Advanced Effective Communication, Cultural Competence, and ...

A Roadmap for Hospitals
Appendix D: Laws and Regulations
• Catskill Regional Medical Center (CRMC). The complainant,
who is deaf, reported that staff failed to provide
her with a sign language interpreter on several occasions at
CRMC, a 162-bed hospital serving 56,000 patients each
year in Sullivan County, New York which has an emergency
response helicopter and a trauma center. After a
subsequent investigation by the Office for Civil Rights,
CRMC signed an OCR Resolution Agreement to resolve
the matter and agreed to do the following:
— Prohibit surcharges on auxiliary aids and services, including
sign language interpreters, video interpretation
services, note takers, assistive listening devices, and
computer-assisted real-time transcription
— Affirm its compliance with Section 504 of the Rehabilitation
Act of 1973
— Designate a Section 504 Coordinator and develop a
Section 504 grievance procedure
— Issue and post revised policies to make sure it provides
appropriate auxiliary aids, including sign language interpreters
or video interpretation services, to deaf or
hard of hearing patients or companions within set time
periods
— develop procedures to assess the sign language interpreter
needs of patients or companions
— Train CRMC personnel on its revised policies and procedures
to ensure effective communication
— Provide regular compliance reports to the Office for
Civil Rights.
• Florida Department of Children and Families (DCF). In
its complaint investigation, the Office for Civil Rights
found that the state violated Section 504 of the Rehabilitation
Act of 1973 and Title II of the ADA when it failed
to provide interpreters to deaf persons in critical situations,
such as during child protective services investigations
and during treatment in state mental health facilities.
Under the agreement, Florida DCF will make a wide spectrum
of health and human services programs available to
an estimated total state population of 3 million deaf or
hard of hearing residents. The agreement requires the state
to take a number of unique (and potentially costly) corrective
actions, including the following:
— Hiring an independent consultant to oversee implementation
of the settlement’s terms
— Convening an advisory committee in partnership with
the Florida Coordinating Council for the Deaf and
Hard of Hearing
— Undertaking a comprehensive self-assessment that requires
surveys of staff and of disability advocacy organizations
regarding gaps in service experienced by deaf
and hard-of-hearing individuals
— Establishing an interpreter quality assessment and certification
program
Under some circumstances, the federal agencies’ agreements
and decrees have provided for compensatory damages for the
lack of an interpreter or other aid for a patient’s family members
who are deaf or hard of hearing. In 2003, the DOJ filed a
lawsuit in 2003 against Parkway Hospital, a private hospital
in Queens, New York, for allegedly failing to provide a qualified
sign language interpreter for an elderly deaf patient or her
deaf husband during the woman’s extended hospitalization. In
addition, DOJ alleged the hospital violated the ADA by imposing
communication responsibilities on the couple’s grown
children, who were expected to act as conduits for information
between the family and hospital staff. Because of these
failures, the patient’s husband allegedly was unable to obtain
complete information about his wife’s medical diagnosis,
treatment, and prognosis. Under the ruling in United States v.
Parkway Hospital, Inc. [8], the hospital was required to pay
$125,000 in compensatory damages to the family and to
adopt sign language interpreting policies and procedures intended
to ensure effective communication for deaf patients
and their family members [9].
Settlements have also addressed standards for video interpreting
services. Enhanced and emerging technologies may allow
health care providers to obtain qualified interpreters more
quickly, economically, and efficiently 24 hours a day. Video
interpreting services allow a qualified sign language interpreter
to appear via video from a remote location on a television-like
screen. A hospital opting for this approach must
ensure that the appropriate hardware and software are in place
to support the system and that staff understand how to operate
and maintain the equipment [9]. If a hospital purports to
utilize video interpreting services but does not provide the
necessary administrative and operational support to make the
system work, a patient with a hearing disability is denied his
or her right to fully participate in health care decisions and
family members are shut out from communicating with the
hospital about their loved one.
In 2006, the DOJ intervened in a private lawsuit brought by
seven deaf individuals against Laurel Regional Hospital alleging
a failure to provide either in the emergency department or
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