Providing Paths of Travel

Copyright 2022

Patients come to your practice for quality medical care and the government wants to ensure that everyone has equal access to your offices.

Courts Define Hardship

The question of what constitutes undue hardship when it comes to providing access to the disabled has generated many lawsuits and hinges on the facts and circumstances of each case.

But generally, judges consider several factors when gauging the obligation to provide access:

  • The industry.
  • The nature and costs of the accommodations.
  • The resources and size of the organization.

A Family Affair

The parents of a 15-month-old child sued a Pittsburgh Ear, Nose & Throat group after the medical practice sent a letter to the couple saying it would not provide service to the child because the father was deaf and required an interpreter.

According to court documents, after the parents made an appointment for a surgical evaluation for the child, they requested interpreter services. The practice then sent a letter to the parents canceling the appointment and informing them they would not provide medical services for the child.

The parents and the practice settled the case for an undisclosed sum after a judge refused to throw the lawsuit out and noted that the letter tying the denial of care to the request for an interpreter was ``as close to a smoking gun as it gets in federal court.'' (Majocha v. Turner, 166 F. Supp.2d 316, W.D.Pa. 2001)

Under the terms of settlement, the doctors agreed to provide an interpreter for that family and any other deaf patients at no charge. It also agreed to post signs in its offices and train doctors and staff on the new policy.

The federal Americans With Disabilities Act (ADA) requires that patients, their family members, and vendors with disabilities have the same access rights as able-bodied people. And access issues include both physical and communication barriers.

Under the law, your practice must provide reasonable accommodation to the disabled that allows them access as long as it doesn't create "undue hardship" for you. Among the steps you must take:

1. Remove all physical barriers if doing so is "readily achievable." Court rulings generally define this as meaning that the work can be accomplished without much expense or difficulty. If the costs are prohibitive, you should provide alternative access to your services, such as house calls.

Examples: Physical access doesn't just mean wheelchair ramps to the front door. Accessible paths of travel can include hallways, waiting rooms, bathrooms and work areas wide enough for wheelchairs or walkers, grab-bar equipped bathrooms and modified water fountains. Patients with mental or visual impairments may require special signs to aid them in emergency situations.

2. Allow working dogs in your offices. Disabled individuals must be able to use guide or other service dogs to gain access to your services.

Exception: This provision can be ignored if allowing access to animals would fundamentally alter the nature of the service. For example, you wouldn't want service animals in operating rooms or other sterile facilities.

3. Provide communication aids and services for patients with such disabilities as visual or hearing impairments, speech impediments and mental infirmities such as dementia.

Full comprehension: You must provide services that help disabled patients and their families fully understand the medical issues involved so they can make informed treatment choices. Such aids can include certified sign language and other interpreters, Braille documents and large-print handouts.

The costs of providing full access to your services cannot be passed on only to the patients who benefit from them. However, the costs are considered overhead and you can raise your fees on all patients to cover the expenses.

Tax Breaks

Two tax breaks are available to businesses to help cover the cost of making improvements to comply with the ADA:

  • The first is a tax credit that can be used for architectural adaptations, equipment acquisitions and services such as sign language interpreters. The credit, which is a dollar-for-dollar reduction of your tax bill, is available to businesses with $1 million or less in annual revenues or 30 or fewer full time employees.
  • The second is a tax deduction that can be used by businesses of any size for architectural or transportation changes and communication services. It is worth up to $15,000 per year.