Denise Hinxman was selected to caption the Southern States Presidential Inaugural Ball. She flew from Reno, Nevada to Washington, D.C. on a moment’s notice. With her encoder in hand, Denise arrived and captioned the speeches of President Barack Obama and Vice President Joe Biden.



One Reno resident’s valuable expertise was her ticket to Washington, D.C., during last week’s inauguration festivities.

Denise Hinxman was invited to attend the Southern States Inaugural Ball on Tuesday at the National Guard Armory so that she could provide real-time captioning — which allows deaf and hard of hearing people to follow along with speeches, lectures or even songs they cannot hear.

Captioners capture in machine shorthand every word that is being said on a stenographer’s machine, which is then translated by computer software back into English.

“Captioning is performed by a highly skilled court reporter,” Hinxman said. “I have been tested up to 260 wpm, but many times sportscasters go upwards of 320 wpm. President Obama and Biden speak very slowly, so they are a captioner’s dream.”

A court reporter since 1985, Hinxman founded Captions Unlimited in Reno in 1996.

“I provide these services on-site, like at the inauguration balls, or remotely over the Internet,” she said. “I’ve captioned live President George W. Bush, when he was here in Reno speaking before the American Legion folks, and then 11 years prior, in 1996, I captioned his mother, Barbara Bush. She was at a forum, speaking along with General Colin Powell, former (Israeli) Prime Minister Shimon Peres. I captioned Rich Little at this same event.”

Other notable people she’s transcribed are golf pro Tiger Woods and radio talk show host Rush Limbaugh in a phone conversation with former President George W. Bush.

For the Southern States Inaugural Ball, Hinxman was notified by Lorraine Carter with Caption Reporters, a captioning company in Maryland. That company had received a last-minute call to provide eight on-site captioners.

There were 10 official inaugural balls, and each had its own captioner, she said.

Reprinted with permission from the Reno Gazette-Journal

Every day working as a CART provider and captioner is an adventure. Not only do we have to prepare for the unexpected in terms of the material that we will be hearing, but we also have to deal with the technology component, everything from modems and encoders, to streaming text over the Internet.

We are oftentimes asked to CART or caption what seems to be the impossible: the foreign speaker whose words are unintelligible, the professor speaking at 300 words per minute, or an outdoor event where the acoustics are poor. We strive to do our best under all of these circumstances. And despite the obstacles, these CART events generally turn into very rewarding experiences. We meet some wonderful people, and even become their friends and “part of the family” in many cases.

Working in the medical arena can be both challenging and rewarding. I have been working in the hospital setting for over a year now. I have only spoken to the administration, nurses and doctors over the phone and through email, never meeting them in person. I have never met the patients that I work with. Yet, I feel that they all trust me. The administration trusts that I will be there at the scheduled time and that I will CART to the best of my ability. The patient trusts that I will write what is being said accurately and that I will consider everything confidential. The majority of these patients have never used CART, certainly never in the doctor/patient setting, instead relying on the doctor or nurse to write important information on a notepad. “Most of us rely on a combination of the physician’s note writing proficiency and willingness, our ability to read lips, perhaps a sign language interpreter, a friend or spouse to accompany us to the appointment and remember enough of what the doctor said to share it with us later. It’s all scary stuff,” (Michie O’Day, NF2 patient).

Recently I had occasion to remotely CART a doctor’s appointment for a man I will refer to as “John” (not his real name). John has a severe hearing loss caused by neurofibromatosis. I received the assignment to work with John on a Thursday. I was contacted by the doctor at the scheduled time and remotely CART’d the appointment. At one point, when the doctor left the room, I chitchatted with John. He was curious how I got started CARTing in the medical field. I explained to him that for the past three years I had been “going to” medical school with a student who had a hearing loss. CART was a foreign technology to John, but he found it was very useful, especially in the medical setting. Every human being should receive quality healthcare. A component of quality healthcare is effective communication.

“Next to providing a germ-free environment, I can think of nothing more important for any patient than good communication with the medical team while in the hospital or doctor’s office.” (Michie O’Day, NF2 patient).

I didn’t know if I would hear from John again. A few days after the appointment, though, I received an email from John’s girlfriend, Annie. They found my email address on our website. She asked if I could CART a funeral. She didn’t say whose funeral it was. I told her it could be done as long as there was an Internet connection and a way for me to hear what was being said. I then received an email from John. John said that his mother passed away the day after his doctor’s appointment. I remember him lovingly talking about his mother during the appointment. Because, you see, his mother also had neurofibromatosis. My heart was broken for this man I did not know. I also wanted to help him participate in his mother’s funeral. John told me that there was one obstacle, though: The funeral was going to be outside. We brainstormed through email and decided to just try to see if it would work.

