News

Lawsuit: California fails to accommodate deaf workers

Written by BROOKE DONALD (AP) Sunday, 23 May 2010 05:54

Deaf and hard-of-hearing state employees in California are regularly denied sign language interpreters for meetings and have been left behind during emergency evacuations because of a failure to accommodate their disability, according to a lawsuit filed Friday.

"Our investigation reveals a systemic breakdown," said Joshua Konecky, a lawyer for the plaintiffs. "Deaf employees describe a haphazard and patchwork environment for requesting and securing accommodations, if they get them at all."

The problems have resulted in workplace "isolation, exclusion, prejudice and overall pervasive discrimination," the suit says.

The lawsuit filed in San Francisco Superior Court cites problems at the Department of Rehabilitation, Department of Justice, California Public Employees Retirement System and Department of Social Services.

It seeks class action status and includes seven named plaintiffs, including a woman who works in the Office of Deaf Access for the Department of Social Services.

There are about 1,500 state workers who are deaf or hard-of-hearing.

Rachel Arrezola, a spokeswoman for Gov. Arnold Schwarzenegger, a defendant in the case, said the state is committed to accommodating disabled employees to ensure they are able to fulfill their job responsibilities.

"We are always looking for ways to improve access and the Department of Rehabilitation will continue to work with these individuals and their representatives, and we are hopeful this will be resolved soon," Arrezola said.

Evan Westrup, a spokesman for Attorney General Jerry Brown, said his office was reviewing the lawsuit and could not immediately comment.

The lawsuit alleges the state has violated the Americans with Disabilities Act and the Rehabilitation Act of 1973.

It claims deaf employees are often denied sign language interpreters for work-related events, including staff meetings, job training, performance reviews and meetings with the public and clients.

It also says the state frequently substitutes insufficient or ineffective forms of communication — lip reading, e-mail, videophones and interpretations by co-workers unskilled in sign language — rather than provide qualified interpreters.

The state often fails to caption videos shown to employees and cites budget limitations as a reason for denying interpreter requests, the lawsuit states.

"On paper, the state recognizes the need for sign language interpreters and other forms of reasonable accommodations, but in practice, the state has no reliable systems in place to ensure that its deaf employees have effective communication with their clients, co-workers and management," said Laurence Paradis, executive director of Disability Rights Advocates and a lawyer for the plaintiffs.

The lawsuit seeks improvements to state procedures and attorney fees.

Paradis said inadequate emergency procedures are the most disturbing example of the state's failure to accommodate deaf employees.

"We have had numerous reports of employees being left behind in buildings during evacuation drills and actual emergencies," he said.

State employee Melanie Thao Nguyen said her ability to serve the deaf community is hampered by the state's failure to provide her with sufficient interpreters in her position as associate governmental program analyst at the Office of Deaf Access.

The lawsuit claims the interpreting position at her workplace has been vacant for more than three years, and no one is due to be hired because funds had dried up.

Related articles by Zemanta

• Lawsuit: Calif fails to accommodate deaf workers (seattletimes.nwsource.com)
• Lawsuit Alleges EBay Violates Disabilities Laws (blogs.wsj.com)
• Deaf state workers sue over lack of services (sfgate.com)

New Joint Commission Standard Defines Medical Interpreters

Written by Heather Comak, for HealthLeaders Media Saturday, 08 May 2010 10:28

One of the most vital parts of providing adequate healthcare is the exchange of information between patient and caregiver. Without clear communication, it can be difficult, and even dangerous, to treat a patient.

For patients who have limited English proficiency (LEP), as well as providers, the presence of a medical interpreter can allay fears about care. Most importantly, using a qualified medical interpreter to assist with communication keeps patients safe.

Until recently, however, there has been no national standard by which to evaluate medical interpreters. Even national requirements on the part of hospital accreditors were lax. In January 2010, however, The Joint Commission released new standards concerning patient-provider communication, that will be implemented no sooner than January 1, 2011. One standard specifically will address qualifications for language interpreters and translators.

Certification opportunities are opening up as well. In October 2009, the National Board of Certification for Medical Interpreters (NBCMI) launched the National Medical Interpreter Certification and hopes to have the first 500 interpreters certified by June. The certification helps define a qualified, proficient medical interpreter.

"The fact that diversity is a national issue, it really does need a national response," says Louis F. Provenzano, Jr., president and chief operating officer of Language Line Services in Monterey, CA. "There hasn't actually been, up until we launched, a single industry-wide standard for training, education, and evaluation of medical interpreters."

Language Line University, along with the International Medical Interpreters Association (IMIA), was a founding board member of the NBCMI.

In addition, the Certification Commission for Healthcare Interpreters (CCHI) will launch its own separate certification for medical interpreters. CCHI expects its first certification exams to be available in the fall. CCHI's process for establishing a certification has been similar to that of the NBCMI.

These certification opportunities for the estimated 15,000 to 17,000 medical interpreters will bring the field up to par with their court interpreter and sign language interpreter counterparts. It will also provide a national standard in the face of many dozens of smaller certificate programs available that do not have one defined level of achievement.

The need for qualified medical interpreters
As the link between an LEP patient and his or her physician, nurse, or other care provider, the medical interpreter has long had a place at the patient's bedside or patient procedure. However, in the past, the interpreter might have been the only person without a credential.

"In healthcare, credentials are very important—not only for professionalization, but for patient safety's sake," says Izabel Arocha, MEd, president of the IMIA. "What we've seen in all these years is that in an operating room, they might be doing a catheterization with all sorts of professionals there that are credentialed according to their specific boards, except for the medical interpreter, who's always been the missing link, the one individual who has been completely unregulated."

