Friday, August 01, 2014

Did You Know That People with Disabilities Can Shelter with Friends and Neighbors in Red Cross Shelters? Why Is This Information Such A Secret?

Did You Know That People with Disabilities Can Shelter with Friends and Neighbors in Red Cross Shelters? Why Is This Information Such A Secret?

I was recently reviewing a “Hurricane Guide” issued by the City of Key West, and wanted to see what information was being conveyed to the public about sheltering services for people with disabilities. As many readers of the ADA Advocacy Blog are aware, one of the goals of the ADA is to enhance the integration of people with disabilities. To that end, the law mandates that when necessary to avoid discrimination on the basis of disability, state and local governments, under title II of the ADA, must make reasonable modifications of policy  - that is, they must change policies to accommodate people with disabilities when it is reasonable to do so. (Businesses must also do so, pursuant to title III of the ADA).

A typical example is a rule that may be in place at a courthouse prohibiting people from bringing an animal into the courthouse. Pursuant to this rule, individuals seeking to bring their dog into the courthouse may lawfully be told that they cannot enter with the dog. If the individual is a person with a disability, however, and the dog is a service dog, the “no animals” policy must be modified, and the individual must be allowed to bring their service dog inside the courthouse with them. Failure to modify this policy would constitute discrimination on the basis of disability, and violate the ADA. This policy modification obligation was developed to enhance integration of people with disabilities, and to avoid discriminating on the basis of disability.

In the context of emergency shelters, the shelter may lawfully have a series of policies in place that apply to evacuees, but the shelter must reasonable modify the policies so as not to discriminate on the basis of disability. There are plenty of examples of this. Consider:

The shelter may lawfully prohibit evacuees from bringing animals into the shelter. However, if the evacuee is a person with a disability, and seeks to bring their service dog into the shelter, the shelter must reasonably modify the no animals policy and allow the evacuee with a disability to be accompanied by their service dog.
The shelter may lawfully tell evacuees that they should bring blankets, and will be sleeping on the floor – that the shelter will not be providing beds or cots to evacuees. However, evacuees with mobility disabilities may not be able to use the shelter’s services unless they are provided with an accessible cot or bed. Therefore, the shelter must reasonably modify the policy and provide evacuees with mobility disabilities an accessible cot or bed. In addition, as a reasonable modification of policy, the shelter must also modify other policies – they must provide transfer assistance, assistance with toileting, assistance with activities of daily living, and other assistance so as not to discriminate against people with disabilities. The failure, or refusal,to do so constitutes discrimination on the basis of disability, and violates the ADA.
The shelter may choose a food plan that includes high levels of salt, but many evacuees with disabilities may not be able to eat this food as a result of their disability. For example, an evacuee who has recovered from a stroke, or has high blood pressure, may not be able to eat this food. As a reasonable modification of policy under title II of the ADA, the shelter must plan to provide other foods that better meet the dietary needs of evacuees with disabilities.

But can’t evacuees with disabilities all just go to Special Needs Shelters? After all, aren’t those shelters specially equipped to address the needs of evacuees with disabilities?

No.

Special Needs Shelters are designed to serve some members of the disability community, but not all of them, and not even the majority of them. Special Needs Shelters are designed for those individuals with enhanced medical needs – those dependent on oxygen, or who need nursing care. The vast majority of evacuees with disabilities can function quite well at a general needs shelter, amidst their friends, family members, and neighbors. And the general needs shelters need to be ready to admit them and serve them, with the necessary modifications of policy in place to avoid discrimination on the basis of disability.

General Needs Shelters are commonly run by the American Red Cross, in partnership with the County and the school system. Title III of the ADA covers the American Red Cross (as a nonprofit), and title II of the ADA covers the County and the school system. When evacuees with disabilities are not properly served at these shelters, due to a failure to engage in a reasonable modification of policy, the Red Cross may be held liable under title III, and the County and school system may be held liable under title II of the ADA. In addition, because the County and the schools receive federal financial assistance, they may also be held liable for discrimination on the basis of disability under Section 504 of the Rehabilitation Act of 1973.

