Regulatory Compliance: Disability Access and Nondiscrimination Laws

CDA Practice Support

Federal and state disability access and nondiscrimination laws have a broad impact on dental practices. A practice owner needs to ensure that the office:

■ Meets physical access standards.

■ Provides sign language interpreters to individuals who are deaf or hard of hearing if they request them.

■ Ensures website content is accessible to individuals with sight impairment.

■ Permits a service dog or service dogin-training to accompany their owner.

■ Does not deny services based on an individual’s disability.

Recently, the U.S. Department of Justice settled with a North Carolina dental practice over a complaint that an individual was denied routine dental services because they have HIV. [1] In California, CDA and TDIC have heard from many dental offices in the last few years who have sued over the accessibility of their respective websites. [2] CDA Practice Support regularly receives calls from dental offices seeking to verify that they are indeed required to provide a sign language interpreter for patients who are deaf or hard of hearing.

Clearly, dentists and their staff need to better understand their obligations under disability access and nondiscrimination laws. This article does not intend to be a comprehensive look at these obligations and will instead point to resources for compliance assistance.

Physical Accessibility Standards

Physical accessibility standards are part of the California Building Standards Code with the Division of the State Architect in collaboration with stakeholders, experts and public entities to develop regulations and to interpret code. The building code is available on the state Building Standards Commission website. A local building department may have additional requirements and is permitted to interpret and enforce the state building codes to best fit community needs.

Building owners may seek assistance from a state-certified access specialist (CASp) to ensure compliance. An owner can obtain compliance information from a CASp working at the local building office or hire a CASp to walk through a site or review building plans. A list of these specialists is available on the website of the Division of the State Architect. The website also has an FAQ for business owners and information on financing for small businesses that want to make accessibility improvements.

Communicating With the Deaf or Hard of Hearing

A dentist is required to ensure a patient understands the risks and benefits of proposed dental treatment. When working with a patient who is deaf or hard of hearing, the dental practice should ask the patient which communication method they prefer. The options include using:

■ Printed or written instructions, questions, responses via paper and pen, computer or other device.

■ Lip reading.

■ Sign language, either in person or live-remote.

Not all patients who are deaf or hard of hearing ask a dental practice to provide a sign language interpreter. Be prepared, however, to provide an interpreter if requested. A dental practice may not charge the patient for the cost of providing the interpreter or for any other cost associated with ensuring you and your patient are able to communicate. If the patient has dental benefit coverage, contact the plan and inquire about the availability of an interpreter. Medi-Cal Dental also will provide interpreters for its beneficiaries with advance notice.

Website Accessibility

Litigation over the accessibility of business websites is growing. If a dental practice is uncertain its website content is fully accessible to individuals with visual impairments, it should take the website down as soon as possible. To ensure it has an accessible website, a dental practice should work with a website designer who is familiar with the Americans with Disabilities Act standards for website design known as WCAG 2.0 levels A and AA. If a website has videos or links to videos on another site, it should have closed captions or another option so that an individual knows what the video content is without watching it. Another way to improve the website’s readability for an individual with sight impairment is to ensure high contrast between the text, graphics and background. The best practice, however, is to have the entire website reviewed regularly, dependent on how frequently the website is changed.

If a dental practice is served with a notice of a lawsuit, it should contact the liability carrier.

Service Dogs

A service dog is one that is trained to do work or perform tasks for the benefit of an individual with a disability. Places of public accommodation, such as a dental practice, may not prohibit or limit an individual with a service dog or a service dog in training or the dog itself from entering solely due to the animal’s presence.

A business may not require documentation that the service dog is certified or licensed as a service dog. If the need for a service dog is not obvious, dental practice staff may ask two questions of the individual with the service dog: (1) Is the dog required because of a disability and (2) what work or task is the dog trained to perform? A comfort animal is not the same as a service dog, and the dental practice is not required to accommodate a comfort animal.

Nondiscrimination

Under state and federal law, a business may not:

■ Refuse service to an individual because of their disability.

■ Require additional steps or fees in providing service to a person with a disability.

■ Discriminate against an employee or potential employee because of an individual’s disability.

Additional information on how to comply with state and federal laws on disability access and nondiscrimination is available in a CDA Practice Support resource titled “Best Defense Against Disability Lawsuits” on cda.org.

REFERENCES

1. Settlement Agreement Between the United States of America and Night and Day Dental Inc. Under the Americans With Disabilities Act, DJ #202-54-195, www.ada.gov/night_and_ day_sa.html. Accessed June 24, 2021.

2. Website accessibility a legal issue for dental practices, cda. org; Practice Website Accessibility: A New Wave of AwDA Litigation. J Calif Dent Assoc 49 Mar(3):185–186.

Regulatory Compliance appears monthly and features resources about laws that impact dental practices. Visit cda.org/ practicesupport for more than 600 practice support resources, including practice management, employment practices, dental benefit plans and regulatory compliance.