Julie Hay arrived at the emergency department of the University of Vermont Medical Center in Burlington just before midnight on July 15, 2015.
Hay, who was 50 at the time, had just experienced a heart attack. When she arrived in the emergency department, she was upset, found the environment overwhelming, and had difficulty communicating.
While Hay has a host of conditions that complicate her health care — high blood pressure, Parkinson’s disease, migraines, thyroid problems, stomach pain and schizophrenia — her biggest limitation in getting care was the fact that she was born deaf.
Within an hour of arriving in the emergency department, Hay was admitted into the UVM Medical Center, where she stayed for three days. She had not discussed the admission with an in-person interpreter, and during the whole time she was there, she spent a total of 22 minutes signing with a remote interpreter through Skype-like technology, according to findings by the Vermont Human Rights Commission.
Both Hay and her son asked for an in-person interpreter throughout her stay, but she never got one — despite the fact that the hospital had a translation coordinator on staff whose job includes American Sign Language interpretation.
Hay later had a procedure, and the doctor who performed it could not verify to state officials whether she had given informed consent, according to a decision from the Human Rights Commission.
In May, the commission declared unanimously that Hay has the legal grounds to pursue a discrimination case, and that staff at the UVM Medical Center had merely “a surface-level understanding of deaf people and deaf culture.”
The hospital told VTDigger that it did not provide adequate services to Hay, has made efforts to improve its overall treatment of deaf patients, and has tried to settle with Hay and her lawyer, with no success.
“We agree that we did not provide this patient with the quality of communication that she should have received, and that we strive to achieve,” Michael Carrese, the hospital’s spokesperson, said in a statement. “We have apologized to her for that shortcoming.”
“We took this as a learning opportunity, and have strengthened our translation services in a number of ways,” Carrese said.
Nonetheless, Hay’s lawyer said she’s afraid to go back to the hospital.
Seven cases since 2010
For Barbara Prine, the disability lawyer with Vermont Legal Aid who represented Hay, the case was all too familiar.
Since 2010, Prine has personally worked with five deaf patients, including Hay, to lodge seven separate discrimination complaints against UVM Medical Center.
The hospital settled several of those cases before officials started investigations. Hay has not agreed to settle her case, and Prine is now working on a new case with the Vermont Human Rights Commission.
In several of the cases, Prine said, the hospital gave deaf patients access to a remote interpreter through a device similar to an iPad, and using video technology similar to Skype, but the device often doesn’t work or takes too long for staff to turn on.
“Each one of these complainants wanted an in-person interpreter, and instead they got a machine that didn’t work,” she said.
Prine said the patients should be given in-person interpreters to discuss procedures, medical complaints and consent for care. The hospital should only use remote interpreters over the Internet when nurses check in briefly with a patient who has already met with an in-person interpreter.
“Sign language is a three-dimensional language, so it doesn’t play well on a screen,” Prine said. “It just is never going to work as well on a screen. If you’re having a conversation about someone’s condition, you’re getting informed consent for a procedure, you need an in-person interpreter.”
Ed Paquin, the executive director of Disability Rights Vermont, agrees. Although he has had no involvement in these cases, he said the basic idea of a deaf person having a “reasonable accommodation” in the form of in-person interpretation in the hospital is a no-brainer.
“The medical setting really is one in which an accommodation should involve very good, clear communication in the language that the patient is most comfortable with, and if that means an American Sign Language interpreter, that’s what should happen,” Paquin said.
“As a reasonable accommodation, you may not expect to have someone there around the clock if someone is there in an inpatient setting, but having an interpreter so the communication is direct is especially important,” he said.
Prine started filing legal complaints in 2010 with the Vermont Human Rights Commission, a small state agency that seeks to protect people from unlawful discrimination.
The five-person commission has just a handful of staff members but performs legal investigations to inform people whether they have “reasonable grounds” to pursue action under Vermont’s Fair Housing and Public Accommodations Act.
