Ensuring Open and Effective Communication in Hospitals for Persons Who are Deaf or Hard of Hearing. Press Packet

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1 The New Jersey Office of the Attorney General Ensuring Open and Effective Communication in Hospitals for Persons Who are Deaf or Hard of Hearing Press Packet December 5, 2005 RICHARD J. CODEY Governor PETER C. HARVEY Attorney General J. FRANK VESPA-PAPALEO Director, NJ Division on Civil Rights BRIAN C. SHOMO Director, NJ Division of Deaf and Hard of Hearing

2 Table of Contents Office of the Attorney General s Press Release * Letter of Support from the New Jersey Division of Deaf and Hard of Hearing * Letter of Support from Self Help for Hard of Hearing * Letter of Support from Sean Gerlis, President of New Jersey Association of the Deaf * Letter of Support from Lila Taylor, Disability Advocacy Working for Northwest * NJ Division on Civil Rights Fact Sheet: Ensuring Open and Effective Communication in Hospitals for Persons Who are Deaf or Hard of Hearing

3 Peter C. Harvey, Attorney General For Immediate Release: For Further Information Contact: December 5, 2005 Lee Moore (609) or Ron Czajkowski, NJHA (609) AG Harvey, NJHA Announce Initiative to Improve Communication for Deaf, Hard of Hearing TRENTON Attorney General Peter C. Harvey announced today a major new initiative, launched in conjunction with the New Jersey Hospital Association (NJHA), that will result in improved communication between hospital care providers and patients who are deaf or hard of hearing at more than 100 hospitals throughout the state. According to Harvey, the key to the new initiative is a commitment from 112 NJHA member hospitals to comply with the New Jersey Law Against Discrimination (LAD) and other state and federal laws by providing sign-language interpreters, assistive listening devices and other reasonable accommodations to ensure that persons with hearing loss can communicate effectively with hospital staff. Adults and children who are deaf or hard of hearing must be able to effectively communicate with doctors and nurses to explain their illness or injury, said the Attorney General. This is as much a public safety issue as one of health care. Certainly, communication cannot be the barrier between life and death. I credit New Jersey s hospital community for recognizing that a disparity has existed, that it can do a better job of serving the needs of deaf and hard of hearing persons, and for its willingness to work cooperatively with us to improve the situation. Reasons for the Hospital Deaf/Hard of Hearing Initiative There are an estimated 720,000 deaf or hard of hearing persons in New Jersey alone. Advocates agree the number could be substantially higher because it is often difficult to identify those with hearing loss. Absent the services of a sign language interpreter, assistive listening device or other accommodation, deaf and hard of hearing persons often experience difficulty in conveying vital information about their symptoms and medical histories. In addition, said Attorney General Harvey, patients with hearing loss have complained about being placed in the awkward and potentially harmful position of relating sensitive medical or personal information through friends and relatives, including small children. -more-