The following day, John and his girlfriend arrived at the gravesite. John, using his Treo, hooked up the data connection cable to his laptop. He connected to the Internet! They then used her Sidekick and tested the audio component. It was perfect. We tested it out several different times by connecting and reconnecting to the Internet. We were all excited that this was going to work. John was going to arrive at the site an hour early to get set up. But because of family obligations, John wasn’t able to arrive an hour early. He had 20 minutes. One thing we didn’t take into account was the sun shining down on the computer. John connected to the Internet, and we were ready to go. Then I lost John. I had audio, though, and spoke to Annie. She said he was having a computer problem. I told her to keep the line open and when he was ready he could just reconnect. I never saw John again on the computer. I tried to figure out what was happening, at the same time writing the funeral. After the funeral was over, John emailed me and said that it was “operator error.” Because the sun was so bright, John was mistyping on the keyboard; he just couldn’t see. I was so disappointed that I wasn’t able to help him participate in this most precious event.

In the end, though, John was given a copy of the pastor’s sermon immediately after the funeral, and I was able to transcribe and email the remainder of the funeral proceedings to him.

I learned a tough lesson that day: As a CART provider, we have to be prepared for everything. And in the future I won’t forget the sun component when working outside. This event also proved to me that we can CART anywhere, as long as we have a good Internet connection, good audio signal…and a little shade.

The CART profession – (Communication Access Realtime Translation) also known as captioning – brings new experiences, new knowledge, and new friends.

Today I had the privilege of working with a gentleman who apparently was in an accident of some kind. He is in ICU on a ventilator. This gentleman has a condition known as Neurofibromatosis 2. Many people with NF2 end up losing their hearing because tumors develop around their acoustic nerves. I have provided communication access remotely for many patients each time they meet with a doctor or healthcare professional.

This particular CART job, though, had more of an impact on me than most of my CART jobs. This gentleman was clear across the country lying in a hospital bed on a ventilator and I was able to use my skill to help him communicate with his caregivers and his family, instantaneously.

The hospital has developed a system called the IPOP and COW: IV Phone on a Pole and CART on Wheels. They wheel the speaker phone that is mounted on an IV pole into the room and place it next to the patient. I know this information about the equipment not because any of the staff told me but because this gentleman’s young son commented on the acronyms, thinking it was a funny use of letters.

The hospital staff phones the CART provider and we listen to the conversation and simultaneously stream the text back to the computer they have placed in front of the patient. In this instance, when the patient needed to speak, they took him off the ventilator for a brief period so he could talk. It was difficult not to get emotional when the patient said that through the night he felt he was dying because he couldn’t breathe. And when the doctors told him that he may be on the ventilator for the rest of his life, I just about fell apart. I feel as if I know him even though I’ve never met him.

The family and staff call me by my first name and often ask how I am doing. I am a part of the team to help someone recover. It is so rewarding to know that CART providers can use the skill, knowledge and technology that we possess to help someone wherever he or she may be; that we can be an integral part of someone’s recovery and to be there to help someone communicate, to hear his son say “Daddy, can’t wait for you to get home,” and for that son to hear daddy say “Daddy’s gonna be okay and be home soon.”

Written by:
Denise Hinxman, Owner of Captions Unlimited in Reno, Nevada

Mary Pat Gallagher
New Jersey Law Journal
October 17, 2008

A Hudson County jury’s $400,000 verdict for a deaf patient whose doctor refused her an interpreter may be a wake-up call for all professionals — including lawyers — that they risk liability for disability discrimination.

Worse, malpractice liability insurance does not usually cover such liability, says plaintiff’s attorney Clara Smit.

Smit’s client, Irma Gerena, claimed she repeatedly asked Jersey City rheumatologist Robert Fogari to hire an American Sign Language interpreter. Fogari said that as a solo practitioner, he couldn’t afford the estimated $150 to $200 per visit an interpreter would cost.

Fogari treated Gerena for lupus for about 20 visits, stretched out over 20 months. He would sometimes exchange written words with her civil union partner, Lourdes Torres, who had better written English skills, and he also communicated with Gerena through the couple’s 9-year-old daughter.

But Gerena claimed that for the most part, she was deprived of the opportunity to participate in and understand her medical situation and the treatment Fogari provided, including the attendant risks and alternative approaches. She kept seeing Fogari because her primary care physician had referred her to him; she was not sure of the nature of her illness and fearful about her worsening symptoms; and she could not just pick up the phone and find another doctor.

Gerena allegedly tried to get Fogari to change his mind, giving him an interpreter’s business card and having the interpreter call him to explain the law to him, all to no avail. She switched doctors after Fogari told her to go to someone else because of her repeated requests, says Smit, an East Brunswick solo.

The new doctor took her off steroid treatments, which were causing her face to swell. Gerena claimed she had not realized the swelling was a side effect of the medicine rather than a symptom of the illness, says Smit.

Gerena sued Fogari under the federal Americans with Disabilities Act and Rehabilitation Act, which applies to recipients of federal funding, including hospitals and doctors whose patients are covered by Medicare and Medicaid. She also sued under New Jersey’s Law Against Discrimination.

