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I wonder what happens when a hospital -out in a rural area- has no ASL Interpreter?? This is from my local paper.

It’s been more than two months, and still the frustration rises up in Joan Case’s face and hands like it was yesterday.

“They told me an interpreter would come, but they never showed up,” said Case, describing her experience during a medical emergency at an area hospital through Laurie Gilbert, a paid interpreter fluent in American Sign Language.

Case says her complaints have fallen on deaf ears.

“I’m ready to make some noise,” she said.

On Sept. 17, Case was at home in Weare, suffering from high fever and body aches. “I was in a lot of pain. I told my husband to call 911,” Case said. Her husband, Bill, also deaf, called for help using a TTY, or Telecommunications Device for the Deaf.

When EMTs arrived, Bill Case handed them a small white card with an 800-number for the Emergency Interpreter Referral System.

Case said the EMT gave the card to the emergency room nurse at Concord Hospital, who made a photocopy of the card and said she’d “take care of it.”

But no interpreter ever arrived, Case said.

Over the next three days Case endured a series of tests for heart problems she didn’t have because, said Case, the ER doctor misunderstood her symptoms. Eventually she was admitted and treated for cellulitis — she had a serious infection in her leg. It took two days before she was finally informed of the diagnosis, after asking a nurse.

Adding to her frustration, patients must use a phone to order daily meals rather than circling food choices on a paper menu. Case, who does not speak and has limited vision, said she was never told about the procedure. She said she had no meals her first day in the hospital.

She was discharged without an interpreter present.

A review of the interpreter referral system records shows no call was ever placed from Concord Hospital to the toll-free number over the course of her stay, said Susan Wolfe-Downes, executive director of Northeast Deaf and Hard of Hearing Services Inc. in Concord.

Joan Case fell through a huge crack in the state’s health-care system — it’s not the first time for Case, said Wolfe-Downes — and she’s not the only one who’s frustrated.

It’s a complaint heard daily by Aimee Stevens, lead referral specialist at NDHHS.

“What’s really unfortunate is that, in 2005, this kind of thing is still happening. Deaf people have been around since the beginning of time — and the Americans with Disabilities Act has been in place for 15 years,” Stevens said. “It’s not isolated to one hospital, either — it happens all over the state.”

Concord Hospital did not comment directly on Joan Case’s complaint, but issued a statement that read in part: “We are committed to quality patient care for all . . . we are one of only eight hospitals in N.H. to provide Deaf Talk, a new and promising technology which provides immediate access to interpretation services.”

State Department of Health and Human Services Commissioner John Stephen said it’s up to individual providers to make sure patients don’t fall through the cracks.

“This is the first time I’ve heard of a hospital having an issue or problem with compliance,” Stephen said, of Case’s experience. “There’s no question more can be done in this particular area to provide quality services for the hearing impaired.”

Andrew Stewart, who served recently as chairman of the New Hampshire Advisory Committee to the U.S. Commission on Civil Rights, says there’s no excuse for the lack of education or response within the state, and particularly the medical community, to the needs of the deaf and hard of hearing.

His committee issued a report in June detailing the problems of access to health care for those with limited English language skills — a cultural minority that includes the deaf and hard of hearing.

“It’s outrageous,” said Stewart. “That John Stephen doesn’t know about the problem says something about the system itself.”

Stewart said he heard testimony detailing people’s everyday experiences in a health-care system that falls short of adequate.

“We heard about extreme disadvantages faced by people arriving at hospitals — often with children in tow — lapses in communication that amount to civil rights violations,” Stewart said.

One solution may come through the Foundation for Healthy Communities, which recently received a grant from the Endowment for Health to specifically address such issues affecting the deaf, hard of hearing and other cultural minorities.

“It’s not just an issue of availability within a system to get an interpreter. We have to make sure a nurse, a doctor or other staffer in a given health-care system recognizes this need, and knows when to make use of it appropriately,” said Shawn LaFrance, the foundation’s executive director.

One such effort is a workshop, “Cultural Awareness in Healthcare,” open to health-care providers and scheduled for Dec. 15 from 11:30 to 4:30 p.m. at Crowne Plaza in Nashua.

Wolfe-Downes said a 2003 study conducted by her organization showed that access issues are the No. 1 concern among New Hampshire’s estimated 110,000 deaf and hard of hearing — a number rising annually thanks to the aging population.

“We have this card, this emergency service referral system in place already,” said Wolfe-Downes, holding up a replica of the little card Case tried to use back in September. “Our request fill rate is 100 percent, when we are contacted. But as you can see from Joan’s story, people are still falling through the cracks.”