locally and nationally on the issue and

>> have served on panels for HCFA (now called CMS) regarding services

>> for the deaf.

>> >>

>> >> First off, I will make clear that my personal preference would be

>> that interpreters could bill directly to insurance companies. My

>> second preference would be that doctors could pay interpreters and

>> then have a code to receive payment (at least partial) through the

>> insurance companies with the in regular charges. This would

>> respect the extra work that is inherently needed for the great

>> majority of deaf patients we see.

>> >>

>> >> Regarding the discussion so far I want to make a clear there really

>> is no " urban legend " about the requirements for interpreters for

>> the deaf in medical care. Just because not many cases are brought

>> before the courts does not mean that this is not a reality.

>> >>

>> >> Also, understand there are cases that have made it through the

>> courts but most often these are settled out-of-court. I believe

>> most of the challenges to ADA have been regarding the jurisdiction

>> of the law and whether they apply to state hospitals or other

>> subtle situations.

>> >>

>> >> Whether we think it's fair or not we are obligated to follow laws

>> of the land and the contracts we sign with the insurance companies.

>> >>

>> >> Also, when considering the need for interpreters for the deaf we

>> must understand how medical professionalism is interpreted by our

>> society as well as the limited English skills of most deaf patients

>> and the difference of American sign language from English.

>> >>

>> >> Whether we feel we are simply running a business are not, the truth

>> is our society has established high standards for our behaviors and

>> expects us to live up to them. This has been supported for many

>> decades by professional organizations outlining medical ethics and

>> professionalism. These are so ingrained in our society that they

>> have a legal standing. Our actions cannot be considered the same

>> as hairdressers, auto mechanics or other laborers. We have an

>> obligation to our society, our patients and our colleagues to

>> maintain a professionalism when providing care.

>> >>

>> >> Also, financially the ADA is clear in stating the overall financial

>> burden is not judged by an individual event but on our total

>> financial status. The ADA has many parts to it and each must be

>> considered in relationship to the others. Be careful in pulling on

>> single sections or clauses. See below regarding certain sections

>> of the law than cover the financial issues.

>> >>

>> >> Most deaf patients have far weaker English skills than hearing

>> patients. Trying to communicate with them with written English in

>> most situations could be argued as close to malpractice as we are

>> potentially jeopardizing our ability to gather the medical

>> information needed to make proper decisions and to be sure the

>> information we communicate may be understood.

>> >>

>> >> I will offer one example. If we write, " your test was negative for

>> anemia " that could be understood by a sign language user as

>> meaning, " your test was bad. You have anemia. " Now, I recommend

>> we do not speak that way but the truth is we physicians often do.

>> What is written in English by using the word " negative " suggests

>> the absence of anemia. But the sign for " negative " is not used in

>> that way. Rather, it suggests a " bad " condition. Thus, by

>> depending on the written English we may be

>> >> communicating the exact opposite of what is intended.

>> >>

>> >> I know of many, many situations where doctors communication with

>> patients has been misunderstood because of the lack of

>> interpretation.

>> >> Often, I need to re-explain to my patients what the specialist

>> >> believed had been communicate at an appointment.

>> >>

>> >> Finally, please see below for an excerpt of something I have

>> written regarding the ADA and the use of sign language

>> interpreters.

>> >>

>> >> Thank you for considering this issue. I do beg you to use

>> >> interpreters when working with deaf patients.

>> >> Tim

>> >> .... excerpt from my writing...

>> >>

>> >> To safeguard the rights of American citizens with disabilities to

>> access services throughout our society on as equal terms as

>> possible with non-disabled citizens, the United States Congress

>> passed, and President Bush signed into law, the Americans With

>> Disabilities Act of 1990 (commonly referred to as the ADA). The

>> ADA addresses the issue of accessibility for our citizens with

>> disabilities in all aspects of our society. There are pertinent

>> details in the ADA as it relates to an initial doctor-patient

>> consultation when a Deaf person requests an ASL interpreter but

>> then must use pen-and-paper for communication.

>> >>

>> >> Section 2 of ADA finds that “discrimination against individuals

>> with disabilities persists in such critical areas as ... health

>> services” and that “the Nation's proper goals regarding individuals

>> with disabilities are to assure equality of opportunity, full

>> >> participation, independent living, and economic self-sufficiency

>> for such individuals.”

>> >>

>> >> Section 3 of ADA includes within its definition of an auxiliary aid

>> and service “qualified interpreters or other effective methods of

>> making aurally delivered materials available to individuals with

>> hearing impairments.”

