Let me open by stating as clearly as possible I’m a fan of the Americans with Disabilities Act. It has made a profound difference in easing hardships for millions of Americans. So, the Act is useful.

Still, tools that are used can also be abused.

We’ve written before (here and here) about “patients” abusing the ADA to seek cash remedies from physicians whose websites were “not compliant.”

First, there is no universal standard for ADA compliance for websites. Further, where you live determines how federal courts judge what is reasonable for a commercial website and what isn’t. And state law also plays a role.

In any event, over the past several years, webmasters have stepped up to make it easier for those with vision and hearing challenges to access content on commercial websites and make their experiences better and easier.

Widgets abound to simplify the task.

Webmasters can do a quick screen to identify where those with vision and hearing challenges will struggle.

Yet, the money grab continues.

Several Medical Justice members received this recent letter.

I am writing to you in regards to your website xxx.com and its lack of ADA compliance. Your website is in violation of Section 508 Standards & W3C WCAG 2.1. Under Federal law, your website must comply with the new requirements of the ADA and WCAG 2.1 AA (Web Content Accessibility Guidelines).

I am color blind and was unable to use your website to its full capacity. Your website has insufficient color contrast between text and background. On October 15th 2023 I attempted to use your website but your website’s Color contrast limitations prevented me from being able to use your business website properly. Your non compliant website prevented me from being able to get the proper cosmetic procedure I needed to fix my deviated septum that has caused me many breathing and health issues. Your website not being compliant has prevented me from receiving proper health care.

I had a consultation with a lawyer about this matter for which I was charged $1,190 for a two hour consultation. I am requesting that I be reimbursed for my legal fees by you and your business entity as I do not want to pursue this any further. If I am reimbursed for my legal fees and you make your website compliant in the next 180 days then I will stop my pursuit, If not then I will continue this pursuit. ADA Compliance widgets and plugins are not a substitute for a fully compliant website. I am in contact with another law firm that specializes in website compliance matters and we will sue you.

This is a very easy case to prove and the amount of money you will lose will be substantial. $10,000+ in Plaintiff law firm fees, $5,000+ in your defense attorney fees, and $20,000+ for accessibility audit and remediation.

Please send, made payable to me, certified funds in the amount of $1,190, to the address listed herein within seven (7) days of you receiving this correspondence. In exchange, I will release any and all claims related to this matter, and forgo any future reports, complaints or grievances to state or federal government agencies or authorities not yet made.

Well, what to do?

I recommend any physician receiving such a letter send it to his/her webmaster for consideration and feedback on the allegation. Meaning, based on the website at issue, is the person’s allegation even believable? If so, how can anyone comply?

There is no perfect answer in working to comport with ADA. Many webmasters place specific widgets on their sites. Some are more effective than others. This demonstrates the physician made an effort to get closer to an optimum outcome for the general public. But all widgets come with tradeoffs. Some actually interfere with devices patients own which allows them individually to hear and read websites. In other words, in trying to be all things to all people, one may inadvertently make it harder for specific individuals.

In the accusatory letters, the “plaintiff” spoke to a lawyer who charged by the hour. If that lawyer, or any lawyer, was thrilled about taking the case, the physician would have received the shakedown letter from an attorney.

The universe of challenges any individual patient may experience with a website is near infinite. There is no ideal solution. Congress or the agency that oversees enforcement of the ADA (Department of Justice) could and should specify what are minimum reasonable expectations for commercial websites. Safe harbors should be outlined. The guessing must stop.

The whole thing is enough to make you see red.

What do you think?

Medical Justice provides free consultations to doctors facing medico-legal obstacles. We have solutions for doctor-patient conflicts, unwarranted demands for refunds, online defamation (patient review mischief), meritless litigation, and a gazillion other issues. If you are navigating a medico-legal obstacle, visit our booking page to schedule a free consultation – or use the tool shared below.

Jeffrey Segal, MD, JD

Chief Executive Officer and Founder

Dr. Jeffrey Segal, Chief Executive Officer and Founder of Medical Justice, is a board-certified neurosurgeon. Dr. Segal is a Fellow of the American College of Surgeons; the American College of Legal Medicine; and the American Association of Neurological Surgeons. He is also a member of the North American Spine Society. In the process of conceiving, funding, developing, and growing Medical Justice, Dr. Segal has established himself as one of the country’s leading authorities on medical malpractice issues, counterclaims, and internet-based assaults on reputation.