Back to the “Hurricane Guide” – The Guide discusses shelters, and discusses the County’s “Special Needs Registry”. There is no mention, at all, of what services will be available to evacuees with disabilities in the Red Cross shelters, and no mention of what services will be available to evacuees with disabilities in the Special Needs shelters. Instead, evacuees are told that they are to bring their own supplies. No mention is made of ways that evacuees with disabilities will be integrated, or of what services they will receive at the shelter. Evacuees are told to bring a “sleeping bag, blanket and pillow, and light weight portable lounge chairs”. No mention of what an evacuee in a wheelchair, or any other evacuee with a disability,  can expect in the way of services.

Concerning the “Special Needs Registry”, the Guide states that:
“The ill, infirm and elderly will have an extra network of support in the Florida Keys in the event of a hurricane. It’s called the Special Needs Registry, and it’s a guaranteed ride off the islands to the mainland.”  It goes on to state that:
“Individuals are eligible to be registered if they are 60 years of age or older, frail, medically needy, and/or disabled and are not served in or by a residential facility program.” (At p. 14).

Again, no mention of evacuees with disabilities being served at the Red Cross shelter, and no mention of the services to be provided at a Special Needs shelter.

The Keys are not unique in this approach. On Miami Dade County’s website, for example, the County neglects to mention any services available to evacuees with disabilities. Instead, visitors to the website, located at http://www.miamidade.gov/hurricane/evacuation-assistance.asp, are informed that:

“All Miami-Dade County Hurricane Evacuation Shelters exceed Americans with Disabilities Act (ADA) criteria for emergency shelters, and include accessible entryways, service/activity areas and bathrooms. Service animals are permitted.”

No mention of accessible beds, transfer assistance, toileting assistance, or any other modifications of policy to avoid discrimination on the basis of disability.

The County does mention the availability of a special registry:

“Emergency Evacuation Assistance Program (EEAP)
Anyone who is unable to evacuate and/or shelter on their own, who may require specialized transportation assistance or whose medical needs prevent them from evacuating on their own should  register with the EEAP registry prior to an emergency evacuation.  Individuals on the registry will receive priority and assistance evacuating to a facility appropriate for their level of care.The program is specifically for individuals who live alone or with their families, not those residing in nursing homes, assisted living facilities or group homes….”

Again, no mention of accessible beds, transfer assistance, toileting assistance, or any other modifications of policy to avoid discrimination on the basis of disability. Evacuees with disabilities are left in the dark concerning what services will be provided.

The American Red Cross, which operates many of the shelters, is similarly unhelpful when evacuees with disabilities visit their website looking for information about what services to expect.  For example, there is no mention of evacuees with disabilities on the Red Cross website for the Miami Dade community. See http://www.redcross.org/fl/miami/about. Once again, evacuees with disabilities are left without information about services they can expect to receive at the shelter. 24 years after the passage of the ADA, why is this information withheld?

Why is this information not made available to the disability community? Are they afraid that if they tell us, we will show up? And then, they will have to serve us?




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What Doctors (and Their Office Managers) Need to Know About Patients With Hearing Disabilities and Interpreter Services

http://www.fccdhh.org/system/js/back/ckfinder/userfiles/files/ADA_Explained.doc

What Doctors (and Their Office Managers) Need to Know About Patients With Hearing Disabilities and Interpreter Services

January 4, 2013

Marc Dubin, Esq. 
Director of Advocacy, Center for Independent Living of South Florida
Former Senior Trial Attorney, U.S. Department of Justice, Civil Rights Division, Disability Rights Section, Washington, D.C. 1993-2005
mdubin@pobox.com
305-896-3000 mobile

This document may be freely reproduced, in its entirety, with attribution to the author. 

Please note that this paper does not discuss other obligations under the ADA (e.g., title I - employers, and title II - programs and services of state and local governments). Rather, it focuses primarily on title III obligations (places of public accommodation, including nonprofits, regardless of number of employees).
  
