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A Small Practice, a Deaf Patient, an ASL Translator Paid For … What Happens When the Patient Cancels?

A request for ASL translation shakes up this small office. Does the practice have any options?




A Small Practice, a Deaf Patient, an ASL Translator Paid For … What Happens When the Patient Cancels?

SANGAMON VISION SERVICES, an efficient office of one optometrist and two employees, was situated near the capital city of Springfield, IL. One day a man called to schedule an appointment for his son … with an unexpected request.

  • Real Deal scenarios are inspired by true stories, but are changed to sharpen the dilemmas involved. The names of the characters and stores have been changed and should not be confused with real people or places.
  • NATALIE TAYLOR is owner of Artisan Eyewear in Meredith, NH. She offers regional private practice consulting and ABO/COPE approved presentations. Email her at
  • “My son is deaf and will need a professional translator,” explained the man briskly.

    Receptionist April paused to process the request and stumbled on her words. “Oh, uh, well, we don’t have any one at the office who knows sign language,” she explained, “is there something on the internet saying we offer–”

    The man interrupted her. “No. It’s a requirement, under the Americans with Disabilities Act.”

    April quickly asked if he would hold, and went to find the optometrist, Dr. Simms. “The patient is a deaf child, and his father is going to be in the exam with him,” she explained, handing the receiver to him. “He is requesting an interpreter.”

    Dr. Simms took the phone and greeted the patient. “I’ve examined deaf patients before,” said the doctor, “we don’t need an interpreter, I have a system that works well.”

    “That’s all well and good, but for medical visits I need someone fluent in ASL,” replied the father. “I have the phone number of a local service if you want it?”


    The doctor cleared his throat and said, “Okay, give the receptionist the number and we’ll make it happen.”

    April made the call and was told a translator would come to the office for a two hour minimum, at $150. The translator also reminded April that the office was responsible for the fee, not the patient. 

    The appointment was scheduled for the following Friday, first thing in the morning. As the translator found a seat in reception, April checked the voicemail. She found a message from the patient’s father asking to reschedule. Dr. Simms called the patient’s father himself.

    “My son is physically getting sick and needs to stay home, so we need to reschedule for another day,” the man explained. 

    “That’s fine, but we did pay the translator $150 to come today,” said Dr. Simms. “Would you please contribute to that balance before we reschedule you?”

    “This service is supposed to be covered by the office!” said the man. “Besides, I did call and cancel.”

    “According to the machine, we got the message at 9pm last night, so we weren’t able to reschedule the translator,” continued Dr. Simms. “Even if you covered half, that will make me feel better that this won’t happen a second time.”

    “Absolutely not!” he said.

    “Then I’ll be happy to refer you to a colleague locally, but as a small office I just can’t help you. Maybe a larger practice will have better resources,” said Dr. Simms.


    The Big Questions

    • Is there anything April and Dr. Simms should have done differently prior to the appointment?
    • Should the patient be expected to incur a penalty for no-showing? What if it happens a second time?
    • Is it ethical and fair for Dr. Simms to refer this patient to a larger practice?

    Expanded Real Deal Responses

    DJ S. Pinson, AL

    The law is the law and unfortunately there’s nothing you can do but factor the cost of those appointments. Be very careful with how you handle such appointments and make sure you get the translator to fill out a W-9 form because that fee you pay is tax deductible. Also, offices large and small need to understand that when that person does come in the office, you and your staff need to speak directly to the patient (not the translator) during all services, from the exam room to the sales desk. It’s up to the translator to follow along and convey your message to the patient.

    You have to operate like the patient doesn’t have a disability even though it’s covered by the Disability Act. These appointments have worked well for us in the past. The translator sees whether you truly care and will recommend other deaf patients to your office. Embrace and love on them and the profits will come.

    Dr. Tex S. Citrus Heights, CA

    On the initial call I would have told the father I will find an eye doctor that is proficient in ASL. Several years ago, I needed an ophthalmologist that could sign in Italian. I found such a doctor and the patient had cataract surgery. It all worked out OK.

    Pam P. Downers Grove, IL
    1. If you currently have a cancellation fee policy that was established with the patient, then charging the patient for the cancellation would be appropriate.
    2. If the patient is insisting and the doctor has additional patients that could benefit from the service, perhaps a “signing” day or two would be beneficial to the doctor and the community.
    3. I believe there is a tax credit for this paid service. The service is paid at this point whether the patient is seen or not. Make a note for your accountant!
    Tim S. Philadelphia, PA

    Directly from “For people who are deaf, have hearing loss, or are deaf-blind, this includes providing a qualified note taker; a qualified sign language interpreter, oral interpreter, cued-speech interpreter, or tactile interpreter; real-time captioning; written materials; or a printed script of a stock speech (such as given on a museum or historic house tour). A “qualified” interpreter means someone who is able to interpret effectively, accurately, and impartially, both receptively (i.e., understanding what the person with the disability is saying) and expressively (i.e., having the skill needed to convey information back to that person) using any necessary specialized vocabulary.” I take this to mean that it is sufficient that the OD already has a tried and true method of communicating with the deaf. Being armed with this information would drastically change the tone of the conversation with the patient’s father.

    Adele P. Jacksonville, FL

    The patient’s health insurance may cover the cost of the interpreter. It did so for me and it was a Medicaid HMO.

    Casimiro G., MD Los Angeles, CA

    I would not have gotten an interpreter and referred him to another practice, since this is too much of a financial burden for my small practice. If I had been able to communicate with this patient using my system for the deaf for the refraction, then the parent should be happy with my effort and not insist on a certified ASL translator, unless he provides one.

    Lynette M. Loveland, CO

    Interesting that the dad was so pushy. It seems to me that the office went out of their way to work with them, incurring a cost that is not going to be covered by anyone. At this point, it seems that referring the patient elsewhere would be mutually beneficial. The dad is not being reasonable; at the same time, I am sure he struggles in his own situation. For the office to recommend a facility that is better equipped to meet their needs, as well as some accountability on dad’s part in terms of “this is not working for our office” seems more than reasonable and best for both parties. The reality is that not every office is a perfect fit for every patient.

    Gail R S. Chesapeake, VA
    1. They should inform the customer they needed 48 hours in advance notice to cancel the appointment since prior accommodations were made for his son’s visit and that a penalty will occur if they cancel short notice of $150.00 or half $75.00.
    2. Yes, because the accommodations were made there would not be a second time cause the patient will be informed.
    3. Yes, it was fair because they tried to accommodate the patient and could not accommodate him any longer because the father is not being reasonable.
    Jen Arlington, TX

    I think they should have checked with his medical insurance to see if an interpreter is covered for the office visit. Also check the guidelines of the act. The patient should incur a no-show fee. It is ethical for Dr. Simms to refer the patient out.

    David F. Colorado Springs, CO

    We see a lot of deaf patients. I simply ask that they have a referral from an agency that is willing to help. Here in Colorado Springs there are many willing to help.


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