U.S.

Department of Justice
Civil Rights Division
Disability Rights Section

Americans with Disabilities Act

ADA Business BRIEF:

Sign language interpreters
Sign language is used by many
Communicating with People Who Are Deaf people who are deaf or hard of
or Hard of Hearing in Hospital Settings hearing. It is a visually
interactive language that uses
a combination of hand
motions, body gestures, and
People who are deaf or hard of hearing use a variety of ways to facial expressions. There are
communicate. Some rely on sign language interpreters or assistive several different types of sign
listening devices; some rely primarily on written messages. Many language, including American
can speak even though they cannot hear. The method of Sign Language (ASL) and
communication and the services or aids the hospital must provide will Signed English.
vary depending upon the abilities of the person who is deaf or hard of
hearing and on the complexity and nature of the communications that Oral interpreters
are required. Effective communication is particularly critical in health Not all people who are deaf or
hard of hearing are trained in
care settings where miscommunication may lead to misdiagnosis and
sign language. Some individu-
improper or delayed medical treatment. als with hearing disabilities are
trained in speech reading (lip
reading) and can understand
Under the Americans with face-to-face conversations, such as spoken words fairly well with
Disabilities Act (ADA), hospitals a visitor’s inquiry about a patient’s assistance from an oral inter-
must provide effective means of room number or a purchase in the preter. Oral interpreters are
communication for patients, gift shop or cafeteria. specially trained to
family members, and hospital articulate speech silently and
clearly, sometimes rephrasing
visitors who are deaf or hard of Written forms or information words or phrases to give
hearing. sheets may provide effective higher visibility on the lips.
communication in situations where Natural body language and
The ADA applies to all hospital there is little call for interactive gestures are also used.
programs and services, such as communication, such as providing
emergency room care, inpatient billing and insurance information Cued speech interpreters
and outpatient services, surgery, or filling out admission forms and A cued speech interpreter
clinics, educational classes, and medical history inquiries. functions in the same manner
cafeteria and gift shop services. as an oral interpreter except
that he or she also uses a hand
Wherever patients, their family For more complicated and
code, or cue, to represent each
members, companions, or interactive communications, such speech sound.
members of the public are as a patient’s discussion of
interacting with hospital staff, the symptoms with medical personnel, Computer Assisted Real-time
hospital is obligated to provide a physician’s presentation of Transcription (CART)
effective communication. diagnosis and treatment options to Many people who are deaf or
patients or family members, or a hard of hearing are not trained
Exchanging written notes or group therapy session, it may be in either sign language or
speech reading. CART is a
pointing to items for purchase will necessary to provide a qualified
service in which an operator
likely be effective communication sign language interpreter or other types what is said into a
for brief and relatively simple interpreter. computer that displays the
typed words on a screen.
Communicating with People Who Are Deaf or Hard of Hearing in Hospital Settings (continued)

Hospitals may need to provide an It is inappropriate to ask family

Situations where an interpreter members or other companions to
interpreter or other assistive
may be required for effective
communication: service in a variety of situations interpret for a person who is deaf
where it is a family member or or hard of hearing. Family
• discussing a patient’s companion rather than the patient members may be unable to
symptoms and medical who is deaf or hard of hearing. interpret accurately in the
condition, medications, and For example, an interpreter may be emotional situation that often
medical history necessary to communicate where exists in a medical emergency.
the guardian of a minor patient is
• explaining and describing deaf, to discuss prognosis and Hospitals should have
medical conditions, tests, arrangements in place to ensure
treatment options with a patient’s
treatment options,
medications, surgery and spouse or partner who is hard of that qualified interpreters are
other procedures hearing, or to allow meaningful readily available on a scheduled
participation in a birthing class for basis and on an unscheduled basis
• providing a diagnosis, a prospective new father who is with minimal delay, including
prognosis, and deaf. on-call arrangements for
recommendation for after-hours emergencies. Larger
treatment Individuals with hearing facilities may choose to have
disabilities have different interpreters on staff.
• obtaining informed consent
for treatment communication skills and the
hospital should consult with each
• communicating with a individual to determine what aids
patient during treatment , or services are necessary to
testing procedures, and provide effective communication
during physician’s rounds in particular situations.
• providing instructions for
Sign language or other
medications, post-treatment
activities, and follow-up
interpreters must be
treatments qualified. An interpreter
is qualified if he or she
• providing mental health can interpret
services, including group or competently, accurately,
individual therapy, or and impartially. In the
counseling for patients and hospital setting, the
family members
interpreter must be
• providing information about
familiar with any
blood or organ donations specialized vocabulary
used and must be able to
• explaining living wills and interpret medical terms
powers of attorney and concepts. Hospital
personnel who have a
• discussing complex billing or limited familiarity with
insurance matters
sign language should
• making educational
interpret only in
presentations, such as emergency situations for
birthing and new parent a brief time until a A doctor uses a sign language interpreter to
classes, nutrition and weight qualified interpreter can communicate with a patient who is deaf.
management counseling, be present.
and CPR and first aid training
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 Communicating with People Who Are Deaf or Hard of Hearing in Hospital Settings (continued)

