Sunday, January 21, 2007

394: VRI at Beth Israel: the plot thickens

When interpreters at Beth Israel Medical Center were told they would be replaced with televisions, their responses were incredulous. So too were the responses of Deaf community members at the New York City DIRC meeting on Friday, January 19th, 2007. They claim that Video Relay Interpreting (VRI) systems are meant for emergencies, situations where no live ASL interpreter is available to provide the best mutual access for doctors and patients in the medical care system. So why would Beth Israel suddenly start telling people to watch TV for information?

Follow the money. American Sign Language interpreters are highly skilled hearing and Deaf individuals who interpret between ASL, a manually-expressed language, and spoken English to allow the two groups to communicate. Furthering their value is the fact that they can often communicate with a variety of individuals, from the mentally ill to the genius. Combine this with their rarity - reports claim over 30 per cent of requests for interpreters go unfulfilled in New York State - and you have an expensive commodity. Beth Israel Medical Center has recently come under new leadership, and one of their first steps is... to cut costs, especially in light of State-sponsored budget cuts to hospitals around New York. The plan is to cut the live interpreting staff and replace these with video-conferencing equipment which allows a person at a remote location to video-conference and interpret for the patient. VRI is cheaper in that they charge by the minute, rather than by the hour, something billed as a great savings for the hospital. (In my view this is short-sighted; clients given inadequate information require more visits and more time and money from the hospital.)

The head that takes the blow - this particular part of the blow - is the Deaf community. Beth Israel is not only in close proximity to a residence dedicated to Deaf individuals, it's also possessor of a pioneering interpreting team which drew patients from all over the city. This may now be gone. Worse, the video-conferencing system known as VRI (video relay interpreting) is woefully unequal in terms of access (see my previous blog on the subject here.) And, too, a large percentage of New York's mentally ill Deaf population receive services at Beth Israel, due to their sterling interpreting staff (read about the importance of language to the mentally ill Deaf population here.) So it's no surprise that over 200 Deaf, hard of hearing, and deafblind people gathered for an impromptu meeting to discuss the issues, led by Deaf community leaders who called for calm action. Their options were discussed. There was no community representative from BIMC available, although the meeting had been advertised for days.

But what we didn't know at the time of the meeting is that the actions of Beth Israel may be in violation of the law. What's ironic is that Beth Israel may not be aware of it either. Reader-and fellow blogger-MishkaZena reports that a landmark Department of Justice case previously thought to apply only in Maryland, the state in which it was decided, in reality is effective in all states; a link to the decision is here, and her blog about it is here. She comments:
Since the Dept. of Justice is federal, their content decree in [this] landmark case applies to all states, including New York. This case is viewed as a model where all hospitals must follow.
What were some of the specific issues of unequal access pointed out by the decision? MishkaZena continues:
in the landmark case, Dept. of Justice had deemed that the VRI may not be the best appropriate choice for the deaf, contrary to the hospital's insistence it is. Some deaf people are too sick or too incapicated to use VRI. VRI cannot be taken to other rooms, like prep rooms, surgery rooms, CAT Scan rooms, etc, so it has its own limitations, unlike a live interpreter who can accompany the deaf person to different rooms.
One interpreter spoke about a client who was woozy. She, being the one who could communicate to the person, had to keep them awake if they were to live. Doctors could not get them to talk. Could a television?

