Interpreters and Emergency Rooms

I recently came across a news article about a lawsuit by several d/Deaf or hard of hearing people who were denied interpreter services in emergency rooms. It sounds both infuriating and terrifying:

One deaf hospital patient in Jacksonville Beach said she was given a stuffed monkey instead of the sign-language interpreter she requested for hours. Feeling isolated, she finally asked nurses for something to hold.

Another said she thought she was being denied medical care because there was no interpreter to explain why they needed her to wait in a hallway at Baptist Medical Center South. She later learned hospital staff lost a list of sign-language interpreters her mother had given them.

A third woman couldn’t hear when emergency workers at Baptist Medical Center downtown called her name.

The three women are among seven hearing-impaired emergency-room patients suing Baptist Health Systems for violating the Americans With Disabilities Act by failing to provide qualified sign-language interpreters. The lawsuit was filed in federal court last week by Jacksonville Area Legal Aid. Legal Aid attorney Sharon Caserta,  who works with hearing-impaired clients, said the pattern of complaints at Baptist facilities from 2006 to 2009 indicated a breakdown in services that denied deaf patients full access to care.

She said the act requires interpreters or effective auxiliary aids to be provided if needed for communication with medical professionals. The U.S. Justice Department has interpreted the law to mean a one- to two-hour response time is reasonable after an interpreter has been requested, Caserta said.

In Northeast Florida, she said, that shouldn’t be an issue because of a half-dozen organizations that provide interpretive services and the proximity of the Florida School for the Deaf and the Blind in St. Augustine. But Caserta said her clients never got interpreters and, if they didn’t have friends or family with them, had to fend for themselves at Baptist facilities.

Many are now scared to return to Baptist or any emergency room, she said.

These problems are not limited to that hospital, or even to the United States. According to one survey in the UK, “70% of deaf respondents reported being unable to have access to an interpreter when they attended an accident and emergency department.”

These incidents would be bad enough if their impact was limited to the incident itself. Being denied the right to communicate in an emergency situation is beyond unacceptable. It denies people the right to understand what’s happening to them. It denies them the ability to consent to treatment or make any decisions or have any agency at all in their treatment.

Even worse, these incidents undermine the reliability and usefulness of the health system itself. As the article above mentions, many of the plaintiffs “are now scared to return to … any emergency room.” This is echoed by the UK survey, which found that “communicating with health care professionals was such a struggle that 28% of deaf people responding to one survey were left so confused and dissatisfied with their inadequate GP health care that they avoided seeking medical help.” These people have learned that the health care system is unwilling to communicate with them in their time of urgent need. Is unwilling to take the time or make the effort to treat them as autonomous people participating in their own care.

In a demonstration of intersectionality, the facilities and areas in the US that have the best policies and practices about providing sign interpreters to d/Deaf and hard of hearing people are those with good policies for accommodating people with limited English speaking proficiency. (I would expect the same holds true for non-US locations which accommodate folks who don’t speak the primary language.) These places have created an infrastructure where interpreters are available and staff are trained on how to access them, and they’ve prioritized communication access in their facilities.

7 Comments

  1. The lack of interpretors in so many situations is a big reason why I at one point had studied towards getting certified. I sometimes wish I had actually finished getting certified, but the reality is that I would have to give up substantial things (time I need to rest and recover, my schooling) in order to be able to act as an interpretor.

    And as that article mentioned, it’s not uncommon that the lack of an interpretor is caused by something other than interpretors not being available.

    ~Kali

  2. This reminds me of an episode of Miami Medical that pissed my partner and me off when we originally saw it. In it, a patient “seemed to be having a hand twitch” and in order for staff to operate (or whatever) they’d decided to strap his down. Everyone in the hospital is entirely mystified why this patient isn’t talking and is having a hand twitch! Literally everyone.

    And then suddenly, as if by magic, one of the main characters realizes he is signing! She then communicates in *almost perfectly fluent* (as far as the show decides to portray) ASL with him (and of course finds him an interpreter for the medical terms she doesn’t know). Seriously. She went from being concerned about his twitch to full on signing in the space of 5 minutes of TV show. And she explains it to him/others as that she used to know someone who Signed *years* ago.

    It just pisses me off looking back on it, because in addition to making it seem like signing is so easy that someone who hasn’t done it in years could pick it right back up (and as though someone would realize it was signing when minutes ago she thought he had a fucking hand tremor, and totally skating over how fucking *terrible* it’d be to be a d/Deaf person whose means of communication was strapped down), this show also manages to imply that oh hey, if you’re d/Deaf, the worst that’ll happen is a little bit of people being confused, but it’ll all work out swimmingly at the end. Which is (apparently, given the stats you mentioned) not in the same Universe as the ball park.

  3. That is very depressing. In UK hospitals I’m always seeing signs that advertise how seriously they take their responsibility to provide interpreters for people who don’t understand English, but I’ve always wondered how good that service is in practice, and likewise the provision of staff who can sign, given that so many other aspects of hospital care are vulnerable to the familiar combined forces of understaffing, underfunding and sheer incompetence.

    I do remember that last time I was in hospital, another patient in the same bay was blind. One day she asked a passing nurse, newly on duty, to pick up her hair scrunchie which had dropped off the table where she couldn’t find it, and the nurse said, ‘Oh, it’s just there’ [pointing], because she did not know the woman was blind – though she was then informed of that by a chorus consisting of the patient and other nearby patients.

    And that really disturbed me because it’s such a fundamental fact which should have been communicated at the handover from one shift of nurses to the other. The potential for problems if a patient’s sensory disability is not communicated between staff and accommodated is enormous, and that would be incredibly upsetting for a patient who has enough to put up with through being in hospital in the first place… and I know enough about hospital life to see all sorts of problems that could ensue if someone is d/Deaf and that is not accommodated.

  4. Ack, I’m not communicating clearly today. In my above comment I wasn’t trying to conflate being d/Deaf with not understanding English; I was referring to patients for whom English is a foreign language (jumping off from the comment someone else made about provision for language interpreters), and whether hospitals’ claims to accommodate people who speak other languages can be backed up in practice. Sorry for any confusion.

  5. This was very interesting for to me. I’m caught in the middle of all this. I got sick and ended up moderate hearing loss. Without my hearing aids I cannot hear people speaking. So I decided I needed to learn BSL, I enrolled in a wonderful class and got through units 101 and 102. Unfortunately, because of my illness I was unable to do 103 part. I’m hoping to pick it up again in September. So here I am: sick, deaf and unable to sign/lip read.

    In the past, I’ve had doctors write to me on notepads, but as you know doctors tend to have horrible handwriting. Thankfully, my wife has been able to go with me to nearly all of my appointments so she can help me.

    The real problem though is that I have fairly regular operations on my lungs [next one is 1 July] and I can’t wear my hearing aids in the theatre. When I wake up in recovery, I’m fairly disoriented and coughing and I can’t hear anyone. The first time was incredibly scary, but I’ve done it so much now I can cope.

    I don’t think there is anything I could even for to help someone in my situation. If I lost my hearing but remained healthy the BLS classes would have been a breeze.

  6. This is one of those things where medical education is massively behind the curve. In the last few years UK medical schools have introduced communication skills training for med students – because it took them that long to realise that good communication was important! I have a feeling it will take another while before communication with PWD, with people with English as a second language etc will occur to them.

  7. This one really pissed me off: “She later learned hospital staff lost a list of sign-language interpreters her mother had given them.” WTF? Implication is that the ED did not take it on themselves to have such contact info until one d/Deaf person’s family provided it! And then they forgot where the damn list was.