Questions & Answers -- Communicating with Hearing Impaired (Attachment B2)

Questions & Answers
Communicating with Hearing-Impaired Individuals
(Attachment B2)

Q: How do persons communicate who cannot hear?

A: Most persons who are severely or profoundly deaf use Sign Language, the principal language of hearing impaired persons in the United States.

Q: Why is this important with respect to emergency rooms?

A: OCR's own research on hospital emergency room usage reveals that most people coming to emergency rooms, regardless of medical condition, are conscious and able to communicate with emergency room staff. OCR finds no evidence that emergency services are required any less for hearing impaired persons than for persons without such impairments. Therefore, most persons with impaired hearing will arrive at the emergency room conscious and ready to communicate with hospital personnel. Their lives may depend on such communication taking place without delay.

Q: What about other hospital services?

A: Hearing impaired persons can be expected to contact health care providers for a wide range of information and services, either for themselves or for others, just as hearing persons do. For example, a deaf parent may seek emergency medical treatment for a sick or injured child, who may or may not be deaf. Or, an accident victim might be brought in by a hearing impaired person who witnessed the accident and could provide critical information if someone were available who understood sign language.

Q: What does Section 504 require?

A: Section 504 of the Rehabilitation Act of 1973, in effect, affirms the right of sensory impaired persons, including hearing impaired persons whose primary or exclusive language is sign language, to receive health care and related services in inpatient, outpatient, and emergency settings which are equal to, or as effective as, those provided to persons without disabilities. This standard applies regardless of the need for the recipient to provide specialized language/communication services and appropriate communication-facilitating auxiliary aids. Subsections (§§) 84.52(c) & (d) of the Section 504 regulation state:

Emergency treatment for the hearing impaired. A recipient hospital that provides health services or benefits shall establish a procedure for effective communication with persons with impaired hearing for the purpose of providing emergency health care.

Auxiliary aids. (1) A recipient to which this subpart applies that employs fifteen or more persons shall provide appropriate auxiliary aids to persons with impaired sensory, manual, or speaking skills, where necessary to afford such persons an equal opportunity to benefit from the service in question....(3) For the purpose of this paragraph, auxiliary aids may include brailled and taped material, interpreters, and other aids for persons with impaired hearing or vision.

Q: How do we go about developing a procedure for communicating with hearing impaired persons that will meet the Section 504 requirements?

A: The key is consultation with knowledgeable persons, preferably including the persons who will be affected.

The procedure which a recipient health care provider establishes for effective communication with hearing impaired persons for the purpose of providing emergency health care, and the appropriate auxiliary aids which it provides in emergency, inpatient, and outpatient settings, must have been developed, or reviewed and modified as necessary, in consultation with persons with disabilities or organizations representing persons with disabilities, including persons with impairments of sight or hearing, as part of the self-evaluation process required by § 84.6(c) of the Section 504 regulation.

Q: What about services provided over the telephone, such as answering questions about charges and financial arrangements, indicating bed availability, and answering health care questions?

A: §§ 84.52(c) & (d) of the Section 504 regulation pertains to health care and related services and benefits, including emergency medical services, which are provided via the telephone.

The telephone is obviously one of the principal methods by which beneficiaries contact providers for appointments, request emergency assistance, or seek other services and information. A recipient which provides information and services over the telephone to hearing patients must provide equal or "as effective" telephonic communication for persons with impaired hearing. Usually this requires the use of a telecommunication device for the deaf (TDD). This applies to persons whose primary language is sign language, as well as to other persons with impaired hearing.

If the hospital makes bedside telephones available to hearing patients, then hearing impaired patients should have similar telephone access by TDD.

Q: What are some other communication-facilitating auxiliary aids?

