What do you know about the Americans with Disabilities Act (ADA)? You may be thinking that you are a pelvic health provider, so you don’t need to worry about laws, rules, and regulations. You may need to know more about the ADA than you thought.
Scenario: Your patient calls and requests an American Sign Language interpreter during their pelvic health evaluation. You don’t know much about this. You start to research online, and here is what you find…
Google search answer: “Yes, under the Americans with Disabilities Act (ADA), if your practice is a place of public accommodation (e.g., a healthcare provider), you are generally required to provide effective communication, which may include an ASL interpreter when necessary. However, the law considers "undue burden," meaning if the cost is too high relative to your resources, alternative accommodations (like written communication or remote video interpreting) may be acceptable. You cannot charge the patient for the interpreter.”
You do more research and find out the Americans with Disabilities Act (ADA) is a landmark civil rights law enacted in 1990 that prohibits discrimination against individuals with disabilities in various aspects of public life. It ensures that people with disabilities have the same rights and opportunities as everyone else, covering areas such as employment, public accommodations, transportation, government services, and telecommunications.
Under the ADA, as a pelvic health provider, you will have to provide public accommodations. You may work for a location or be a private business owner, but in either setting, you’ll have to be able to make accommodations. This means being ready to cover physical accessibility (ramps, elevators, bathrooms) and accommodations for people with visual, hearing, or other impairments.
How does this relate to ethics?
Consider the scenario above. You find out that in-person ASL interpreters charge $60 - 90/hour, have a two-hour minimum, and also include paid travel. This means that each visit will cost you between $130 and $250 for just the interpreter. Virtual visits are $1.99 - $2.99 per minute, and the company tells you most deaf people prefer in-person when given the option. The companies you talk to explain that not all deaf people can even use a virtual interpreter. The cancellation windows vary from 48 business hours to 5 business days. You now know that based on the ADA, you have to provide this if you take on this patient, AND you have to pay for this service. What do you do?
An ethical dilemma is the choice between two “right” options. There isn’t a straightforward right versus wrong as there is with an ethical problem. This puts more pressure on the therapist or manager (if the therapist is in a larger organization) to make a judgment call.
The decision you make will likely be based on a few different factors. These are the questions that come to mind for making a decision on this ethical dilemma.
- What is my practice model - fee for service or insurance based?
- How much will I be reimbursed for the therapy session?
- Will this session take more time than other sessions?
- What is my profit margin like?
- Do I have the financial cushion to take on a patient that may actually have my practice losing money?
- How long will the patient need to be seen?
- Is there anyone else in the community I can refer this patient to who may have better resources to accommodate this patient?
- Is the interpreter going to be HIPPA compliant?
- Is the patient going to be comfortable with the interpreter in the room?
- Am I confident the patient will attend appointments regularly?
What would you do as a provider?
I can tell you what our clinic did when this happened. When this patient called, we told them we’d need to take a moment to do some research to find out if we were able to accommodate them. We did our research and were able to find a friend of a friend who was qualified but had better rates than the bigger agencies. We looked at what we HAD to provide and compared that to what we COULD provide, and we decided to take on this patient. Financially, the visit would “net zero,” meaning we wouldn’t make any money, but we also wouldn’t lose money if the patient attended regularly. We felt our clinic was best able to accommodate this patient of the providers in the area. We weighed the pros for the clinic vs. the cons and did the same for the patient and made our decision. That is what we must do every day as a providers. Choosing to refer the patient to an equally qualified location that could accommodate the patient might also have been a good choice.
For pelvic health practitioners, understanding the ADA is crucial when working with individuals who may have disabilities. Some key considerations include:
- Ensuring clinic accessibility (ramps, door widths, exam tables) for individuals with mobility challenges
- Providing communication accommodations for those with speech, hearing, or cognitive impairments
- Offering reasonable modifications to treatment plans for patients with disabilities
- Knowing how legal protections apply when treating patients and ensuring compliance in documentation and practice policies
Ethical dilemmas don’t come with easy answers.
That’s why ongoing education is critical for pelvic health providers. Understanding both the ethical and legal implications of our work ensures that we protect our patients, our licenses, and our professional integrity.
For those looking to deepen their knowledge in this area, the Ethical Considerations from a Legal Lens course is a must-attend event. Taking place remotely on April 12, 2025, this course is designed to provide pelvic health practitioners with the tools they need to navigate real-world ethical challenges with confidence.
What You’ll Gain from the Course
- A deeper understanding of legal considerations in pelvic health practice
- Strategies to navigate informed consent and patient autonomy
- Insights into trauma-informed care and how to approach sensitive patient cases
- Tools to manage professional boundaries and ethical decision-making
- Interactive discussions and case studies to help apply concepts in real scenarios
As providers, we want to deliver the best care possible while ensuring that our practice remains ethical, respectful, and legally sound. Education is the key to making that happen. If you’re ready to strengthen your ethical knowledge and enhance your practice, sign up for the Ethical Considerations from a Legal Lens course today!
Freebie:
ADA Compliance for Pelvic Health Providers - Free Download Reference
AUTHOR BIO
Mora Pluchino, PT, DPT, PRPC
Mora Pluchino, PT, DPT, PRPC (she/her) is a graduate of Stockton University with a BS in Biology (2007) and a Doctorate of Physical Therapy (2009). She has experience in a variety of areas and settings, working with children and adults, including orthopedics, bracing, neuromuscular issues, vestibular issues, and robotics training. She began treating Pelvic Health patients in 2016 and now has experience treating pelvises and ages with a variety of Pelvic Health dysfunctions. There is not much she has not treated since beginning this journey, and she is always happy to further her education to better help her patients meet their goals.
Dr. Pluchino strives to help all of her patients return to a quality of life and activity that they are happy with for the best bladder, bowel, and sexual functioning they are capable of at present. In 2020, she opened her own practice called Practically Perfect Physical Therapy to help meet the needs of more clients. She has been a guest lecturer for Rutgers University's Blackwood Campus and Stockton University for their Pediatric and Pelvic Floor modules since 2016. She has also been a TA with Herman & Wallace since 2020 and has over 150 hours of lab instruction experience. Mora has also authored and instructs several courses for the Institute.