Wednesday, January 17, 2007

393: VRI... Sign Language! Access!

This Friday night in NYC my darling Zlotte will be leading a really important discussion at Morton St.:

Important DIRC meeting Friday, January 19th! Your support is needed!

Are you now or have you ever been a patient at Beth Israel Hospital? Did you know that Beth Israel is planning to fire their sign language interpreters and switch to Video Remote Interpreting (VRI) for all their Deaf patients?

How do you feel about using a VRI service during your medical appointments? Are you comfortable working with a TV screen when your doctor asks you how you're feeling? Will you trust the VRI interpreter to understand your sign language and your medical history? Do you want to work with a TV screen when you're getting serious information and instructions about your health?

When Jane Fernandes was hand-picked to be President of Gallaudet University her ASL skills came under discussion repeatedly. Hearing people didn't really understand what the problem with Jane was, and because it was a Deaf university, they pointed to what was different - her use of sign language and her Deafness. It was easier to accept what they already knew to be different as the problem, rather than seeking a true understanding of the issues. It was easier to find a reason to dismiss the concerns of the protest.

VRI (Video Remote Interpreting) uses videoconferencing equipment to present an interpreter on a TV screen. The interpreter is in a different city. When I went to a hospital in Brooklyn one day with a friend and found that they had been using VRI with him, I was curious. I had never seen it before. Another friend is doing a dissertation on the issues surrounding VRI, and I was excited to get my hands dirty, so to speak. My experience was abominable. The hospital staff took an hour to find the equipment, and another hour because "the guy who knows how to hook it up isn't here." The friend understood nothing on the screen, and I wound up having to "deaf interpret" everything. The friend was really frustrated. Why?
  1. He didn't understand a three-dimensional language in two dimensions.
  2. The technology was good, but this portable VRI technology was still not Sorensen - most VRI doesn't seem to be as high quality as what Deaf people use.
  3. They were talking about VERY personal things. Because he'd never met the interpreter before, my friend had no comfort level. Because the interpreter was on TV, he had no way to develop that comfort level.
  4. The terp itself sucked. He had no experience with the hospital staff or with this particular person and no connection to the person's history. In the past I've requested the same interpreter for my medical appointments because it makes things a lot easier when you don't have to take a half hour to teach the terp names for things. That's if the terp ASKS - they may just brave it out and fingerspell stuff, and because you (as a Deaf person) are LOOKING AT THE TV SCREEN you don't have an opportunity to try to lipread the doctor and suss out if the terp is correct.
  5. The terp didn't understand the patient. He was apparently from Minnesota, and didn't understand the NYC dialect of ASL. (There's correlations to this in spoken language - interpreters do not always understand spoken variation.)
  6. Erfo wants me to add that the Doctor was standing BEHIND the patient at this point and prattling on, then left the room. With no visual or audio connection to the patient, they had no reason to bring out their bedside manners.
"But he has sign language!" cried the hospital staff, three hours after we started, when the client's 15-minute appointment was completed. "That's access! You can't complain!" But we did complain, and legally: it's the hospital's responsibility to match the needs of the patient, not focus so hard on finding ways to save money that they reduce the quality of their own service. When I was a youngster in the NYC public school system, the school was frustrated with the cost, and to save money once gave me an interpreter - who sat down in my French class and began speaking Italian.

I imagine that's how many hearing people felt about the Gallaudet protest. And like the Gallaudet protest, the underlying problems are very similar. But like the advertisement for the meeting on Friday states, do you feel comfortable telling a TV screen about your health? The most effective health care for Deaf people comes about when Deaf people's self-expressed boundaries, in terms of communication, are established and respected. VRI was initially created as a means of providing access to people in remote areas where there are few or no terps - not to become standard in big cities where hospitals have STAFF who are interpreters. It's expensive, in terms of money but especially time (there were four hospital staff standing around for an hour trying to hook up the television - certainly their time cost more than the interpreter!)

God. One day you KNOW some nurse is going to show up saying "Sorry, we couldn't find the terp, the television, or anything else, but... we did find this!" And when she pulls the signing puppet bear from behind her back and we complain, they'll say, hey, it's sign language: it's access... (Yeah, and they speak English on subway car announcements. Sure.)

