Another aggravating aspect of it is that it doesn't really matter how right I am; there's not much I can do about it. Oh, well! Better luck next time!
In general, being up-close to E. Messily's health care process is ...dystopic. Like I'm in some rigged land where the rules are all funhouse/scary clown style, and the stakes are very high.
These are serious issues, but you can't title a post "It Happened To Me!" on a day when the big news is about a Ted Cruz sex scandal.
I'm pretty sure this never happens to my stepson only because he never calls people on their shittiness. So maddening. (the world, not my stepson)
Will the local TV news do stories on ADA violations as a part of their consumer advocacy stuff?
You're a good friend, h-g. I'm sure Messily has more experience, but it's always good to have somebody else willing to act as an advocate.
Personally I'm a terrible advocate because I'm conflict averse and hate calling people on bad behavior. But it really is necessary, and I have no idea how I will handle it when I need to do so.
If you want to complain to doctors, you find an old person. They're almost all great at it.
What gets me is the Catch 22, where you obviously want to get the state of the law across to the doctor and keep them from discriminating in future, but it seems like you'd have to be at least ambivalent about being treated by that kind of jerk if you had any other options.
You'd at least worry about going in with a sore throat and walking out with a prescription for castor oil.
I worry about that anyway, because I spent too much time watching M.A.S.H.
8 comes up a lot around here with illegal discrimination by landlords - say, refusing to rent to you because you have kids. You want to call them out on it, but you don't really want to be in a long-term landlord-tenant relationship with that at the foundation.
That's awful. And a lot of people don't know their rights, and would just take it as given when a doctor tells them s/he's not qualified to see them.
I find it's much easier to advocate for other people than for myself -- I actually kind of enjoy calling people up and arguing with them when it's on behalf of a friend, whereas doing so on my own behalf is prohibitively anxiety-provoking.
I can relate to 12.last. I also have a problem with any numbers that pertain to me which have dollar signs in front. Any other numerical issue I can tackle easily, but make it money and I get all anxious. Anyone else's financial issues I can deal with, it's just my own that panic me.
The OP is weird because what doctor wouldn't want a deaf patient? They just sit there quietly and never disagree with you or shout at you or anything! The only way they could be more ideal patients is by being unconscious or dead.
WTF, ajay?
I am certain it's a joke but not certain what the joke is.
I find it's much easier to advocate for other people than for myself -- I actually kind of enjoy calling people up and arguing with them when it's on behalf of a friend, whereas doing so on my own behalf is prohibitively anxiety-provoking.
Do you have kids? Once people have kids they become able to argue for stuff all the time by justifying it as actually arguing on behalf of their kids. Especially helpful in salary negotiations.
3: Hadn't heard of this. Five minutes on Google News makes it seem like the only source is the National Enquirer, which is a joke about everything except politicians' affairs FWIW. Interesting. Also mildly interesting how Breitbart kinda apparently sat or is sitting on it, but I really don't think anyone should be surprised.
As for the OP, sorry Heebie and especially of course E.M., that sucks. I agree with 12.last. I don't normally think of it as anxiety, I just think of it as not being worth the trouble, but when I think about the amount of money I've left on the table or nearly did if not for Cassandane's reminding me, I should be more willing to go through that kind of trouble than I am.
Liable for miscommunications?
"Well, she didn't tell me she had sharp pains in lower abdomen, so how was I supposed to diagnose acute appendicitis and schedule emergency surgery"
"She didn't tell you? You didn't have an ASL interpreter on call when you accepted the patient? Sorry, $3 million dollars awarded."
A HS friend of mine who is blind was living in Manhattan for a year recently. His wife said that the rate of cabs refusing to take them places with his guide dog was about 20%. They had a whole routine: You aren't allowed to refuse to take us because of the dog. No, the dog is not going to pee in your cab. Oh, you still refuse to take our fare? Okay, I'll need to get your cab number.
And then they'd report it. Who knows if the reports ever went anywhere or did any good.
Yeah, joke at the expense of doctors often having a rather disdainful attitude towards actually listening to their patients.
The actual story is infuriating.
That Didn't Take Much Searching
The patient, Irma Gerena, sued under the New Jersey Law Against Discrimination, the Americans with Disabilities Act (ADA) and the Rehabilitation Act. The jury found that Dr.Robert Fogari violated the law by failing to provide the patient with an interpreter and by retaliating against her based on the request. Dr. Fogari told Ms. Gerena that he could not afford to pay the $200 per visit charge for the interpreter and instead communicated with Ms. Gerena through family members, including her nine-year-old daughter. It was also alleged that the doctor refused to meet with an interpreter who could have explained the law to him. The patient eventually switched to another doctor who immediately changed her treatment. Dr. Fogari said that as a solo practitioner, the per visit cost of the interpreter was prohibitive, although at the time of trial, his tax return showed earnings in excess of $400,000 per year.
