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Critical Partnerships: Ethical Medical VRI & Sign Language Interpreters

Ethical Medical VRI & Sign Language Interpreters

Danielle Meder discusses the responsibility of sign language interpreters when working in medical VRI environments. Since VRI is here to stay, partnering with ethically responsible VRI providers is the most effective way to improve the medical VRI experience.

In her article, Behind the Screens: The Ethics of Medical VRI & Sign Language Interpreters, Shelly Hansen discussed her perceptions of the ethical implications of VRI. In addition, she explored the most common assumptions about VRI, at times upholding stereotypes while also utilizing extreme examples of patient experiences with VRI. However, by exploring how sign language interpreters and VRI providers can work together to raise the standards and improve the patient experience, VRI will be seen as one viable option for communication access.

[View post in ASL.]

If You Can’t Beat ‘Em, Join ‘Em

It is undeniable that VRI is here to stay. As a result, hospitals see the opportunity to provide immediate access, increase the availability of interpreting services when on-site interpreters are not available, in addition to seeing the cost-saving benefits of VRI–and as a result, they are making it a permanent part of their language access plans. However, many hospitals are misguided when it comes to the proper use of VRI for Deaf patients. It is unrealistic to imagine all ASL interpreters refusing to work for VRI providers in an effort to drive VRI out of medical environments. Therefore, it becomes the practitioner’s responsibility, when exploring VRI employment, to take positions with ethically responsible VRI companies; VRI companies where sign language interpreters have a voice and Deaf patients are respected.

Ethically Responsible VRI

It may seem like an oxymoron, but ethically responsible VRI companies do exist. Just as sign language interpreters vet any number of companies/organizations they work for, purchase from, or have relationships with, they can also do so with VRI companies. This vetting is not only from the perspective of potential employees but also as allies to the Deaf community. If local hospitals and clinics are going to use VRI, then it is imperative that VRI providers in local hospitals are working with Deaf patients.

As professional sign language interpreters, we should be asking VRI providers if they do the following:

  • Offer CDIs on-demand
  • Empower VRI interpreters to advocate for onsite when VRI is not effective or appropriate
  • Hire experienced and trained sign language interpreters in both medical and mental health vs. general practitioners
  • Provide training to hospital staff on how to utilize the VRI equipment
  • Offer cultural sensitivity training for providers when working with Deaf patients
  • Adhere to all national and state licensure laws for sign language interpreters
  • Provide readily accessible tech support to sign language interpreters and providers

If a VRI provider cannot answer ‘yes’ to the full list above, then practitioners are faced with two options: to not accept work from them or to accept work in an effort to help develop ethical business practices from within the company. Further, it’s important to include local Deaf communities in the conversations in order to limit the ill-prepared VRI provider’s presence in local medical facilities until they change their practices.

VRI Does Work/VRI is Not One Size Fits All

Unfortunately, there are a number of cases where VRI hasn’t worked, and the fallout has been devastating for patients and their families. There are also cases where unqualified onsite sign language interpreters have been hired, as well as medical encounters where no sign language interpreter (onsite or via VRI) has been procured. These situations create equally damaging results. Communication disasters are not exclusive to VRI, and while onsite is best, it’s not a guarantee of quality or effectiveness.

Most commonly, it is said that VRI ‘will do’ until an interpreter shows up on-site or only in a dire emergency room visit, yet there are plenty of times where VRI does work beyond the emergency room. It’s also important to note that VRI is used at the patient’s request, too. Patients are requesting VRI when they want privacy from their local interpreting communities; when they want an appointment this week instead of in two weeks when the first available onsite interpreter can be booked; when their local interpreters aren’t experienced enough; or when they want a CDI for their appointment and their local community doesn’t have or has a limited number of CDIs.

Frozen Screens and Dropped Calls Do Happen

One very real and unacceptable aspect of VRI is that frozen screens, heavy pixelation, and weak internet connections make communication cumbersome, at best, and often impossible. This can also lead to potentially dangerous health care results. It is the responsibility of the hospitals to provide a stable, secure, and strong internet connection. When sub-par internet connections are used, VRI providers, sign language interpreters, and Deaf patients must demand medical facilities invest in fortified internet services for VRI to even have a chance at providing effective, quality communication access. Without a robust Internet connection, even the best sign language interpreters will, in essence, have their hands tied. Again, if VRI is not going away, then it must be properly deployed on all fronts, and sign language interpreters can have a strong influence on that deployment.

ACA Section 1557

“Covered entities are prohibited from using low-quality video remote interpreting services or relying on unqualified staff, translators when providing language assistance services.”