Let me close on a personal note. The other week in Florida I was walking with my father on the side of the road. I asked if we could switch sides; he was puzzled and frustrated, but agreed. I noticed his frustration and asked if he understood why I wanted to move - he said yes, because we were now walking on the left side of the road, into oncoming traffic! I explained that as a Deaf person I could see traffic in front of me, but not hear it behind me, so I'd rather walk on this side so I could protect myself. His eyes cleared and he understood. (Then we got into an argument about why I had to be so bloody independent. But that's another story.)


Anonymous said...

Joe, What the hospital proposes to do counteracts the decison by Dept of Justice at my group civil right lawsuit against Laurel Regional Hospital. I suggest you to share this decree from DOJ( with the hospital lawyer and the deaf advocacy group. DOJ discovered that the VRI has limitations and doesn't migitate the disability of the person. Therefore Hospitals can no longer force VRI on deaf patients against their wishes legally.

Please do let me know what happens next. :)


JRS said...

Thank you for the link! It's information I can use in my own advocacy. However, I don't know if a case tried in the DOJ in the state of Maryland is still valid in the state of New York.

I asked the doctor if he would be willing to get health information from some television people didn't know how to set up. I think he took the point. Right now they are looking to go back to the live terp.... but I see cases like this every day. The problem is for Deaf people who are prisoners or in hospital, they don't have a lot of time or strength to go through these legal battles... sigh

Anonymous said...

I am supposed to use VRI when I begin student teaching at a high school this semester. Technology and bureaucracy issues keep on popping up, however, and I already am delayed. It is a last resort because the area I live in has a severe shortage of terps. I am kind of excited to try out the new technology, though.

Incidentally, in the examples I have watched of how VRI works, the screen is placed between the deaf person and the hearing person in such a way that the deaf person can view both the terp and the hearing person. I am not sure how that will work in my situation. If you like, I can keep you posted.

There ARE medical situations when one would probably prefer a stranger. If you live in a small population, you might not want a terp you know. Think psychotherapy.


JRS said...

Hi Belle - Thanks for your response! Do keep me posted - we can't erase our problems if we don't communicate our solutions! Grin. Yes, technically the tv screen is supposed to be "between the Deaf person and the hearing person." In reality this is bull - you have cables and wires and plugs behind the tv, you know? It's not realistic, especially in a medical setting (think about how drs offices are constructed.)

I work in a mental health clinic and our philosophy is that interpreters are not conducive to a counselling/psychotherapy process because they come between the connection the client has with the therapist. New Yorkers are lucky: there have to be all of 8 or 9 counselors/therapists who can use ASL. Other places, not so fortunate.

Hope to hear back from u soon -

Kate O. Breen said...

there are parts of NYC population that isn't so "small world" with interpreters and couldn't care less. deaf patients with multiple developmental delay and mental ill diagnoses will not benefit from VRI. especially those who are autistic and cannot connect with those on tv.

most facilities have one tv (witin 9 floors) and it's a huge drag. one of my staff and consumers often has to wait three hours for a 20 minute appointment. because someone else is using the tv for something else!

Todd said...

Thanks for pointing out the technical difficulties in using VRI services in medical settings. However, I suspect that ever-advancing technology will eventually make VRI services easier and more comfortable to use.

However, keep in mind that the ADA requires a 'floor' in accommodating individuals with disabilities. Hate to play a devil's advocate here, but where in the ADA does it allow a Deaf user to have the best possible accommodation?

If someone was serious, this issue could be litigated in favor of public places, as they are only required to make an individualized inquiry and contract for a *reasonable* accommodation. That could very well turn up to be VRI offerings, not on-site ASL interpreting.

That all said, I think VRI interpreting is the future; it allocates scarce resources for the Deaf community's benefit. The more companies that join the VRI trend, the more critical ASL interpreting services can be offered to the general public.

Anonymous said...

Joseph, sorry for the delay in responding. Since Dept of Justice is federal, their content decree in my landmark case applies to all states, including New York. This case is viewed as a model where all hospitals must follow.

If you have problems with the hospital's complaince with the content decree, let me know and I can get you in contact with the Dept of Justice lawyers who handled my case. They are absolutely wonderful people! :)

Breenie, the facilities also violate the law if they are using just one VRI. They must provide more VRI if it has been proved that one VRI isn't sufficient, according to ADA.