When the situation didn’t improve, Prine said, she asked the U.S. Justice Department to take on two cases under the federal Americans With Disabilities Act. The problem continues, she said, and she has since gone back to the Human Rights Commission with complaints.
“I’m just trying to use every avenue at my disposal, with Legal Aid’s limited resources, to fix this problem,” she said.
The Justice Department continues to investigate at least one of the cases, Prine said. However, a spokesperson for the U.S. attorney’s office for the District of Vermont declined to comment to VTDigger on whether an investigation exists.
Prine said the hospital has violated both the ADA and the state’s Public Accommodations Act, which she said both require that deaf people “get equally effective communication” as people without a hearing disability.
“None of these people got equally effective communication,” Prine said. “None of these people got anything close to equally effective communication. They basically didn’t get communication when other people did.”
The hospital hired a full-time translation services coordinator in early 2015, who is also a certified American Sign Language interpreter, according to Carrese. The coordinator brings in contract interpreters to “help achieve the goal of 24/7 coverage,” he said, but the hospital does not have enough demand for services to hire a second employee in addition to the coordinator.
Meet George Lareau
George Lareau, another of Prine’s clients, has been the plaintiff in three separate legal complaints that Prine filed about the UVM Medical Center. Each reported more than one incident at the hospital.
Lareau, 50, has complained about the communication he received both as a patient in the emergency department and as the primary caretaker for his elderly father, whom he lives with and regularly accompanies to the hospital.
“I’ve been really frustrated,” Lareau said, speaking through an American Sign Language interpreter. “I feel like the hospital treats me like a third-class citizen, like I’m definitely not on par with other patients that they deal with, people that they deal with.”
As a deaf person, Lareau said he experiences discrimination all the time in restaurants and stores, but that the situation is different when he goes to the hospital, where his or his father’s life is on the line.
“There are a lot of things I get used to as a deaf person, and, those things, I actually don’t let them bother me at all. I just move my business elsewhere,” he said. “But not a hospital. You can’t do that at a hospital.”
In the fall of 2010, Lareau went to the UVM Medical Center’s emergency department with a blood clot in his upper arm and then to a follow-up appointment. Lareau said he requested an in-person interpreter. Instead, he said, the hospital gave him access to remote video technology called DeafTalk, but the nurses had a difficult time getting the machine to work.
Because of interpretation issues, Lareau said, he waited six hours for treatment and an emergency room visit that should have taken an hour or two became an overnight stay. “Really that was a huge waste of my day, my time,” Lareau said.
A few months later when Lareau went for a follow-up appointment, he said, the hospital again gave him DeafTalk, and the doctor “struggled and struggled” for “at least an hour” to try to get it to work.
When the machine was working, Lareau said, another staff member came in to remove it for another deaf patient. “I don’t know how many (machines) they had, but they needed the same one for someone else,” Lareau said.
In 2013, after fracturing his arm in a motorcycle accident, he was taken to the hospital in an ambulance. He asked the emergency medical technician for an American Sign Language interpreter.
Instead, Lareau said, a nurse in the emergency room gave him an iPad with a remote interpreter and asked him to hold up the iPad with the injured arm, which was bleeding.
“I actually had a hairline fracture, and so I’m holding it with the arm that I have a hairline fracture and trying to sign with my other arm,” Lareau said. “And the interpreter’s saying, ‘Are you OK? I feel bad for you that you have to hold that screen.’”
So why didn’t the nurse hold up the iPad for him?
“That’s a very good question,” Lareau said. “I was really angry about that because I was in pain while this was happening. I was really pretty badly hurt in this motorcycle accident, and I just sucked it up.”
In April — while Prine said the UVM Medical Center’s legal team was involved in Hay’s case before the Human Rights Commission — Lareau said he experienced two more issues with interpretation while accompanying his father to the hospital.
“As his son, as a family member, the law protects me to have communication under the Americans With Disabilities Act,” Lareau said. However, he said he had become accustomed to nurses telling him, “I will, I will, I will” when he asks for an interpreter.