“Providers’ required to give ‘primary consideration’ to the choice of an aid or service requested by the individual with a disability.”

These two statements are linchpins in the Affordable Care Act when it comes to language access. The first statement is the provision that holds providers responsible for quality and effective language access while the second statement is the provision that is most misunderstood and misused when defending the right to an onsite interpreter.

At one point last year, social media sites were ablaze with the phrase “primary consideration” and what that meant for patients. What many thought it meant was providers had to honor the patient’s preference for onsite sign language interpreters. What it means is that providers must consider a patient’s preference, however, if VRI offers effective communication access, then VRI can be used in lieu of an onsite interpreter (ACA Effective Communication). While a patient may want an onsite interpreter because they prefer it to VRI, preference is not a protected right; quality and effective communication is a right. Reasons onsite interpreters must be arranged, and VRI should not be used are when a patient is:

  • Low vision and/or blind
  • Experiencing a highly traumatic incident
  • Experiencing a psychotic episode
  • In a physical position or condition that prevents them from easily seeing and communicating with the interpreter
  • Case sensitive pediatric encounters
  • Not able to communicate because technology is not working reliably
  • Participating in group therapy

There are also case-by-case instances where VRI is not suitable.

I highlight this to further make a point; although VRI is not appropriate for all situations, it is not going away. Therefore, medically experienced video remote interpreters have a multi-layered responsibility. They must provide clear and effective interpreting, while also skillfully explaining to the provider, using healthcare terminology, why VRI is not appropriate for a given situation. Finally, the interpreter must advocate for onsite sign language interpreting services.

In Need of Standards

Currently, the only provisions in place for VRI are the terms ‘quality’ and ‘effective’ as put forth by the Affordable Care Act (ACA) and the Americans With Disabilities Act (ADA). No industry-wide screen size minimums exist, no mandatory medical interpreter certifications, nor experience requirements are in place. Additionally, no internet standards for medical facilities, nor protocol where VRI should not be used are set. At this time, the National Association of the Deaf (NAD) has written a position paper, and each VRI provider has their own business practices that may or may not align with NAD.

Much like courtrooms across America that have policies, rules, or laws in place which require sign language interpreters to be trained, vetted, and certified to work, medical facilities need to take the same approach when it comes to language access. The ACA made great strides when it stated that family, minors, and bilingual staff may not work as interpreters with patients. However, there is still work to be done to standardize what it means to be a medical interpreter whether onsite or in a VRI setting.

VRI and the CPC

All of the CPC tenets below can be honored and maintained while working in VRI with ethically responsible VRI companies. Sign language interpreters can assess the consumer needs and advocate for effective communication from the moment a VRI call begins through its completion.

2.0 Professionalism:

2.2: Assess consumer needs and the interpreting situation before and during the assignment and make adjustments as needed.

3.0 Conduct:

3.1 Consult with appropriate persons regarding the interpreting situation to determine issues such as placement and adaptations necessary to interpret effectively.

6.0 Business Practices:

6.3 Promote conditions that are conducive to effective communication, inform the parties involved if such conditions do not exist and seek appropriate remedies.

6.5 Reserve the option to decline or discontinue assignments if working conditions are not safe, healthy, or conducive to interpreting.

Further, advocacy should also extend to the leadership and management of the VRI company which, if their priorities are properly placed, will work with the medical facilities to educate them on the proper use of VRI.

Final Thoughts

The VRI industry is booming right now, and sign language interpreters are faced with the choice to accept employment opportunities within VRI or resist on principle. If we, as sign language interpreters and allies to the Deaf community, want to protect communication access in medical environments, then it is our duty to hold providers responsible for ethical practices. We know VRI is going to be one of the communication tools medical providers use, so we must work with ethically sound VRI providers to ensure quality and effective communication access is the top priority for all parties involved.

Guest Translator – Mistie Owens, BA, CDI, QMHI, YMHFAI, has been serving the local Deaf community as a CDI since 2011, although she remembers interpreting from her early youth. Dedicated to the healthcare field, she is employed by InDemand Interpreting and holds certifications as a Qualified Mental Health Interpreter and Youth Mental Health First Aid Instructor; her work in Mental Health and related disciplines are her passion. She resides near Salt Lake City, Utah with her husband and rescue dogs.

Questions to Consider:

  1. What committees or advocacy groups are in place that are working to create industry standards for language access and VRI?
  2. Who is holding VRI providers accountable when they negatively contribute to ineffective and unsuccessful medical encounters?
  3. How can ASL interpreters work within their own communities and with existing VRI providers to raise standards in language access in ways that honor Deaf patients while respecting legal and fiscal considerations?