20, 23: It is mildly interesting to know that there's a not-literally-completely-baseless fear of liability. However, by the details in the quoted paragraph, the story is in no way exculpatory to the doctor - an additional $200 per visit, boo fricking hoo.
Since apparently the interpreter is hired and paid by the doctor, if the interpreter screws up, does the doctor still share liability?
Is a sign language interpreter always necessary? Can't dr and patient communicate via notes?
24: Oh You want more. Answer to 25 is apparently yes.
The High Cost of Language Barriers in Malpractice ...pdf, UC Berkeley
Section Headings
The Seminal Case of the failure to Provide Competent Interpretation
Failure to Provide Competent Interpreters
Defective Informed Consent and Lack of written Translations
Inadequate Documentation
Allegations of Discrimination
Bob has now turned into a clone of the Republicans from back home that I see on Facebook.
Except they sometimes post recipes.
The ADA requires "reasonable accommodation". What that is depends on the patient. Some deaf people do not read/write English well enough to have notes ensure adequate communication. Doctors/clinics/hospitals are expected to cover the cost of interpreters the same way they are expected to be in accessible buildings*, with the money coming out of operating expenses. And the cost of hiring an interpreter for a few hours every once in a while is substantially less than hiring a staff interpreter on salary with benefits, which is what would actually provide full accessibility but is not required or expected of anyone.
I, personally, can speak clearly and lipread very well. I am comfortable asking for clarification if I don't understand something, and a written note will always solve the problem. This particular doctor is a therapist, so there was no chance of any emergency, time-sensitive miscommunication, or whatever. I hadn't planned on requesting an interpreter, but Heebie didn't get anywhere near that far in the process. She said "I'm calling for my roommate, who is deaf, and interested in setting up an appointment with you" and he said "no, I am not trained to see deaf clients."
*They often don't follow that rule either.
I don't think we'd like Bob's recipes.
It makes me a little crazy that no doctors or nurses or any staff seems to ever had had any training or knowledge about the ADA, ever. (most of the time). They are always telling me the weirdest lies based on hearsay. Sometimes they're refusing to provide interpreters, sometimes they're arguing that the incompetent, unlicensed interpreter they provided satistfies the law, and sometimes they refuse to see me WITHOUT an interpreter. "No, we legally can't treat you without an interpreter, and since the one we scheduled didn't show up, you'll have to make another appointment."
I have heard stories from other deaf people, who don't use ASL at all, of having doctors insist on interpreters being in the room at all times, which is a very weird invasion of privacy if they aren't providing a useful service. Plus then the doctor think he doesn't have to look at the patient or write notes.
25- very occasionally, doctors or hospitals have been held resonsible for the quality of the interpreters they provide. This only happens when there's a lengthy documented history of interpreter mistakes and formal complaints, repeated. Then you have to actually have a bad result- the kid dies, or the dad isn't let in to the delivery room, or whatever. THEN you can sue them. Then they get in trouble, sort of. (They have to promise they will hire better interpeters in the future.)
I wonder how often doctors get sued for ADA violations based on client service, and what the damages are. The law is pretty complicated and is mostly known in the employment context and then mostly to relatively large employers; doctors are famously bad managers and don't generally employ lots of people and people that they do employ are for a variety of reasons probably less likely to bring reasonable accommodation claims.
Essentially all of the training that doctors get on their legal responsibilities comes from their insurance companies, so if the insurers don't see substantial risk from patient-service ADA violations the training is probably extremely minimal if it exists at all. (And to the extent it does exist, is likely entirely about being as hyper-over-defensive as possible so as to limit liability).
This is the opposite of the point that Bob was trying to make -- if ADA violations for dealing with deaf people were a serious liability risk for doctors, they would have more serious and defined procedures for it, because their insurers would define rules more precisely. Those rules might or might not suck, but you wouldn't get situations like those described in the OP.
I mean, I could sue him for refusing to see me (if he hadn't changed his mind), and then I'd win, and the court would tell him he has to see me and other deaf patients.
But I don't want to go see him anymore, very much.
Right, but damages are (I think) slim to none and most people would just find another doctor. So the insurer is probably not to worried about this as a risk, which means that the doctors don't get trained or have much of a reason to give a shit. If it's not something a doctor needs to know as part of licensing, and not something their insurer cares about, they're not going to know it.
I'm reminded of an ableist variant of Awesome Hospital's Dr. Casual Racism. Motherfuckers suck, but motherfuckers with medical authority trying to deny you treatment suck even more. Sorry to see it.
I tried looking this up earlier today, and it appeared to me that the federal ADA doesn't give any damages (they remedy the situation and pay your legal fees), but in California there's a state law that does allow damages.
I bet Moby's republican relatives have never once recommended good anime.
36. Yes. Agreed!
I want there to be an Office of ADA inspectors who go around doing surprise visits and investigating complaints and issuing big fines. I'm sure our fine Congress and Senate would be happy to add some clauses to accomplish that. Any day now.