Dr. Segal was a practicing neurosurgeon for approximately ten years, during which time he also played an active role as a participant on various state-sanctioned medical review panels designed to decrease the incidence of meritless medical malpractice cases.

Dr. Segal holds a M.D. from Baylor College of Medicine, where he also completed a neurosurgical residency. Dr. Segal served as a Spinal Surgery Fellow at The University of South Florida Medical School. He is a member of Phi Beta Kappa as well as the AOA Medical Honor Society. Dr. Segal received his B.A. from the University of Texas and graduated with a J.D. from Concord Law School with highest honors.

In 2000, he co-founded and served as CEO of DarPharma, Inc, a biotechnology company in Chapel Hill, NC, focused on the discovery and development of first-of-class pharmaceuticals for neuropsychiatric disorders.

Dr. Segal is also a partner at Byrd Adatto, a national business and health care law firm. Byrd Adatto was selected as a Best Law Firm in the 2023 edition of the “Best Law Firms” list by U.S. News – Best Lawyers. With over 50 combined years of experience in serving doctors, dentists, and other providers, Byrd Adatto has a national pedigree to address most legal issues that arise in the business and practice of medicine.

As physicians, if you suspect child abuse, you are mandated to report to the appropriate authorities, such as Child Protective Services (CPS). In Texas, where our vignette played out, professionals are beholden to the following law.

Section 261.101 of the Texas Family Code mandates that anyone who suspects child abuse or neglect must report it immediately. The report may be made to (1) any local or state law enforcement agency; or (2) the Department of Family and Protective Services.

All persons are required to make the report immediately, and individuals who are licensed or certified by the state or who work for an agency or facility licensed or certified by the state and have contact with children as a result of their normal duties, such as teachers, nurses, doctors, and day-care employees, must report the abuse or neglect within 48 hours.

Deric Cahill took his toddler to an urgent care center in Dallas. He alleged the doctor turned him into CPS for leaving a one-star Google review. In other words, the doctor weaponized the duty to report because of a nasty review.

The Cahill family is a content creator for Instagram and TikTok with 750,000 followers. What followed, predictably, did not go well for the physician.

To state the obvious, what follows are only allegations. As to whether the doctor believed, in good faith, she suspected abuse and HAD to report, is unknown.

And in Texas:

A person acting in good faith who reports or assists in the investigation of a report of child abuse or neglect is immune from civil or criminal liability. Failure to report suspected child abuse or neglect is a Class A Misdemeanor, punishable by imprisonment of up to one year and/or a fine of up to $4,000. Merely reporting the incident to a supervisor or manager is insufficient.  

The incentive TO report based on reasonable suspicion is high. The penalty for NOT reporting is steep.

Back to the urgent care center.

Cahill’s toddler had a fever for several days. He called a nurse’s hotline. He then took the child to pediatric urgent care center.

Cahill says the physician checked his ears, nose, and throat and listened to his breathing.  After a few minutes, Cahill says the doctor told them that his fever could have been caused by anything and recommended they visit the emergency room to get blood work, urinalysis, and other tests to rule everything out. Cahill says he and his wife sat in stunned silence after the doctor’s recommendation and were surprised the provider hadn’t asked them more questions. After the doctor repeated her recommendation, Cahill said he wasn’t happy with how the appointment went and left.

Miffed, Cahill wrote his online review in the parking lot.

“This is the most transactional experience I’ve ever had with a caregiver. We brought our son in with a fever, and after five minutes of normal tests: check ears, check throat. The doctor tells us to just go to the hospital to get urine, blood, and x-rays to figure out if it’s pneumonia, UTI, or some other infection. Bring your kid here if you just need antibiotics…anything else, it’s a waste of time and money.”

And, he emailed the corporate office for the urgent care center to express his displeasure. He wanted a refund for the perceived lack of service.

Within two hours of leaving the urgent care center, a report was filed to CPS about a severely dehydrated child. Within one hour of filing, a CPS officer showed up at the Cahill’s house.

Cahill says the case worker told him she expected to see a severely ill child but left after 30 minutes of sitting, talking with the family, and observing [the child].

Cahill went back to the urgent care center to speak with the physician about the CPS report. He received the records related to dehydration, but was instructed to wait outside. Meanwhile the staff called the police. All of this was documented in a TikTok video.

