“Writing back and forth works for my other patients who are Deaf. So, no, we don’t provide sign language interpreters.”

This refrain has been repeated by eye doctors, vision centers in big-box stores and, for that matter, other health specialists throughout Maine.

The most recent civil rights law regarding access for people with disabilities is the Americans with Disabilities Act, which became law in 1990, now 24 years ago.

The 1973 federal Rehabilitation Act, which required removal of barriers for people with disabilities by any entity that receives federal dollars (think Medicare – so yes, this applies to almost every health care provider), has given us a 41-year lead time to figure out how to include people with disabilities in every aspect of life.

People who are “Deaf” with a capital “D” identify as culturally Deaf, share the use of American Sign Language and associate with others in the Deaf community. People who are “deaf” with a lower-case “d” strive to identify themselves with hearing people, regard their hearing loss solely in medical terms and don’t associate with other members of the Deaf community.

Deaf people who use American Sign Language to communicate do not ask for interpreters to inconvenience those of us in the hearing world.

They just want to understand their health care, their vision changes, why their glasses aren’t quite right, why their child needs a specific procedure and what they’ll have to do to provide home care for their partners, spouses and children. Just like people who can hear.

They request an interpreter because they know that will be the best communication accommodation that works for them.

“The doctor had experience working with patients in writing, but he never had a chance,” one attorney said (“Deaf Maine man had right to interpreter, panel rules,” June 29, 2011), after the eye doctor he represented was ruled against 3-1 at the Maine Human Rights Commission.

“You can’t say working through an interpreter orally is as effective as one-to-one written communication.”

Actually, we can – though, granted, a health care provider is likely to encounter patients who’ve lost hearing later in life and prefer to write back and forth for their health information.

Fewer than 1 percent of Maine’s population have been Deaf from early childhood, before they learned to understand and speak a language, and they may never have learned to read and write well enough to carry on a complex conversation about health care and medical issues. Now is not the time to debate why the public education system failed to teach reading to prelingually deaf students – it’s the time to provide health care to the patients, as they are.

In any event, do health care providers have the time to write out, in the same level of detail, what they say on a routine basis to patients who can hear and speak English? Is their handwriting legible when writing under the time constraints of today’s shortened appointments?

Communication is a two-way street. Absent “effective communication,” misdiagnoses are more likely; costly, invasive and unnecessary tests are ordered to compensate for the lack of patient-provided information, and inadequate or harmful treatments may be prescribed.

Utilizing a qualified (state-licensed and, preferably, nationally certified) interpreter will make the appointment more efficient and take less time than trying to write back and forth. It may be the only way that the health care provider has of providing “effective communication,” as the ADA mandates.

The cost of providing interpreters should be viewed as a normal cost of doing business, to serve everyone who qualifies for your services. Just like the electric bill and paper for the copier. Just like ensuring your facility is wheelchair-accessible, with a ramp and perhaps an elevator, a communication ramp is necessary each time a Deaf sign language user requests an accommodation.

There are tax breaks for providing ADA accommodations (see http://tiny.cc/DATax Credit). MaineCare will reimburse providers for the cost of interpreters for MaineCare-covered services (MaineCare Benefits Manual, Chapter 1.06-3).

So why the reluctance? Cost? Unfamiliarity? Inconvenience?

Recent court cases have awarded Deaf plaintiffs significant damages, not covered under traditional medical liability insurance, for failure to ensure an equal right to benefit from medical services via interpreting. A health care practitioner may be found liable for discrimination even if there is no medical negligence.

When there is any possibility that direct communication without a qualified interpreter will not be effective between a health care practitioner and a Deaf patient or a patient’s Deaf family members or companions, an interpreter should be provided – to protect both the medical practitioner and the patient.