ADA and RA Protect Hospital Patients’ Ability to Exchange Medically Relevant Information

In Silva v. Baptist Health South Florida, Inc., 2017 WL 1830158 (11th Cir. May 8, 2017), the Eleventh Circuit clarified the standard for liability for ADA and RA effective-communication claims against hospitals. The court held that “the relevant inquiry is whether the hospitals’ failure to offer an appropriate auxiliary aid impaired the patient’s ability to exchange medically relevant information with hospital staff.”

The plaintiffs brought an action against three hospitals under Title III of the Americans with Disabilities Act (“ADA”), and Section 504 of the Rehabilitation Act of 1973 (“RA”), alleging unlawful discrimination.  The plaintiffs are “profoundly deaf,” and communicate primarily through American Sign Language (“ASL”).  The ADA and RA require healthcare facilities to ensure effective communication between hearing-impaired patients and medical staff.  However, the plaintiffs visited the hospitals several times, and the plaintiffs alleged that the hospitals failed to provide appropriate auxiliary aids necessary to ensure effective communication.  The plaintiffs requested a live ASL translator, but the hospitals provided remote video interpreting, where an ASL interpreter, located remotely, would interpret via an internet-connected portable screen.  The technology supporting the remote video interpreting routinely suffered from technical difficulties and was frequently unusable.

The plaintiffs sought injunctive relief and monetary damages. In the district court, the defendants won summary judgment on the ground that the plaintiffs lacked Article III standing to seek prospective injunctive relief because the plaintiffs failed to prove they were likely to return to the hospitals in the future.  Because the plaintiffs failed to prove they had suffered any actual adverse medical consequences, and “otherwise failed to articulate what they did not understand during their hospital visits,” the district court rejected their damages claim, too.

The Eleventh Circuit reversed, finding the plaintiffs to have standing, and rejecting the district court’s substantive standard for liability.

On standing, the court explained that, to satisfy the injury-in-fact requirement for constitutional standing, a plaintiff seeking injunctive relief in relation to future conduct must show a likelihood that he will be affected by the allegedly unlawful conduct. The threat of future injury must be “real and immediate” rather than “merely conjectural or hypothetical.”  Although the district court held that Article III standing did not exist because the plaintiffs failed to establish that they were likely to ever return to the hospitals, the Eleventh Circuit disagreed, and held that the plaintiffs did offer sufficient evidence that they would return to the hospitals, and that they would face discrimination upon their return.  The plaintiffs testified that they were likely to return due to, among other factors, the location of their doctors’ offices.  In fact, the plaintiffs had visited the hospitals dozens of times in the years preceding the litigation.

The Eleventh Circuit also reversed the district court’s grant of summary judgment in favor of the defendants on the plaintiffs’ damages claim. The district court found that the plaintiffs had not established that they suffered any adverse medical consequences due to the lack of communication aid, and that the plaintiffs did not articulate anything they were unable to understand during their hospital visits.  The Eleventh Circuit rejected the district court’s standard, and held that the correct inquiry under the ADA and RA is “whether the hospital provided the kind of auxiliary aid necessary to ensure that a deaf person was not impaired in exchanging medically relevant information with hospital staff.”

The court held, “[f]or an effective-communication claim brought under the ADA and RA, we do not require a plaintiff to show actual deficient treatment or to recount exactly what the plaintiff did not understand.” The court rejected the defense that the plaintiffs could “participate in the most basic elements of a doctor-patient exchange.”  Instead, the court held that “the relevant inquiry is whether the hospitals’ failure to offer an appropriate auxiliary aid impaired the patient’s ability to exchange medically relevant information with hospital staff.”

Posted by Margaret Flatt.

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