Way back at 4: I'm pretty sure this never happens to my stepson only because he never calls people on their shittiness.
You mean he never gets in arguments or he never has doctors refuse him services?
Therapists are extra-weird sometimes. A close friend is seeking out a new therapist after years of going without. She's now 0 for 3 on being phone-interviewed by a group practice and then being rejected as a client. In one case they did the interview and then when she called back a week later said "oops, sorry, not taking new clients", which we both think was an annoying way of saying "no". She thinks that they're avoiding her because she checked herself in to an inpatient psych ward once, a decade ago (she was surprised that they all asked about it, and after the first one, concluded that she wasn't willing to lie about it either), and they consider that that makes her too risky somehow, but there's no way to be sure.
It probably wouldn't help if I tried to get an appointment with the "not taking new clients" practice, as a much more boring patient, and got one, just so I could show up and say "You were lying to my friend. Why?" But it is a little tempting.
(My own therapist is boggled at the way this is going down, but that also doesn't help.)
A non-profit organization that funded pro bono ADA lawsuits for people who had been turned away/not given reasonable accommodations could probably do a lot of good, along the lines of the way the ACLU just sort of steps in to take most of the hassle out of free speech lawsuits for people when the legal remedies are relatively minor (and as a result the whole thing is a collective action problem). There would be an awful lot of "The judge ruled that you have to see me... buuut I've found a new doctor anyway" situations, but that's probably a lot easier to accept (on the part of the plaintiff) when the bar is a lot lower and they're not risking being out a lot of money. Or at least it would lower the bar to the point where I can see people's punitive desires being strong enough to override what inconveniences were involved.
You'd need to find some very, very healthy lawyers though, or at least ones who probably wouldn't have any serious health problems until a bunch of cases scared a lot of doctors into actually taking the ADA seriously and the number of lawsuits died down a bit.
41: he never would get into an argument. He doesn't know asl, and currently is using neither his hearing aid (one side) nor implant (other side). I think he communicates phenomenally well given these circs via speech and lip reading but you know everyone in the family is used to getting his attention, making it easy for him to lip read us, etc. But he must be doing okay as he runs his own small business, deals with the public, employees, etc. Reading and writing he's gangbusters, as you know not a given in light of being born profoundly deaf.
He has a lot invested in not pushing people who are jerks, is all. Might well change if he had a partner or kid and discrimination affected him/her.
Also Kaiser has a wide array of translators on tap as well as a rotating duty dermatologist in the SF main building to confirm lice infestation, I know to my sorrow.
Yeah, the KP roving dermatologist program is fantastic. Everything medicine should be - instead of endless referrals and appointments, your PCP makes a quick phone call, the dermatologist pops bywith barely any wait, both doctors look at your epidermal horrors together, and they collaborate to determine a course of action. Unfortunately I'm told by someone on the inside while the program is extremely popular they didn't find it to be feasible for any other kind of specialist.
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Ted Cruz likes talking obliquely about ratfucking so much you'd think he was a commenter.
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30: my huge top ranked hospital doesn't usually bring in interpreters in person. (I'm sure that have people who can sign ASL.). They use a telephone service which seems pretty suboptimal. One of our health centers isn't even wheelchair accessible.
Further to 45: KP has been nationally recognized for the quality of their work on linguistically accessible healthcare. However, I don't think that award looked at ASL.
You aren't allowed to refuse to take us because of the dog. No, the dog is not going to pee in your cab.
IME, the issue that cab drivers commonly have with dogs has nothing to do with peeing in the cab, and everything to do with being Muslim and not wanting to have to repeat their ablutions before the next call to prayer.
If there was an ADA whistleblower incentive scheme where you got a share of the fine, it might even be self funding.
Qui tam suits for the ADA! What could go wrong?
(Seriously, it would be nice if there were more enforcement teeth in a lot of our civil rights law.)
So, Muslims are fine with dog urine?
Are there ritually clean alternative guide animals? Guide cats would have other disadvantages.
In any case a) I thought you were supposed to perform abortions before each prayer anyway and b) surely if you don't actually touch the dog it's not unclean?
ABLUTIONS. Perform ABLUTIONS before each prayer.
Well no wonder the Republicans hate Muslims so much.
54.1: I cannot tell if you were referencing Les Barker's poem (set to music by Cindy Mangsen here). If not, I recommend these links, and if so, here they are anyway. Lyrics here.
(Thank you, "preview")
58: I wasn't, but thanks! very entertaining.
46: Because all that's needed for a diagnosis is usually a quick look and maybe taking some scrapings? Pretty much everything else requires vast noisy machines, propofol, and liters of blood draws.
That depends - there's an awful lot a neurologist can do with "walk over there and then come back" or "hold your hand steady". It's probably more that a quick dermatologist visit is something that patients can regularly need/want so it makes sense to have one hand on hand to check out any moles/rashes/itching/etc. that patients might be worried about in a way that isn't true for a lot of specialists.