4 Joining Attorney General Harvey for today s announcement were J. Frank Vespa-Papaleo, Director of the Division on Civil Rights, representatives of the NJHA, representatives of the state Division of the Deaf and Hard of Hearing in the Department of Human Services and Albert Gutierrez, Chief Executive Officer of Shore Memorial Hospital in Somers Point, who chaired an NJHA task force on hospital communication with the deaf. By virtue of the New Jersey LAD and the federal Americans with Disabilities Act (ADA), hospitals are required to provide deaf and hard of hearing patients as well as third parties with a legal right to health care information and/or authority to make health care decisions with an effective means of communicating with hospital staff. The means of communication must be provided with minimal delay, and at no cost to the patient or third party needing the service. Attorney General Harvey noted that, while the law does not require hospitals to provide every service requested by a person with hearing loss, it does require an accommodation that is reasonable under the specific circumstances. For example, Harvey explained, it may be reasonable under certain circumstances for hospital staff and a person with hearing loss to communicate by using simple hand gestures, a nod of the head, or by writing basic questions and answers on a sheet of note paper. However, the Attorney General noted, more complex interactions the discussion of symptoms, personal history, medical diagnosis, treatment options, etc. are likely to require a certified sign language interpreter, assistive listening device or other accommodation to ensure that vital information is communicated accurately, and in keeping with informed consent and patient confidentiality requirements. Division on Civil Rights Director Vespa-Papaleo noted that the State and the NJHA are in agreement that -- save for a genuine medical emergency, or a situation in which the patient has refused the services of an interpreter or assisted listening device -- using family members, companions and friends as interpreters is not to be considered a reasonable accommodation. This is not only a matter of protecting the individual rights provided for by law. It is also a matter of patient well-being, said Vespa-Papaleo. Persons with hearing loss should be advised up front, in clear terms, that they have a right to an interpreter or assisted listening device provided by the hospital at no cost to them. The individual with hearing loss should also be consulted as to his or her preferred method of communication. It is important to remember that different people within the deaf and hard of hearing community experience different degrees of hearing loss. A one-size-fits-all approach to enhancing communication will not suffice. Attorney General Harvey acknowledged that, based on input from the advocacy community, it appears there is a shortage of qualified sign-language interpreters serving New Jersey, particularly after hours. He agreed that developing a larger pool of qualified interpreters is a priority issue, and one that will not be resolved overnight. -more-

5 However, the Attorney General said, other factors have also contributed to a lack of accommodation for the deaf among New Jersey hospitals including a failure to consistently commit needed financial resources. (Hospitals contend that, where this has occurred, it is directly related to inadequate reimbursement from insurers for services to the deaf.) Attorney General Harvey also observed that there has been a lack of consistent training and education among care providers and other staff at hospitals throughout the state. He noted that the NJHA has agreed, as part of the joint initiative, to take a lead role in coordinating information, education and staff training efforts at member hospitals, and has committed to serving as a general catalyst for change. To be certain, there are complex issues that need to be addressed on a continuing basis, but a commitment from the New Jersey Hospital Association to improve training and education at its member hospitals and to act as a catalyst in making this a priority issue at those hospitals - - is an important part of the overall solution, said Harvey. Hospital Signs As part of the joint initiative, NJHA hospitals have agreed to post signs throughout their facilities including the admissions, registration and emergency care areas informing persons who are deaf or hard of hearing that the hospital provides reasonable accommodations to individuals who suffer from hearing loss. In addition, the hospitals have agreed to assess the individual needs of those who request an accommodation, and provide him or her with written materials describing the types of services available, as well as reminding that the services are free. Fact Sheet In addition, the Attorney General s Office and the Division on Civil Rights have created a two-page fact sheet that explains what NJHA member hospitals will be doing to improve communication between care-providers and patients with hearing loss. The Fact Sheet also contains answers to frequently asked questions, and provides information on what recourse is available to a deaf or hard of hearing person who believes he or she has been denied a reasonable accommodation. The Fact Sheet will be provided to NJHA member hospitals for posting within their facilities and/or distribution to patients and visitors. It will also be posted on the New Jersey Division on Civil Rights Web site at as well as on the Web site of the Division of the Deaf and Hard of Hearing at and the New Jersey Hospital Association Web site at Training Manual The NJHA has also developed an extensive manual to be circulated among its member hospitals entitled Interpreter Services for the Deaf & Hard of Hearing: a Resource for Hospitals. -more-

