Deaf patients are too often unable to communicate with doctors or hospital staff because of a lack of translation services — which can be daunting, and frightening, when dealing with medical care and life-and-death situations, according to advocates for the hearing impaired.
The Governor's Office of the Deaf & Hard of Hearing in Maryland is working with hospitals to improve sign language interpreting services and looking at establishing regulations to ensure that only qualified and perhaps licensed interpreters are used.
While federal disability law requires hospitals to provide translation services for people who are deaf and hard of hearing, advocates say the services hospitals provide are sometimes inadequate. They complain that translators are not provided consistently or don't stay through entire visits.
Many hospitals use video services, in which an interpreter is provided through a video-link, much like FaceTime or Skype, but some deaf patients say the systems aren't reliable and calls drop or the screens freeze.
"Communication is very critical so medical providers can understand what patients need and patients can understand what kind of care is being provided to them," said Kelby Brick, who Gov. Larry Hogan appointed as director of the office in July. "Without that information the providers are operating in the dark, and that can have devastating consequences for the patients and increase liability for hospitals."
An estimated 55,000 Marylanders between the ages of 18 and 64 have a hearing disability, according to census estimates complied by the Gallaudet Research Institute. Nationwide, about 2.1 percent of all Americans have a hearing problem, while just under 1 percent are considered deaf.
Their advocates say the deaf persistently encounter difficulty with interpretation in the health care system. The Public Justice Center has launched an investigation into the issue in Maryland after getting some complaints from deaf people.
"I cannot imagine trying to go to a doctor for yourself or your children and not being able to understand what is going on," said Camilla Roberson, a staff attorney with the Public Justice Center. "I just think it's wrong."
The U.S. Department of Justice launched the barrier-free health care initiative in 2012 with the goal of making sure people with disabilities, particularly the deaf and hard of hearing, are provided medical information in a manner understandable to them.
The agency has sued nearly three dozen hospitals, doctor's offices and other medical facilities for failing to accommodate the hard of hearing, but none in Maryland.
Simone Jackson of Forestville alleged in a lawsuit several years ago that Doctors' Community Hospital in Prince George's County used inoperable video conferencing equipment to provide an interpreter remotely or relied on handwritten notes and lip reading. Jackson, who is hospitalized frequently because of complications from sickle cell anemia, said she had to change insurance companies, specialists and hospitals because of the lack of sign language services.
According to court records, the case was settled in 2014. Terms were not disclosed.
Doctor's Community Hospital did not return calls seeking comment.
Michael Pearlman settled a case with Adventist Health Care in 2012, according to court records, after he complained about inadequate interpretation services when he went to the Silver Spring hospital with nausea, dizziness, blurred vision, fever, chills, vomiting and diarrhea. Terms of that settlement also were not disclosed.
The hospital provided an interpreter via video, but it was poor quality, according to his lawsuit. Pearlman alleged he was told a live person would not be provided. After 12 hours, he said he transferred to Johns Hopkins Hospital where an interpreter was provided.
Washington Adventist Hospital officials said they could not discuss individual cases because of privacy laws. The hospital said in a statement that it provides various sign language interpretive services, including video interpretation available via laptop and in-person sign language interpreters. The hospital works with two different contractors.
Advocates say many deaf people might not complain and may use family members as translators or write notes back and forth with the doctors. Neither option is ideal when dealing with complicated and personal medical issues, they said.
"A family member or friend may not know how to explain medical terminology and make sure the right questions get asked," said Caroline Jackson, an attorney with the National Association of the Deaf Law and Advocacy Center.
"It is difficult for people to understand how dehumanizing it is to have people moving in around you poking and prodding without communicating with you," she said.
Laura Miller, a deaf mother of three, said through a translator that she has experienced inadequate translation services at Johns Hopkins Hospital in the past. When she delivered her son two years ago, she said, doctors used a video system. She said it was hard to see the computer screen as she lay on her back during a C-section.
Since then, her son, who is now 2 years old, has undergone several reconstruction surgeries for a cleft palate. On one occasion, she said, a translator left midway through a surgery because she was only paid for two hours. When the doctor arrived after the surgery, Miller said, the doctor gave her a thumbs up to let her know everything was OK.
"That was unacceptable," Miller said. "If your child just went through something so complicated you want to know what happened."
Hopkins officials said they were not aware of problems with their sign language translation services but would look into the issue. If there is no staff interpreter available, the hospital said, it subcontracts to experts.
"Providing a safe and high-quality experience for our patients is always our priority. A critical element in doing so is ensuring clear communication with a patient and his or her family members about the patient's care," the hospital said in a statement. "For this reason, we make every effort to provide medical interpretation services for the deaf and hard-of-hearing patient population.
"We can assure you this is something we take extremely seriously, and we are carefully reviewing all processes in place and vendors on contract to ensure the services we offer meet and exceed legal requirements," the statement continued. "If we need to make changes to ensure our patients and visitors receive optimal care, we will do so."
Other hospitals use a combination of contract interpreters and video remote interpretation.
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Sinai and Northwest Hospitals, both owned by LifeBridge Health, use interpreters from the We Interpret agency. They request interpreters in advance for appointments and call in people for emergency situations.
Greater Baltimore Medical Center uses video and live contracted interpreters.
The hospital "does not utilize our own staff — as we feel this is in the best interest of our patients," said spokesman John Lazarou. "Medical terminology can be very complex and even the most fluent person may not be skilled in medical terminology."
At Mercy Medical Center, video teleconferencing is used in the majority of cases. The services have gotten better over the years because of wireless capabilities, a spokesman said. In circumstances such as baby deliveries or when a video screen is problematic, a live interpreter is used.