74% of emergency departments have no policy for communicating with deaf patients, so deaf people arriving in crisis get handed a pen and paper instead of an interpreter

A survey of 166 emergency physicians found that 74.1% reported their departments had no policy or procedure for communicating with deaf patients. 88% of these physicians had never attended any training on deaf patient communication, despite 83.7% believing such training should be available. A separate 2025 mixed-methods study found that 65% of deaf and hard-of-hearing patients reported difficulties communicating with ER staff, and only 28.8% could independently communicate with ER staff at all. This matters because the emergency department is where communication failures have the highest stakes. A deaf patient arriving with chest pain, a stroke, or an allergic reaction cannot explain their symptoms, medication allergies, or medical history via a notepad in a high-stress, time-pressured environment. The most common communication method offered was a family member acting as interpreter (63.9%) or writing on paper (16.9%). Family interpreters are ethically problematic — patients may not disclose domestic abuse, substance use, or sexual health issues through a relative — and medically dangerous, since family members lack medical vocabulary and may mistranslate critical information. The result is misdiagnosis, wrong medications, delayed treatment, and preventable harm. The structural reason this persists is that the ADA requires 'effective communication' but does not specify exactly how hospitals must achieve it, leaving enforcement reactive (complaints and lawsuits after harm occurs). Video Remote Interpreting (VRI) technology exists and could provide an ASL interpreter within minutes via tablet, but many hospitals either have not purchased VRI equipment, do not maintain it, or place it in storage rooms where staff cannot find it during emergencies. The cost of a VRI subscription is roughly $3-5 per minute — trivial compared to the cost of a malpractice lawsuit — but hospital administrators treat accessibility spending as overhead rather than patient safety infrastructure. Meanwhile, the Department of Justice has taken enforcement action: in December 2024, DOJ found that Arizona's Department of Child Safety violated Title II of the ADA by failing to provide interpreters for deaf parents and children, demonstrating that this is an ongoing, systemic failure, not an isolated incident.