"I'm a doctor in private practice, and I can choose my patients - If a patient is deaf, and doesn't agree to bring their own interpreter, I can turn them away, right?"
No.  Doctors in private practice (not employed by a state or local government) are covered by title III of the Americans with Disabilities Act (ADA),( regardless of the number of employees they have), and cannot discriminate on the basis of disability. (Doctors employed by a state or local government are covered by title II of the ADA.) 

 In addition, if they receive federal financial assistance, they are prohibited from discriminating against patients on the basis of disability by a law that has been in existence since 1973 - Section 504 of the Rehabilitation Act of 1973. Violation of Section 504 of the Rehabilitation Act could result in a suspension or termination of all federal financial assistance by the federal funding agency. This has great significance for public hospitals in particular.

Patients with hearing disabilities (and other disabilities) are a protected class under federal civil rights laws. Other protected classes under other federal civil rights laws are people of color, women, and people expressing religious beliefs, among  others.
The ADA was passed in 1990, and took effect in 1992. It prohibits discrimination by places of public accommodation (businesses - title III) and programs and services of state and local governments (title II). It also prohibits discrimination on the basis of disability in employment (Title I), by private employers who employ 15 or more employees. Regardless of the number of employees a business has, title III prohibits discrimination against its customers (patients and companions).


The ADA is very comprehensive, and includes requirements concerning the removal of architectural barriers and the renovation or new construction of buildings, and requires strict compliance with federal standards set forth in the ADA regulations. it also mandates the modification of policies that serve as barriers to people with disabilities, such as "no animals allowed" policies that restrict the right of people with disabilities to be accompanied by service animals, and an "effective communication" requirement that mandates that doctors (and others) ensure that  the communication they engage in with people with hearing disabilities are effective. This provision of the ADA requires that persons with sensory disabilities be provided with the appropriate auxiliary aids and services necessary for effective communication. This includes qualified sign language interpreters and CART services (real time captioning) for persons who are late deafened, among other auxiliary aids and services. Far too often, providers seek to utilize auxiliary aids and services that do not result in effective communication, such as lipreading and the passing of notes, or rely on friends and family members as sign language interpreters, when these individuals lack the necessary specialized vocabulary or are not qualified as a result of their lack of impartiality.

In addition, the ADA mandates that printed material be made available to people with vision disabilities in alternative formats, upon request, at no charge.

If a doctor rejects a patient's request for service, the reason for the referral or denial of service must be based on something other than the patient's disability. According to the Justice Department:

"A public accommodation may refer an individual with a disability to another public accommodation, if that individual is seeking, or requires, treatment or services outside of the referring public accommodation's area of specialization, and if, in the normal course of its operations, the referring public accommodation would make a similar referral for an individual without a disability who seeks or requires the same treatment or services.
(2) Illustration -- medical specialties. A health care provider may refer an individual with a disability to another provider, if that individual is seeking, or requires, treatment or services outside of the referring provider's area of specialization, and if the referring provider would make a similar referral for an individual without a disability who seeks or requires the same treatment or services. A physician who specializes in treating only a particular condition cannot refuse to treat an individual with a disability for that condition, but is not required to treat the individual for a different condition.http://www.ada.gov/reg3a.html.
 Refusing to treat a patient, or referring the patient to another doctor, because the patient needs a sign language interpreter to effectively communicate, would constitute discrimination, and would violate the ADA.

'Okay. I can't turn them away, and can't refer them away unless their medical need is outside my area of specialization (and in the normal course of my operations, I would make a similar referral for an individual without a disability), but they have to bring their own interpreter, right, or at least a friend or family member to serve as their interpreter, right?"
No.  The patient never has to pay for the services of the interpreter. Never. Requiring them to do so is a violation of their federal civil rights. The doctor's office, as a place of public accommodation under title III of the ADA, is obligated by federal  law to provide appropriate auxiliary aids and services to ensure that the communication between patient and doctor is effective. Unless doing so would be an undue burden or a fundamental alteration (specifically defined terms, discussed further below), failure to do so would constitute a violation of the patient's federal civil rights. One should note, of course, that the doctor is also obligated by the state licensing agency to effectively communicate with patients - failure to do so may also constitute negligence and malpractice, and may risk a hospital's accreditation.

