Managing Communication Access in Health Care: Who's in Charge?

Disability rights activists have made substantial progress in securing the rights of citizens with disabilities.  In the United States, the landmark Americans with Disabilities Act, passed in 1990, stands as both a signal achievement of that movement and also the foundation for future efforts.  As with any legislation, however, achievement of the intent of the ADA—full social inclusion for people with disabilities—will depend on the implementation of the legislation, a fundamentally social process.  This paper focuses on deaf patients’ experiences of health care in the United States, and on the responses of health-care professionals and facilities to the ADA mandate to provide access.  Drawing on interviews with professionals in different positions within the health-care hierarchy, I examine policies and practices.  The results suggest that managers and front-line professionals must navigate a web of competing mandates as they confront communication differences, and that well-intentioned policies may sometimes give the appearance of access while significant problems remain.