Federal legislation mandates effective communication for deaf U.S. hospital patients. Despite this directive, evidence indicates that access to healthcare remains inadequate, inappropriate, or unethical. This study employs an institutional ethnographic approach to investigate established policies for legislative compliance vis-à-vis medical professional actions and deaf patient experiences within a U.S. health care system. Participant observation, interviews, and textual analysis can isolate points of disjuncture and reveal institutional processes implicated in negotiating access. The aim is to identify systemic factors contributing to disparities reported by deaf patients.