>> >>

>> >> Section 301 of ADA states “the following private entities are

>> considered public accommodations for purposes of this title, if the

>> operations of such entities affect commerce ... professional office

>> of a health care provider, hospital, or other service

>> establishment.” It also defines “commercial facilities (as)

>> facilities (which) ... are intended for nonresidential use; and

>> ... whose operations will affect commerce.

>> >>

>> >>

>> >> The same section also states “the term " readily achievable " means

>> easily accomplishable and able to be carried out without much

>> difficulty or expense. In determining whether an action is readily

>> achievable, factors to be considered include-- (A) the nature and

>> cost of the action needed under this Act; ( the overall financial

>> resources of the facility or facilities involved in the action...”

>> >>

>> >> Section 302 of ADA states, “Goods, services, facilities,

>> privileges, advantages, and accommodations shall be afforded to an

>> individual with a disability in the most integrated setting

>> appropriate to the needs of the individual.”

>> >>

>> >> Also, Section 302 of ADA includes in the definition of

>> discrimination “a failure to take such steps as may be necessary to

>> ensure that no individual with a disability is excluded, denied

>> services, segregated or otherwise treated differently than other

>> individuals because of the absence of auxiliary aids and services,

>> unless the entity can demonstrate that taking such steps would

>> fundamentally alter the nature of the good, service, facility,

>> privilege, advantage, or accommodation being offered or would

>> result in an undue burden.”

>> >>

>> >>

>> >>

>> >>

>> >>

>> >>

>> >>

>> >> > Yes, I think you are correct. The whole ADA interprtor thing

>> >> persists in " urbal legend " form despite no such law.

>> >> >

>> >> >

>> >> >>

>> >> >>

>> >> >> Date: 2006/03/25 Sat AM 08:17:47 EST

>> >> >> To:

>> >> >> Subject: Re: medical interpreter and non

>> >> compliant pt.

>> >> >>

>> >> >> There may be such a law in Washington, I am sure there is none

>> in

>> >> Indiana and I will check about Illinois. The federal law they are

>> talking about applies to state agencies or " receivers of federal

>> funding " , which we are not.

>> >> >>

>> >> >>

>> >> >>

>> >> >> >

>> >> >> > My information came from my malpractice insurance company. 

>> Here

>> >> is

>> >> >> the link:

>> >> >> >

>> >> >> >  

>> >> >> >

>> >> >> > http://www.phyins.com/pi/risk/faq.html

>> >> >> >

>> >> >> >  

>> >> >> >

>> >> >> > It specifically addresses requiring people to bring their own

>> >> >> interpreter, and suggests against it.

>> >> >> >

>> >> >> >  

>> >> >> >

>> >> >> > We also find our patients that require interpreters (about 7)

>> are

>> >> >> pleasant to deal with, even if we don?t make money on their

>> >> visits. 

>> >> >> Don?t get me wrong, I think the law is stupid and that it

>> should

>> >> >> provide funds and a limited time for those who do not speak

>> English

>> >> but do speak other languages (so they are forced to learn the

>> language of the country they live in).  Sign language does not

>> include articles, which makes it difficult to have an appointment

>> with a note pad.  It is hard to read and difficult for them to

>> understand.  It also seems to be difficult have a detailed

>> >> >> conversation about managing diabetes through gesturing.  But I

>> >> have called our legislators about it as well as crummy Medicare

>> >> >> reimbursement, but they haven?t changed the law yet.  I keep

>> >> holding my breath.

>> >> >> >

>> >> >> >  

>> >> >> >

>> >> >> > And I hate to say it, but if your defense is you?re a doctor

>> and

>> >> >> can?t afford a $60 bill for an interpreter, I wish you luck.  I

>> >> don?t think you would fare well in open court.

>> >> >> >

>> >> >> >  

>> >> >> >

>> >> >> > Ernie

>> >> >> >

>> >> >> >  

>> >> >> >

>> >> >> >  

>> >> >> >

>> >> >> >

>> >> >> > From:

>> >> >> > [mailto: ] On Behalf Of

>>

>> >> >> Brock DO

>> >> >> > Sent: Thursday, March 23, 2006 7:17 AM

>> >> >> > To:

>> >> >> > Subject: RE: medical interpreter and

>> non

>> >> >> compliant pt.

