Doctor liable for not providing sign language interpreter

[Redhawk]

AMNews: Jan. 5, 2009. Doctor liable for not providing sign language interpreter ... American Medical News

That is exactly what befell New Jersey rheumatologist Robert A. Fogari, MD, when a Hudson County jury in October 2008 unanimously handed down a $400,000 award against him for allegedly refusing to pay for a sign language interpreter for a patient who is deaf. Half of the award was for punitive damages.

The Jersey City rheumatologist argued that, as a solo physician, he could not afford the cost, which was estimated at $150 to $200 per visit. The expense was overly burdensome given that Medicare reimbursed only $49 per visit, according to Dr. Fogari's attorney. Instead of hiring an interpreter, Dr. Fogari exchanged written notes with Gerena, with the help of family members. After her diagnosis, Gerena's treatment largely involved monthly check-ups to monitor her medication, with no major complications, the doctor's attorney said.

Gerena transferred to another doctor. She then sued Dr. Fogari, alleging he violated the federal Americans with Disabilities Act and the Rehabilitation Act, as well as New Jersey's anti-discrimination law. The jury agreed, finding Dr. Fogari discriminated against Gerena when he failed to provide a sign language interpreter to make sure he was effectively communicating with his patient. Dr. Fogari is appealing the verdict.

State and federal law generally prohibit discrimination on the basis of disability and require physicians and other private, covered entities to provide reasonable public accommodations to ensure "effective communication" with patients who have disabilities such as blindness or hearing impairment, and with their family members.
But those accommodations include a range of so-called auxiliary aids that doctors can use, including note-takers or video or computer-based transcription devices, which can be less expensive than an interpreter service, said Lawrence Downs, general counsel to the Medical Society of New Jersey. The physician organization is considering getting involved in the case on appeal.

Gerena had argued to the jury that the annual cost of a sign language interpreter amounted to less than a quarter of a percent of Dr. Fogari's yearly income.
The expense may seem negligible for a single patient, said Antranig Aslanian Jr., the rheumatologist's attorney. "But what if you had 40 or 50 patients?"

Meanwhile, because disability discrimination claims typically are not covered by medical liability insurance, physicians are left personally liable for any judgments. That, on top of the interpreter costs, puts additional strain on doctors and ultimately strains access to care, Aslanian said. He added that in this case, the punitive damages -- typically rendered for intentional conduct -- were unwarranted.

 

[Jake]

I'm a CFO for a healthcare provider. We are required to accept Medicare/Medicaid as "payment in full" even though the reimbursement often falls well short of the actual cost to provide the service, as was the case here.

Moreover, if we refuse to provide service we risk being sued for discrimination. Too often, as a medical provider you're damned if you do and damned if you don't when dealing with patients on Medicare/Medicaid.

 

[Best Buckeye]

you can't fix stupid.

 

[BB73]

Why wasn't the written communication with the patient sufficient?

 

[Best Buckeye]

Why wasn't the written communication with the patient sufficient?

New Jersey is filled with liberals.

 

[DaytonBuck]

Why wasn't the written communication with the patient sufficient?

It's discriminatory, Un-American and degrading to the patient

 

[BB73]

New Jersey is filled with liberals.

Great comment if you intend to lead this thread into the political forum.

 

[Best Buckeye]

Great comment if you intend to lead this thread into the political forum.

Dayton had the same answers , only different words.

 

[Gatorubet]

Why wasn't the written communication with the patient sufficient?

I'm just guessing, but the problem conceptually with the docs operation leaving the patient to use family members to help communicate could be a problem in a different circumstance. For example, I could foresee instances of abuse, or neglect, or even privacy issues where a patient would not want the family involved in the patient-doctor/staff communication about STDs or pregnancy. And this doc admittedly did not use the cheaper alternative methods available, he simply decided to forego all other means and use the family to help communicate...

I agree that it does not seem bad on its face, but sometimes the law is there for reasons that are important, even if in the individual case here an issue of - say - neglect did not arise.

Again, I am just guessing. But - and this is important - people unwisely get all jazzed up about lower court verdicts that have not been subject to appellate review. Just because the ref calls it one way, that does not mean that the reply booth will not get it right.

 

[BuckeyeRyn]

At what point did it become acceptable behavior that others are responsible for personal problems?????

I find the ruling on this case to be absurd. The patient should take with her an interpreter...

For instance, say I am partially hearing impaired, should the doctors office provide me with a pair of hearing aids to use while I am at an apt? No, I should bring my own.

I can understand if the doctor would like to provide interpreters as an "above and beyond" service for his patients but in no way, shape or form do I think it should be an obligation that could cost him hundereds of thousands of dollars if he doesn't deliver...

Not to mention, as BB73 said, why was written communication not acceptable? Was the patient illiterate? I guess before long the doctor will be responsible for hiring a full-time teacher to educate those that are unable to read and write...

UGH! The cycle just continues.

 

[BB73]

I'm just guessing, but the problem conceptually with the docs operation leaving the patient to use family members to help communicate could be a problem in a different circumstance. For example, I could foresee instances of abuse, or neglect, or even privacy issues where a patient would not want the family involved in the patient-doctor/staff communication about STDs or pregnancy. And this doc admittedly did not use the cheaper alternative methods available, he simply decided to forego all other means and use the family to help communicate...

I agree that it does not seem bad on its face, but sometimes the law is there for reasons that are important, even if in the individual case here an issue of - say - neglect did not arise.

Again, I am just guessing. But - and this is important - people unwisely get all jazzed up about lower court verdicts that have not been subject to appellate review. Just because the ref calls it one way, that does not mean that the reply booth will not get it right.

Um, why couldn't written communication strictly between the patient and the doctor avoid the privacy issues? I saw no indication that the patient can't read and write.

Ans simply stating an opinion on the limited facts of the case doesn't mean that those of us posting in this thread are 'all jazzed up'.

 

[BuckeyeRyn]

Um, why couldn't written communication strictly between the patient and the doctor avoid the privacy issues? I saw no indication that the patient can't read and write.

Ans simply stating an opinion on the limited facts of the case doesn't mean that those of us posting in this thread are 'all jazzed up'.

Speak for yourself, I'm all decked out in my bling, bling today... Jazzed up??? You betcha!!!

 

[BB73]

I guess if a doctor in this country has a patient like the guy in The Diving Bell and the Butterfly, it's up to the doctor to provide a person to interpret eye-blinks into words.

 

[Redhawk]

I guess if a doctor in this country has a patient like the guy in The Diving Bell and the Butterfly, it's up to the doctor to provide a person to interpret eye-blinks into words.

As a physician, my question is this: where does it stop? I often times have patients who can't make it to an appointment because they don't have a ride. Should I provide them a taxi service? Am I liable if something undesirable happens regarding their health because they couldn't make it to an appointment or surgery? What if they work during the day and need that paycheck and "can't" take the time off to come to a visit? Should I provide evening and weekend appointments or just give them my address so I can see them at my house? I don't say these things in an attempt to demean these patients or sound like I'm smarting off. I just question the need to lay this burden on the physician. Perhaps the physician, in these situations, should be reimbursed more for such patients if this is deemed a service that the physician should provide.

 

[Gatorubet]

I guess if a doctor in this country has a patient like the guy in The Diving Bell and the Butterfly, it's up to the doctor to provide a person to interpret eye-blinks into words.

How else they gonna know "Argggh! Fuck! You're sittin on my air hose doc!!!" when the patient blinks it?