6 Brian Shomo, Director of the Division of the Deaf and Hard of Hearing, welcomed NJHA s development of a resource manual, and its readiness to serve as an industry clearinghouse for training and education on accommodating persons with hearing loss. Shomo said the NJHA is demonstrating a genuine commitment to achieving optimum health service for people with hearing loss by way of giving health care organizations and front-line professionals the freedom and support they need to work more effectively. Attorney General s Focus on Deaf and Hard of Hearing Community Attorney General Harvey made improving hospital communication for persons with hearing loss a top priority in the wake of two public forums on issues of concern to the deaf and hard of hearing in Sponsored by Director Vespa-Papaleo and the Division on Civil Rights, the forums one at Camden County College in Blackwood, one at Montclair State University in Montclair brought together representatives of government, persons with hearing loss, their loved ones, and advocates for the deaf and hard of hearing. First Phase Movie Theater Initiative During the same public forums held in March 2004, many persons with hearing loss related tales of having been unable to fully experience first-run Hollywood movies in a theater setting due to a lack of adequate captioning. Some spoke of their sadness at seeing their deaf or hard of hearing children miss the thrill of experiencing a popular new movie, as their hearing friends had, or of not being able to share the experience with their children. In the aftermath, the Attorney General s Office spearheaded a legal initiative that helped ensure that persons with disabilities would have the same opportunity to enjoy first-run movies as everyone else. Through settlement agreements with four major movie chains operating in New Jersey American Multi-Cinema (AMC), Loews Cineplex Theaters, Clearview Cinemas, and National Amusements the State brought cutting edge deaf captioning technology to multiplex theater screens across the state. ( In addition, AMC, Clearview and National Amusements agreed to install technology that enables the blind and visually impaired to better follow the action of a movie through special narration provided via audio headset. The technology is known as DVS or Descriptive Video Service.) As a result of the captioning agreements, New Jersey went from three to 38 movie screens that provide new captioning technology for the deaf and hard of hearing more than any other state. In each case, the four participating theater chains chose a form of closed captioning known as Rear Window Captioning. However, the Attorney General s Office made plain that it viewed either Rear Window Captioning or another approach, known as Open Caption Projection, as reasonable accommodations for the deaf and hard of hearing, and had no preference. One theater chain refused to install technology to assist the deaf and hard of hearing view movies Regal Cinemas. As a result, the Attorney General s Office filed suit in 2004 against the Tennessee-based Regal, the largest multiplex operator in New Jersey. The complaint, which alleges violation of the New Jersey LAD by Regal, remains in litigation. ###

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9 SHHH-NJ Statement in Support of the Hospital Communication Access Initiative December 5, 2005 The New Jersey State Association of Self Help for Hard of Hearing People (SHHH-NJ) applauds the New Jersey Attorney General Peter C. Harvey, the N.J. Hospital Association, and the N.J. Division of Civil Rights for their successful groundbreaking efforts to ensure effective communication in hospitals for people with hearing loss. Hearing loss, an invisible disability, is typically overlooked, misunderstood and underestimated. The resulting poor communications can have a critical impact on the quality of healthcare in a hospital environment. The Hospital Communication Access Initiative requires a communication needs assessment at intake, which is particularly important for hard of hearing people who don t use sign language. This population, which makes up 97% of all people with hearing loss and includes a disproportionately large number of geriatric patients, is often reluctant to admit having a hearing loss, is unlikely to be aware of devices (such as personal amplifiers) that can help them, and may need assistance with their hearing aids and other aspects of their hospital stay. Even those people who use hearing aids or cochlear implants effectively still require trained staff that are knowledgeable and attentive to their communication needs. With this initiative, the hospital s responsibility for effective communication is finally being recognized as an essential component of healthcare a significant advancement for people with hearing loss. Contact person: Arlene Romoff Trustee, SHHH-NJ 2 Westwind Court Saddle River, NJ (voice) (cell) aromoff@aol.com

