What accommodations does a hearing-impaired patient require?

April 1, 2002

Q: Last week, one of our phlebotomists was sent to the floor to draw blood on a patient who happened to be deaf. The patient didnt understand what tests were being done and why, and our phlebotomist didnt know how to communicate with her. There was no interpreter available at that hour. Ultimately, she was able to get the idea across with gestures, but it was pretty unsatisfactory. What is the labs responsibility in such a situation?

A: Healthcare providers, under the American with Disabilities Act, must ensure that disabled patients have access to healthcare services despite the effects of their particular disabilities. The ADA requires that healthcare providers, including physician practices and hospitals, make certain accommodations to ensure that their disabled patients can physically access medical
facilities and can appropriately communicate with their caregivers. In the case of deaf patients, this means that the provider must ensure that there is some adequate way to communicate information to the patient and receive information back. In the case of many, if not most, deaf patients, this means the provision of an interpreter skilled in sign language. Not every patient will require an interpreter, and neither will every situation, but its a good idea to take a look at how these decisions are made in your institution to avoid being caught in such a situation again. 

Most advocates believe that an interpreter is required for a deaf patient who relies on sign language when any new medical situation emerges, in order to explain medical detail, and to ensure that the caregiver gets adequate information. For the most part, that obligation rests on the physician to ensure that the patient can communicate adequately and the hospital to provide the interpreter in the in-patient setting. It is unfortunate, but too often true, that deaf patients can find themselves admitted to hospital and scheduled for complex tests or surgery without having been adequately informed, often because of the lack of interpretive services. 

The hospital should have a policy for evaluating hearing-impaired patients to determine their need for interpreters, as well as having a policy for obtaining adequate interpretive services when needed, even at odd hours, on short notice, and on holidays or weekends. The laboratory should be aware of the procedures for enlisting interpreters when needed, and this should be incorporated into orientation procedures. Perhaps most important, laboratory personnel should not proceed with even routine specimen collection when there is a suspicion that the patient does not understand what is going on because there has been a failure to provide an interpreter. Lab staff can provide valuable early warning to the hospital and attending physician of an impending problem with appropriate accommodation of such patients.

Most of the time, however, the need for an interpreter at the time of routine blood drawing can be eliminated if an adequate orientation is done when the patient is first admitted. If, at that time, with appropriate interpreting assistance, the patient is introduced to laboratory staff, and the process for routine blood drawing is discussed, the phlebotomy staff may not need additional interpreting assistance except when an unusual laboratory test (such as bleeding time or bone marrow biopsy) that has not been previously explained is ordered.

Barbara Harty-Golder is a pathologist-attorney in Sarasota, FL. She directs the clinical laboratory at Health South Rehabilitation Hospital in Sarasota, and maintains a law practice with a special interest in medical law. She writes and lectures extensively on healthcare law, risk management, and human resources management.

© 2002 Nelson Publishing, Inc. All rights reserved.

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