“Don’t You Know How to Sign?”

Sign Language Interpreters in the Medical Setting


By Kris Flott, Parent/President, Nebraska Hands & Voices

As the parent of a deaf child, it is always a bonus to go to an event with an interpreter.  While I have no problem stepping up and interpreting for my child, whether it is at a family party, for his cousin, at the movies, or at a sporting event; it’s nice to sit back and be “just mom;” however, in a medical situation, it is vital to be “just mom.”    

Again and again, I get the question, “Don’t you know how to sign?” ...
... I’ve learned to stand up for myself and my son.

My first experience requesting a sign language interpreter for a medical visit was when my son, Thomas, (now 17) was about ten years old.  We were referred to a specialist to deal with a possible vision issue.  Since we would be dealing with complex medical information, and I needed to concentrate on comprehending what the doctor recommended and not so much on explaining to Thomas what was being said, I called the office and made the appointment.  My request for an interpreter was immediately met with resistance.  The medical staff didn’t feel that they had to provide an interpreter for me. I got a question that I would get used to hearing over the years:  “Don’t you know how to sign?” After calls to the Nebraska Commission for the Deaf and Hard of Hearing (NDCHH) and to a few friends for advice, I got an interpreter.  A few weeks later, I also got a bill from that doctor’s office for the cost of that interpreter. The doctor’s office eventually paid for the interpreter, and I later got a referral to a different specialist. I didn’t feel that office had our best interests in mind.

Unfortunately, over the years, we have seen and dealt with many more medical clinics and hospitals. As Thomas got older, it became even more important to have an interpreter present for both Thomas, myself and my husband.  Most medical providers have policies that include their responsibility to provide an interpreter, and many large hospitals and clinics have staff that coordinate sign language interpreters and Spanish or other foreign language translation for patients and families.  One facility I work with sets up interpreters through their social work department; one has a specific interpreter services department, and another calls it the ‘language access department.’  While these services are, in theory, available from the facility as a whole, that doesn’t mean that staff of a specific clinic or department fully know and understand their responsibility when patients and their families make requests for sign language interpreters.  Again and again, I get the question, “Don’t you know how to sign?”  I’ve had to educate myself to become familiar with the different departments and procedures in place, so that I can educate the staff of the clinics we visit. I’ve learned that it is okay to complain and be demanding when needed. I’ve learned to stand up for myself and my son.

According to the U.S. Department of Justice, Civil Rights Division, Disability Rights Section, the Americans with Disabilities Act (ADA) is a law that prohibits discrimination against people with disabilities, including people who are deaf or hard of hearing. There are four sections in the law: employment, government, public accommodations, and telecommunications. Each section of the ADA lists services that should be provided for deaf individuals. Hospitals are covered under Section 504 of the 1973 act, and under Titles II and III of the ADA. Under the ADA, hospitals must provide effective means of communication for patients, family members, and hospital visitors who are deaf or hard of hearing. The ADA applies to all hospital programs and services, such as emergency room care, inpatient and outpatient services, surgery, clinics, educational classes, and cafeteria and gift shop services. Hospital staff is obligated to provide effective communication. Written notes may be considered effective communication for brief, simple issues. However, for more complicated and interactive issues that would require full and direct communication, such as a patient’s discussion of symptoms with medical personnel, or a physician’s presentation of diagnosis and treatment options to patients or family members, a written note would not be considered effective communication. 

I’ve had many discussions with interpreters over the past year about my difficulties and have learned that I am not alone. One story I heard was about a deaf adult who spent several weeks in the hospital before an interpreter was requested. A staff member requested an interpreter because she could see that the doctors were having difficulty treating the patient; he was just not getting better. The interpreter went in and educated both the patient about his rights as a deaf individual and the medical staff on their responsibility to provide communication. There was an obvious communication breakdown because the patient had been in the hospital for a significant amount of time and was not recovering.  

While I am not endorsing taking legal action every time there is a problem, I would encourage parents to educate themselves about this process. Knowing your child’s rights and knowing your rights gives you the ability to advocate for your child and for yourself.  There is case law that supports these rights.  One example is a 2001 New Jersey appeals court decision in Borngesser v. Jersey Shore Medical Center. This case has served as a state and national precedent, and was among the first to define ‘effective communication’.  Judges ruled that effective communication was essential during "critical" points of the patient's treatment -- aspects that involve significant procedures, consent, diagnoses or treatment options -- and that the efficacy of the communication method chosen had to be viewed from the patient's perspective. In that case, the patient was hospitalized after complications arose from an abnormally rapid heartbeat, during which time the hospital declined her requests for a sign language interpreter. The hospital was found liable for disability discrimination. 

My son recently spent three days in the hospital following surgery and I requested an interpreter for the pre-op visit, the day of surgery, for all doctor visits, nursing shift changes and dismissal.  While it is difficult to have someone there for every little thing, these are important events during a hospital stay that you need to be “mom” or “dad” and not the interpreter.  An interpreter is really not needed for the nurse when she comes in every two hours to take a temperature and blood pressure.  I acted as interpreter during the night for Thomas, and when we had physical therapy and went to x-ray.  I felt that I was getting interpreter services when they were most needed. I did get more services this time than the last time Thomas was in the hospital.  I guess you kind of have to pick your battles. I was more educated and more assertive this time around.  An interpreter is even allowed to go into the operating room until the patient is asleep and be in the recovery room while he is waking up. During Thomas’ recent surgery, as our interpreter headed back with Thomas to the operating room, a nurse stopped her saying she was not allowed. Later the anesthesiologist stood up for her (and Thomas) saying, “This woman is a professional and is and will be allowed to do her job.”  

On the last day of our stay, the social worker came to the room and told us she was having trouble getting an interpreter for Thomas’ dismissal. I explained the problem to Thomas and let him know it was his choice: I could interpret the dismissal instructions, or because it is his right to have an interpreter, we could wait until they found someone. I always knew that it made a difference to me to have an interpreter – I am able to concentrate on what is being said, ask the questions I need, and know that Thomas is getting the same information as me. He immediately responded by saying “I want an interpreter.”  Thomas’ response to my question on that last day in the hospital confirmed to me that it makes a difference to Thomas, too. ~

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