There have been a few highly publicized incidents of medical interpretation gone wrong, one being the 1980 case of Willie Ramirez, a Spanish-speaking teenager from southern Florida. Ramirez reported feeling dizzy and having a headache—the result of an intracerebellar hemorrhage—to doctors at an area hospital.

However, because, among other reasons, he and his family insisted he was intoxicado, his original ailment was diagnosed as an intentional drug overdose. The word intoxicado in Spanish, however, can mean feeling dizzy or nauseous. Ramirez became a quadriplegic as the result of the misdiagnosis.

This case is often referred to as one example of the need to have qualified medical interpreters available in the hospital. It is also a federal requirement. Hospitals that accept federal funding are required to comply with Title VI of the Civil Rights Act of 1964, which prohibits discrimination based on race, color, or national origin. This includes providing a translator for those patients who are not proficient in English.

Similarly, Section 504 of the Rehabilitation Act of 1973, which protects the rights of individuals with disabilities, requires healthcare organizations that receive federal funds to provide effective communication for patients who are deaf or hard of hearing.

Many hospitals subscribe to a telephone interpreting service because of the many languages for which they may have to be responsible. Similarly, because of the lack of one national standard, many facilities had to rely on bilingual staff members who could serve as an interpreter in addition to their normal duties—and many still do.

"What many people don't understand is that in order to be a professional, you have to accurately and completely interpret what has been said," says Marc Friedman, interpreter coordinator at St. Jude Children's Research Hospital in Memphis, TN. "People who are not practiced in the profession are not accustomed to capturing what has been said."

In addition, the practice of using children as interpreters for their parents or relatives is not only dangerous because of the potential lack of understanding of what the patient has said, but because of the situation in which the child is placed.

A great deal of research has been conducted on the link between language proficiency and adverse events. Joint Commission researchers, funded by The Commonwealth Fund, found that LEP patients were more likely to experience an adverse event than English-speaking patients.

"Language Proficiency and Adverse Events in U.S. Hospitals: A Pilot Study," which was published in the International Journal for Quality in Healthcare in 2007, found that more communication-related adverse events were reported for LEP patients than English-speaking patients.

Certification will change the field
The NBCMI's certification has been developed by a 12-member board and is administered by PSI, a national testing agency. The test comprises a written and oral exam. In this way, the NBCMI is following the National Commission for Certifying Agencies' accreditation guidelines and hopes to become accredited by 2011.

"Unless we have a regulated profession, we're not going to change healthcare quality in this country," says Arocha. "It affects all of the other services. If the provider and specialist is going to be accountable for that patient, they need to know what that patient is saying."

Trained Interpreters Improve Patient and Provider Satisfaction, Says Study

Last Updated on Saturday, 17 July 2010 22:13 Written by Cheryl Clark, for HealthLeaders Media Saturday, 08 May 2010 10:17

Even as the Joint Commission introduced standards for medical interpreters, a new study reveals that the use of trained language specialists to assist physician-patient communication dramatically improves satisfaction in emergency room settings with non-English speaking patients.

According to Mathematica Policy Research, a non-partisan survey team, "The use of professional interpreter services dramatically increased satisfaction with patient-provider communication during the ED visit, not only for patients, but for all types of providers—including triage nurses, doctors, and discharge nurses."

Mathematica conducted the study with 424 Spanish speaking, limited English proficiency patients in two central New Jersey hospitals between October 2008 and April 2009.

Patients were assigned to one of two groups. The control group received "usual" language services in the ED, such as telephone language line and ad hoc interpreter services provided by bilingual staff and family members. The treatment group utilized professionally trained medical interpreters, along with the usual language services.

The improvement in satisfaction was not limited to patients and providers, said Ann Bagchi, a Mathematica senior researcher who led the study. "These professional interpreters may also improve other outcomes related to quality of care."

According to the Mathematica report, 96% of patients responded they were "very satisfied" with patient-provider communication in the treatment group compared with 23% in the control group. Likewise, 94% of doctors said they "very satisfied" when trained interpreters were used, compared with 19% when usual language services were provided.

Language and cultural barriers between patients and providers are an increasing concern, as evidenced by the decision last year by the Joint Commission to release new standards for patient provider communication, effective Jan. 1, 2011. Several interpreter certification programs are now in development to accredit and/or train would be interpreters to work in healthcare settings.

The idea is that medical interpreters should have proficiency standards much like those required of court reporters, sign language interpreters, and others who convey essential information. All too often, many hospital officials have acknowledged, children are being used to interpret medical care issues on behalf of their parents.

Instructions for taking medication, conversations with family members, and information on diagnoses and prognosis may get muddled when interpreters are not properly trained or sensitive to cultural fears and values.

Failure to effectively communicate can also drum up health costs, for example, if a patient has already undergone a test but is unable to convey that. Likewise, the inability of a provider to relay the importance of a follow-up visit, or compliance with a medication regimen, can result in avoidable progression of disease or hospitalization.

The Mathematica survey concluded that because high levels of satisfaction increase the likelihood that a patient will return to the same emergency department, the study's results "may influence hospitals' decisions about whether to hire interpreters."

The authors suggested that quality of care may also improve with better, more accurate communication between providers and patients, and recommended rigorous future research in both acute care and other health settings to examine the impact on patient outcomes.

The Robert Wood Johnson Foundation funded the study.

Cheryl Clark is a senior editor and California correspondent for HealthLeaders Media Online. She can be reached at This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Marlee Matlin, Oscar winning actress, author and advocate

Each year, World Day for Social Justice draws global attention to efforts to eradicate poverty and promote social well-being, equality and full and decent employment. In 2010 this search for a "society for all" faces severe challenges brought on by the global economic and jobs crises, resurging poverty and long-term social uncertainty.