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When it comes to accommodating people with hearing, visual, mobility, speech, and other impairments, the ball has been in the physician's court since Title III of the Americans with Disabilities Act went into effect in 1992.
After Toni Iacolucci, who works in donor services at the Michael J. Fox Foundation for Parkinson's Research in New York City, lost her hearing in 2006, among the aspects of life that became more complicated were visits to physicians' offices.
She does her best to speech-read, but because many words - such as mat, pat, and bat - look the same on the lips, and because some physicians tend to glance at their notes or computer screens when talking to patients, speech-reading can be a hit and miss way to discern information.
"I may need the doctor to jot down notes of what I've missed," she says, "or to type to me on their computer. If they prescribe medication or use technical terms that I'm not familiar with, I always ask them to write that information by hand or on the computer."
Among the Title III provisions that apply to physicians' offices:
The ADA is enforced by the Department of Justice, which recommends that operators of public accommodations consult with disabled individuals and their advocates to determine what types of aid are needed to ensure access. Decisions regarding what measures to put in place ultimately rest with the public accommodation.
DECIDING WHAT IS READILY ACHIEVABLE
First, some clarifications. The ADA defines undue burden as "significant difficulty or expense." Architectural barriers include steps, curbs, narrow doorways and aisles, and other structural impediments that limit access by people who use wheelchairs. Communication barriers that are "structural in nature" include signage that is inaccessible to people with vision impairments and audible alarm systems that cannot be heard by people with hearing impairments.
"Readily achievable" barrier removal refers to those projects that can be completed without much difficulty or expense - considering the nature and cost of the action needed and the financial resources of the facility involved. In weighing "undue burden" and "readily achievable" standards, cost is not the only factor. "The passage of time also comes into play," says Denise L. Sanders, JD, who is with Kern Augustine Conroy & Schoppmann in Bridgewater, New Jersey. "If something is too costly now but becomes less costly in the future, the undue burden standard may no longer apply."
Modifications that can be put into place at minimal expense:
The ADA permits portable ramps when installation of a permanent ramp is too costly, but such ramps should be properly secured and feature railings and nonslip surfaces. Even if full accessibility isn't readily achievable, evidence that you have a plan and have made good-faith efforts toward increased accessibility can help insulate you from a lawsuit.