10 New Jersey Association of the Deaf Attorney General Peter C. Harvey NJ Office of the Attorney General Department of Law and Public Safety Hughes Justice Complex P.O. Box 080 Trenton, NJ /2/2005 Attn: Peter C. Harvey, Attorney General Dear Attorney General Harvey: Communication access in hospitals for individuals who are deaf or hard of hearing is a continuing concern for both New Jersey Association of the Deaf and DAWN, Inc.' Deaf Senior Citizens of Northwest Jersey. We are not-for-profit organizations that fully support the efforts of the Division of Civil Rights in their campaign to improve the services in hospitals for the deaf and hard of hearing community. At frequent times, when Deaf & Hard of Hearing residents who faced the communication difficulties with the hospitals generally go unnoticed. They often felt much neglected from the system, especially their ability to express their needs to the doctors. They tend try to complete the painstaking process and resume their daily lives by getting the treatments without seeking any answers from their questions or resolutions. Often they felt overwhelmed with the administrations and decide to leave the frustrations alone. It s something that we, New Jersey Association of the Deaf and DAWN, Inc. are trying to resolve these ongoing issues within the hospitals involving the communication access for Deaf & Hard of Hearing residents. New Jersey Association of the Deaf and DAWN, Inc. support your efforts in this campaign. We must ensure that hospitals and staff understand their legal obligation to the deaf and hard of hearing community by providing effective communication, reasonable accommodations, assistive listening devices, visual alarms, mandatory training for all staff. Very truly yours, Sean Gerlis, President New Jersey Association of the Deaf Cc: Lila Taylor, Deaf Outreach Specialist, DAWN Inc. Carmela Slivinksi, Executive Director, DAWN, Inc. NJAD Board File

11 Disabled Advocates Working for Northwest December 5, 2005 Attorney General Peter C. Harvey NJ Office of the Attorney General Department of Law and Public Safety Hughes Justice Complex P.O. Box 080 Trenton, NJ Dear Attorney General Harvey: Communication access in hospitals for individuals who are deaf or hard of hearing is a continuing concern for both DAWN, Inc.' Deaf Senior Citizens of Northwest Jersey and New Jersey Association of the Deaf. We are not-for-profit organizations that fully support the efforts of the Division of Civil Rights in their campaign to improve the services in hospitals for the deaf and hard of hearing community. Several years ago, a group of our committed volunteers met with hospital officials in our area. They arranged for representatives from Deaf-Talk to give a presentation about their services and how their organization could help all hospitals communicate more effectively with deaf patients by utilizing their interpreting service. Unfortunately, we were not successful in our efforts. DAWN, Inc. and New Jersey Association of the Deaf support your efforts in this campaign. We must ensure that hospitals and staff understand their legal obligation to the deaf and hard of hearing community by providing effective communication, reasonable accommodations, assistive listening devices, visual alarms, mandatory training for all staff. Lila Taylor Deaf Outreach Specialist, DAWN Inc. Sean Gerlis President of New Jersey Association of the Deaf Carmela Slivinksi Executive Director, DAWN, Inc.

12 Ensuring Open and Effective Communication In Hospitals For Persons Who are Deaf or Hard of Hearing FACT SHEET The New Jersey Hospital Association, a representative organization comprised of over one hundred member hospitals, is working with the New Jersey Attorney General, including the New Jersey Division on Civil Rights, to ensure that hospitals as places of public accommodation are fully accessible to everyone, including people who are deaf or hard of hearing. This fact sheet is intended to assist hospitals and patients in understanding the New Jersey Law Against Discrimination (LAD) as it applies to accommodating the needs of individuals who are deaf or hard of hearing. 1. What will hospitals do to facilitate open and effective communication with persons who are deaf or hard of hearing? Hospitals will provide persons who are deaf or hard of hearing reasonable accommodations to assist them in communicating with hospital staff. While the law does not require all accommodations that a patient might request, hospitals must provide accommodations that are reasonable under the individual circumstances of the communication. For instance, brief and relatively simple communications, such as inquiring about meal times or purchasing an item in the gift shop, may generally be accomplished through written notes or pointing to items. For more complicated, interactive communications, such as discussing symptoms, diagnosis and treatment options, other forms of communication, such as interpreters, may be required. 2. What are examples of some reasonable accommodations that might be provided? When appropriate for effective communication, reasonable accommodations may include auxiliary aids and services such as qualified sign language interpreters, remote video interpreting services, assistive listening devices, amplified phones, TTYs/TDDs or other devices and services, such as computer assisted real-time transcription (CART) for large group community meetings. Because there is a shortage of qualified sign language interpreters in the State of New Jersey, such services may not always be available. It is important to keep in mind that reasonable accommodations for persons who are deaf may be different than those for persons who are hard of hearing. more... State of New Jersey Office of the Attorney General Division on Civil Rights