The Justice Department’s ADA regulations, which it enforces (and which I enforced on their behalf for over 12 years), states that:

"A public accommodation shall take those steps that 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 public accommodation can demonstrate that taking those steps would fundamentally alter the nature of the goods, services, facilities, privileges, advantages, or accommodations being offered or would result in an undue burden, i.e., significant difficulty or expense."

The regulations further require the doctor's office to:
"... furnish appropriate auxiliary aids and services where necessary to ensure effective communication with individuals with disabilities." 

Auxiliary aids and services include, but are not limited to "qualified interpreters", note takers, computer-aided transcription services, assistive listening systems,  open and closed captioning, videotext display, "or other effective methods of making aurally delivered materials available to individuals with hearing impairments". (For patients with vision disabilities, auxiliary aids and services include but are not limited to "qualified readers, taped texts, audio recordings, Brailled materials, large print materials, or other effective methods of making visually delivered materials available to individuals with visual impairments.")

 Certified interpreters are not required by the ADA. The ADA uses the term "qualified". 

The regulations define this term as: 

"An interpreter who is able to interpret effectively, accurately and impartially both receptively and expressively, using any necessary specialized vocabulary."
In most cases, however, it is advisable to seek out the services of a certified interpreter, as certified interpreters are more likely than others to know how to sign the specialized medical vocabulary.

 While many doctors understandably may think that a family member or friend of the patent who knows sign language should serve as the patient's interpreter, this is generally not permitted. The Justice Department explains the reasoning as follows:
Public comment also revealed that public accommodations have at times asked persons who are deaf to provide family members or friends to interpret. In certain circumstances, notwithstanding that the family member or friend is able to interpret or is a certified interpreter, the family member or friend may not be qualified to render the necessary interpretation because of factors such as emotional or personal involvement or considerations of confidentiality that may adversely affect the ability to interpret "effectively, accurately, and impartially.''

Particularly in the health care context, utilizing the services of a family member or friend of the patient as the interpreter is ill-advised. When discussing intimate, private health information, the patient is entitled to an interpreter who will not be affected by "factors such as emotional or personal involvement or considerations of confidentiality that may adversely affect the ability to interpret "effectively, accurately, and impartially.'" Utilizing a friend or family member will risk inhibiting full and honest disclosure by the patient, and may result in revealing or withholding vital information the patient would not want revealed to the friend or family member. Allowing such disclosure to friends or family members may also violate ethical obligations of the physician.

   "Why do I have to pay for the interpreter? Isn't that the patient's obligation?"

No. The patient is never obligated to pay for the interpreter. The place of public accommodation (the doctor's office) is covered by the ADA - the patient is protected by the ADA against discrimination on the basis of disability. If the patient uses sign language as their primary means of communication, and requests that an interpreter be provided, and there is no other means of communication that would be equally effective (and generally, there is not), then absent an undue burden defense or fundamental alteration defense, the doctor must provide a sign language interpreter upon request, and cannot charge the patient for the cost of the interpreter.

 If the patient chooses to bring an interpreter, that does not shift the burden of payment to the patient. The obligation to ensure effective communication remains with the doctor. The interpreter should send the bill to the doctor, and the doctor should pay it. The doctor may reject the patient's choice of who to use as the interpreter, but must ultimately use the services of a qualified sign language interpreter.

"Why can't we just pass notes back and forth? Won’t that work?"

For discussions about when the patient's next scheduled to see the doctor, or what insurance company to bill, or other minor, short discussions, yes. But for substantive, lengthy discussions where technical terms are used, where the patient can be expected to have questions and need explanations, and where the consequences of a misunderstanding can be consequential, no. 