References:

Hansen, Shelly. “Behind the Screens: The Ethics of Medical VRI & Sign Language Interpreters” StreetLeverage. N.p., 22 March 2017. Web. 24 April 2017.

Registry of Interpreters for the Deaf, Inc. “NAD_RID Code of Professional Conduct.pdf.” Www.rid.org. N.p., 2005. Web. 21 April. 2017.

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Scales of Justice: Legal Ramifications for Sign Language Interpreters

Scales of Justice: Legal Ramifications for Sign Language Interpreters

Traditional roles, responsibilities, and accountability for work product were challenged in a 2016 court case which will affect the work of sign language interpreters moving forward, particularly in legal settings.

 

On January 27, 2016, the Court of Special Appeals for the State of Maryland filed a ruling that affects the work we do as sign language interpreters. The case is Clarence Cepheus Taylor, III v. State of Maryland.1 This ruling centers on whether a Deaf criminal defendant has the constitutional right to confront the interpreter who interpreted his ASL statements into English during a police interrogation when the State offers those interpretations as evidence against the defendant in a criminal prosecution.2

The defendant, Mr. Taylor, was arrested on the allegation that he had sexually abused minors. A hearing interpreter and a Certified Deaf Interpreter (CDI) interpreted while detectives interrogated Taylor for almost five hours. Later in court, a jury found Taylor guilty of abusing two of the seven complaining witnesses.

[Click to view post in ASL]

Although the appellate court looked at several issues regarding interpreters, the main issue in this case was whether or not the prosecution could include the statements interpreted to the police in English without calling to the stand to testify the interpreter who spoke the English.

Even though Taylor’s attorney objected at trial that an audio of an interpreter’s English-language interpretations of Taylor’s sign-language statements should not be admitted as evidence, the court allowed the jury to hear the interpreter’s voice for the almost five-hour police interview. Taylor took the stand in his own defense and contended that there were many “misinterpretations” and “miscommunications” between him and the interpreters.

How does this decision impact the lives of interpreters and Deaf people?

Interpreters are responsible for word choices and content of interpretations. According to the State’s brief, the interpreter was “merely a relay for Taylor’s own statements,” “simply conveying, in a different language” rather than providing the interpreter’s “own independent statements.” (Taylor p. 30). The appellate court disagreed. The appellate court recognized that interpretation is not a word-for-word process, but one in which the interpreter has control over the target language, in this case, English.

Police interviews need to be videotaped. The interpreters in this case were correct in having the interview recorded. Without the video, Mr. Taylor’s direct answers would be lost and only the English would remain. The videotaped recording was one of the main sources of evidence against Mr. Taylor. As stated above, the trial court allowed the State to play the entire English language recording to the jury. However, the appellate court made a distinction between the “video of the sign-language communications between Taylor and the interpreters” and “the audio of the statements by the ASL interpreter…” (p. 7). The appellate court realized that English is a distinct language from ASL and a truer understanding of what the defendant meant could be obtained through analysis of the actual signed statements. “The English words that the jurors ultimately heard in this case were not the words of Taylor, but of [the interpreter],3 expressing his opinion as to a faithful reproduction of the meaning of Taylor’s sign-language expressions.” (p. 34)

Even the best interpreters make errors, particularly when fatigue sets in. “Over the nearly five-hour course of Taylor’s interrogation, the two interpreters received only two breaks: a ten-minute break after about two and a half hours of testimony, and a two-minute break another hour later. Most of the more incriminating statements attributed to Taylor occurred during the later portions of the interrogation.” (p. 36). Interpreting services are expensive, but police interviews may need to be suspended until a second team of interpreters is available to relieve tired interpreters and monitor for errors. Interpreters are responsible to set limits on conditions that are not conducive to accuracy.

Both Deaf and hearing interpreters need to prove their skill level by obtaining education and certification. “Recognizing the high level of education, knowledge, skills, and judgment needed to produce faithful interpretations between English and sign language, Maryland typically requires that court interpreters of sign language undergo a rigorous certification process.” (p. 33). In Carla Mathers’ StreetLeverage posting, How Practicing Sign Language Interpreters Protect Against Legal Liability, she states, “An interpreter can be sued for malpractice if they undertake an assignment and do not follow the standard of care in performing that assignment. If this breach of the standard of care causes damages to any of the parties, the interpreter can be liable.”

