A Broken System.

I’ve written about dealing with inadequate hospital accommodations. Most anyone in the Deaf world knows that last-minute interpreting requests are tricky, at best, to accommodate, especially with specialized medical appointments.

I happen to know Christopher Rawlings from my UW-Milwaukee days. He has three children whom he adores. Recently, his oldest daughter went in for surgery; and later on suffered life-threatening complications that required a stay in the ICU. She’s doing better now. However: someone at the hospital seriously dropped the ball on this one, because at no point– save for a one-hour block after the crisis had died down– did the hospital secure a professional, in-person sign language interpreter for Chris, despite all his efforts to arrange one.

Here’s the story in his own words, after which I will proceed to dissect where the hospital fucked up– and yes, this situation warrants the f-bomb on what is normally a fairly family-friendly blog, because his kid almost died. Watch on and try not to rage, because this happens far too often in the d/hh world, and we really, seriously need workable solutions for hospitals, interpreting agencies, and deaf clients here.

 

Now, the promised reaming.

  1. This wasn’t an emergency or a walk-in. The hospital had time to prepare. Chris requested an interpreter well in advance– an in-person interpreter, specifically not a Video Remote Interpreter (VRI).
  2. He followed up three times– three!– to ensure that his request would be met. No dice.
  3. Instead of a live interpreter, the hospital consistently provided a VRI machine that took time to set up, biting into valuable communication access for Chris while the rest of the room exchanged vital information about his daughter’s state and care; and regularly shut down without warning. 
    1. Now, VRIs can work, sometimes and in some situations. However, in this case, it wasn’t even close to enough for high-risk procedures nor highly-charged emergencies, much less one that involved multiple speakers. Chris covers a bit of the difference at 10:30 -“I couldn’t care less about nurses checking in for this or that — the VRI system is enough. But anything that involves my daughter’s doctors and her prognosis? I NEED a live, in-person, ASL interpreter!”
    2. VRIs run on high-speed Internet access, so having a good connection is vital– and often lacking, as happened hereWhen Chris brought this up at 11:05, their solution was to provide two VRI units.
  4. The hospital had time, during what turned out to be a 9-hour wait for his daughter’s initial surgery to finish, to contact several state agencies for an interpreter.
  5. The staff tried to recruit his wife, ex-wife (mother to the daughter), and his 14-year-old daughter– the patient— as interpreters. OK, it’s bad enough that they tried to ask the mother, then the wife, to interpret. Emotional investment, lack of impartiality, lack of expertise, etc., etc.– but the daughter?! A minor?! Who was also the patient?!
  6. When they did send an interpreter, they sent a Spanish one– twice.

    Spanish.For a deaf man who uses American Sign Language. And whose family members all use spoken English.

There is more, but you get the idea. Someone dropped the ball, enormously, and kept dropping it throughout. This wasn’t an understaffed rural hospital; Children’s Hospital of Wisconsin is located in Milwaukee with decent-to-excellent national rankings in several fields. These people should know better. While Chris’s experience is one of the more egregious examples I’ve seen to date, stories like his are depressingly common in the d/hh world. Now, I don’t like to jump on the outrage train without looking into solutions. Chris is right; the system is broken and it needs to be fixed. But how?

I don’t have answers yet. I do have some specific questions to start off with. First, what can hospitals and interpreting agencies do in advance to prepare for and address situations like this, especially last-minute or emergency requests? Can a partnership be set up with local agencies where interpreters agree to be “on call” (much like nurses)? Can agencies or advocacy centers reach out to the relevant authority at hospitals to educate them? How feasible is it for a hospital to have a staff interpreter on retainer? How do they manage it with other language interpreters (e.g., Spanish)? Which hospitals do it right, and how do they pull it off?

If you know me, you know I’m spamming all the relevant friends I have for answers on this. And hopefully soon enough I’ll have a new post with answers beyond “He should sue!” (I think he should.) and “They’re breaking the law!” (They are.) What Chris went through was the aftermath of someone’s else’s fuck-up. What can local agencies, hospitals, and deaf clients do beforehand to ensure that they don’t run into more fuck-ups?

In A Perfect World

Some weeks ago, I watched this clip from ABC Family’s Switched at Birth:

Then, yesterday, I saw a Facebook video of a deeply upset Deaf man in a hospital waiting room as one of the nurses held up an iPhone with a VR interpreter on the line:

Transcript, with original commenter’s permission to copy-and-paste:

Nurse: ..can’t be in the video.
VRI (assumingly SIM-COMing): Hello, my name is Kathleen; I’ll be your ASL interpreter #664403
Nurse: I can’t be in the video.
Interpreter: And I’ll interpret everything you say and keep… (not audible due to nurse speaking)
Nurse: You’ll have to delete it if I am, it’s-it’s against the law.
Nurse: Can you see her?
Interpreter (voicing for Deaf patient): Yes. The internet is not .. is very, very slow. I can see the interpreter; it’s very, very slow. It’s not a valid fair communication because the internet is not working.
Nurse: Ok well then you’ll have to tell him our director is coming. You’re our only option. I don’t know what else to do, this is the best we have at the moment.
Interpreter: Ok, um, just for your information, I don’t.. I don’t need to see you. If you could just keep the video camera on the Deaf patient, that would be great. … I only need to hear you, can you say that again please?
Nurse: I just said that this is the only option that we have until our- my director gets to the facility. I understand that the internet is slow, but this is the only thing that I have at the moment.
Interpreter (voicing for Deaf patient): It’s not the only option, period. It’s not the only option. VRI is not the only option because the internet is not working. It’s not the only option. We need to get (unintelligible) here now.
Nurse: OK we don’t have one.
Interpreter: This is the interpreter speaking, could you put the camera lens down on the patient and keep it there. Because right now it’s going all over the place so I cannot see his hands. Could you please stabilize the camera and keep it there. Make it stop moving. (Voicing for the Deaf patient: ) See this is an example: the interpreter can’t see because the camera keeps moving around and around and around. And so do you think this is fair communication?
Nurse: Yes ma’am I understand that.
Interpreter: What’s your name?
Nurse: My name is Tanisha.
Interpreter: Could you spell that for the interpreter please?
Tanisha: T-A-N-I-S-H-A
Interpreter: Tanisha, T-A-N-I-S-H-A, Tanisha.
Tanisha: Yes ma’am.
Interpreter: And what’s your last name Tanisha?
Tanisha: Akins.
Interpreter: Could you spell that for the interpreter please?
Tanisha: A-K-I-N-S
Interpreter: I’ve got K as in Kathleen, I, N-S. Is that N as in Nancy or M as in Mother?
Tanisha: N as in Nancy.
Interpreter (voicing for Deaf patient): So,.. can we go ahead with this appointment? (unintelligible – “I’m fed up with this?”)
Tanisha: If, if that’s what he, I mean if he’s okay with this, until we can get someone here. I-I’m just doing what my director told me.
Interpreter: Can we still get an interpreter to be on the way and use VRI to communicate until the interpreter er.. uh.. until the live interpreter gets here..
Tanisha: Exactly.
Interpreter: It’s already been an hour and a half. So… I’d like to, I would like a live interpreter to come here and uh.. and we’re waiting for an hour and a half. Can you call and request a live interpreter. We need an in-person interpreter.
Other Nurse: [unintelligible]…you can’t be recording.
Cameraperson(?): We are.
Tanisha: You’re going to have to delete that.
Other Nurse: I’m going have to del-
[END OF VIDEO]

Ech.

I have such mixed reactions to these clips.

Legally, both the Deaf man and Daphne from Switched at Birth are in the right. The ADA does mandate accommodations, and there’s probably no other scenario more important than when your life or health is at stake.

Pragmatically… they didn’t really help the hospital find any workable solutions. Honestly, I felt sorry for the nurses in the second video, who genuinely seemed to be doing the best they could with what they had at the time.

But d/hh people shouldn’t have to deal with this!  

You’re right. They shouldn’t have to. In a perfect world, they wouldn’t. But this isn’t a perfect world: internet connections fail; on-site interpreters aren’t available, or take a long time to arrive; the call comes in at 2am; hospitals struggle with budget and staffing limitations.

In all the times that I’ve wound up in the hospital– fortunately none of which were immediately life-threatening– I had an interpreter maybe twice. The on-site one took about an hour to arrive. I didn’t request one; the hospital took the initiative and called one in when I showed up. That is how long it took for him to come in at short notice. The other one was a VRI on an iPad, and that one actually worked really well.

The other times, I either talked directly with the doctors/nurses, or we wrote back and forth. Because English is my native language, I didn’t have any language barriers with the written communication; it just took more time. It wasn’t ideal, but like the doctors and nurses there, I was doing the best with what I had. We all were.

That’s why reactions like these bother me. Sure, they rile people up, but they don’t really change anything about the financial or logistical challenges that institutions face in providing accommodations for deaf and hard of hearing clients, especially last-minute. It’s all complaint and no solution.

Worse, they reinforce some harmful perceptions. First, many d/hh people prefer accommodations other than sign language interpretation. Case in point: I am OK with sign language interpretation for basic conversations, but for in-depth medical explanations, I really prefer exact transcription (and Signed English usually doesn’t really cut it). Moreover, I really don’t want to have to wait an hour for an on-site interpreter to show up when we can have the whole business done in fifteen minutes of writing back and forth.

Second, these reactions can portray a very simplistic, adversarial stereotype of d/hh people as angry, demanding clients– and with the power of the ADA behind them to boot. Yeah, it’ll probably get you accommodations, eventually, but at what price– especially when dealing with institutions that are already overstretched and under-budgeted?

Fundamentally, communication is a two-way street. And no matter which route you go, it’s going to take time, effort, and patience– for everyone involved. This much I can guarantee you, though: being argumentative, confrontational, or otherwise difficult isn’t going to get you a solution any faster– and in some cases, can even impede your communication access.