Sight Translation by Tara Adams.

The new guidelines for the Affordable Care Act (ACA) took effect last month and while much of it remains the same when it comes to language access services, there is some language that is worth mentioning. The laws and provisions are exhaustive and can be easily misunderstood if the entire context is not reviewed. In fact, there has been recent discussion within the Deaf, hard of hearing, interpreter and health care provider communities around the term “primary consideration” and the impact this will have on language services.

Most importantly, all patients, their families or friends with them, and providers are entitled to effective communication, but what does effective communication mean?

“When choosing an aid or service, Title II entities are required to give primary consideration to the choice of aid or service requested by the person who has a communication disability. The state or local government must honor the person’s choice, unless it (the entity) can demonstrate that another equally effective means of communication is available or that the use of the means chosen would result in a fundamental alteration or in an undue burden (see limitations below). If the choice expressed by the person with a disability would result in an undue burden or a fundamental alteration, the public entity still has an obligation to provide an alternative aid or service that provides effective communication if one is available.”  ( )

At first blush, the language “….must honor the person’s choice….” can send the message to patients and their families that if they request an on-site interpreter, one must be provided and any other means of effective communication is a violation of their rights. However, the second half of that sentence states: “unless it can demonstrate that another equally effective means of communication is available or that the use of the means chosen would result in a fundamental alteration or in an undue burden.” What this tells us is that if a patient requests an on-site interpreter and VRI is in place and meets all the necessary criteria to be effective, then the use of VRI is an acceptable means of communication in lieu of a patient’s preferred, on-site interpreter.

Necessary Technical Criteria:

We’ve discussed the appropriate use of VRI and the technical requirements in previous posts:

  • A large enough screen for the patient to easily and comfortably see the interpreter
  • A solid and stable internet connection
  • Staff and personnel trained on how to use the equipment
  • Qualified Interpreters (ideally nationally certified and medically experienced)

Medical Encounters Suitable for VRI (not exhaustive)

  • Clinic appointments
  • Well baby checks
  • Triage
  • Routine tests and examinations
  • Consultative appointments

Medical Encounters Not Suitable for VRI (not exhaustive):

  • Patients with limited vision or are Deafblind
  • Patients experiencing critical mental health episodes
  • Patients that physically cannot see the interpreter
    • Strapped to a gurney
    • Other physical disabilities
    • Neck injuries that require the patient not lift their head at all

Our philosophy at InDemand is that VRI is not one-size-fits-all, especially with Deaf patients. Depending on the Deaf patient’s physical, cognitive and linguistic abilities and the strength of the internet, VRI may not be a good fit. Our interpreters are empowered to tell the medical personnel if VRI just isn’t going to work and to help patients and medical providers determine the best course of action. However, if technology, staff training and the circumstance of the Deaf patient are suitable, then VRI is an equally effective means for communication. We also employ CDIs in an effort to provide additional clarification in communication. Just as VRI is not one-size-fits-all, VRI providers are not created equally. We encourage medical providers and patients to review their VRI providers to ensure they are not just offering language access, but are providing experienced medical interpreters to effectively support communication, giving all patients the chance to be engaged in their healthcare.