Language access is an undisputed necessity for patients when they are seeking medical care. Title IV under the 1964 Civil Rights Act guarantees limited English proficiency (LEP) patients the right to language access in addition to the American with Disabilities Act that protects language access for D/deaf patients. However the debate lies in how language services are provided, whether they provide effective communication and whether or not they line up with the patient’s preferences. This debate came to a head between a Deaf patient and Bethesda Hospital East in Florida, leading to a federal magistrate ruling on the hospital’s obligation to provide language access, while considering the patient’s preference.
Margaret Weiss, a Deaf patient who who is pregnant with her second child, due in July, filed suit against Bethesda Hospital East in Florida after her request for an on-site American Sign Language interpreter during labor and delivery was denied. The hospital asserted that the use of video remote interpreting (VRI) would be provided to her rather than an on-site interpreter.
During previous visits to Bethesda East, Ms. Weiss has used the VRI service and it had not gone smoothly, prompting her to request an on-site interpreter during her second child’s birth. However, Bethesda has provided proof that they’ve corrected the connection and technology issues that plagued the VRI service previously and that its use during labor and delivery would be sufficient.
After hearing the concerns of Ms. Weiss, reviewing the proof that Bethesda East has made the appropriate improvements to their VRI system, and the law that requires interpreting services be effective, the judge ruled in favor of the hospital’s original plan to use VRI.
The difficulty here lies in the paradigm shift from on-site interpreters being the only option to video remote interpreters being a part of the language access tool kit. The Deaf community as a whole prefers on-site interpreters, but hospitals are learning to balance patient preference, fiscal responsibilities and legal obligations to provide quality and effective services.
Ms. Weiss has a strong preference for on-site interpreters during the birth of her child, however, the hospital is legally obligated to provide her with effective communication with qualified interpreters. If VRI has proven to be reliable and not disruptive to communication, accommodating her preference is not mandated. This ruling by the federal court is a critical decision for not only the Deaf community, but for the hospitals as well.
Often times patient preference for an on-site interpreters is confused with the right to have an on-site interpreter when in fact the patient’s right is to have effective communication with the provider. By ruling that VRI is an acceptable accommodation, it reinforces the Deaf person’s right to language access and the hospital’s right to access all the means available to provide effective communication.
Yet it is important that this ruling isn’t misconstrued to assume that VRI is acceptable in all situations or that the patient preferences aren’t to be considered. The ADA states, “Title III entities are encouraged to consult with the person with a disability to discuss what aid or service is appropriate. The goal is to provide an aid or service that will be effective, given the nature of what is being communicated and the person’s method of communicating.” Bethesda East has agreed to provide an on-site interpreter if VRI proves to be ineffective, but they assert their right to use VRI during her labor and delivery until proven ineffective.
While Ms. Weiss may not be satisfied with the use of VRI, her ADA protected right to communication is intact. Communication in the medical setting is going through an intense re-calibration. As hospitals are expanding their language access tools and creating an infrastructure to support them, Deaf patients are being asked to expand the ways in which they receive effective communication. During such a transformative time in communication, it is important to clearly understand the protected rights of individuals and the medical facilities legal and fiscal responsibilities.