Sign language interpreters sorely lacking in Colo medical care

[dropcap]I[/dropcap]t was the kind of text message every parent dreads.

One evening in July 2013, George Baca’s friend wrote to say he heard on the news that Baca’s daughter was critically injured after being struck by a car.

Baca rushed to Pueblo’s Parkview Medical Center where his 17-year-old, Eva, was losing lots of blood.

The sight of his child comatose and on life support was traumatic enough. But what made things worse – far worse – was that Baca, who is profoundly deaf, couldn’t communicate with doctors or nurses because, he says, the hospital wouldn’t provide a sign language interpreter. He needed to tell them Eva is allergic to penicillin. He wanted to understand the extent of her injuries. And he had to know if she would live or die.

“I had no information about why she was there, why she was so bloody. I didn’t know where she was injured or how badly. I kept asking for an interpreter. But it seemed they viewed me like I was deaf and dumb person who was unimportant and didn’t really matter,” says Baca, a construction worker who’s suing Parkview in federal court today for what he argues is a violation of federal and state disability laws.

Advocates for the deaf and hard of hearing say Baca’s experience is all too common in hospitals and other businesses throughout Colorado, where about 446,000 people have hearing impairments of some sort and about 43,000 are profoundly deaf. Of those, an estimated 10,000 rely on interpreters – a service many don’t get, despite laws guaranteeing them access to effective communication.

Keeping fully informed about Eva’s condition wasn’t just Baca’s legal right. It was a basic human need.

“The deaf community, as a linguistic minority, has been denied access to qualified sign language interpreters,” especially in hospital settings, says Jennifer Pfau, president of the Colorado Association of the Deaf. “With the lawsuit, it is my hope that the public recognizes George Baca’s challenges when it comes to make informed decision on medical care is dangerous. Effective communication is critical to quality medical care.

“Walking into the hospital settings where no one will face barriers is all we ask for.”

Baca can’t hear or speak. And, like many native deaf people, he isn’t fluent reading English. Through an interpreter, he told The Independent that he asked Parkview’s staff over and over again to bring an American Sign Language interpreter to answer his questions and explain the medical documents they were asking him to sign. The hospital didn’t provide an interpreter until the next day, and then only for two hours. Baca had to wait until day three for the hospital to hire a full-time interpreter to spell out details about Eva’s treatment and prognosis for her brain injury.

When the crisis was most acute, he says, Parkview blew him off.

Parkview won’t comment on the case, citing a need to protect the family’s privacy and a policy of not commenting on pending legal cases.

The hospital has defended its handling of Baca’s disability, writing in a letter to Baca that “it was documented multiple times that the ‘patient’s family declined to have an interpreter at this time’.”

As Robertson tells it, however, there’s no mention of sign language interpretation in over 900 pages of Eva’s medical records. The thoroughness and accuracy of those records are questionable given that Parkview seems not to know when Baca arrived to see his daughter and its risk management director referred to Eva — in correspondence with both Baca and Robertson — as “Ava.”

Parkview asserts that, beginning on the second day at the hospital, “Mr. Baca’s ex-wife and son were acting as interpreters and the patient’s needs were being met and information was being shared with the family.”

The problem, Robertson points out, is not only that the ex-wife and son are both hard of hearing , but that it’s not their responsibility to provide interpretation, especially during a medical crisis in their family. Robertson also cites the following note, written by a nurse to Baca, showing that Parkview staff’s written communication to him was substandard: “The doctor said he come back. He is saying he (sic) injury is something that will heel (sic) on its own.”

In a letter from October, Parkview “acknowledge(d) internally that our ASL interpreter services could be improved.”

Spokeswoman Michelle Peulen told The Independent that since the Baca incident, Parkview since has put a system in place that provides sign language interpretation 24/7 through a videoconference phone.

“It allows patients and family members with hearing impairments to full access to the communication they need,” Peulen said.

Video remote interpreting – known as VRI – is a great idea in theory, but almost never in practice, disability advocates say. As Robertson tells it, medical staff often don’t know how to set up the system up or work it; hospitals often don’t have the bandwidth to sustain a reliable videoconferencing connection; the picture and sound can be jumpy, disrupting doctor-patient communication; the equipment often isn’t adaptable for a patient lying prone in a bed talking to a roomful of medical personnel; and staffers often aren’t trained to stay within camera range and to speak audibly, intelligibly and one-at-a-time.

“There are a number of very common logistical problems, all of which have to be overcome for the system to work,” Robertson says. “If any one of these factors goes awry, crucial medical communication doesn’t happen.”

Baca wants Parkview – the hospital where he and his children were born — to have live interpreter services available on the spot when needed.

His lawsuit stems from collaboration between CREEC, the Colorado Cross-Disability Coalition and the Colorado Association for the Deaf to gauge a lack of ASL interpretation in medical facilities and improve communication with deaf and hearing impaired Coloradans. The goal of Medical Communications Access Project, Robertson says, “is to solve a problem before it has turned into a lawsuit.” Aside from Parkview, Porter Hospital, Rose Medical Center, several private medical offices, a homeowners’ association at Heather Gardens and the Denver County Jail have all been sued for failing to provide sign language interpretation. In a case that ended up before the 10th Circuit Court of Appeals, the Las Animas County Sheriffs Department was found in violation of the law for having denied a deaf defendant an interpreter at his arraignment.

The coalition says there are two patterns they see in the medical communication arena. One is in emergency room settings, where things come up quickly and hospitals often are slow hiring interpreters. The other is small to medium sized doctors’ offices, which often assert that they have no obligation to provide interpreters’ services.

Robertson says the both situations show a fundamental ignorance of the Americans with Disabilities Act. In order to avoid paying for interpreters, medical businesses that receive federal funding – such as Medicare and Medicaid — would have to prove that the $80 an hour interpreter’s fee would break their budgets. That likely isn’t the case with most medical offices, let alone a hospital like Parkview.

“How can anyone fail to be horrified at the thought of trying to understand your child’s life-threatening injuries by just simply being shown her bloody body?” Robertson asked.

Baca, 40, says being shut out of information about his critically injured daughter was the most powerless he has ever felt.

“Laws are in place for good reasons – for people to communicate when they need to communicate,” he said. “I don’t want my kids – or anybody – to have to go back to the hospital and be put through that again.”

[ Photos of notes George Baca passed with Parkview Medical Center staff the night his daughter was struck by a car. ]