The goal of the Deaf community is to ensure that when we need health care, information is being relayed by qualified individuals. Televisions have no bedside manner - and the VRI system was never intended to be used except in other than an emergency situation where a live interpreter could not arrive in time; indeed the DOJ decision which MishkaZena describes specifically states that is the best use of VRI. Some of the stories of VRI experiences I witnessed at DIRC were highly disturbing. I want to close with a story one interpreter told which stunned me, but may help explain why Deaf people like real, live, heart-beating interpreters. Here's the story as best as I can remember it:
I worked with a client who had cancer. The client had been going to the doctor for several years and believed she was going to be well. The doctors knew she was going to die, but they had been keeping this information from her for several years out of fear of how she would react. One day she asked me to explain something when the doctor was out of the room, and... I ended up explaining that she was going to die. The client got very upset and started to interrogate the doctor, who attacked the interpreter. Now this client had a daughter in another country. She kept telling the daughter to wait till she was healthy again before visiting. But once she knew the truth she asked her daughter to come immediately, and they were able to say goodbye before she died.
This kind of intervention, which gave the client information she could not hear but should have had access too, is not possible with VRI. Doctors sometimes have low opinions of Deaf people, possibly reinforced by certain traditions in medicine; they see the problem, not the person. My friend Butterfly (name changed to protect the innocent!) told me once how as a medical student she witnessed another student stand up and ask their teacher if Deaf people could think. Interpreters have often been the cultural link which helps people get over their personal issues about deafness and connect with Deaf people. Should this link go.... what might not happen?

And televisions have no bedside manner. They may be cheaper, but you get what you pay for. To be continued...

ADDENDUM: Deaf blogger Ridor describes his own experience with VRI here.

ADDENDUM: What should you do if you're concerned about these issues? My primary concern is EDUCATION. Sick people aren't always good at advocating for themselves. Have you experienced VRI? Share your experience and your story. Help further the discussion.


Anonymous said...

I went to DIRC meeting. I was turned off by staff interpreters at Beth Israel Medical Center. They wanted to use Deaf community in order to protest for staff interpreters to keep their jobs.

If a client requests for a live interpreter, she/he will be provided by a free lance interpreter or agency.

These staff interpreters are the ones who need to protest because they wanted to save their permanent job. Beth Israel Medical Center cut many programs. It is not only staff interpreters.

Please don't use us to make us look like we are a major of Deaf whiners who demands everything all the times.

There were not even 200 Deaf people in the meeting. I saw many interperters, but not many Deaf people.

Look at Empire State Association of the Deaf (ESAD). It has been dead about four years. One of the speaker tried to preach us while he should be focus on ESAD to rebuild and become more stronger. So they can provide a better service for Deaf community.

Joseph Rainmound said...

That's a really cheap shot. I know some of these interpreters. They've volunteered time to the Deaf community. And they will easily get work at any of the other agencies, because there is a shortage of interpreters in the country.

Can't you see that by firing staff interpreters and paying for the installation of this equipment, they create a bias towards using that equipment?

Can't you see that some people can't advocate for themselves - but still need equal services?

Can't you see that we need to advise them in order to help them provide us with good services? You say we need to "not look like a major of Deaf whiners." Fine, but I'm not whining. I'm EXPLAINING to people what the best way to provide services to Deaf people are. Like an adult explains to another adult what they need. I pay for services - don't you? I have a job - I pay taxes - do you? I deserve equal access - and so does any Deaf or hard of hearing citizen in this country.

There are many, many reports of equal or worse delays in using VRI than there are for "live" interpreters. "Instant interpreting" is basically the only positive argument they have for this service with the Deaf community. If it takes just as long to plug in the television - what benefit do we get from this?

You're entitled to your own opinion but you know what, I was there, and I reported. You don't even post your name.

Anonymous said...

Joseph is providing a valuable service. I know for many deaf people VRI wasn't appropriate and I am sorry nobody stood up for us at my local hospital. Had they done that, our rights wouldn't have been so flagrantly violated and a lawsuit not needed.

Kudos to you, Joseph for fighting for the civil rights of the local deaf people.


Anonymous said...

We already got a studio in our office good to set up a VRI service. We're still working out the kinks and bugs and we could establish our VRI services at all the hospitals that already contract our interpreting services.

Richard Roehm

Aidan Mack said...

I understand good intention of Joseph hosting DIRC and spread out the awareness about firing these staff interpreters. They will be replaced to VRI. I think he did a wonderful job even though he spent a lot of time with his pager during the meeting... :o)

I understand that Deaf people with mentality challenged, passive personality, and Visual Sign Language wouldn’t be able to speak out.

