Advocacy Statement: Use of VRI in the Medical Setting
Use of Video Remote Interpreting in the Medical Setting1 (2008)
The National Association of the Deaf (NAD) acknowledges that technology has the potential to improve the delivery of health care services to deaf2 individuals, but urges the development of standards and protocols for the proper use of certain technology. One such technology is the use of Video Remote Interpreting (VRI) in medical settings for communication between health care professionals and deaf individuals.
Communication Access Mandate in the Medical Setting
The combined mandate of Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act require all health care facilities (private or public, non-profit or for-profit) to ensure effective communication with deaf individuals.3 Effective communication is possible through a variety of auxiliary aids and services including but not limited to qualified sign language interpreters and computer-aided transcription services.4 Deaf individuals requiring such communication access may be patients, family members or companions of patients, and/or health care providers.
The NAD is concerned that deaf individuals continue to experience communication barriers in accessing medical care. In many parts of the country, doctors and hospitals may have a hard time finding qualified sign language interpreters to ensure effective communication during the provision of medical services involving deaf people. Further, hospitals may have difficulty finding qualified sign language interpreters during time-sensitive emergency room admissions and other medical settings.
Video Remote Interpreting as an Option
VRI is an Internet-based service that may be used when a qualified sign language interpreter cannot be physically present in a medical setting. This service uses a high-speed Internet-based video connection to provide visual access to an interpreter who is in a different physical location. As in the case of on-site sign language interpreting services, VRI services are typically contracted and paid for on a fee-for-service basis. Unlike on-site interpreting services, which are often retained for a minimum period of time (i.e., two hours), VRI services are charged by the minute and have no minimum. However, VRI has limitations, which are explained further in this advocacy statement and should be considered a stopgap measure until an interpreter arrives on site. The U.S. Department of Justice has also recognized the shortcomings of VRI in a recent settlement with a hospital for its improper insistence on using VRI as the sole means of communication access.5
Video Remote Interpreting Usage Limitations
Due to the following limitations, the NAD maintains the position that VRI services should only be used for brief encounters, including emergency situations, until an interpreter arrives on site.
The NAD recommends using qualified sign language interpreters on-site and in-person whenever possible. However, the NAD recognizes that VRI may be necessary in certain and limited situations. Towards this end, the NAD outlines the following conditions for use of VRI services, and urges reference to its extensive position statement on Video Remote Interpreting Services in Hospitals for elaboration of these conditions:
The NAD recognizes that VRI services are a valuable back up communication tool which has the potential to ensure that no deaf person will ever be without communication access in the medical setting. Nevertheless, due to the limitations of VRI, the NAD recommends that hospitals provide VRI services only when they are unable to secure the services of on-site qualified interpreters.
This advocacy statement was prepared by the Civil Rights Subcommittee of the Public Policy Committee, and approved April 2008 by the NAD Board of Directors.