Under these circumstances, passing notes back and forth would not constitute effective communication, and would violate the ADA. In addition, it is important to note that for individuals with hearing disabilities who use sign language as their primary means of communication, English is a foreign language. American Sign Language is its own language, with its own vocabulary and syntax.  For those who rely on American Sign Language as their primary means of communication, reading and writing English is often very difficult. In addition, it should be noted that many late-deafened adults do not know American Sign Language or use alternatives, such as Signed English or oral interpreters. The ADA regulations contemplate a discussion between doctor and patient to determine what the patent uses as their primary means of communication so as to ensure effective communication results.     

The Department of Justice, in responding to an inquiry concerning this issue, stated the following:

"In determining what constitutes an effective auxiliary aid or service, a physician must consider, among other things, the length and complexity of the communication involved. For instance, a notepad and written materials may be sufficient to permit effective communication when a physician is explaining possible symptoms resulting from a simple laceration. Where, however, the information to be conveyed is lengthy or complex, the use of handwritten notes may be extremely slow or cumbersome and the use of an interpreter may be the only effective form of communication. Use of interpreter services is not necessarily limited to the most extreme situations--- for example, a discussion of whether to undergo surgery or to decide on treatment options for cancer."

   "What is an undue burden? What is a fundamental alteration?"
If the cost of the interpreter service would constitute an undue burden, then the doctor's office is not required to provide the service, and can select another means that would be effective.  The Justice Department defines an undue burden as follows:

"Undue burden means significant difficulty or expense."
 Undue burden must be determined on a case-by-case basis in light of factors such as the nature and cost of the aid or service, and the overall financial resources of the practice. 
This defense, however, is very, very difficult to successfully maintain.

The Justice Department provides the following guidance:

"In determining whether an action would result in an undue burden, factors to be considered include --

(1) The nature and cost of the action needed under this part;
(2) The overall financial resources of the site or sites involved in the action; the number of persons employed at the site; the effect on expenses and resources; legitimate safety requirements that are necessary for safe operation, including crime prevention measures; or the impact otherwise of the action upon the operation of the site;
(3) The geographic separateness, and the administrative or fiscal relationship of the site or sites in question to any parent corporation or entity;
(4) If applicable, the overall financial resources of any parent corporation or entity; the overall size of the parent corporation or entity with respect to the number of its employees; the number, type, and location of its facilities; and
(5) If applicable, the type of operation or operations of any parent corporation or entity, including the composition, structure, and functions of the workforce of the parent corporation or entity."

 The Department of Justice's guidance states:

"In determining whether the provision of an interpreter would result in an undue burden, the physician should consider not only the fees paid for providing the medical service or procedure, but also the overall financial resources of the practice. The physician should consider other factors that would minimize the degree of burden on the practice, such as the ability to spread costs throughout the general clientele and the provision of tax credits for costs of providing auxiliary aids (which is available for eligible small businesses)."

 In my experience, having handled these investigations for the Justice Department for over 12 years, this defense rarely succeeds, primarily because the costs incurred in hiring an interpreter rarely come close to the "overall financial resources" of the title III entity. I never had a single case in which this defense was successful, and to mount the defense, the business would have to turn over its financial records. None ever did.

Similarly, the defense of a fundamental alteration rarely succeeds in this context either. The Justice Department says the following about a fundamental alteration:

"If provision of a particular auxiliary aid or service by a public accommodation would result in a fundamental alteration in the nature of the goods, services, facilities, privileges, advantages, or accommodations being offered or in an undue burden, i.e., significant difficulty or expense, the public accommodation shall provide an alternative auxiliary aid or service, if one exists, that would not result in an alteration or such burden but would nevertheless ensure that, to the maximum extent possible, individuals with disabilities receive the goods, services, facilities, privileges, advantages, or accommodations offered by the public accommodation."

 Here too, for this defense to succeed there would have to be a showing that in some way the use of an interpreter would be disruptive to the practice, or would in some other way fundamentally alter the services provided. In the context of the provision of services by a doctor, I cannot imagine this defense being successful except in the most extreme of circumstances.

   "What if I schedule an interpreter and the patient fails to show up for the appointment? May I charge the patient for the cost of the interpreter under those circumstances?"

