Understanding ADA Compliance and How It Impacts Naturopathic Doctors

Confused about what the Americans with Disabilities Act (ADA) requires of you as an ND practice owner who provides “public accommodations?” You are not alone.

Understanding the ADA can be complicated. Even many legal experts say that the language of the ADA is subject to interpretation and its requirements are often misunderstood.

Fortunately, making your practice more accessible and welcoming to people with disabilities is not as difficult as you may think—and it could help you avoid costly litigation.

The Obvious: Make Your Building Environment Accessible

People with disabilities continue to face architectural barriers that limit or make it impossible to access services or goods offered by businesses. Examples include:

  • A parking space with no access to allow deployment of a van’s wheelchair lift
  • Steps at a facility’s entrance or within its serving or selling space
  • Aisles too narrow to accommodate mobility devices
  • Counters that are too high
  • Restrooms that are too small to use with a mobility device

The ADA strikes a careful balance between increasing access for people with disabilities and recognizing the financial constrains many small businesses face. Its flexible requirements allow businesses confronted with limited financial resources to improve accessibility without excessive expense.

ADA Compliance Beyond Building Accessibility

Whoever coined the phrase “ignorance is bliss” certainly was not referring to the ADA and its requirements for business owners, including NDs.

A common misconception about the ADA is that it only involves making buildings accessible for people with disabilities. The ADA is actually a civil rights law, which was created to ensure individuals with disabilities are treated with dignity, respect and fairness under the law. It also involves making all goods and services available to people with disabilities. One simple way to do this and comply with the ADA requirements is by providing effective means of communication for your patients and family members who have vision, hearing or speech disabilities.

How do you determine an effective communication method?

  1. Decide what type of communication aids or service is most appropriate, based on the complexity of the information being conveyed and the patient’s normal method of communicating.
    • You can write notes to “speak” with a patient who is deaf or hearing impaired.
    • A patient who is blind may need physical assistance to maneuver through your office space.
    • In situations where there is little call for interactive communication, such as providing insurance information or completing medical history inquiries, having simple written forms or information sheets available may suffice.
  2. Ask your patients what type of communication assistance they require. Sometimes they will ask in advance which ones you provide. If not, it is your responsibility to find out what technique a patient normally uses to understand printed information (in the case of a vision disability) or spoken information (in the case of a hearing disability).
  3. If your website uses a mobile app for communication and education, ensure that it is accessible. For instance, the font should not be multi-colored as some people cannot see certain colors. Also, the font should be scaled larger to make it readable to those with poor vision.

When You Need an Interpreter

There may be times when you will need to obtain the services of a qualified sign language interpreter, or an oral interpreter for a patient trained to speech read (read lips).

In these cases, you are required to provide the services free of charge to the patient.

Here are some examples of situations where an interpreter may be required for effective communication:

  • Discussing a patient’s symptoms and clinical condition, medications and health history
  • Providing a diagnosis, prognosis and recommendation for treatment
  • Explaining and describing clinical conditions, tests or X-rays, treatment options and other procedures
  • Providing instructions for post-treatment activities and follow-up treatments
  • Obtaining informed consent for treatment
  • Discussing complex billing or insurance matters

It is important to note that the ADA places limits on how far you must go in “providing effective communication.” For example, the ADA does not require you to furnish any communication aids or services that would place an “undue burden” on your business. The ADA defines undue burden as “significant difficulty or expense.”

In the case of interpreters, it would be an undue financial burden for most NDs to have full-time interpreters on staff. However, when requested by a patient or family member in advance, the ND can arrange for an interpreter to be available at a specified time.

For this reason, it is a good idea to familiarize yourself with agencies in your area that provide these services. Check with your local disability organizations for names of qualified interpreters. The Department of Justice ADA Information Line (800-514-0301 voice or 800-514-0383 TTY) can also help you identify local service providers.

Helping Patients Receive Examinations or Treatments

Under the ADA, patients with disabilities should not have to wait an undue amount of time for a special exam table to open up. Therefore, it makes sense to have your standard treatment room ready for any patient. If your staff is not trained in the safe transfer of patients (from wheelchair to table and back), then arrange for them to receive this training. Staff should not be expected to put themselves or patients at risk. (Example: A very large patient transferred by a small person could lead to injury to both.)

Who Pays for Services?

Two questions many NDs often ask about providing assistance to people with disabilities are:

  • Can I simply require patients to bring their own interpreters?
  • Can I charge extra to cover the costs of any aids or services needed to communicate effectively?

The answer to both questions is: “No.”

However, this is an area in which the ADA language is purposefully flexible. If a patient prefers to bring his or her own interpreter, the ADA allows you to accept this arrangement, if agreed upon in advance. In cases like this, you are responsible for paying the interpreter’s fees. But if a patient shows up with an interpreter unarranged, you are not obliged to use or pay for the interpreter’s services, unless you have agreed to do so.

Your Responsibilities as a Provider

Keep in mind you are required to provide qualified interpreters when needed. This is why it is not a good idea to ask family members and friends of patients with disabilities to act as interpreters, particularly in situations requiring explanations of clinical terminology and those that that are stressful for the patients.

Relying on family members or friends to interpret also puts an ND at risk for breaching well-established rights of patients to privacy and confidentiality. Only after a hearing-impaired person has been fully informed of the availability of qualified interpreters and communication options (at no cost to the patient)—and refused them—should an unqualified interpreter such as a family member or friend be used.

The bottom line: More than 61 million Americans with disabilities—along with their family and friends—are potential consumers for your professional services. Familiarizing yourself with the ADA requirements and making naturopathic goods and services more accessible not only lets you avoid the risks of future litigation, but it also helps you and other NDs attract an untapped group of patients, which can translate into practice success.

For More Information

The U.S. Department of Justice ADA Information Line is another resource. Anyone can call the Information Line at 800-514-0301 (voice) or 800-514-0383 (TTY) to speak with an ADA Specialist for answers to questions about the ADA. 

ND Insights is published for NCMIC policyholders. Articles may not be reprinted, in part or in whole, without the prior, express consent of NCMIC. Information provided in ND Insights is offered solely for general information and educational purposes. Names and events are created for illustrative purposes only. It is not offered as, nor does it constitute, legal advice or opinion. You should not act or rely upon this information without seeking the advice of an attorney.


Risk Management

ND Insights Winter 2019 Issue