During a three-week trial before Superior Court Judge Mary Costello, Fogari argued it would have been an undue hardship to pay an interpreter when he was being reimbursed only $49 per visit by Gerena’s insurer, but his tax returns showed he earned over $400,000 a year, says Smit.

On Oct. 9, the jury found Fogari violated the law by failing to provide Gerena an interpreter and by retaliating against her for requesting one. Half of the $400,000 verdict was for punitive damages.

Smit says the award is a national record for such a case in the nation. She also says Fogari’s malpractice carrier did not defend the case and will not cover the liability because quality of care was not at issue.

Neither Fogari nor his lawyer, Antranig Aslanian of Aslanian & Khorozian in Fort Lee, returned a call for comment.

The leading New Jersey case on the issue is a published Appellate Division decision from 2001,Borngesser v. Jersey Shore Medical Center, 340 N.J. Super. 369, which eschewed a per se rule in favor of a fact-sensitive inquiry. The court differentiated between critical points, when a hospital or doctor must provide “auxiliary aids and services,” such as interpreters, video test displays or note takers, to enable “effective communication,” and routine care, like a blood-pressure reading, when they might not be needed. Critical points include taking a patient’s medical history, explaining a course of treatment and obtaining informed consent. Smit represented the Borngesser plaintiffs.

The defense lawyer in Borngesser, Michael McGann of Ronan Tuzzio & Giannone in Tinton Falls, says “the law does not require a sign language interpreter every time, just reasonable accommodation for the hearing impaired.”

How Borngesser translates to lawyer-client interactions is uncertain in the absence of case law.

The Justice Department went after at least one lawyer who failed to provide a deaf client with an interpreter based on a complaint filed by the National Association of the Deaf, on behalf of the client, Carolyn Tanaka.

Joseph David Camacho, of Albuquerque, N.M., was accused of refusing to provide an interpreter to communicate with Tanaka on a lawsuit he was handling for her. Ironically, the suit was against a hospital for failing to provide an interpreter for Tanaka during the admission of her 9-year-old son. Camacho allegedly withdrew from the case, leaving Tanaka without counsel, which led to dismissal of the action for failure to respond to discovery.

Camacho claimed he was able to communicate effectively with Tanaka by written notes, e-mail and telephone relays and through the interpretation provided by her son.

He settled with the department on Aug, 9, 2007, agreeing he would pay Tanaka $1,000 in damages and his office would adopt a policy of providing interpreters

By:  Michie O’Day

Appointments with our doctors, especially to learn about or discuss any serious medical condition, are one of the most frightening challenges for late-deafened adults.  Will the doctor (or other medical professional, now often a physician’s assistant) take the time and exhibit the patience we require to understand what he or she is telling us?  And if not, what important information will we miss?  Information that may affect how long we live, and will surely affect the quality of our lives.

Most of us rely on a combination of the physician’s note writing proficiency and willingness, our ability to read lips, perhaps a sign language interpreter, a friend or spouse to accompany us to the appointment and remember enough of what the doctor said to share it with us later.  It’s all scary stuff.

But now we have a new option.  Most late-deafened adults are familiar with CART  (communication access realtime translation).  It is similar to closed-captioning, which we see on TV and in movies and which the general public now sees on TVs in bars, airports and other noisy places.  There are CART interpreters in most states now, and some of them now have remote-CART technology.  Remote-CART enables them to provide a live, real-time transcript from their office to your location.  All you need is a computer with current internet access software and a phone line, which is available in many examining rooms at major medical centers now, and a good speaker phone.

The good news is that this accommodation for our deafness is covered under the Americans with Disabilities Act (the ADA).  All you need to do is contact the Interpreter Services office of the hospital where you will have your doctor appointment and tell them you need a CART interpreter – and then be ready to do a lot of follow-up and explaining, especially if you are the first person who has ever requested CART.  Be prepared to be tenacious, but polite.  And give them as much notice as you can.

The other good news is that it gets easier each time you go back to the same facility.  Remote CART is new.  A learning curve is to be expected.  But, as everyone gets used to it, it becomes easier and more natural.

Since 2004, I’ve been requesting and benefiting highly from CART each time I see my neurologist at Mass General Hospital for follow up for my case of neurofibromatosis-2.  At my last appointment, we used remote CART provided by Captions Unlimited of Nevada, Inc.  Remote CART is more convenient and usually less expensive than having a CART interpreter on site.

This leads to my last point.  CART is wonderful for us late-deafened adults.  It is the closest we’ll ever get to real hearing again.  Because the interpreters go through extensive training and are highly skilled, it is not cheap.  Thanks to the ADA, the patient does not have to pay for it.  The hospital does.  Please be sure to thank all parties involved (the interpreter services office, your physician, the CART interpreter) for providing this important service for you.