Interpreters need to understand the adversarial legal system before accepting legal work. The Miranda warning and subsequent police interview are the first, and some would say, most important part of a legal case. Interpreters need to understand their roles and responsibilities. In this case, the detective told the interpreter to inform Taylor that anything he said could be used against him. The appellate court responded to this by stating, “A reasonable person in the interpreter’s position would expect that his English interpretations of Taylor’s statements would also be used prosecutorially.” (p. 23). This means that interpreters should expect to be subpoenaed and challenged on the stand for their interpretations. Interpreters should be ready to defend their English word choices or admit to errors. “The interpreter does not escape confrontation simply because he…did not personally observe any criminal act.” (p. 29)

Legal interpreters need to continually update their knowledge of legal decisions. For example, the legal concept of “admissibility of interpreted statements over hearsay objections” has changed over the past few years due to court decisions. (p. 42).  Unlike the past, when the interpreter was seen as a tool to decode languages other than English, now, an interpreter is “the declarant of his or her own statements about what the defendant has said.” 4 (p. 43). These changes recognize that sometimes the English that an interpreter speaks may not have the same meaning as what a Deaf person has signed. Taylor testified that the interpreter did not render the appropriate English of a conditional statement; “He testified that he told the interpreters that, if he had touched anyone, it would have been an accident, and he would have apologized.” (p.9). The statement was interpreted as a declarative stating that Mr. Taylor did touch the girls.

This decision is good for Deaf people. When stakes are high, Deaf people should challenge the accuracy of interpreters. Substantive interpretation errors should be “brought to light.” In other words, Deaf people should not be punished or disadvantaged by interpreter errors.

Conclusion

The 2016 court decision, Clarence Cepheus Taylor, III v. State of Maryland is a pivotal case in the interpreting field. It raises the issue of when an interpreter’s English statements can be used as evidence in trials without challenging the interpreter’s rendition. Going forward, we need the input of Deaf community members and Deaf and Hearing interpreters to help craft best practices and standards. Through dialogue and education, justice will be better served.

 

Nichola Schmitz, MA, CDI, SC:L, is a Trilingual Deaf Interpreter, specializing in Mexican Sign Language and Mexican gestures. She has a BA in Psychology and MA in Clinical Psychology.   Nichola has several generations of Deaf people in her family. She interprets mainly in legal and immigration hearings. She has trained Deaf and hearing interpreters in several countries including Ghana, Trinidad, and Mexico.

Questions for Consideration:

  1. Can the interpreting field develop standards for handling police interactions with Deaf people? What rules would you include in our “best practices”?
  2. How does a case like the one above change your approach to interpreting for the police?
  3. What other recent court decisions affect our work in the legal interpreting field?

 

1 The author thanks Carla Mathers for calling this case to her attention.

The Sixth Amendment to the United States Constitution provides: “In all criminal prosecutions, the accused shall enjoy the right . . . to be confronted with the witnesses against him[.]”

Author decided against using the interpreter’s name in this article since the issues discussed reach far beyond this one instance.

See United States v. Charles 722 F.3d 1319 (11th Cir. July 25, 2013) (No. 12-14080)

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Is it Time to Certify Sign Language Interpreter Referral Agencies?

In the ever-growing industry of interpreter referral agencies, sign language interpreters and the Deaf community we serve are often look on as profitable afterthoughts. Stephanie Feyne calls for greater ethical scrutiny and consideration of agency certification.

Alarmingly, sign language referral agencies are sending increasing numbers of unqualified signers to interpret for Deaf consumers, causing harm to the communities we serve and to the interpreting field. Friends, consumers and colleagues around the US have been sharing their local horror stories for years. As this is a national issue it cannot solely be resolved at the local level. It requires a coordinated national response.

I believe that the RID membership should collaborate with Deaf leaders to establish standards for agencies that refer sign language interpreters in order to ensure that the Deaf community receives the best possible service. If an agency does not measure up to the standard, then there should be some public acknowledgment of this fact, so that when they bid for work it is clear that these agencies provide no guarantee of quality service.

No Standards

Currently, there are no standards for being a member organization of RID. Any agency can join RID, no questions asked. It enhances an agency’s status to have the RID brand on their letterhead and helps them bid for contracts – while it simultaneously compromises RID’s name, as it appears we support substandard sign language interpreting services. Why don’t agency members have the same standards and obligations that interpreters have? Why are agencies that have no connection to the Deaf community allowed to earn a profit by providing “signers” instead of qualified interpreters, and still benefit from the privilege of being affiliated with RID? What steps can we as professionals take?

Responsibility for Quality Services

When I began interpreting in the ‘70s, referral agencies were housed in Deaf service organizations (such as NYSD in NYC, GLAD in LA, DCARA in San Francisco) and in religious organizations (e.g.; Catholic Charities in Brooklyn and St. Benedict’s in San Francisco).  They provided community interpreters for medical, legal and social service needs.