No. You may charge the patient a cancellation fee for missing the appointment with you if you charge the same standard fee to other patients who miss appointments with you, but you cannot charge for the cost of the interpreter.  According to the Justice Department:

 "A public accommodation is not permitted to impose surcharges for auxiliary aids or services necessary for effective communication, regardless of whether those aids or services are used or not….Events may arise in an individuals life that are beyond his or her control, such as illness or business emergencies. Imposing the costs of interpreter services in the event of cancellation under such circumstances places the person in need of an auxiliary aid or service at a distinct disadvantage relative to others in similar situations. Of course, the ADA would not prohibit (the doctor) from charging a standard cancellation fee for missed appointments provided that the policy of charging cancellation fees is applied uniformly to all patients."

“What if I violate the law - what are the consequences?"

 First, a failure to provide a qualified sign language interpreter when one is necessary for effective communication puts both the doctor and the patient at risk of misunderstanding one another, and of miscommunicating.  The patient may be incapable of providing informed consent to procedures, and may misunderstand the risks or hesitate to ask essential questions. This may result in consequences to the health of the patent and may constitute negligence or malpractice, and may be actionable in tort or by the doctor's insurance carrier or state licensing board.

 Violation of the ADA is actionable in federal court, and may be enforced by private attorneys or by the Justice Department.  The ADA allows private attorneys to seek injunctive relief and attorneys' fees, but not damages. Damages may be sought under state law.

If the Justice Department opens an investigation, it may resolve the matter by finding no violation has occurred, or may determine that a violation of the ADA has occurred. In either event, if an investigation is opened, it could take up to a year or more to resolve, and the subject of an investigation would be well-advised to hire legal counsel. Expect the government to move at the speed of government, and expect to have the Justice Department request lots of information and make lots of site visits. 

If the Justice Department determines that a violation of a patient's federal civil rights has occurred, it has several options. It may settle the case with a Settlement Agreement, which is not filed with a court but is enforceable, it may resolve the investigation with a Consent Decree, after filing a complaint and suing  the doctor in federal court, or it may file a complaint against the doctor in federal court  and litigate the matter. 

Under each of these options, the Department may seek damages on behalf of the patient, as well as civil penalties against the doctor. It cannot seek attorneys' fees. 
Civil penalties may be as high as $55,000 for the first incident, and as much as $110,000 for subsequent violations.

 If the physician receives federal financial assistance, such as a grant for research from the CDC or U.S. Department of Health and Human Services, the Department can seek to terminate the funding for having violated the Rehabilitation Act as well by discriminating on the basis of disability.

 "Okay, you've convinced me. Where do I get a qualified sign language interpreter?"

 There are several resources to contact. Your local Center for Independent Living may have a list of interpreters, or your local hospital may (should) have one. If it is a public hospital, ask to speak to the ADA Coordinator. Do not expect to get a volunteer interpreter. Volunteer sign language interpreters are usually not qualified under the ADA, and are often a lawsuit waiting to happen. 

Sign Language Interpreters:

There are many fine sign language interpreter companies available. In addition, video remote interpreting is an option as well. Please visit www.deaflink.com for an example of video remote interpreting. 

The Center for Independent Living of South Florida offers assistance in obtaining the services of a qualified sign language interpreter. Call 305-751-8025 and ask for Nury.



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Statistics and Information About the Deaf Population of the United States

Source: http://www.accessingsafety.org/index.php/main/main_menu/understanding_deaf_culture/prevalence


"It is difficult to estimate the size of the deaf population in the United States because studies use different definitions of deafness. The Gallaudet Research Institute offers this summary of estimates for the size of deaf populations in the United States:

A Brief Summary of Estimates for the Size of the Deaf Population in the U.S.A. Based on Available Federal Data and Published Research

•About 2 to 4 of every 1,000 people in the United States are "functionally deaf," though more than half became deaf relatively late in life; fewer than 1 out of every 1,000 people in the United States became deaf before 18 years of age.