>> >> >> >

>> >> >> >  

>> >> >> >

>> >> >> > Good info.  And chances are that if a potential patient is

>> going

>> >> to

>> >> >> be that adamant about following the letter of the ADA law right

>> >> from the start by waving the requirements in your face, then most

>> likely they will not be a good fit anyways & will not last long

>> (will be dismissed for other reasons probably).

>> >> >> >

>> >> >> >  

>> >> >> >

>> >> >> >

>> >> >> >

>> >> >> >  

>> >> >> >

>> >> >> > Re: medical interpreter and

>> non

>> >> >> compliant pt.

>> >> >> >

>> >> >> >  

>> >> >> >

>> >> >> > The ADA does not mandate the use of interpreters in every

>> >> instance.

>> >> >> The health care professional can choose alternatives to

>> >> interpreters

>> >> >> as long as the result is effective communication. Alternatives

>> to

>> >> >> interpreters should be discussed with hearing impaired patients,

>> >> especially those not aware that such alternatives are permissible

>> under the Act. Acceptable alternatives may include: note taking;

>> written materials; or, if viable, lip reading. A health care

>> >> >> > professional or facility is not required to provide an

>> >> interpreter

>> >> >> when:

>> >> >> >

>> >> >> > ·         it would present an undue burden. An undue burden is

>> a

>> >> >> significant expense or difficulty to the operation of the

>> facility.

>> >> Factors courts use to determine whether providing an interpreter

>> would present an undue burden include the practice or facility's

>> operating income and eligibility for tax credits, and whether it

>> has sources of outside funding or a parent company. Courts also

>> consider the frequency of visits that would require the services

>> of an interpreter. However, the single factor of the cost of an

>> interpreter exceeding the cost of a medical consultation generally

>> has not been found by the courts to be an undue burden.

>> >> >> >

>> >> >> > Source:  http://www.ama-assn.org/ama/pub/category/4616.html

>> >> >> >

>> >> >> >  

>> >> >> >

>> >> >> > Brett

>> >> >> >> medical interpreter and non

>> >> >> compliant pt.

>> >> >> >>

>> >> >> >>  

>> >> >> >>

>> >> >> >> Hi group

>> >> >> >>

>> >> >> >> I would like to know if as physician we are obligated to

>> >> provide

>> >> >> and

>> >> >> >> pay fro interpreter or patient has to do it? and the second

>> >> >> question is what is the best way to document or track or get

>> the

>> >> pt. to follow up and what is the best way to protect the practice

>> from the legal consequences? Thanks

>> >> >> >>

>> >> >> >> Mandana

>> >> >> >>

>> >> >> >>  

>> >> >> >>

>> >> >> >> -------------- Original message --------------

>> >> >> >>

>> >> >> >>

>> >> >> >> > Health care is a basic human need, depends on how you

>> define

>> >> it.

>> >> >> Certain christian sects would say wrong. It is not food and

>> water. It is not shelter from the elements. How far do you take

>> it?

>> >> >> >> >

>> >> >> >> > We are all in this to help people be the best they can be.

>> >> You

>> >> >> have to be careful of how you define the patient relationship

>> >> nowadays also. Much is being done in chiropractor offices, mall

>> clinics , and in the Emergency Room.

>> >> >> >> >

>> >> >> >> > Just stirring the pot a little to see what floats to the

>> top.

>> >> >> Brent

>> >> >> >> >

>> >> >> >> > >

>> >> >> >> > > i've been reading about the social burden of being a

>> doctor

>> >> >> and

>> >> >> >> > how it relates to low overhead practice with great

>> interest.

>> >> >> >> > >

>> >> >> >> > > there are some underlying fundamental precepts i like to

>> >> keep

>> >> >> in

>> >> >> >> > mind when discussing these things.

>> >> >> >> > >

>> >> >> >> > > they are:

>> >> >> >> > >

>> >> >> >> > > health care is not a right or privilege; it is a basic

>> >> human

>> >> >> >> > need, just like food, clothing and shelter. everybody

>> needs

>> >> it.

>> >> >> >> > >

>> >> >> >> > > good health care arises from a healthy doctor-patient

>> >> >> >> > relationship. the relationship facilitates healthy choices

>> >> >> resulting in good outcomes.

>> >> >> >> > >

>> >> >> >> > > any framework surrounding the doctor-patient

>> relationship

>> >> must

>> >> >> >> > be defined by the needs of the doctor-patient

>> relationship.

>> >> form

>> >> >> follows function.

>> >> >> >> > >

>> >> >> >> > > just my thoughts.

