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SignNexus sets the standard for excellence and efficiency when accommodating the diverse communication and cultural needs of individuals who are Deaf, DeafBlind, and Hard of Hearing.



SignNexus is a distinguished interpreting agency that specializes in American Sign Language, International Sign, and other sign language modalities. On-site and Remote Sign Language Interpreting Services are available to help organizations fulfill their obligations under the Americans with Disabilities Act.

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SignNexus offers Communication Access Realtime Translation (CART) services, also known as Realtime Captioning, for live events. Remote Captioning Services are also available to facilitate ADA compliant accessibility for virtual events on any platform.


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SignNexus Interpreters and Captioners have extensive experience in a variety of specialized settings.



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Category Archives: Medical ASL Interpreting

Accessibility for Medical Practices

I can recall a number of times throughout my childhood when my mother and siblings were turned away from receiving medical care simply because they were deaf. Sometimes they would arrive to a scheduled medical appointment where there were just no interpreters or accommodations, or other times they’d be denied the opportunity to even schedule an appointment. The person at the desk would tell my mother that their office wouldn’t accommodate the needs of deaf patients, and perhaps offer a referral to an office located all the way across the city. Not only are these practices totally illegal, but it is a form of oppression, and it unfortunately still happens today.

asl-accessibility-medical-practices-01Despite the Americans With Disabilities Act (ADA) being law for more than 25 years, deaf individuals continue to face difficulties when seeking medical care. In 2014, a woman in Washington State arrived at the hospital for a planned induced delivery only to discover that her request for an interpreter had not been fulfilled. When the delivery became complicated and a cesarian section was necessary, the woman struggled to comprehend what was happening. Less extreme situations commonly go unreported. A deaf person who needs to see a doctor but gets turned away at the desk might get upset and frustrated, then just book an appointment somewhere else— but it would be well within their rights to bring a lawsuit against the doctor’s office for violating Title III of the ADA, which guarantees equal access to privately owned places of public accommodation.

For the most part, medical office staff do not maliciously engage in oppressive behaviors toward deaf patients. The disconnect is typically a general lack of knowledge. It should be a priority for office staff and medical practitioners to understand deafness, as more than 15% of adults in America are living with some level of hearing loss; and more than 25% of people over 65 have disabling hearing loss.

How to Interact with an Individual who is Deaf

To help create positive relationships with deaf patients, medical office staff can familiarize themselves with a few basic communication strategies.

Often, the first frustrating hurdle to medical care occurs when the deaf patient calls the medical office to schedule an appointment and the receptionist hangs up on the relay call, thinking it’s a telemarketing call. Do NOT hang up on relay calls! Receptionists should be trained to recognize a call from a relay service and feel confident engaging with the deaf consumer in this way.

asl-accessibility-medical-practices-02Some deaf people are able to read lips, but it’s not safe to assume anyone’s comfort with this method. Lip reading is generally not a reliable means of communication in a medical setting, unless the deaf individual explicitly indicates that they would prefer to receive their medical information using oral communication. Studies have shown that even the very best lip reader can only capture about 30% of what is being said. Always defer to the patient’s preferences.

If a deaf patient is in the office, notes can be a good way to communicate short, simple ideas. When interacting with a deaf individual, medical staff and providers should have a pen and paper available, or opt for digital using a smartphone or tablet to write back and forth. This can be a great way to ask the deaf person how they prefer to communicate, if they have their insurance card, or when they would like to schedule their next appointment. Notes may be a preferred method of communication for some late-deafened or hard of hearing individuals.

However, for those who use American Sign Language as their primary form of communication, notes are not an effective way to discuss symptoms or deliver a diagnosis, since ASL is a unique language that doesn’t translate directly to English. If a deaf person who uses ASL arrives to the office and an interpreter has not been scheduled, office staff may use notes to communicate regarding the patient’s interpreter preferences and reschedule the appointment. Medical professionals must avoid pressuring deaf patients to proceed without an interpreter, as this can open up a potential liability.

Staff members and medical professionals should remember to keep checking in every step of the way to make sure the patient remains engaged. If one communication strategy doesn’t seem to be working, work together with the patient to create a more effective strategy.

Providing Interpreters

asl-accessibility-medical-practices-03Under the ADA, it is the obligation of the medical service provider as a public entity to offer equal access for all citizens. For those who identify as ASL users, the most reasonable accommodation is usually an interpreter.