•However, if people with a severe hearing impairment are included with those who are deaf, then the number is 4 to 10 times higher. That is, anywhere from 9 to 22 out of every 1,000 people have a severe hearing impairment or are deaf. Again, at least half of these people reported their hearing loss after 64 years of age.

•Finally, if everyone who has any kind of "trouble" with their hearing is included then anywhere from 37 to 140 out of every 1,000 people in the United States have some kind of hearing loss, with a large share being at least 65 years old....

Number of Culturally Deaf

The number of people who are culturally Deaf in the United States is also difficult to determine for a number of reasons.

1.Identifying as Deaf is not based on a specific level of hearing ability. Instead, it is based on identification with a specific culture and language. There are people with varying levels of hearing that identify as Deaf, and there are people with the same levels of hearing that do not identify as Deaf, but as deaf or hard of hearing.

2.No major federal survey activity inquires about special language use or social identification among those who are deaf (or hard of hearing). That is, there are no questions about American Sign Language (ASL) or any other signed language use on federal surveys.

According to Gallaudet University, there has only been one study conducted that attempted to measure the language use of deaf people in the United States. But, the study was conducted in 1972. According to this study, which was part of the National Census of the Deaf Population, in 1972, a little more than 1 of every 1,000 people in the United States was a deaf person who reported s/he was a "good" signer.

If this proportion remained the same today, although there is no way of knowing that it has, a rough estimate of the number of deaf signers would be somewhere in the hundreds of thousands (360,000 to 517,000).

While the number of Deaf people in the United States may seem small, Deaf survivors experience significant barriers to accessing safety and other services/supports in the community and have unique needs, many of them cultural, which must be met to create an accessible and welcoming environment. Deaf people are at risk for experiencing increased levels of violence for longer periods of time because their access to services in their local area is limited...." 




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Thursday, July 31, 2014

Doctors and Patients Who Are Deaf - Training Available From the CILSF

The Center for Independent Living of South Florida is interested in addressing a problem commonly experienced by patients and companions who are deaf - the lack of sign language interpreters when meeting with one's doctor. We commonly receive complaints from consumers who are deaf that they have not been provided with a sign language interpreter when meeting with their doctor. Often, we are informed that the doctor insists on passing notes back and forth, or requiring the patient to lipread what the doctor is saying, or that the doctor has the patient bring a family member or friend to serve as the sign language interpreter.

In response to these complaints, the CIL tries to educate the doctor about the need to provide the services of a sign language interpreter. We provide education about the ADA, and seek to convince the doctor of the need to comply with the law, and about the potential consequences for failing to do so. Sometimes it works, and sometimes it doesn't.

If you are a patient or companion who is deaf who wants to learn more about your rights under the ADA, please contact us. If you are a doctor who is interested in learning more about the deaf community and about the ADA, we urge you to contact us as well. We want to help.

Please contact Marc Dubin, Esq., Director of Advocacy, at mdubin@pobox.com. or by phone at 1-305-896-3000.

