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.