Every medical practice, without exception, ought to have a current contract on file with a reputable local interpreting agency. Deaf-owned or interpreter-owned agencies are preferred because they offer higher quality services with a focus on consumer satisfaction. Be prepared! The ADA has been law for more than 25 years so the funds for accessibility services should be allocated into the operating budget; financial hardship is difficult to prove.

When requesting services, it is advised to provide as much information as possible to ensure a good interpreter match. Note that interpreters do book up in advance, so it is ideal to make the request with at least a week’s notice to secure coverage.

Family Members and Staff Members are NOT Interpreters

asl-accessibility-for-doctors-04Utilizing a deaf patient’s family members or medical office staff as interpreters is a HUGE no-no, and a liability lawsuit waiting to happen. Medical interpreters are trained professionals with specialized vocabularies, they navigate both linguistic and cultural barriers using an established code of ethics.

If staff members at the medical office happen to know sign language, they should only utilize it to converse with deaf patients if they are fluent. A person seeking medical care does not necessarily want to help the receptionist practice their ASL. If a staff member is not a licensed interpreter, it is not appropriate for them to provide sign language interpreting services, nor is it appropriate for the family members of deaf patients to provide interpreting services.

Cultural Competency

asl-accessibility-for-doctors-05Cultural competency training offers exciting opportunities for medical providers and support staff to connect with a segment of the population that has for too long been forced to the sidelines when it comes to their own healthcare.

A comprehensive training program led by deaf panelists can provide employees of a medical practice a safe space to work through common misconceptions, break free of stereotypes, and consider new perspectives. As a professional development program, cultural competency training helps employees understand their legal responsibilities, and cultivates a deeper sense of compassion.

For medical providers and employees within the medical care industry, of course people are the first priority. By laying a foundation of cultural understanding, it’s easy to build a successful practice that attracts diverse members of the community, and to earn a positive reputation for accessibility.

SignNexus is pleased to offer Sign Language Interpreting services both on-site and remotely to help medical providers effectively fulfill their obligations under the ADA. Contact us today!

Medical Interpreting

doctor-asl-interpreter-05bPicture yourself at a hospital– maybe you are the patient, or perhaps your child has come down with an illness. The doctors and nurses are attentive, but there’s one problem: they all use a foreign language. Speaking from behind their masks, the medical professionals poke and prod the patient, gesturing at you and expecting answers. Without the ability to accurately describe symptoms or understand diagnoses, receiving medical care is extremely difficult. To help the deaf community get access to the medical care they deserve, specially trained Medical Interpreters should be utilized.

Let’s face it, medical terminology and sterile healthcare settings can be overwhelming enough without a language barrier. When a person’s wellness is on the line, or even a person’s life, there is no room for misunderstanding. According to the National Association of the Deaf (NAD), “individuals whose language is American Sign Language (ASL) or another sign language are often denied access to the health care system because most providers do not provide adequate communication access through qualified interpreters.” That means hundreds of thousands of deaf individuals across this country struggle to receive appropriate medical treatment, simply because they use an American language other than English. This is not what equality looks like– it’s a violation of the Americans with Disabilities Act, and it is oppressive.

hospital-asl-interpreter-03bIn a healthcare setting, qualified Medical Interpreters must be provided upon a patient’s request to help ensure effective communication. If a patient, their family members, or companion utilize ASL as their primary form of communication, it is the duty of the healthcare institution to ensure these persons receive the same level of care as non-deaf patients. A doctors office might have some of the best practitioners in the field, but without a qualified Medical Interpreter to facilitate communication, that office does not provide quality services to deaf individuals. Sadly, this discrimination is common in the healthcare industry.

Medical Interpreting: Important Factors

Providing qualified Medical Interpreters is one of the most fundamental ways a healthcare institution can respect the rights of deaf patients. Medical Interpreters possess a specific skill set which enables them to facilitate the delivery of important, possibly life changing medical diagnoses.


Qualified Medical Interpreters will be highly proficient in both ASL and English, demonstrating linguistic and cultural competency. They will also be prepared to make accommodations for patients with little fluency in ASL or English, such as immigrants, or people who have developmental disabilities. When a person’s health is in jeopardy, effective communication between the patient and doctor is absolutely critical. Doctors need to know specific symptoms with as much detail as possible. Patients deserve to understand the examinations and tests they undergo, along with any concerns their physician might have. Doctor-patient communication is very particular, and can mean the difference between early diagnosis and overlooking a serious issue.

