John has taken a special interest in helping the blind and visually-impaired since 2005, when he was approached by Stephen "Bulldog" Miyagawa (1929-2007), a Korean blinded veteran, tireless advocate for the visually-impaired and author of Journey to Excellence: Development of the Military and VA Blind Rehabilitation Programs in the 20th Century (Galde Press, 1999). Mr. Miyagawa was an inspiration to everyone who knew him. At age 76, living alone and blind, Mr. Miyagawa found it practically impossible to manage his multiple prescription medications. The only pharmacy within walking distance of his apartment in the Hyde Park neighborhood of Chicago, a branch one of the biggest pharmacy chains in the U.S., refused to implement a simple, effective and inexpensive "audible label" which had recently become available on the market.
Individuals with vision disabilities face unique difficulties in their attempt to utilize prescription information such as medication descriptions, dosage instructions, side-effect warnings and other information often considered to be detailed and complex, yet essential. Similarities in container shapes and sizes along with having multiple prescription medications compound these problems.
Legislation Regarding Labeling of Medications - Sighted pharmacy customers are obvious beneficiaries of state and federal requirements obligating pharmacies to provide detailed, written medication information to prescription containers. These requirements govern both the content of the information and the duty to physically affix or attach the content to prescription containers. The requirements serve to protect an important public health interest: to help ensure the safe and effective use of prescription drug products. Without special accommodation, blind and visually-impaired pharmacy customers are unable to take advantage of the protections afforded by these requirements.
The Americans with Disabilities Act (ADA) - The ADA addresses the obligation of pharmacies to provide their blind and visually-impaired customers with effective auxiliary communication aids. Based on current ADA legislation, regulation and enforcement guidance, pharmacies are required to furnish appropriate auxiliary aids and services where necessary to ensure effective communication with their blind and visually-impaired customers. In the past, pharmacies may have resisted providing auxiliary communication aids because they viewed the only such available aids as creating an undue burden on pharmacy operations; however, recent technological advances have facilitated the development of new auxiliary communication aids, specifically designed to benefit blind and visually-impaired pharmacy customers, which are economical, efficient and effective.
The Health Insurance Portability and Accountability Act (HIPAA) - Pharmacies are required to permit their customers, individually, to request that communications of the customer's protected health information be made by alternative means. The right of blind and visually-impaired pharmacy customers to request delivery of his or her health information by alternative means is significant because one of the primary methods pharmacies have utilized in the past to deliver prescription medication information to such customers is through the customers' family members. HIPAA regulations are designed to protect the right of an individual to keep his or her health-related information private and to prevent such information from being disclosed, even to family members if such a level of privacy is desired by the individual. While pharmacies may require that requests for alternative means communication be made in writing, reasonable requests must be accommodated.
What Auxiliary Communication Aids are Available? - Currently, the most commonly utilized auxiliary method of communicating prescription medication information to the blind and visually-impaired is face-to-face counseling. This method is also one of the most ineffective at communicating complex, detailed medication information to this population and can be considered one of the most burdensome methods that may be implemented by pharmacies. Other auxiliary communication methods have been attempted in order to alleviate some of the problems experienced by pharmacies and their blind and visually-impaired customers with face to-face counseling. Producing written prescription medication information in Braille is overly expensive for pharmacies, and such material can only be read by a small portion of the blind and visually-impaired population. Some pharmacies have attempted to utilize cassette and CD recordings, but these methods remain problematic, particularly with respect to blind and visually-impaired pharmacy customers taking multiple medications, due to the fact that the information contained on cassettes and CDs may not be securely affixed to the prescription containers to which the information relates, increasing the risk of coupling instructions with the wrong prescription medication. Recent technological advances, however, have led to the development of Audible Prescription Labeling Systems (APLS) specifically designed for blind and visually-impaired pharmacy customers, providing such customers, for the first time, a meaningful opportunity to enjoy the ability to keep their prescription medication information private. While each of the available APLS communication aids has a relatively insignificant impact on pharmacy expenses and operations, they do vary in communication effectiveness.
One of the four available APLS communication aids on the market overcomes issues related to communication effectiveness and pharmacy burden by utilizing text-to-speech technology and a Radio Frequency Identification (RFID) enabled label that securely affixes to any type of prescription medication container, including odd-shaped glass and plastic bottles, blister packs and boxes. Pharmacists or pharmacy technicians pass textual prescription medication information from their computer to a dedicated, small-footprint RFID label printer which encodes the prescription information in an electronic format on a microchip embedded in the label. In the home, the patient uses a hand-held reader, which decodes the label information using speech synthesis technology, to hear medication information such as patient name, drug name and dosage information, instructions for use, warnings and cautions, the prescription number and the name and phone number of the pharmacy and the prescribing doctor.
What are Pharmacies Required to do by law? - Pharmacies are required to communicate certain information to their customers concerning the medications they dispense. They are required to securely affix specific information to the containers holding these medications, decreasing the risk of medication errors such as the accidental consumption of the wrong medication. Pharmacies are prohibited from discriminating against their blind and visually-impaired customers with respect to the full and equal enjoyment of the goods, services, privileges and advantages available to sighted customers. They are required to furnish effective auxiliary communication aids for the benefit of blind and visually-impaired customers, and they are required to accommodate reasonable requests by such customers to receive their health information by alternative means in order to protect the privacy of such information.
Due to recent technological advances leading to the development of specially-designed audible prescription labeling systems, pharmacies now have the means and ability to provide effective auxiliary communication aids and services to their blind and visually-impaired customers with minimal burden on themselves and insignificant alteration of their current operations. In addition, thanks to these specially-designed systems, blind and visually-impaired pharmacy customers are now able to enjoy the same privacy rights enjoyed by sighted customers, rights which have historically been forfeited due to a lack of alternative means of receiving prescription medication communications.
See John's published journal article on these issues: Effective and Confidential Communication of Prescription Information: Accommodating the Blind and Visually-Impaired, The International Conference on Aging, Disability and Independence (ICADI) Proceedings (January, 2006).
If you or someone you know is blind or visually impaired and facing a pharmacy's refusal to accommodate a request for an effective auxiliary prescription information communication aid, contact John Little, Attorney at Law, PC.