13 3. How will a hospital determine what type of accommodation to offer to a person who is deaf or hard of hearing? Bearing in mind the health care needs of the individual, as early as possible before or during a hospital visit (such as at the time of scheduling an appointment, registration, and/ or admission) the hospital staff will assess the individual s needs, with appropriate input from the person who is deaf or hard of hearing, and will determine which reasonable accommodation will be provided. 4. Can a hospital charge for the accommodations it provides? No. Reasonable accommodations are to be provided free of charge to the patient. At the time the accommodation is offered to the person who is deaf or hard of hearing, the hospital will inform the person that there is no charge for the service. 5. Who may receive these reasonable accommodations from a hospital? Hospitals will provide reasonable accommodations, such as those described above, to patients who are deaf or hard of hearing, and to third parties who are deaf or hard of hearing who accompany patients and who have the legal right to have access to healthcare information or authority to make healthcare decisions. In addition, DISCLAIMER: This fact sheet is intended to provide general guidance regarding reasonable accommodation under the LAD. While it attempts to be as accurate as possible, it should not be relied upon as comprehensive or error-free (particularly given the changing nature of laws, rules and regulations), and should not be used as a substitute for consultation with a legal advisor for specific circumstances. If you have specific questions, you may wish to contact the Division on Civil Rights or a legal advisor. if a hospital offers educational or other programs to the public, it will also offer appropriate auxiliary aids and services to persons who are deaf or hard of hearing in attendance. 6. How will hospitals inform their staffs about the provision of reasonable accommodations to persons who are deaf or hard of hearing? Hospitals will train appropriate staff on the differences in communication needs between persons who are deaf and those who are hard of hearing, and on the provision of assistive technology and interpreter services for persons who are deaf or hard of hearing. Such training will instruct staff how to assess the needs of each individual and determine the most effective form of communication assistance required by the circumstances. Hospitals will also ensure that appropriate personnel know how to access available interpreter services and assistive technology when needed. 7. How will the hospitals help people who are deaf or hard of hearing know that they can request reasonable accommodations? Hospitals will post signs at appropriate places throughout their facilities where people generally go for information, including admission, registration and emergency care areas, informing persons who are deaf or hard of hearing that the hospital provides reasonable accommodations to individuals who are deaf or hard of hearing. In addition, at the time of assessing the reasonable accommodation needs of an individual who is deaf or hard of hearing, hospitals will provide him or her with written materials describing the types of services available and indicating that the services are provided free of charge. Such information will also be included in any general information packets that are provided to patients. In addition, this fact sheet will be posted on the Web sites of the NJHA, the NJ Division of Deaf and Hard of Hearing, and the NJ Division on Civil Rights. Copies of this fact sheet may also be available in hospitals and on their Web sites. 8. What recourse is there for a person who believes that s/he has been denied a reasonable accommodation by a hospital? Persons who believe that they have been denied a reasonable accommodation may first wish to try to resolve the problem informally through the hospital s complaint procedure. If that is not successful, such persons may contact the New Jersey Division on Civil Rights in the Attorney General s Office to inquire about filing a complaint under the New Jersey Law Against Discrimination (LAD) by calling (973) or TTY (973) , or by viewing However, persons who believe they have been denied a reasonable accommodation under the LAD must file a complaint with the Division on Civil Rights within 180 days of the denial of the reasonable accommodation, or, alternatively, file a complaint directly in New Jersey State Superior Court within 2 years. State of New Jersey Richard J. Codey, Acting Governor Office of The Attorney General Peter C. Harvey, Attorney General Division on Civil Rights J. Frank Vespa-Papaleo, Director Department of Human Services James M. Davy, Commissioner Division of Deaf and Hard of Hearing Brian C. Shomo, Director DHS NJ Department of Human Services v

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