>> >> >> >> > >

>> >> >> >> > > LL

>> >> >> >> > >

>> >> >> >> > >

>> >> >> >> > > ---------------------------------

>> >> >> >> > > Yahoo! Travel

>> >> >> >> > > Find great deals to the top 10 hottest destinations!

>> >> >> >> > >

>> >> >> >> >

>> >> >> >> >

>> >> >> >> >

>> >> >> >> >

>> >> >> >> >

>> >> >> >> >

>> >> >> >> >

>> >> >> >> >

[Guest guest]

Annie --

I agree, those charges and time requirement are crazy. Unfortunately, I

can't know what the standards are across the country. But that sounds more

like a charge for a conference or lecture interpreter, not for medical.

And in that case, if an interpreter is needed for an extended time, you

need two (I believe with a discounted rate) so they take turns (about 20

minutes each) for continuous interpreting, otherwise they fatigue and

quality drops off.

Here in Rochester we have a lot of interpreters due to NTID, a deaf

college that is part of RIT -- that also gives us a large, and diverse,

Deaf population, something that is not the standard in other communities.

But most interpreters are in educational field, not medical. Thus, we may

actually have a relative shortage of community, free-lance interpreters

for health care. Those would charge $35-$50 per hour, usually with a one

hour minimum.

There are a handful of services too. Those may cost a bit more but they

find the interpreter for you, so you pay for only needing to make one

phone call.

Again, I believe that using sign interpreters in health care is so

remarkably, unquestionably valuable and important that it should be a

service billable to insurance. A good medical interpreter increases both

the time efficiency of the doctor and the quality of care. I firmly

believe in my heart the service is as valuable, and often more valuable,

than visits with nutrition or many PT appts (and I'm a supporter of

working closely with nutritionists and physical therapists!!). I only

wished there was a way to prove that belief so insurers would pay -- of

course we'd have to show financial benefit for the insurance company

first. But here in Rochester we have the NCDHR, National Center for Deaf

Health Research, and we hope to move forward to answering such questions

in time.

Take care. And good luck with the patients and interpreters (but try to

shop around if you can).

Tim

> Tim, I am curious what you have to pay. I have only one deaf patient,

> and she usually shows up with no appointment and brings someone with her

> to interpret and we make do the best we can. But several years ago, I

> did have a patient who insisted on an interpreter and at that time we

> found one that charged $45/hour and required a minimum 2 hour booking.

> So with $51 reimbursement for a 99213, we lost $40 without even covering

> any overhead, and getting $70 for a 99214 means we only lose $20. Seems

> like more than a little loss to me...

> Annie

>

> Re: medical interpreter and non

> compliant pt.

>

> My apologies if I offended. That was not my intent. I was presenting

> the

> perspective of how a lawyer might approach the idea that a doc refuses

> to

> provide an interpreter and says it's because of cost. I meant for

> example

> sake only. This has been part of the approach used in legal discussions

> and even in court cases related to this issue.

>

> As I started out saying, I'd much prefer that insurance companies would

> pay for the services as I think it is basic to allowing us to provide

> care. Some insurers in the country are trialing such efforts. But,

> what

> I wish for doesn't match the reality of ADA.

>

> Again, I meant no offense. I wish you success and hope you are far in

> the

> red very soon (and I'm praying the same for myself too)!

>

> By the way, I pay for interpreters 1-2 times a month even though I know

> sign language. Why? Because some of my patients have minimal language

> skills and are deaf. I get a certified deaf interpreter. That is a deaf

> person who is skilled in sign language linguistics and can take the

> formalized language of ASL and transform it to gestural communication.

> It

> is remarkable to see the comprehension of the patients soar when the

> communication method is changed from my sign language to the certified

> deaf interpreter.

>

> Tim

>

>> Tim, I started 4 months ago from zero patients. I do not " decorate "

> my

>> office, nor can I afford a lawyer for such advice. I do locum

> tenens

>> to pay my rent and malpractice.

>>> Realistically, if such a small fee will delay you

>>> from getting in the red, your business plan may well fail anyway

>> No, it will delay me to pull a salary and feed my three children.

>>

>>

>>

>>> A physician operating in the black is actually a very rare thing. So

>>> it

>>> would be a special situation I imagine when considering a legal

> issue.

>>>

>>> However, I imagine any half decent lawyer would clarify how long you

>>> project to remain in the black and whether a " small fee " to pay for

> an

>>> interpreter that allows you to offer appropriate care will prevent

> you

>>> from getting there. Realistically, if such a small fee will delay

> you

>>> from getting in the red, your business plan may well fail anyway.