For training or other educational post signs at locations where The ADA established a free
services offered to patients or patients or visitors typically seek nationwide relay network to
members of the public, additional information or assistance and to handle voice-to-TTY and TTY-to-
aids and services such as note include information in general voice calls. Individuals may use
takers, captioned videos, and information packets. this network to call the hospital
assistive listening systems may be from a TTY. The relay consists of
necessary for effective Hospitals cannot charge patients or an operator with a TTY who
communication. other persons with hearing receives the call from a TTY user
disabilities an extra fee for and then places the call to the
Hospitals should develop interpreter services or other hospital. The caller types the
protocols and provide training to communication aids and services. message into the TTY and the
ensure that staff know how to operator relays the message by
obtain interpreter services and For telephone communications, voice to the hospital staff person,
other communication aids and many people who are deaf or hard listens to the staff person’s
services when needed by persons of hearing use a teletypewriter response, and types the response
who are deaf or hard of hearing. (TTY, also known as a TDD) back to the caller. The hospital
rather than a standard telephone. must be prepared to make and
It is helpful to have signs and These devices have a keyboard receive relay system calls, which
other types of notices to advise and a visual display for may take a little longer than voice
persons with disabilities that exchanging written messages over calls. For outgoing calls to a TTY
services and assistance are the telephone. user, simply dial 7-1-1 to reach a
available and what they need to do relay operator.
to obtain them. It is most useful to
If telephones and televisions are
provided in patient rooms, the
hospital must provide patients who
are deaf or hard of hearing
comparable accessible equipment
upon request, including TTY’s,
telephones that are hearing-aid
compatible and have volume
control, and televisions with
closed captioning or decoders.

Visual alarms are not required in

patient rooms. However, hospital
evacuation procedures should
include specific measures to
ensure the safety of patients and
visitors who are deaf or hard of
hearing.

A hospital need not provide

communication aids or services if
doing so would fundamentally
alter the nature of the goods or
services offered or would result in
A hospital patient uses a TTY in his hospital room. an undue burden.
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Communicating with People Who Are Deaf or Hard of Hearing in Hospital Settings (continued)

Certain built-in communication • A certain percentage of public ADA Information

features are required for hospitals phones must have other You may view or download ADA
built or altered after the effective features, such as TTY plug-in information on the ADA website.
date of the ADA: capability, volume controls, and This website provides access to the
hearing-aid compatibility. ADA Business Connection, ADA
• Visual alarms must be provided Consult the ADA Standards for design standards, regulations,
in all public and common-use Accessible Design for more policy letters, technical assistance
areas, including restrooms, specific information. [ADA materials, and general ADA
where audible alarms are Standards 4.1.3(17), 4.31] information. It also provides links
provided. to other Federal agencies and news
about new ADA requirements and
• TTY’s must be provided at enforcement efforts.
public pay phones serving
emergency, recovery, or waiting www.ada.gov
rooms and at least one TTY
must be provided at other If you have specific questions
locations where there are four concerning the ADA, call the
or more pay phones. Department of Justice ADA
Information Line.

(800) 514-0301 (voice)

(800) 514-0383 (TTY)

A man uses a TTY that is connected to a pay telephone

in a hospital emergency room waiting area.

Duplication is encouraged
October 2003
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 The Americans with Disabilities Act authorizes the Department of Justice (the Department) to
provide technical assistance to individuals and entities that have rights or responsibilities under the
Act. This document provides informal guidance to assist you in understanding the ADA and the
Department's regulations.

This guidance document is not intended to be a final agency action, has no legally binding effect,
and may be rescinded or modified in the Department’s complete discretion, in accordance with
applicable laws. The Department’s guidance documents, including this guidance, do not establish
legally enforceable responsibilities beyond what is required by the terms of the applicable statutes,
regulations, or binding judicial precedent.