The agencies I worked for had CODAs and/or Deaf referral specialists who had years of experience in the field. From my observations, they made every effort to assign newer interpreters (like me) only to assignments that we were qualified for. That was true for both certified and non-certified interpreters. Agencies understood that certification signified only entry-level skills and that they needed to assess the skill level of novice interpreters. They did not assign us to highly sensitive work, but often teamed us with more seasoned interpreters in lower risk environments, providing us support for our growth as professionals and providing reassurance to Deaf consumers that we would not compromise their lives.

Sign Language – A Profitable Afterthought

Over the last several years, however, we have seen the entrance of “language service” agencies into the arena of sign language interpreting.  Most of them tack on ASL in addition to the other languages they provide.  Most of their spoken language interpreters are born bilinguals, whereas many of the sign language interpreters on their rosters are self-professed “interpreters,” who have passed no screening or certification exams. While some of these language agencies may have a commitment to providing quality services to the Deaf community, most have no idea how to evaluate the skills of sign language interpreters or the needs of Deaf consumers. Their knowledge base is in bidding for and maintaining contracts.

Although ethical referral agencies do exist, there has been a marked increase in contracts being awarded to agencies that have no background knowledge of our field or the Deaf world, and no ability to evaluate the quality of the services of the interpreters they send to work. For all appearances, it seems that profit, rather than service, is the overweening motive.

(Recent Street Leverage posts on the impact of working for agencies with questionable standards are Self-Talk: A Sign Language Interpreter’s Inner Warning System by Anna Mindess and The Duality of the Sign Language Interpreter by Aaron Brace.

The Human Cost

Sending unskilled workers is a common practice in agencies that provide “interpreting as a business” rather than as a service, but that practice has serious repercussions. Recently in NYC, a call went out from a language agency needing interpreters for an “end of life” situation in a hospital.  A few weeks later, I spoke with friends of the family. They said that throughout the entire weekend the Deaf parents thought their child was “sleeping,” even after all the “interpreters” sent by that agency had “interpreted” the words of the doctors. This is not the only incident. Locally, I have seen language agencies with city contracts send basic signers to evaluations of the fitness of Deaf parents and uncertified interpreters to court, threatening the legal status of Deaf claimants, defendants, and the integrity of the court itself.

The decisions these agencies are making have a negative impact on all parties present: Deaf, hearing, and interpreters. Sign language interpreters who are not appropriate misrepresent themselves and the Deaf parties. Deaf people often do not get their message across; neither do the hearing participants. The only ones guaranteed to succeed in attaining their goals are the agencies, which get paid regardless of the caliber of the interpreting work.  This is not just happening in New York City, but also around the country.

An Ethical Quandary

Professional interpreters are left with an ethical quandary… Do I stop interpreting for an unethical agency and leave Deaf people with poor interpreters? Do I spend hours educating the agency, only to see them ignore the advice and go with lesser skilled interpreters? Do I develop relationships with these agencies? Do I accept lower fees in order to ensure quality interpretation?

Can sign language interpreters solve this problem alone? Clearly, the Deaf communities have been left out of the decision-making process. Local interpreting chapters or collectives that work in tandem with Deaf individuals and associations may be able to make some headway in certain locations, but I believe we should use the power of our national association to address this issue.

Agency Certification

RID certifies interpreters, why not certify agencies? This would imply an ethical practice mandate for agencies that refer sign language interpreters, and an obligation for RID to monitor complaints and de-certify agencies that are not behaving ethically. This could then be written into local and state contracts. There should be consequences if an agency sends inappropriate “signers” to jobs.

We, the members of RID, need to take the first step by developing stringent requirements for the business practices of referral agencies, with consequences for those agencies that are not following best practices. The requirements should state that agencies must:

  • abide by an ethical business model – that would include sending the most highly qualified interpreter, not just a warm body;
  • utilize a valid evaluation mechanism for non-certified interpreters;
  • provide sign language interpreters with relevant information prior to the assignment;
  • protect confidential information, by not including it in the emailed call for interpreters;
  • respect the communicative norms, rights and personhood of the Deaf individuals  by presenting them with the most appropriate qualified interpreters for their needs (which means seeing the Deaf individuals as their clients, not just the hearing contract holders).

If agencies do not live up to such standards they should lose the privilege of being a member of RID, and that information should be publicly available for any potential clients to view.

Let’s Get Started

Let us begin now to discuss the standards and the consequences. Let us engage both locally and nationally. Let us not allow agencies in their pursuit of profits to harm Deaf people.

What other requirements should be included when considering the certification of referral agencies?

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