This time, Lareau said, he did two things to get interpretation: He asked the nurse directly, and he text messaged the hospital’s translation services coordinator, Lynette Reep, who is also a certified American Sign Language interpreter.
Lareau said the nurses spent 30 to 45 minutes trying to find an interpretation machine and then getting it to work before Reep showed up.
Later in April, Lareau said, he went to take his father home from the hospital after an inpatient stay. Lareau needed an interpreter to help with discharge instructions.
Lareau said he called in advance and asked for an interpreter, and his sister also called. Upon arriving at the hospital, Lareau said, there was no interpreter, so he continued to ask for one and look for the remote interpreter machine.
Lareau said the nurses struggled to find the machine and that when the nurses found it hours later, the doctor had already gone to see another patient, so Lareau had to wait.
Later, when the doctor was available to speak with Lareau — who had the remote video interpretation machine turned on — he discovered the machine’s screen was pixelating, so he was not able to see the interpreter.
“I was catching bits of information but not the whole message,” Lareau said. “The screen was so pixelated, and the pixelation would go on and off, so the signing would kind of distort and move. I wasn’t receiving the interpreter’s message because of the pixelation.”
He said, “It’s really bullshit to be going around in circles all the time with regard to direct services, direct communication.”
New interpreter policy based on 2011 case
In the Hay decision, the hospital adopted a policy that cited reasons for providing patients with an interpreter.
That policy, however, did not say patients could have access to interpreters if it is their preference, according to the commission, or that they could get interpreters if they were getting news of a sensitive nature.
The hospital then updated its interpreter policy in 2016, according to the commission, removing all the specific reasons staff should give patients an interpreter and instead providing a one-paragraph summary.
“When feasible, individuals who prefer in-person interpreters should contact the hospital directly before leaving home or while en route to the Emergency Department to enable staff to try and provide coverage,” the policy reads, according to the commission.
The commission wrote: “In short, (the UVM Medical Center) placed the burden on the patient to directly contact the hospital, in advance, for a live interpreter.”
According to Prine, hospital officials said they would change the policy after the Lareau settlement in 2011. At some point since, “they reverted to bad policy,” Prine said.
Carrese, the spokesperson for the hospital, said in an email: “We review and revise our policies and procedures every two years according to changes in best practices, technology and other factors.”
A long-term solution?
Carrese said the hospital’s translation services coordinator is responsible for “responding to the immediate needs of deaf patients, including training our providers and members to better serve those patients.”
Additionally, he said the hospital has “strengthened” its relation with American Sign Language interpreters, trained 1,200 staff members on language access services for patients, and will “continue to seek out opportunities to strengthen our translation services and our internal policies regarding the treatment of deaf patients.”
Prine said the hospital should have solved the problem after she filed her second complaint. “You complain, they try to fix it,” she said. After receiving the second complaint, “then they should know they have a real problem.”
Prine said the most effective solution is for the hospital to pay American Sign Language interpreters. Local interpreters are cheaper, more reliable and more effective than the technology UVM Medical Center has tried over the years.
Prine then referred to the live American Sign Language interpreter who was facilitating the interview between Lareau and VTDigger. “Joan’s not pixelating,” Prine said. “She’s not. Joan’s screen is good.”
Lareau said the hospital needs to improve its Wi-Fi signal so that machines don’t pixelate while in use. He also said the hospital should have a single Wi-Fi network throughout the hospital so a user doesn’t have to connect to different networks and reboot the machines when moving to different areas of the hospital.
In the short term, Lareau said he has become comfortable sending text messages to American Sign Language interpreters to help him in the hospital.
For any other deaf people who experiences the same issue, he has another solution: “I think that they should be in touch with Barb because she’s really there ready to fight for us.”
But for Hay, who spent three days at the hospital in 2015 and received only 22 minutes of remote interpretation, that advice may have come too late, according to Prine.
“Her feeling is, ‘I’m afraid to go back to that hospital because they’re not going to tell me what’s wrong with me,’” Prine said.