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What’s at Risk When Communicating With a Deaf Patient

Effective physician-patient communication is an integral part of the clinical practice and serves as the cornerstone of physician-patient relationships. The critical importance of the information a physician is relaying to their patients must be communicated in a manner so the patient understands their health condition and is able to make an informed decision about their medical treatment plan. Equally important is the patient’s ability to communicate medically relevant information to the provider. A lack of effective communication and understanding can result in delayed or inadequate treatment, possible harm, and even death.

Communication with deaf or hearing-impaired patients requires additional considerations to ensure that effective communication is provided. When necessary, a qualified interpreter or interpretation service must be provided to the patient.

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In 2018, the Eleventh Circuit Court heard an appeal of a Florida case, Crane v. Lifemark Hospital, involving a deaf person’s right to an interpreter.1 Mr. Crane, a profoundly deaf individual who communicates using American Sign Language (ASL) filed a lawsuit against a hospital for failure to provide a sign language interpreter to effectively communicate during an involuntary commitment evaluation. Mr. Crane appealed the district court’s order granting the defendant hospital’s motion for summary judgment. The issue on appeal was whether Mr. Crane was afforded an equal opportunity, through an appropriate auxiliary aid, to effectively communicate medically relevant information during his involuntary commitment evaluation.

Mr. Crane suffered from chronic depressive and anxiety disorders. In July 2011, police responded to a call that Mr. Crane was suicidal and transported him to Palmetto General Hospital where he was treated for alcohol intoxication. Mr. Crane reported that while at the hospital, he repeatedly requested a sign language interpreter but was not provided with one. The following day, Mr. Crane was evaluated by a psychiatrist for possible involuntary commitment for psychiatric care. The psychiatrist communicated with Mr. Crane through written notes and limited sign language skills. Although the psychiatrist determined that Mr. Crane was not a threat to himself or others, he remained in the hospital for two more days. It was not until his day of discharge that an ASL interpreter was provided to assist the psychiatrist in communication with Mr. Crane.

Mr. Crane subsequently filed a lawsuit alleging the hospital violated the Americans with Disabilities Act of 1990 (ADA)² by failing to provide a qualified sign language interpreter or other appropriate form of assistance to a deaf patient. The ADA prohibits discrimination on the basis of disability in employment, public accommodations, state and local governmental services, public transportation, and telecommunications.³ Under the ADA, the definition of discrimination includes: “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, services, facility, privilege, advantage or accommodation being offered or would result in undue burden.” Title II of the ADA covers medical services and facilities run by government bodies, including public hospitals, clinics, and medical offices because they are public entities.4 A deaf patient has the right to actively participate in their care just as a hearing person. That includes both receiving medical information from physicians and/or staff and providing medically relevant information to the physician and/or hospital staff provider.

In the Crane case, the defendants contended they provided Mr. Crane with sufficient auxiliary aids, i.e., written notes and basic sign language services, for effective communication. However, Mr. Crane asserted that he was not afforded the opportunity to sufficiently communicate with the physicians and staff. In an affidavit he declared “I was never able to thoroughly express my feelings [about] the traumas I have experienced in my life . . . during any of the doctor’s evaluations and daily interactions with the Hospital’s nurses. For example, besides writing down that I was depressed, I was never provided the opportunity during my hospitalization to go into detail…about why I was depressed.” The appellate court opined that “At a bare minimum, this provides evidence that Crane could not understand and suffered a real hindrance due to his disability to provide material medical information with his health care provider.” The appellate court reversed the district court’s order granting summary judgment and remanded the case for further proceedings.

Next month, CAP’s risk management and patient safety team will share valuable strategies for communicating with and managing patients with hearing disabilities to help physicians and their staff remain compliant and provide effective medical treatment.   

1Crane v. Lifemark Hosps., Inc., 898 F.3d 1130 (11th Cir 2018).

²42 U.S.C. § 12110 et seq.

³California Medical Association Health Law Library. The California Physician’s Legal Handbook, Document #6002, Disabled Patients: Health Care Services, February 2022, p. 1

428 C.F.R. § 35 and § 36.