Pearl:  Nan , first off, tell us a bit about yourself and your current position?

Nan : I am a Manager of Patient Relations and Interpreting Services since 1994-present and prior to that I worked in Psychiatry. I am a 1979 graduate of the Medical University of South Carolina with a degree as an Occupational Therapist.

Pearl: Are you hearing impaired or deaf? And/or is anyone in your family?

Nan : I am hearing. No one in my family is deaf. My daughter has been learning ASL for many years. I hope one day she will be fluent.

Pearl : As Patient Relations Director, what can you tell us about our rights if we are hospitalized?

Nan :  As the Director of the department responsible for providing interpreters at our hospital, I want to say that hospitals by law have some very specific responsibilities. If you have identified that your hospital is lacking in what they have to offer, may I suggest that a coalition of deaf or hearing-loss individuals get together and ask the hospital for a planning meeting?

Take the best, most professional interpreter you can hire to this first meeting and start building bridges with the administrators. Hospitals want to provide safe environments for patients and are under considerable national pressure to do so. What some are finally coming to understand is that effective communication is essential to patient safety. Put your requests/concerns in terms of patient safety. It will carry the most weight! Commit to helping the hospital. Maybe they need deaf people  or people with hearing loss  to come teach their staff about deafness. Maybe they would be open to having deaf individuals help  identify good agencies to hire interpreters from. Offer your help, rather than threatening lawsuits and you may just accomplish something wonderful that impacts people in your community for the future for your children! If you can initiate contact in a collaborative manner rather than waiting until a deaf person is in the Emergency Department having a health crisis/heart attack/whatever, it will benefit everyone.

There may be some hospitals who don't know (care?) about interpreting issues but in every hospital, you can find some individual who does and may champion doing the right thing from within. It may be the patient advocate or social worker or the director of nursing or chaplain or the risk manager but there will be someone who will be or can become invested if they are educated. Waving your rights in the face of the doctor or nurse at the moment they may be trying to save a life will accomplish little. Creating a partnership ahead of time to listen to each other and establish a realistic plan is better.

My hospital is in a community of large deaf population and we try very hard to make sure every patient has effective communication. In the first 6 months of this budget year, for sign language alone, we have spent $96,000 on staff interpreters, VRI (Video Relay Interpreting), and agency back-up for times our on-staff interpreters are not available. That is a significant expense in any budget. I tell you the amount not so you will be impressed, but so you will be reassured that there are hospitals out there which can serve as a model for those that have not yet gotten on board. We are by no means perfect, but we are committed to trying to do the right thing. We have a video phone which we roll to the bedside of inpatients so they can be in touch with family while they are here. We have adaptive devices like door and baby cry alarms. Our hospital operators have TTYs to answer as well as loan to patients if they request one. If a patient does not receive a hospital-provided interpreter for whatever reason, we take that seriously and try to figure out what happened so it does not happen again.

We educate staff about not relying on lip reading, not using family and friends and to focus on the patient, not the interpreter. The law says "qualified interpreter" but it does not define "qualified." We have decided our minimum standard is RID certified. Using family and friends not only means using unqualified people but also breaches the patient's confidentiality - therefore the HIPAA laws (Health Insurance Portability and Accountability Act).

Bottom line, one should expect hospitals to follow the Federal law, funded mandate. 

Pearl:  Are we entitled to an interpreter and/or CART  (Communication Access Real Time)?  If a patient is deaf but does not sign and CART is not available, what accommodations are made?

Nan : Yes, an interpreter would be provided. Also, here in Frederick Memorial, we have made the decision that if staff believes a patient needs an interpreter, even if the patient does not believe they need one, we will provide the interpreter. In certain cases, the patient cannot possibly know in advance what they may be in for and the staff realizes from their experience that an interpreter will be needed to help explain procedures and what to expect.

Anyone with a hearing loss is entitled to "effective communication." The ADA (American Disabilities Act)  info line can help in determining if one method of communication is more effective than another.

We do not use CART at our hospital but I understand how it could be helpful for an English-based person who has become deaf but does not sign.  I am aware that our local court system uses CART so it is certainly in our community.

Pearl : What should we bring with us when knowing we will be hospitalized?

Nan : Nothing that I know of, except a willingness to be patient with staff and not assume they are trying to get around the law.  In most cases, they just don't know better and need educating.

Pearl: How can we better inform Doctors or emergency technicians to our hearing loss?

Nan : As early as possible, let them know ahead of the appointment. Some communities have something called the Vial of Life. This is where pertinent health information and conditions such as deafness or blindness can be noted for EMTs who show up at your house. The medical team can get their hands on this info even if you are unconscious. Everyone needs to take responsibility for alerting. It may be a sign on your refrigerator or a medical alert bracelet, but do something. For further info on the Vial of Life go to: http://www.vialoflife.com/how_to_use_the_vial_of_life.html

Pearl : Any further recommendations you'd like to make for the individual with hearing loss and late-deafened community and our needs when hospitalized?

Nan : None except let the staff who are treating you know what your strengths and limitations are. Perhaps writing something up and carrying it in your wallet as well.

Pearl: Thanks Nan for being part of this interview.