HospitalInspections.org

Based on interview and documentation review, the facility failed to provide 1 of 10 patients (patient #1) with interpreter services when the patient requested an in person American Sign Language (ASL) interpreter for communication. Findings include:

A review of patient #1's medical record revealed that she was admitted from another area hospital. The admission documentation revealed that patient #1 is hearing impaired, wears hearing aids, and is able to communicate without an interpreter. She was admitted with suicidal ideations and placed on a 72 hour hold. Patient #1 participated in group therapy sessions, and counseling sessions for the first two days of her stay at the hospital. On the third day, during a commitment meeting, patient #1 expressed concerns that she did not understand the commitment process, and concerns that the testing completed by the hospital regarding her diagnoses was not accurate. Patient #1 requested an ASL interpreter. The staff of the hospital brought in the Marti system (remote interpreting service which uses video conference technology to provide sign language, oral translators, or language interpreters) to interpret for patient #1. Patient #1 refused the use of the Marti system. Following the meeting, patient #1 refused to attend counseling sessions with her physicians, and refused to attend group meetings, as she requested a live ASL interpreter, and the facility continued to offer the Marti system.

A 12/19/2012 at 10:15 a.m. progress note documents that patient #1 was concerned with access to a 1:1 sign language interpreter. The Marti system was offered to patient #1 but patient #1 reports difficulty with the Marti system when more than one person is talking,"it becomes too confusing." The note documents that patient #1 denies suicidal ideation, and feels that the information provided has been misinterpreted during her hospital stay. Patient is "tearful and frustrated." She is currently not attending groups unless an interpreter is available.

A 12/19/2012 at 23:15 progress note documents that an interpreter for the deaf will be in the hospital at 9:00 a.m. on 12/20/2012 to prepare patient #1 for discharge from the hospital. Due to inclement weather, the interpreter was unable to travel to the hospital on 12/20/2012.

A 12/21/2012 intervention note documents that patient #1 denies suicidal thoughts with interpreter present, and patient #1 was discharged with her husband.

Employee (E)Licensed Social Worker (LSW) was interviewed on 2/7/2013 at 10:30 a.m. and stated that on the day of the commitment meeting, patient #1 was offered the Marti system several times during the meeting. Patient #1 expressed concern during the meeting that she did not understand the commitment process, and requested an in person ASL interpreter. She refused the Marti system each time offered. Following the commitment meeting, patient #1's behavior changed and she refused to attend group meetings or therapies without an interpreter present. Employee (E) stated that prior to the meeting, patient #1 was speaking to staff and other patients, talking on the phone, and participated in groups and therapy sessions.

Employee (D)/nurse was interviewed on 2/7/2013 at 9:40 a.m. and stated that patient #1 was initially interractive with staff and other patients until the commitment meeting. Following the meeting, patient #1 requested a live ASL interpreter 24/7. She stated that the Marti system meets the legal requirements for interpreter services, and was offered to patient #1 several times during her stay at the hospital. Employee (D) stated that she was not aware of any concerns regarding communication barriers with patient #1 until the commitment meeting and was not offered interpreter services prior to this meeting.

Individual (H)/County Social Worker was interviewed on 1/30/2013 at 11:10 a.m. and stated that patient #1 refused to use the Marti system for communication and told her that the Marti system is difficult to use, she didn't like the screen, and she didn't want to use the system. Patient #1 felt that she was misdiagnosed during the first two days of her hospital stay, and was stressed by the lack of understanding regarding the commitment process. She stated that the hospital did provide an interpreter on the last day of patient #1's stay, per patient #1's request. Patient #1 told her that she repeatedly asked for a live ASL interpreter following the commitment hearing, and the hospital stated to her and patient #1 that the Marti system was legal, and they would not be requesting a live interpreter.
Patient #1 was interviewed via text message and email sent on 2/13/2013 and stated that she did participate in counseling sessions and group sessions for the first two days of her stay at the hospital without an interpreter. On the third day, when the hospital staff talked about a Civil Commitment Notice, she realized that she did not understand what was happening, and why she received the commitment notice. She asked for an ASL interpreter, and Employee (E)/Social Worker brought the Marti system into the room. Patient #1 refused the system, and Employee (E) stated that is what the hospital uses for interpretation. Patient #1 again refused. Patient #1 stated that the Marti system is not effective for her, does not work well, and will freeze at times. She stated that she also has to look at the screen, and then back at the speaker, and didn't feel that she received the information she needed to hear. Patient #1 refused to attend further counseling sessions and group meetings, as she told staff that she wanted an interpreter present. She was not provided an interpreter until the day of discharge from the hospital.