Letter to President of Beth Israel Medical Center

Dr. David Shulkin
President
Beth Israel Medical Center
16th Street and 1st Avenue
New York, NY 10003

January 25, 2007

Dear President Shulkin:

My name is Joshua Finkle and I am the current president of the Empire State Association of the Deaf. Last week, nearly 200 members of the New York City deaf and sign language communities met to discuss their concerns about your recent decision to radically downsize Beth Israel Medical Center’s on-site Sign Language Interpreting Department and replace live interpreters with Video Remote Interpreting (VRI) equipment throughout your facility. We are taking this opportunity to express some of these concerns.

For over a decade, BIMC has been the “gold standard model” for accessible health care for the deaf because of its sign language interpreting department. Your hospital has been a regional leader in the health care industry by providing exemplary full-time, live, on-site and on-call interpreters. The deaf community is diverse, akin to the make-up of New York City. Deaf and hard-of-hearing individuals come from a wide range of familial and educational backgrounds. Some come from different countries and utilize their native sign languages. Others use signs with regional dialects. BIMC’s sign language interpreting department has been very successful in adapting to this diversity and accommodating everyone’s needs. Consequently, the New York City deaf community relies on BIMC for the highest quality of care. That will change once VRI becomes the standard interpreting service offered to your patients.

We recognize that the decision to expand VRI services is undoubtedly the result of a cost-benefit analysis and an effort to relieve financial pressures. However, as much as we appreciate the economic challenges faced by a facility such as BIMC, we implore you to halt further action on your plan and reconsider your decision after meeting with representatives from the deaf, hard-of-hearing, and sign language communities.

VRI has serious limitations. We are aware that BIMC currently uses VRI in its emergency room to satisfy the requirements of the State of New York Department of Health Code (Section 405.7 – Patient’s Rights, 7, viii (a)). However, the Federal Communications Commission qualifies VRI as a way to provide interpreting services when an interpreter cannot be physically present (FCC Public Notice DA 05-2417).

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Other considerations regarding the use of VRI are vast. Several examples were offered by members of the community, from their own experience. To cite just a few:

• VRI cannot be accessed by deaf persons with vision loss including those who are deaf-blind, have limited vision, or have Usher’s Syndrome;

• VRI cannot be accessed by deaf persons who have some form of mental incapacitation including mental retardation, autism, psychotic disorder, etc.;

• Live and physical contact with a deaf patient is often necessary, especially when a patient is experiencing pain or is compromised physically, e.g. lying in a prone position;

• VRI cannot accommodate the full progression of a patient’s experience at BIMC. Live interpreters move with deaf patients between clinics, surgical suites, testing suites, administrative offices, etc. Limited availability of VRI equipment cannot match this standard of care nor satisfy accessibility requirements;

• VRI technology is not always reliable. In addition to technical difficulties (will the medical staff know how to fix a connection problem?), problems can arise from regional differences in sign choices as well as vocal accents. Physical and aural positioning during an examination or a procedure, etc. often cannot be reliably captured or conveyed through a stationary screen.

We request that you, along with involved members of your staff and Board of Trustees, meet with us in an open forum to discuss the practical, ethical, and medical concerns of your plan. Certainly, the decision to switch to a VRI system should not be made without representation and input from the deaf community. We invite you to schedule this meeting for no later than the end of February, 2007.

We want to help BIMC avoid making a calamitous error that would potentially lead to litigation and adversely affect our community. Instead, we want to encourage BIMC to continue to be an outstanding leader in accessible health care as we continue to regard your institution with utmost respect.

Sincerely yours,

Joshua Finkle, M.S.W., President, Empire State Association of the Deaf
Mary Kay Adams, CI, Deaf and Hard of Hearing Interpreting Services, Inc.
Charlotte Lewis, M.A., Assistant Residence Manager, F.E.G.S. / New York Society for the Deaf Services, Tanya Towers Apartment Treatment Program
Henry Sang, Deaf Task Force Moderator/Leader
Debbie Swamback, Deaf/Interpreter Relations Committee (DIRC)
Christopher Tester, Civil Rights Advocate
Lusanne Massaro, MA, President NYC Metro Registry of Interpreters for the Deaf, RID Certified ASL Interpreter CI, CT

cc:
Morton P. Hyman, Chairman of the BIMC Board of Trustees
Laura Weil, Director of BIMC Patient Representative Department

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