Anonymous said...

Todd, in my 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


JRS said...

Mishka, please email me the contact information. We need this to stop the firing of an entire staff of interpreters-they have already fired the CDI in the hospital.

Anonymous said...

Thanks for blogging about these important issues. Here in the UK, they keep trying to foist computer generated 'avatars' on us for things like doctors appointments.

One comment:

'The friend understood nothing on the screen, and I wound up having to "deaf interpret" everything.'

You mean 'relay interpret'? It's a growing field in the UK and many deaf are becoming professionally qualified relay interpreters, with full membership of the association of interpreters etc.

Maybe it's cos we have more immigrants, with different sign backgrounds and/or low level sign skills. A hearing terp just can't understand them, but deafs can, hence the use of relay terping for medical consultations, advocacy etc.

Anonymous said...

Let's take these objections in order.
1. He didn't understand a 3 dimensional language in 2 dimensions, does he use VRS? If so there is no difference. This is an old argument basically nullified to nothing due to the popularity and spead of VRS throughout the deaf community.

2. Didn't like the equipment, well my doctor uses a automatic blood pressure cuff, even though I know the hand pump cuff works better, but true difference in service? No. Same thing here. You can always suggest they look at better equipment to improve the quality of the video, but it could also be the internet is overloaded in the hospital or other things effecting picture quality.

3. The world of the personal interpreter is going by the wayside, interpreter shortages, VRS and other things make getting the same interpreter consistently difficult so the ability to communicate with a variety of interpreters is no different than having re-explain everything from the beginning with a new doctor, with a specialist or with a sub doctur or an emergency room doctor. It isn't the intepreters job to hold all that information.

4. The terp sucked, guess what that happens with onsite interpreters all the time, has nothing to do with VRI. That is just a problem with the interpreting.

5. See number 4,same issue. Same thing happens with VRS as well.

6. Be assertive and explain that you would like to see the doctor and the interpreter at the same time. The doctor's lack of manners has nothing to do with VRI either. Many doctors do very well with VRI and are very sensitive to the needs over this new medium.

In short, the ADA obligates the hospital to ensure effective
communication. That is all. You will not find language in the ADA
statute or regulations that say, "people who are deaf have the right to an interpreter", what you find is that businesses must "ensure effective communication." If effective communication can be achieved with the video interpreter the hospital has satisfied their job... if it cannot, then the hospital has not done their job.
Remember that refusal to try VRI or whatever the proposed accommodation is on the deaf person's part won't get you anything in a court of law as the hospital made a "good faith" effort and you were the one that refused to participate in the process.

I think that painting all VRI as worthless because of 1 or 2 bad experiences is ridiculous. It is a new way of providing service and it will improve just as TTYs did, just as VRS did, just as sidekicks did. Patience and being part of the improvement is the way to go, not bashing it since it isn't going away.

JRS said...

But nobody's painting it as worthless!

However, it's not useful for the group of people we're discussing.

If effective communication HASN'T been achieved, especially for mentally or physically ill Deaf people, we have a right to speak up - since those people often can't. We have to educate the hospital and explain why their effort may have been in good faith, but was completely useless.

For example. #1. Most of the arguments about this come from visually impaired Deaf people, and Deafblind or functionally Deafblind people.

2. Yes, we are arguing there is a true difference in service. Comprehension and ability to communicate is severely minimized.

3. I agree with you about this. TO have to do it SEVERAL TIMES during the SAME SESSION with the SAME DOCTOR is ridiculous, however.

4. But if the Dr. can't tell the terp sucked because they're so happy about the good faith effort, whose responsibility is it to evaluate the terp? The sick patient who doesn't know medical terminology? Sounds like a good way to let Deaf people get ripped off to me.

5. Yes, but with a live interpreter, it's more likely to get someone who knows the local dialect.

6. How can the patient make this assertation without an interpreter?

Whether you want to admit it or not, the interpreter has also gotten the role of communication support and advocate. It's clear that if the interpreter is not there, they cannot fulfill this role. This is fine if the patient is fully capable and able to advocate and evaluate for themsevles - but not if it is otherwise. That's the bottom line, and that's ALL we've been saying here.