Marisa Peryer

Recent changes to the Yale New Haven Hospital’s interpretation services have left many concerned over the quality of services, according to employees and patients interviewed by the News.

As of December 2019, the YNHH Department of Patient Experiences and Operations, which oversees the hospital’s interpretation services, has implemented a critical shift in its internal policy. The changes expanded the eligibility requirements for in-person interpreters and increased the use of remote interpretation services by video or phone.

According to hospital employees, the new rules have reduced the type of appointments that qualify for in-person interpreters. Appointments often left out under the new system include follow-up appointments and daily “rounding” interactions — in which doctors visit hospitalized patients. Limited English Proficiency (LEP) patients are now more dependent on new remote services to interact with hospital staff. Hospital employees, patients and community advocates have criticized the swift transition, raising concerns about quality of care, the intentions behind the reform and hastiness in implementation.

“The situation is going from bad to worse,” one YNHH employee with close knowledge of the situation, told the News. “We once held the highest standard of practice for our patients.”

The employee requested anonymity to candidly discuss the changes to their employer’s interpretation services.

Interpretation services have long been an integral part of the services offered at YNHH. LEP patients have relied on the hospital’s services. Among them are international patients who visit the hospital for its acclaimed divisions and members of New Haven’s burgeoning immigrant community. The hospital reported processing “more than 100,000 requests for interpretation and translation” in 2017.

In 2018, however, a federal judge ruled that a number of Connecticut hospitals, including Lawrence Memorial Hospital of the YNHH system, were not in compliance with standards for providing interpretation services for deaf and hard of hearing customers. Following the judgement, hospitals like YNHH began to look for ways to reorganize to adjust to the rulings.

YNHH Department of Patient Services and Experiences Director Joan Kelly told the News that the changes implemented regarding interpretation were not solely in response to the 2018 ruling but a broader effort to expand services.

Over the first two months, the policy change surrounding interpretation services has drawn significant criticism. Multiple hospital employees have expressed concern to the News that the new policy does not take into account the potential danger that could arise from using remote interpretation services in sensitive settings, such as those involving tests with medical equipment, consultations for operations and childbirth, where the context of the space is necessary and mistakes can be grave. Some employees have claimed that the hospital administration sought little feedback in designing the new policy and has been largely unresponsive to concerns since implementation. These individuals spoke to news on a condition of anonymity in fear of retribution from their employer.

Jaspreet Loyal, who works at the hospital’s department of pediatrics, told the News that using remote interpretation services often led to “an interruption of flow” due to bad Wi-Fi and malfunctioning technology.

“A lot of us physicians think in-person (interpretation services) are higher quality,” she told the News in an interview. Loyal added that she has found the hospital administrators to be receptive to the concerns of her fellow physicians.

Kelly pushed back on claims that the Department implemented changes without consulting patients or employees. She told the News in an interview that before acting, her department consulted with the hospital’s Patient and Family Advisory Council — composed of patients and employees that provide input on policy changes.

However, members of the council are all Yale-affiliated, and employees told the News that they therefore doubt the ability of such a council to speak for the various communities and populations the hospital serves.

Kelly disputed the idea that the change within interpretation services is a regression from the previous services offered at the hospital. She said that the changes are meant to “streamline” the department and prepare it to grow alongside the increasing amounts of patients that rely on it.

“We maintain one of the largest teams (of in-person interpreters) around,” she said.

Local activists, like the leadership of New Haven-based immigrant activist group United Latina en Acción, have expressed their worry that a shift towards more remote interpretation services represents a drop-in quality of care provided and a lack of consideration for the city’s immigrant community, which will bear the brunt of the burden if the quality of interpretation service falls.

Two weeks ago, Deli Velazquez, a resident of New Haven originally from Mexico, accompanied her son to the emergency room of the Yale New Haven Hospital after he complained of incessant pain in the side of his stomach and nausea.

Upon her son’s admission into a recovery room, Velazquez began to occasionally speak on behalf of her son — who was in too much pain to speak for himself — and was supplied with a phone interpretation service. She told the News that she found the interpretation phone service unintelligible and asked instead for an in-person interpreter, but was told that none were available.

For the next three days, Velazquez relied on the phone interpretation services despite no improvements in quality. She continued to voice her concerns over the service and was later assigned an in-person interpreter, but only at certain hours. She told the News that the concerns over interpretation contributed to her overall confusion over treatment options — that confusion, and distress over her son’s health led her to eventually discharge her son from the hospital and opt to take care of him at home.

Another patient, New Haven resident Paulina Lopez, visits the hospital regularly for treatment.  Lopez, who originally hails from Guatemala, told the News she remembers being confused upon being told that an in-person interpreter, which had been available to her on all previous visits, had been replaced by a video chat monitor during a hospital visit in December.

During that visit, she struggled to understand both her doctor and the video interpreter. Like Velazquez, when Lopez requested an in-person interpreter, the hospital told her that none were available. Later that week, when she tried to call hospital reception, she said that she was told that interpreters were also no longer available. Lopez told the News that she remembers a much more comfortable experience when in-person interpreters were used.

Many patients who spoke to the News, including Velazquez and Lopez, characterized the interpreters employed by the video or phone services as a drop-in quality. They struggled to hear the interpreter and the remote interpreter failed to fully conveying their concerns to the doctors, those patients explained.

Kelly told the News that such negative experiences should be chalked up to adjustment to change, denying that the new policy was inherently a drop-in quality.

New Haven lawyer Howard Gemeiner told the News that he is concerned with who will most suffer negative implications stemming from such a change. Gemeiner, who has worked with immigrant clients, said the potential burden would be particularly heavy on patients from immigrant communities and marginalized groups. These individuals often just “roll with the punches” because they are in the dark about what they have the right to ask for or how they can voice their displeasure with changes, Gemeiner said.

In 2019, YNHH was one of 20 hospitals on U.S. News & World Report’s “honor roll” of best U.S. hospitals.

Emiliano Tahui Gómez | emiliano.gomez@yale.edu

Correction, Feb. 7: A previous version of this article misspelled the name of the New Haven Lawyer Howard Gemeiner.