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ADA Discrimination Prevention

As physicians, we offer clinical services to persons with disabilities and are held to enforceable standards to avoid discrimination, intentional or unintentional. In this article, I’ll summarize a great FAQ by the Doctors Company.

Interestingly, if a claim is made against a clinician by a patient with a disability, it apparently isn’t covered under your malpractice insurance. That’s why knowing these points is important to protect your practice.

1. Discontinuing a patient-doctor relationship with a disabled patient

You need a valid reason to do so, and some guidelines and criteria must be met.

You may not even be aware that a patient was legally disabled.

2. Can you discharge patients from your practice if their medical condition exceeds your capabilities?

Generally, you can discharge a patient from your practice if you think your abilities are limited.

The case of a newly diagnosed MS patient is given in the Doctors Company article.

3. HIV patients and surgical procedures

HIV patients are protected under the ADA. Requiring them to go to the ER or inpatient setting for simple outpatient procedures based on their HIV status alone is discrimination.

4. Difficulty dealing with a deaf patient in your practice

It’s your responsibility to pay for and train your staff to deal with a patient who is deaf. Even if the written communication takes longer, you cannot discharge the patient from your practice for those reasons alone.

5. Patients with limited English proficiency

Though the answer is in relation to HHS providers, it’s important that you understand your legal state/federal requirement for offering interpretation services in your practice.

The ADA has a document available on this.

Physicians in private practice who receive no federal dollars for their patient services may have different rules, and it was difficult to tease that out.

6. Using family members as translators

Whether the patient is deaf or doesn’t speak English, it’s generally unacceptable to use a family member as a translator. Certainly not a child.

7. Website ADA compliance

Your medical website or anything patient facing has to be ADA-compliant. There are services that will give you feedback on what changes you have to make.

8. Service animals and emotional support animals

Service animals fall under the ADA, while emotional support animals fall more under the Medical Practice Act.

Either way, remain consistent in what you do, put the patient first, and develop an internal P&P.

9. Examining patients in mobility devices

All patients should be treated the same. Your staff should be trained to help patients out of their wheelchairs and onto an examination table.

It is not appropriate to examine a patient in their mobility device unless they insist.

The Added Pressure of a Physical Practice

On one hand, reading these onerous rules makes me stressed and fearful. On the other hand, I would want adequate access if I had any disability.

Naturally, these rules are much easier to follow for a multimillion-dollar corporation than for a small community doctor.

However, the laws state that you should do what you can based on what you can afford as a small practice. Nobody expects you to go out of business trying to accommodate a single group of patients.

With a virtual practice, I can use services like LanguageLine to complete translation. Of course, I can also choose which patients I accept into my private practice based on the effort needed to offer services to that patient.

I cannot discriminate against a person based on their English proficiency or disability status, but I can decide based on whether they are a fit for my membership model, which is not on a first-come-first-serve basis.

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