We look forward to hearing from you.
Marc




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Wednesday, July 30, 2014

Doctors' Ignorance Stands In The Way Of Care For The Disabled






An illustration of a disabled man sitting in a wheelchair at the hospital by Katherine Streeter for NPR.i
Katherine Streeter for NPR
Something curious was happening in the emergency room. Eight patients had come in within minutes of each other. Almost instantly, the junior resident, two interns and a medical student signed up for all of the them – except for one.
Half an hour passed, then an hour. As the senior resident doctor at the time, I supervised the others as they tended to the middle-aged man with chest pain, the elderly woman with a broken wrist and the teenage girl with a sore throat.
New patients kept coming in, and they, too, were seen quickly.
Still, there was that one patient everyone seemed to avoid, a man in his 20s with back pain. I watched as the medical student picked up his chart, then placed it back on the rack. Nurses, too, weren't going to his room. Finally, I assigned a team to care for him.
"We drew the short straw here," I overheard the nurse say.
The resident sighed. "I already ordered labs and an X-ray. It's going to take too long to examine him, so let's just get this started."
What was different about this patient? Was it a dangerous, contagious disease? A mental health problem marked by a violent streak? A history of weekly drunken visits to the ER?
No. All he had was a wheelchair.
He had been in a car accident five years before and was paralyzed from the waist down. He told me that he was used to waiting, to being the patient that providers avoided. His back pain was from a kidney infection, and it turned out that all he needed was an antibiotic.
Though nearly 20 percent Americans have physical or mental disabilities, studies show that less than 20 percent of medical schools teach their students how to talk with disabled patients about their needs.
More than half of medical school deans report that their students aren't competent to treat people with disabilities, and a similar percentage of graduates agree. Accreditation and licensing boards don't require clinicians to demonstrate knowledge or skills in treating patients with disabilities.
Numerous studies have found people with disabilities receive inferior health care, including less information about prevention and fewer screening tests.
Mistaken assumptions are a big reason. Doctors and nurses have expressed surprise to me when I explained that they have to discuss risks and benefits with patients who are cognitively impaired. Some doctors are also surprised to learn that they need to ask someone who has a physical disability about sexual activity.
Last year, researchers called doctors' offices in four U.S. cities to make an appointment for a fictional patient who was obese and wheelchair-dependent. One in five offices said that they wouldn't see this patient, citing reasons that included a lack of trained staff and a lack of equipment to help patients onto an examining table.
Medical offices routinely provide phone interpreters for patients who speak a language other than English. Medical schools teach students about diseases so rare that they affect only one in a million people. Yet there's been only halting progress in the care of tens of millions of Americans with disabilities.
The Americans with Disabilities Act is supposed to grant civil rights protection to individuals with disabilities, but it lacks specific provisions to ensure equal treatment in medical settings.
A few medical schools have started pilot programs to teach students about patients with disabilities. At the University of South Carolina, a single 90-minute lecture made medical students more comfortable treating people with disabilities. Other med schools are encouraging students to rotate through rehabilitation centers and are incorporating interdisciplinary learning with occupational and physical therapists.
These programs are a good start, but aren't nearly enough. Disabilities education needs to be a central part of medical training in the same way that learning to care for people from different cultural backgrounds is now.
A few weeks ago, I attended a workshop where a doctor and nurse practitionerwho themselves had disabilities spoke about their experiences as patients. They talked about barriers to care and the stigma they face, and provided some suggestions to clinicians.
Afterward, I watched as two of the attendees, a resident and a nurse looked at a patient's chart. This was another patient in a wheelchair.
I held my breath. This time, nobody put the chart down. They went straight into his room.
Dr. Wen is an attending physician and director of patient-centered care research in the Department of Emergency Medicine at George Washington University. She is the author of "When Doctors Don't Listen: How to Avoid Misdiagnoses and Unnecessary Care," and founder of Who's My Doctor, a project to encourage transparency in medicine.

Subscribe to our ADA Expertise Listserv and get information sent directly to your inbox. To subscribe, send an email to Marc Dubin, Esq., at mdubin@pobox.com. Include your name and contact information, and write "subscribe to ADA listserv."

Are You A Voter With a Disability, Registered to Vote in Miami Dade County?

If you are a voter with a disability, registered to vote in Miami Dade County, the CIL of South Florida wants to hear from you. We are concerned that voters assigned on Election Day to vote at churches that serve as polling places are likely not to have an accessible restroom, as churches are not covered by the ADA. We are also concerned about how long you may have to wait in line to cast a vote.

Please see where you have been assigned to vote on Election Day. If you have been assigned to vote at a church, please contact Marc Dubin, Esq., Director of Advocacy at the Center for Independent Living of South Florida as soon as possible. He can be reached at 1-306-896-3000, or by email at mdubin@pobox.com.

We look forward to hearing from you.



Subscribe to our ADA Expertise Listserv and get information sent directly to your inbox. To subscribe, send an email to Marc Dubin, Esq., at mdubin@pobox.com. Include your name and contact information, and write "subscribe to ADA listserv."

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