Asking why a practice is not able to accommodate you

— 7 minute read

Context

Who was this written by?

This text was written by Mel Chua.

Who was this written for?

I wrote this text on behalf of myself. I am based in the USA and am a citizen there. I am multiply disabled, and the relevant disability in this situation was my deafness. I use both spoken English and ASL, and had planned on using spoken English with this particular provider. I also knew I could easily look for a different provider if I needed to. If these aspects are different for you, you might need to adapt the text or use a different tactic.

Who was this written to?

This was written to a prospective practice I was seeking telemedicine services from.

What prompted this writing?

A few days before my scheduled appointment, I got an email with the following (excerpted):

...Unfortunately we are not able to accommodate you in our practice at this time, and for that we sincerely apologize. There are many situations in which we are not setup at this time to provide optimal care...

We made this tough decision regarding your care to be as safe as possible as we get our practice started. We know this is not the answer you were expecting, however, and do apologize for that… If you would like to understand more, you can contact us via email at [email address]. We are happy to answer questions you may have. Again, we are sorry we can’t accommodate you at this time but do appreciate your interest.

I responded via email to the office staff, and also wrote a separate message to the individual provider appealing to our shared identities as women of color. Both are included in the example text below.

Outcome

After not getting results from this back and forth (they emailed me back an almost identical response, I wrote back again with "this is the same response I received before") I decided to drop it and switch to a different provider instead, because I was managing multiple medical issues simultaneously and did not have enough time to fight everything on principle.

I wonder if a different response would have gotten better results, and would to know what others think about this.

Example text

Email to office staff

I’d like to know the rationale behind the decision of not being able to accommodate me at [practice]. Could you please elaborate?

Since [practice] is a telemedicine-based practice, my relevant disability would be deafness.

My intake process seemed to go smoothly until after my initial (phone) screening when I sent a text message via your platform explaining that I was deaf and asking that my provider be notified in case I needed ADA accommodations. The day before my appointment, I was asked by [name] to call and reschedule; when I called the next day, I was told that I'd just been sent another email message that I could not be accommodated. Are you claiming that the ADA accommodations I'm requesting are an undue burden for your practice? If so, can you explain how you came to this conclusion?

I've called multiple times since, and not been able to reach [name] (and not received a call back from her as I'd been told at least once would happen). I've also messaged several times, but have gotten vague replies similar to this one. I mention [name] specifically because she sent the initial messages about rescheduling and then not being able to accommodate me, but also because she did my screening over the phone, and therefore has already experienced communicating with me - without putting any accommodations in place on her end.

In terms of telehealth limitations or ability to accommodate: I have not been able to have a conversation with someone at [practice] about what my actual access needs are. I’m requesting what I believe to be reasonable modifications (and may not be modifications at all, given that [practice] is telemedicine-focused). Specifically, I would want to confirm that all appointments would be done over a good internet connection with low latency, without masks and with video that can clearly show the provider’s face (for speechreading), and with a good microphone and little to no background noise so that I can use my headphones and audiological equipment to communicate with my provider via spoken English.

Additionally, I would need the platform to support text chat (which doxy.me does - I'm inferring that [provider] uses this based on the appointment link I was provided with prior to the appointment cancellation). I also need the provider to be willing to occasionally type in specific terms like medication names, etc. in case I am having a hard time speechreading unfamiliar vocabulary. This rarely happens, in my experience of over a year and a half working preferentially with telemedicine providers.

The right of disabled people to access healthcare is protected by the Americans with Disabilities Act of 1990 (ADA), which is a federal civil rights law that prohibits discrimination against individuals with disabilities in every day activities, including medical services. Private hospitals or medical offices are covered by Title III of the ADA as places of public accommodation. The ADA requires such places to provide disabled people with full and equal access to their health care services and facilities; and reasonable modifications to policies, practices, and procedures when necessary to make health care services fully available to individuals with disabilities, unless the modifications would fundamentally alter the nature of the services (i.e. alter the essential nature of the services). The ADA does not allow clinics to tell patients they cannot be treated because they don't have accessible equipment; instead, they need to make an accessible option available.

I'd like a more specific rationale on why you cannot accommodate me. In the absence of that, I will feel an obligation to let others know that [practice] might not be willing to accommodate disabled patients, so they don't go through the same experience.

To provider

Hi, [provider name] - I was hoping to work with you at [practice]. (I was so excited at the prospect of possibly seeing a fellow woman of color as my [specialty] healthcare provider for the first time!) I haven't been able to get through your office staff, though - and wanted to see if I could reach you another way and let you know what might be going on, in case you weren't aware yet or there might be something you could do.

We were originally supposed to see each other on [date] - but then [one day earlier], my appointment got mysteriously cancelled. I've dealt with many forms of discrimination as a deaf and disabled woman of color in engineering, and this felt a lot like another one of... those. I've been going back and forth with the office staff and only getting vague answers about "not being able to accommodate me" -- here's my latest message to them.

(text to office staff was included below)

Notes

  1. Not all deaf people consider deafness to be a disability; I used this language because the Americans with Disabilities Act was the law protecting my right to accommodations in this case.
  2. If I'd proceeded further, I could have used something like this to advocate for accelerated scheduling: "Under the ADA, a patient with a disability should not wait longer than other patients simply because they are disabled."