Going to the hospital with a heart attack is traumatic enough, but it can be terrifying if you can't communicate with the doctors and nurses.
"I was in an unfamiliar place, my girlfriend wasn't there, I was just in this white room. It was very scary, I didn't know where I was and what was going on," said John D'Ambrosio.
[Editor's note: To enable closed captioning on the video above, click the "captions" button on the upper righthand corner]
D'Ambrosio is deaf. He said when he had a heart attack in June 2011, no one on staff at Halifax Medical Center in Volusia County knew American Sign Language, making it extremely difficult for him to describe his medical crisis and for the staff to explain what was happening.
In the five days D'Ambrosio was treated at Halifax, he said communication sputtered through a spotty video link with an interpreter and hand-scrawled notes.
"They said, 'Later, later, later, later, later,' and it just kept being later, later," D'Ambrosio said hospital staff told him about a live interpreter.
D'Ambrosio and two other patients have sued Halifax, claiming the hospital failed to provide them with live interpreters who could speed up and clarify communication between patient and medical professionals.
He said he worries that difficulty communicating with doctors and nurses there could have cost him his life.
"When I woke up, she had a mask on her face, and she pulled it down and said, 'Can you read my lips?' I guess," he said, referring to a nurse.
But D'Ambrosio does not read lips. He communicates primarily using American Sign Language, or ASL.
D'Ambrosio said he didn't get a live interpreter for days. Initially, he and hospital staff used a computer system called Video Remote Interpreting to communicate.
VRI is similar to Skype; the deaf person signs to the computer, and an interpreter in the remote location voices those words for the hospital staff. Using that relay system is acceptable under hospital policy and the Americans with Disabilities Act – if it works. D'Ambrosio said that wasn't the case at Halifax where it often didn't function properly.
"I saw there was something over in the room... And my girlfriend explained to me it was a video relay interpreter, but it wasn't working," he said. "The doctor was just standing there and then he left. I guess the internet was down, the network was down. And the nurse says, 'Oh, I hate this thing.'"
When the video link failed, hospital workers turned to handwritten notes to communicate with D'Ambrosio. But he reads at a fourth grade level and much of the complex medical information they wrote was difficult for him to understand.
While D'Ambrosio said Halifax didn't offer effective interpretation, Halifax officials said the hospital did. Earlier this year, a federal judge agreed with the hospital.
U.S. District Court Judge Gregory A. Presnell threw out D’Ambrosio’s lawsuit, saying there's no legal requirement for hospitals to provide a live interpreter on every occasion. Presnell ruled that Halifax’s use of the videoconferencing system and handwritten notes provided them the same level of care as patients who are not deaf.
"It is always Halifax Health's goal to provide necessary and effective communication to all of our patients," Halifax spokeswoman Tangela Boyd said in a written statement provided to Local 6. "We are pleased that the Court has agreed with us by ruling in our favor."
But the hospital policy provided to Local 6 by Boyd says the hospital staff has to make every effort to provide a live interpreter if one is requested.
Now, D'Ambrosio and the other two Halifax patients who filed suit with him are appealing the judge's ruling.
"To say the communication that was provided was effective-- there was no communication, so you don't have to get into the question of effective, because no communication took place," said Bates. "That's unacceptable."
A Different Language
Deaf people who rely on American Sign Language to communicate will tell you, ASL is not English, it's a different language.
Local 6 spoke to Malia Johnson, the CEO of Deaf Talk, LLC. It's an Orlando-based company that offers certified ASL interpreters and focuses on bridging the gap between the deaf and hearing worlds.
Johnson is deaf herself; and said ASL is actually a different language than English. Despite signs that translate to English words and phrases, Johnson said in some cases, deaf individuals that are fluent in ASL may not be fluent in English at all. That means they may have lower reading comprehension levels, just as D'Ambrosio said he does.
Johnson also explained that often, there aren't specific signs to correspond to medical procedures. She said a certified interpreter would actually have to define the terms using ASL to the deaf patient to make sure they understand, rather than just simply finger-spelling them out. For example, rather than just say a patient is having a colonoscopy, the interpreter would have to use gestures and signs to get that point across-- and then check to make sure the patient understood what they meant.
Johnson said that's why, for the most part, family members aren't qualified to interpret medical terms; because in most cases, they may not have the medical knowledge or medical background necessary to explain procedures or other terms correctly.
D'Ambrosio said all of those reasons are why he had trouble making sense of notes that said things like: "Your CK - a lab that tells us heart damage is down from over 8000 yesterday to 2000 today. God is looking after you. Unreal. I never seen anyone live. Lucky."
Another note reads: "You have to keep that leg very straight so that the balloon doesn't slip down and block your renal arteries-- killing your kidneys and so you don't bleed out at the insertion site."
"I still don't understand, I don't know what they were talking about," said D'Ambrosio. "I have the paper that they wrote and said this to me, but it still bothers me because I don't know what that means."
"A few notes is great with ordering at Burger King, not at having a heart attack," said Dietz.
However, when we asked the hospital why D'Ambrosio was not provided a live in-person interpreter during his procedures, a hospital spokeswoman declined to comment citing pending litigation.
Claims Of Past Medical Interpretation Issues
Halifax has been accused of failing to provide interpreters for deaf people before.
According to court records, Halifax Medical Center has settled three prior lawsuits in which they were accused of failing to provide interpreters.
Attorneys for the hospital said those settlements are irrelevant to the facts of this matter.
But Dietz and Bates said the primary issue is the same-- a lack of effective communication to the deaf individual.
Court records show one of the other patients on D'Ambrosio's lawsuit is Richard Martin, who previously settled with Halifax in a similar case. In June 2009, Martin was hospitalized for four days during which time he said did not get an interpreter. In January 2011, Halifax settled with him.
On the current lawsuit that is going to appeal, Martin said it happened again when he was admitted to Halifax in August 2011 after suffering a concussion during an accident. He said he wasn't given an interpreter that time, either.
Yolanda Gevarzes is also a patient on the current lawsuit with D'Ambrosio and Martin.
In Gevarzes' case, she said the hospital didn't fulfill her request for an interpreter when her 17-year-old daughter went to Halifax to give birth. Gevarzes said hospital employees refused to provide her the interpreter because her daughter is not deaf. She said hospital staff told her they only provide interpreters for patients.
But according to the ADA, hospitals are required to provide effective means of communication for patients and their family members or visitors that are deaf. The ADA also says when an interpretation service or auxiliary aid is requested, primary consideration must be given to the method the patient or deaf person feels is most effective.
Bates said now, they're hoping the appeal will be successful.
"We understand that we don't always win, but at some point you have to draw a line in the sand," said Bates. "Essentially we're on a path where there's no recourse for a deaf individual in Central Florida if they're not provided medical treatment or interpreters in a medical situation. We're between a rock and a rock."