I understand that Deaf people with limited vision would have a problem seeing VRI.

But with the protest, I have to reconsider. I strongly believe that Protest should be the last resource if there is nothing else could be worked.

I am sure there is agency in NYC that has some kind of advocacy department to help them out. In California, GLAD has an advocacy department to assist these Deaf people.

At CSUN, Deaf people and interpreters from all over LA spoke out how they felt about VRI on videotape and sent it to Governor.

I also suggest you to contact Bronx Hospital. A group of deaf people who resides in Bronx sued hospital. In order to avoid to get sue, the hospital had to follow the agreement and they would be watched for a long long time. They even hire staff interpreters. It worked.

I will find a person's name and address for you. She works there to make sure hospital to follow the law of ADA and other laws. She is interpreter herself. (ASL/Spanish interpreter)

I suggest you to contact Office with Disabilities at Gallaudet and see what are their suggestions. Share this information with Helen Keller School for Deaf.

The independent living counselors write reports about their frustrations with VRI. They also can write their concerns on letters to President since they are the primary clients’ caregivers.

In closure, talking about the issues at DIRC meeting was a great idea and a great way to start. …But

I don’t believe that we should start with protest first. Find different ways how to approach this situation about Beth Israel Hospital. If there are nothing else we can do, then we can welcome the idea of protest.

Aidan Mack

Anonymous said...

Joseph, give the copy of DOJ content decree to the hospital attorneys. They will then advise the hospital of their legal obligations.


Anonymous said...

ask vri to touch a person who is in a coma... umm that would be interesting to watch... or a psychotic Deaf patient to calm down... keep their attention to the doctor and vri..

I'd buy a extra large popcorn and just let them do their stuff and more lawsuit to come...

sorry but it is true our rights are becoming less and less we need some one strong to fight against this... Deaf Pesident of United State heck why not!!

Jules said...

I would be concerned too if the hospital sees the VRI as the absolute solution instead of getting an interpreter for patients. I have seen so often incidents (Gods know I have been in the ER so often that doctors and nurses started to recognize me and go "Hi, Jules, You in trouble or with someone today?") that if there was no interpreter, the mental ill client would become anxious and frustrated. I have seen how two incidents with a VRI had worsened it for my clients. Repeatedly, I had to jump in and interpret for them when the clients looked at me and asked for help with talking with the VRI. There is no "humane interaction" between the VRI and the patient. I still remember one client of mine told me after she got out of the hospital (where VRI was provided) that she felt like she was in a warehouse, being checked around, packed and then sent out. Interpreters in person treat patients like human beings and can even pick up 'sensations' of what the person may feel yet not say. Could the interpreters at VRI do that? I hugely doubt it.


Charlotte said...

to anonymous -

I am genuninely concerned for the clients that are in my program - they have multiple issues (mental health, ability to understand and receive information), and VRI has to be the option to use when every other form of communication (especially looking for a live interpreter) is exhausted. Because these individuals do not have the skills to advocate for themselves, should we just fuck them and tell them to shut up and stop complaining? Should we stop advocating for them? I can understand why you felt that people were "whining" - my perspective was that they were expressing frustrations in an appropriate forum and figuring out how to address these issues and find appropriate resources. I'm not sure what you are suggesting - that we just just ignore a large part of the deaf community because it is fine for many of us? A large part that cannot advocate for themselves - they try to, they want to, but they do not know how and need the support from us.

Aidan - I can't agree more with you more - a protest is the last resort solution. We need to make noises - contacting DOJ lawyers, other resources, contacting the president and the patient representative at Beth Israel. I think the point of the protest was rasied to get a pulse of how strong / how intense this issue is to the community. Naturally, I hope that the core group would go through appropriate steps; contacting and requesting meetings with the president / the powers that may be, and then go from there to see what their reactions are.

breenie said...

like Charlotte, I work with the similar population who cannot advocate for themselves. I was at the meeting myself and it is a good time to start some kind of intervention before they do further damage in May.