Sunday, February 07, 2010

Deaf patient was dying, but no one told her

Deaf patient was dying, but no one told her

David Nelson got the bad news about his wife in December 2005. He just didn't know it.

For three months, the Nelsons met with doctors at North Memorial Medical Center, but they weren't aware Mary Ann was dying of cancer. In fact, they thought she was doing well enough in her battle with the disease that she could go to her retirement party. So they were stunned in March 2006 when her oncologist abruptly put an end to their hopes -- and their request -- with a terse note saying, "We can't cure the cancer!"

It was the first time the Nelsons, both deaf, understood the cancer was terminal, according to the Minnesota Department of Human Rights. Mary Ann Nelson died in May 2006.

The agency pointed to the incident as an example of the medical team's failure to communicate effectively with the Nelsons. This week, state regulators announced that North Memorial agreed to pay $105,000 to settle charges that Nelson and another patient were not provided access to qualified sign language interpreters. Often, David Nelson had to read lips or write notes to communicate with doctors and nurses, despite his repeated requests for an interpreter.

"It was extremely difficult and painful for them," said Rick Macpherson, Nelson's attorney. "They couldn't ask any questions. They couldn't have any discussion. They couldn't get any kind of comfort."

For decades, the deaf and hearing impaired didn't know if they would get an interpreter when going to a hospital. The landscape changed in 2004 after federal officials accused Fairview Health Services of violating the Americans with Disabilities Act. The lawsuit led to a settlement and improved local compliance with the law, as state and federal officials started visiting other Minnesota hospitals to make sure they were providing properly trained interpreters.

But the problems haven't gone away. Macpherson, an attorney with the Minnesota Disability Law Center, has pursued cases in recent years against hospitals, nursing homes, jails, police departments and other organizations.

No system in place

Nelson and another deaf patient, Mark Epstein, filed complaints with the Department of Human Rights in 2007 over treatment at North Memorial.

Epstein was hospitalized at North Memorial in March 2007 for inflammation in his intestines, according to the state investigation. He requested an interpreter every day, but he never received one. When he was given a medication, he didn't understand what it was or why he had to take it. When he was discharged five days later, he didn't know what kind of shape he was in.

Initially, North Memorial employees maintained that Epstein didn't ask for an interpreter and relied on his wife, who had partial hearing in one ear. But state regulators said the medical records showed that an interpreter was needed in this case.

By relying on family members and others to interpret complicated medical information, the hospital jeopardized the health of both Epstein and Mary Ann Nelson, investigators concluded.

In the settlement, North Memorial agreed to put someone in charge of coordinating services for patients who are deaf or hard of hearing, and make sure interpreters show up for meetings.

Macpherson said that's important, because nobody at the hospital followed through on the oncologist's request for an interpreter at an important family conference with the Nelsons. Instead, the request went unfilled.

In a statement, North Memorial said it has been working with the Department of Human Rights and members of the deaf community to implement changes, including the use of portable electronic devices that connect patients with qualified interpreters via video. Staff training on the needs of deaf and hard-of-hearing patients is expected to be completed by the end of March. North Memorial must show it is complying with the terms of the agreement for two years.

Macpherson said such settlements send an important message to public and private entities.

"Money talks," he said. "It causes the hospital and other institutions to take this seriously."