An Inquiry into Access to Auslan Interpreters in Victorian Hospitals

1. An Inquiry into Access to Auslan Interpreters in Victorian Hospitals Melissa Lowrie 2014

2. Overview • Auslan Interpreting in Victorian hospitals have been an issue for a number of years- for Deaf patients, interpreters and family members, and Deaf Victoria recievesnumerous complaints each year • Report identifies the issues relating to: • the provision of Auslan Interpreters • The problems encountered and the impact on the patient • Real life experiences • Changes recommended to the system of booking and providing Auslan interpreters • The need for continuous professional development of interpreters and hospitals staff, and procedural changes to deal with emergencies

3. Legal Framework for Auslan Interpreter provision in Victorian hospitals • Language Services Policy- requirement that interpreters booked and provided must be NAATI Accredited Professional (Level 3) Interpreters in hospitals at all critical points in their healthcare. • Cultural Responsiveness Framework: Guidelines for Victorian Health Services- standard three states “Accredited Interpreters are provided to patients who require one” • Australian Charter of Healthcare Rights in Victoria- Communication is a key right which is supported by all Victorian public and private health services • Equal Opportunities Act 2010: Failure to provide an Auslan interpreter or to provide health information in a range of formats may amount to discrimination under the EOA.

4. Methodology • One on one interviews • Email accounts of issues that occurred • Two group discussions- public forum, and meeting with a group of interpreters • Altogether, 72 people were captured through the inquiry

5. Issues Identified • Communication Breakdowns due to lack of Auslan Interpreting Support resulting in malpractice and poorer health outcomes • Issue of “informed consent”: Case Study example: Patient had emergency surgery and one week post op, was still unaware of what operation they had. This was noted in Patient file, and no further action taken • Issue of being unable to fully participate in informed decision making about their healthcare, and decisions/ consent is made given in ad hoc ways such as guesswork, family and friend assistance, and writing • 34.7% stated that because they had no interpreter, their health outcome was worse. Case Study example: Patient so stressed about having no interpreter access, they had a family member sleep at the hospital with them. Another Patient left under anesthesia while a deaf/blind interpreter was sourced.

6. Issues Identified • Reliance on Alternative methods of communication resulting in malpractice and poorer health outcomes • 62.5% of respondents did not get an Auslan interpreter at all. In most of these cases, another way of communicating was found- pen and paper, guesswork, gesture , family/friends and reliance on lip-reading. • Lip-reading is an imperfect science- it is made harder with illness and tiredness, and also with staff who are from non-English speaking backgrounds • Pen and paper was also problematic, due to English being a large portion of respondents second language • Communication was made even more difficult in these situations, as the average Australian has trouble with ‘Health Literacy” • 27.7% of cases were not able to have Auslan interpreters the whole time they needed one, 36.1% had to fight to get an Interpreter and 45.8% made a complaint. • For those who did not make a complain, reasons cited included they were in too much pain to argue, or the complaints process was inaccessible.

7. Issues Identified • Skillset of inadequate Auslan Interpreters and family members resulting in miscommunication between practitioners and patients • One third of respondents were forced to rely on family and friends to interpret and a large number of these family and friends were Deaf themselves Case Study example: Patient had brain surgery, and Deaf family member was asked to ask the patient a number of questions to test brain function and memory. • The use of family and friends has lead to serious miscommunication Case Study example, 11 year old patient’s Deaf mother had a meeting with a specialist, using the fathers new wife (who knew no Auslan) to interpret • Cases where practitioners have used children to interpret Case Study example: 11 year old girl asked to come with paramedic in an ambulance to interpreter for her Deaf mother

8. Issues Identified • Auslan Interpreter Booking System Inconstancies resulting in burnout of Auslan Interpreters and breaches of interpreters ethics • Interpreters booked in too many appointments in a short space of time. • Quality of interpreters in the hospital system- many are not at the Professional Level 3 required due to not working for all language booking agencies, and hospitals employing interpreters directly without the assistance of an agency • All language interpreting agencies are generally unfamiliar with the needs of Deaf patients and the needs of the Auslan Interpreter Case Study Example: an Auslan interpreter working for an all language agency worked five hours without a break, as the appointment turned into an emergency, and ended up fainting on the job.

9. Issues Identified • Ineffective Complaints Processes • Complaints processes are inaccessible, particularly if it is about interpreter access • Complaints are solved case by case, not across the board changes Case Study example: major maternity hospital received four complaints about the same issue, and only one was successful. • 31.9% were refused an interpreter by the hospital, mostly in the emergency departments, and lack of knowledge about the interpreter booking system was the biggest factor i.e.: “the interpreter booking office is closed”, “interpreters don’t work on Fridays”, “you can only have an interpreter once a month”, “we cant pay for it, its not a part of our translating policy”

10. What was POSITIVE? • There WERE some positive stories! • The common denominators were: • The hospital used an Auslan Specific agency Case Study example: a maternity hospital used an Auslan specific agency that texted the patient every time the interpreter was booked, and on the one time there was no interpreter provided, they were able to send someone within one hour • Alerts placed on patient files after the first visit • Bendigo Health emergency department

11. Recommendations for Change • Roll out the NABS system to cover all medical services in Australia OR use Auslan Specific Interpreting Agencies for all hospitals in Victoria • Compulsory and ongoing professional development around booking of interpreter services for all frontline medical staff and development of best practice guidelines for interpreter booking procedures • Interpreting Agencies, ASLIA Vic and NAATI to develop continuous professional development around medical interpreting, quality assurance and annual assessment of the skills of Auslan Interpreters • Skype Interpreting on iPads to be used in emergencies in Hospitals

12. In Conclusion • There is no consistency between hospitals and the patient experience depends on: • The knowledge of the staff and interpreter booking officers • The knowledge of the interpreter agencies around the needs of Deaf patients and Auslan interpreters • The quality of interpreters used in hospitals; and • The ability of the Deaf patient to advocate for themselves • A partnership between the Department of Health,Victorian Equal Opportunity and Human Rights Commission, Auslan Specific Interpreter Agencies, ASLIA Victoria and Deaf Victoria needs to be developed to work towards the implementation of these recommendations Victoria wide.

13. Thank you for listening!