After speaking with the police and learning that the provider would not speak with him, he left with his child’s paperwork.

For Cahill, there is a clear connection between his critique of the care and the CPS report. “Why would she wait an hour and a half to call CPS if she was so concerned? Why wouldn’t she follow up with us to ask if we followed the guidance?” Cahill says. “It feels malicious.”

After the CPS visit, the family took the toddler to their usual urgent care, where Cahill says the provider spent 30 minutes with the family and asked more questions. The record of the appointment describes a very different toddler. Rather than “sick looking, weak cry” in the first visit, the second report describes a child that is “alert, pleasant, well-nourished and in no acute distress.” The provider told them to monitor their son, and his fever broke for good that night.

“Based on everything we experienced that day, the only thing I am led to believe is that this doctor was offended that I called her out in her office, that I left a Google review, that I emailed her senior leadership team, and she retaliated against us by weaponizing her position and calling CPS,” he said in a video post.

Cahill filed complaints with the Texas Medical Board and Texas Attorney General Consumer Services Division. In Texas, falsely reporting child abuse with the intent to deceive is a felony. Still, given the incentives to report and penalties for not reporting, I doubt criminal penalties will be imposed.

CPS cases move slowly.

The CPS case isn’t closed yet, but Cahill says the case manager told them she has no concerns and is working on character references to end the investigation. In a conversation with [the] Urgent Care management, Cahill reported that the organization said it would explore ways to improve its policies and that providers are bound by mandatory reporting standards. 

Cahill is a man on a mission.

“Money is not my motive. My motive is to hang this doctor’s license in my bedroom because she will no longer be able to practice medicine. That’s the mission.”

What are the evolving lessons?

1. 1. 1. Physicians need to understand what their obligations are for reporting suspected child abuse.
      2. The protections from civil and criminal liability apply if the report to authorities is made in good faith and without malice (at least in Texas).
      3. As to whether good faith and without malice apply, reviewers will look to the totality of the circumstances – the facts of the case, the timing of the report, and any extraneous circumstances.
      4. Doctors should be cautious about reporting someone to CPS FOR a one-star Google review. They should report FOR suspected child abuse.
      5. If the timeline suggests the father wrote the online review, and then Google sent an email to the physician about the one-star review, and then this email was opened and read, and then the report to CPS was filed, well, you can draw your own conclusions.

What do you think?

Medical Justice provides free consultations to doctors facing medico-legal obstacles. We have solutions for doctor-patient conflicts, unwarranted demands for refunds, online defamation (patient review mischief), meritless litigation, and a gazillion other issues. If you are navigating a medico-legal obstacle, visit our booking page to schedule a free consultation – or use the tool shared below.

Jeffrey Segal, MD, JD

Chief Executive Officer and Founder

Dr. Jeffrey Segal, Chief Executive Officer and Founder of Medical Justice, is a board-certified neurosurgeon. Dr. Segal is a Fellow of the American College of Surgeons; the American College of Legal Medicine; and the American Association of Neurological Surgeons. He is also a member of the North American Spine Society. In the process of conceiving, funding, developing, and growing Medical Justice, Dr. Segal has established himself as one of the country’s leading authorities on medical malpractice issues, counterclaims, and internet-based assaults on reputation.

Dr. Segal was a practicing neurosurgeon for approximately ten years, during which time he also played an active role as a participant on various state-sanctioned medical review panels designed to decrease the incidence of meritless medical malpractice cases.

Dr. Segal holds a M.D. from Baylor College of Medicine, where he also completed a neurosurgical residency. Dr. Segal served as a Spinal Surgery Fellow at The University of South Florida Medical School. He is a member of Phi Beta Kappa as well as the AOA Medical Honor Society. Dr. Segal received his B.A. from the University of Texas and graduated with a J.D. from Concord Law School with highest honors.

In 2000, he co-founded and served as CEO of DarPharma, Inc, a biotechnology company in Chapel Hill, NC, focused on the discovery and development of first-of-class pharmaceuticals for neuropsychiatric disorders.

Dr. Segal is also a partner at Byrd Adatto, a national business and health care law firm. Byrd Adatto was selected as a Best Law Firm in the 2023 edition of the “Best Law Firms” list by U.S. News – Best Lawyers. With over 50 combined years of experience in serving doctors, dentists, and other providers, Byrd Adatto has a national pedigree to address most legal issues that arise in the business and practice of medicine.