A: For communicating with hearing impaired persons who have limited skills in speaking, writing, or reading English, health care providers most frequently mention lip reading (also known as speech reading), writing notes and fingerspelling, family members or friends, and qualified sign language interpreters. OCR has reached the following conclusions with respect to each of these methods:

Lip reading (or speech reading)
Lip reading may be an ineffective means of communication for most hearing impaired persons for several reasons. Lip reading presumes that all hearing impaired persons speak English. However, studies of the expressive and receptive English competence of deaf persons indicate that only a small percent nationwide have demonstrated proficiency in speech reading or speaking.
Lip reading is often slow and requires a high degree of concentration. In an emergency situation, there may not be enough time to use this form of communication, nor are conditions likely to be optimal. Moreover, lip reading does not facilitate two-way communication. Even the relatively few deaf persons proficient in lip reading may not be able to speak the sounds of English or the sounds they do utter may not be understandable to others.
In sum, lip reading does not permit the flow of information between the deaf person and health care provider which is essential to diagnosis and treatment.
Writing notes and fingerspelling
Writing notes and fingerspelling are both ineffective methods of communication for the majority of deaf persons. As with lip reading, these methods presume that all deaf persons are functionally literate in English.
Also, writing notes and fingerspelling are incomplete forms of communication, because these methods are slow and deaf persons are often unfamiliar with the vocabulary of health care professionals.
Finally, the grammar, syntax, and form of American Sign Language are totally different from English.
Family members and friends
Family members and friends are frequently asked by health care personnel to interpret. Such persons may not be effective or reliable as interpreters. They may lack the objectivity required to interpret in a health care setting and can misinterpret pertinent information, despite their best intentions. Health care terms and phrases are likely to be beyond their signing ability. This frequently leads to confusion for both the hearing health care provider and the deaf patient.
By relying on family members or friends to interpret, the health care provider risks breaching well-established rights of patients to privacy and confidentiality. Even if this were not a consideration, family members and friends will not always be available when they are needed, especially in emergency situations.
Finally, the use of family members and friends as interpreters inappropriately places on the patient, rather than on the recipient, the regulatory obligation to provide appropriate auxiliary aids. The only case where this is acceptable is where the patient has been made aware of a full range of communication facilitating options available at no additional charge and, without any coercion whatsoever, selects family members or friends as the option of preference.
Qualified sign language interpreters
With few exceptions, qualified sign language interpreters are persons who, as the result of specialized formal education and experience, have been certified by the Registry of Interpreters for the Deaf (RID) at a level consistent with their training and experience. They follow a professional code of ethics requiring them to maintain confidentiality and accept only those assignments for which they are qualified and in which they have no conflict of interest. While it is not essential that a person be certified to be a competent interpreter, it is a useful indication of such competence.
OCR's research indicates that qualified sign language interpreters are the only "auxiliary aid" which can ensure effective communication between hearing impaired persons whose primary or exclusive language is sign language and hearing persons who have limited or no sign language skills, particularly in emergency and other health care situations where the rapid exchange of accurate information is critical.
The use of qualified sign language interpreters ensures that deaf individuals and hearing health care professionals will be able to communicate with each other at a rate and level of complexity equal to, or as effective as, the communication rate of persons who speak directly to each other in the same language.
Also, qualified interpreters can transmit not only the conversations between deaf and hearing persons but also surrounding conversations and other auditory events. This means deaf persons can be provided with a level of environmental awareness through their sense of sight by means of qualified sign language interpreters which is similar to the awareness level others achieve through their sense of hearing.
As you can see, OCR's research indicates that using qualified sign language interpreters is most effective in ensuring that deaf persons whose primary or exclusive language is sign language will not be subjected to unnecessary delays or inappropriate treatment that could result from the other methods mentioned.

Q: Are there different sign languages?

A: Yes. A commonly used language is American Sign Language (ASL). Also used in the U.S. is Signed Exact English (SEE). Unlike ASL, which has a different grammatical structure than English, SEE relies on sign but presents them in the same order as standard English. It is considered a " manual code for English". Persons who rely on SEE also need qualified sign language interpreters. However, it is usually not necessary to access two types of interpreters. Qualified sign language interpreters should be able to communicate fluently in both SEE and ASL.

Q: How do you determine which forms of communication the person prefers?

A: Obviously, the hearing impaired person is in the best position to determine the means of communication needed to provide an equal opportunity to benefit from health care and related services. In case of disagreement about communication methods between the health care provider and the hearing impaired beneficiary, the judgment of the hearing impaired person should be given primary consideration.

Similarly, in determining the range of communication-facilitating auxiliary aids which you should be prepared to provide, consultation with persons with varying types and degrees of hearing impairments and methods of communication, and with their representative organizations, is essential.

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Date revised: July 23, 2000