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Silva v. Baptist Health South Florida

Eleventh Circuit Court of Appeals
856 F.3d 824
May 8, 2017

Keywords:  auxiliary aids, effective communication, healthcare, medical and health care, public accommodations, standing, video remote interpreting

Keywords: effective communication, video remote interpreting, healthcare, auxiliary aids, standing


Cheylla Silva and John Paul Jebian, who are deaf, sued under the Americans with Disabilities Act (ADA) and Section 504 of the Rehabilitation Act after several visits to two hospitals.  Both persons claim discrimination.  Both claimed they did not receive the aids to communicate effectively with hospital staff. The District Court said that if a person is correctly diagnosed and treated, then the legal mandate is met.  However, the Court of Appeals, focused on the ADA meaning of “effective communication”. The ADA meaning says patients must also be able to participate, in a meaningful way, in their own care.

Facts of the Case

Deaf patients Cheylla Silva and John Paul Jebian sued two hospitals, South Miami Hospital and Baptist Hospital of Miami.  They claimed they had both repeatedly experienced discrimination at the hospitals.

Silva and Jebian communicate in American Sign Language (ASL).  During hospital visits, they use an ASL interpreter or another assistive device.  These tools allow them to communicate with doctors and nurses.  As places of public accommodation, hospitals must follow the ADA.  This means they must give patients with disabilities the auxiliary aids and services they need to engage with medical staff.  Likewise, many hospitals receive federal funds and therefore must follow Section 504 of the Rehabilitation Act.  This law also requires hospitals to provide effective communication and other accommodations to patients with disabilities.

Silva and Jebian allege that the hospitals did not follow these federal laws when they visited the hospitals between 2010 and 2015.  They separately visited the hospitals several times. Each time they asked for a live, on-site interpreter.  Often though, the hospitals offered Video Remote Interpreting (VRI) instead of an on-site interpreter.

VRI uses an off-site ASL interpreter seen on a portable screen.   The interpreter translates for the doctor and patient.   However, VRI machines sometimes have technical problems.  These problems disrupt communication. Silva and Jebian claimed that technical problems often stopped them from fully engaging with doctors.  They said that poor connections, blurry pictures and machines that would not turn on were common.  They recalled that when machines broke, the hospitals often did not call a qualified ASL interpreter.  Instead, the hospitals used family members or pen and paper to communicate. As a result, Jebian and Silva said their care suffered.  They were asked to sign papers they did not understand.   They watched discussions they could not follow.   They also waited long periods of time for care.

Silva and Jebian claimed that there were times when they did not receive the communication aids they needed to participate in their own care. They said this was discrimination under the ADA and Section 504. They sued the hospitals in district court.  The District Court for the Southern District of Florida, however, agreed with the hospitals for two reasons.   It said Silva and Jebian lacked standing to sue the hospitals.  It also found no violation because Silva and Jebian did not prove actual harm.  It said that effective communication only requires a doctor to understand a patient’s main medical concerns and to offer treatment.

Silva and Jebian appealed to the Eleventh Circuit Court of Appeals.

Issues of the Case

  1. What is required to have standing?
  2. What does “effective communication” mean?

Arguments & Analysis

1. What is required to have standing?

To have standing means to be allowed to bring a case to court.  In order to have standing, parties must prove that the claimed discrimination will likely impact them in the future.  In this case, Silva and Jebian had to show that they were likely to visit the hospitals in the future and encounter the same communication problems.  The District Court said that it was not certain that either Silva or Jebian would return to the hospitals in the future.  It also stated there was no clear proof that the VRI systems would continue breaking down.  Thus, the District Court found that neither individual had standing.

The Court of Appeals disagreed with the District Court’s decision.  The Court thought it was likely that Silva and Jebian would visit the hospitals again.  The Court’s reasons included their history of hospital visits, ongoing health concerns, and the convenience of the hospitals’ locations.    The Court of Appeals also said that the frequent breakdowns of the VRI indicated they were likely to fail in the future.  Thus, discrimination likely would happen again.  The Court of Appeals concluded that Silva and Jebian did have standing to sue the hospitals.

2. What does “effective communication” mean?

The ADA, and Section 504, require hospitals to communicate effectively with persons with disabilities. If a deaf person is denied an aid deemed “necessary to ensure effective communication,” they are entitled to sue.

The Court of Appeals focused on what “effective communication” means.  It said that the District Court incorrectly focused only on whether medical concerns were identified and treated.  The Court of Appeals instead emphasized the importance of meaningful participation in one’s own medical care.  The Court of Appeals said that the focus should be on the quality of communication leading to a treatment.

The Court of Appeals stated that a deaf person must be given the tools needed to fully engage in their healthcare.   The experience should be equal to that of a hearing patient.  The Court explained that a hearing person is not limited to talking about symptoms and receiving treatment.  Visits include discussion of current medications, medical history, side effects, and follow up procedures.  The Court found that it is against federal law to deny deaf patients the same chance to fully participate with their doctor.

The Court of Appeals also said that “effective communication” does not require that an on-site interpreter be present for all visits.  It emphasized that there is no one right way to achieve effective communication. It varies from person to person and depends on the different facts of each case.  The Court concluded that the District Court should not have dismissed the case without a full understanding of the facts.


The Court of Appeals reversed the District Court’s ruling in favor of Silva and Jebian.  The Court said that they provided enough clear proof to move forward with the case.  It concluded that a better understanding of the facts was needed.  The Court sent the case back to the District Court to reconsider the effective communication issue.

Policy & Practice

This ruling changes the standard for effective communication that hospitals must provide when serving deaf patrons within the Eleventh Circuit.  The standard now requires successfully engaging an outcome or treatment and the overall communication experience.



These materials do not constitute legal advice and should not be relied upon in any individual case. Please consult an attorney licensed in your state for legal advice and/or representation. These materials were prepared by the legal research staff of the Burton Blatt Institute (BBI) at Syracuse University in partnership with the Southeast ADA Center to highlight legal and policy developments relevant to civil rights protections and the impact of court decisions in the Southeast Region under the Americans with Disabilities Act (ADA). These materials are based on federal disability rights laws and court decisions in effect at the time of publication. Federal and state disability rights law can change at any time. In addition, state and local laws and regulations may provide different or additional protections. Materials are intended solely as informal guidance, and are neither a determination of your legal rights nor responsibilities under the ADA or other federal, state, and local laws, nor binding on any agency with enforcement responsibility under the ADA. The accuracy of any information contained herein is not warranted. Any links to external websites are provided as a courtesy and are not intended to nor do they constitute an endorsement of the linked materials.