>>> And, if

>>> you look at all your financial books you would need to demonstrate

>>> there

>>> are no other " extra fees " paid here or there. For example, have

> you

>>> spent

>>> any extra money for decorating the walls of the office? Do those

>>> allow

>>> you to improve the quality of your service for the patients' sake?

>>>

>>> Thus, the question of our paying for interpreters finances when put

> in

>>> context of professionalism and the total financial picture becomes

>>> very

>>> cloudy. This is not cut and dry whether you are currently in the

>>> black,

>>> in the red or believe that every decision you make is based on

>>> " running a

>>> business " .

>>>

>>> Tim

>>>

>>>> " or accommodation being offered or

>>>> would result in an undue burden. "

>>>> As a solo-solo physician office, still operating in black, I can

>>>> prove

>>>> that this would be an undue burden for my office.

>>>>

>>>>

>>>>

>>>>> or accommodation being offered or

>>>>> would result in an undue burden. "

>>>

>>>

>>>

>>>

>>>

>>>

>>>

[Guest guest]

Thanks Tim,

I will try to hunt for a more cost

effective option if it comes up again.

Annie

Re: medical

interpreter and non

> compliant pt.

>

> My apologies if I offended. That was not my

intent. I was presenting

> the

> perspective of how a lawyer might approach

the idea that a doc refuses

> to

> provide an interpreter and says it's because

of cost. I meant for

> example

> sake only. This has been part of the

approach used in legal discussions

> and even in court cases related to this

issue.

>

> As I started out saying, I'd much prefer that

insurance companies would

> pay for the services as I think it is basic

to allowing us to provide

> care. Some insurers in the country are

trialing such efforts. But,

> what

> I wish for doesn't match the reality of ADA.

>

> Again, I meant no offense. I wish you

success and hope you are far in

> the

> red very soon (and I'm praying the same for

myself too)!

>

> By the way, I pay for interpreters 1-2 times

a month even though I know

> sign language. Why? Because some of my

patients have minimal language

> skills and are deaf. I get a certified

deaf interpreter. That is a deaf

> person who is skilled in sign language

linguistics and can take the

> formalized language of ASL and transform it

to gestural communication.

> It

> is remarkable to see the comprehension of the

patients soar when the

> communication method is changed from my sign

language to the certified

> deaf interpreter.

>

> Tim

>

>> Tim, I started 4 months ago from zero

patients. I do not " decorate "

> my

>> office, nor can I afford a lawyer for

such advice. I do locum

> tenens

>> to pay my rent and malpractice.

>>> Realistically, if such a small fee

will delay you

>>> from getting in the red, your

business plan may well fail anyway

>> No, it will delay me to pull a salary and

feed my three children.

>>

>> On Mar 25, 2006, at 12:12 PM,

Malia, MD wrote:

>>

>>> A physician operating in the black is

actually a very rare thing. So

>>> it

>>> would be a special situation I

imagine when considering a legal

> issue.

>>>

>>> However, I imagine any half decent

lawyer would clarify how long you

>>> project to remain in the black and

whether a " small fee " to pay for

> an

>>> interpreter that allows you to offer

appropriate care will prevent

> you

>>> from getting there. Realistically,

if such a small fee will delay

> you

>>> from getting in the red, your

business plan may well fail anyway.

>>> And, if

>>> you look at all your financial books

you would need to demonstrate

>>> there

>>> are no other " extra fees "

paid here or there. For example, have

> you

>>> spent

>>> any extra money for decorating the

walls of the office? Do those

>>> allow

>>> you to improve the quality of your

service for the patients' sake?

>>>

>>> Thus, the question of our paying for

interpreters finances when put

> in

>>> context of professionalism and the

total financial picture becomes

>>> very

>>> cloudy. This is not cut and dry

whether you are currently in the

>>> black,

>>> in the red or believe that every

decision you make is based on

>>> " running a

>>> business " .

>>>

>>> Tim

>>>

>>>> " or accommodation being

offered or

>>>> would result in an undue

burden. "

>>>> As a solo-solo physician office,

still operating in black, I can

>>>> prove

>>>> that this would be an undue

burden for my office.

>>>>

>>>> On Mar 25, 2006, at 11:47 AM,

Malia, MD wrote:

>>>>

>>>>> or accommodation being

offered or

>>>>> would result in an undue

burden. "

>>>

>>>

>>>

>>>

>>>

>>>

>>>