Medical Terminology

medical-asl-interpreter-01bThe healthcare industry has a culture all it’s own, with a language and lingo most laypeople can’t understand. Qualified Medical Interpreters are intimately familiar with medical terms, and able to communicate these concepts to deaf patients. A Medical Interpreter will arrive to an assignment already prepared to work with a specific patient, having researched their case as appropriate.

Familiar with Technology & Procedures

Specially trained Medical Interpreters must be flexible, ready to adapt to a less than ideal interpreting environment. This might mean interpreting during a eye exams, dental surgeries, X-Rays, MRIs, or other procedures which limit visibility for the patient. Medical Interpreters have a general understanding of these procedures and how they impact communication ability, and will be prepared to provide additional services as needed. A qualified Medical Interpreter knows where to stand and how to avoid disrupting medical professionals as they work.

Cross-Cultural Awareness

medical-asl-interpreter-02bThose who work in the healthcare industry are part of a unique medical culture that has it’s own structure, value, and language. For example, there is a big difference between medical culture– where doctors average only minutes of face time with each patient, and deaf culture– where simple goodbyes often last half an hour. Because of their familiarity with both medical culture and deaf culture, Medical Interpreters are able to adjust their technique and provide special accommodations as needed. The ability to speak on the level of all parties helps effectively bridge the communication gap. Effective cultural mediation can lead to more accurate diagnoses, better healthcare outcomes, and help form positive relationships between patients and healthcare practitioners.

Ethical Boundaries

Medical Interpreters play a very influential role in the healthcare of deaf individuals, so it is critical to know their own limitations. These interpreters must be self aware; prepared to turn down an assignment if they are not absolutely qualified for the job or if an ethical conflict arises. Medical Interpreters value the role of Certified Deaf Interpreters (CDIs) in healthcare settings, and understand how to work as a team with CDIs to facilitate effective communication. Specialized Medical Interpreters recognize the autonomy of deaf people from all walks of life, and endeavor to provide communication access without influencing the healthcare decisions of these individuals. Medical Interpreters adhere to strict confidentiality and privacy terms, in line with both the NAD/RID code of conduct and HIPPA guidelines.


medical-asl-interpreter-10Oppression can be subtle and even unintentional, so one role of the Medical Interpreter is to help protect the rights of deaf patients at a time when they might be unable to do so themselves. Medical Interpreters are able to provide deaf individuals additional support and explanations, and can help practitioners understand the unique needs of their deaf patients. A qualified Medical Interpreter will advocate on behalf of the deaf consumer as necessary: for example explaining to nurses that arm restraints should not be utilized when a patient’s primary language is ASL, or that doctors should speak to the patient directly (not the interpreter). Medical Interpreters are familiar with laws that mandate healthcare, as well as the Americans with Disabilities Act, and endeavor to preserve the rights of deaf Americans under these laws.


As technology becomes more integrated into our healthcare systems, it is important for Medical Interpreters to understand how these advancements impact the treatment of deaf patients. It is crucial that interpreters are able to explain the limitations of devices like Video Relay Interpreters (VRI) to healthcare professionals. There is a misconception that VRI will replace live interpreters; in truth, VRI is a “better than nothing” solution that quickly enables urgent communication. Medical Interpreters are able to describe the benefits and drawbacks of communication technologies, and should encourage institutions to educate themselves about these devices and systems.

Continuous Professional Development

medical-asl-interpreter-04bThe healthcare field is constantly evolving, so Medical Interpreters must be ready to adapt. New machines, new procedures, and new terminology appear each day. Medical Interpreters are expected to engage in continuous professional development to ensure their skill set matches the current medical landscape. It is expected that Medical Interpreters will work to address in any gaps in knowledge through research, mentorship, workshops, seminars, and conferences related to the healthcare and interpreting fields.

Deaf patients looking for medical assistance, from routine checkups to emergency services, must go above and beyond to seek out institutions with reputations for providing communication access, or fight the battle to receive the accommodations they are entitled to. This discrimination is unacceptable in our modern day. To ensure your institution provides equal access to patients of all abilities, be sure to maintain a list of qualified Medical Interpreters.

SignNexus is proud to provide high quality medical interpreting services for deaf/HoH, deaf-blind, deaf close-vision, or late-deafened consumers. We emphasize both patient and provider satisfaction!

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