There are currently 25 million people in the United States who don’t know enough English to get them through a routine hospital or clinic visit, according to 2010 U.S. census data, which tracks language competency.
That number has grown by 80 percent nationally in just two decades. Some individual states have seen triple-digit percentage increases in non-English speaking populations, among them Nevada, North Carolina and Georgia. This increase has created high demand for people who are paid to provide interpretation for patients in clinical settings. But so far there is no national legislation to certify or license this work, and hospitals and clinics are not always able — or willing — to meet the need.
Working without competent medical interpreters can be simultaneously dangerous and unintentionally comedic. Ellen De La Torre, of Mankato, Minn., has been a medical interpreter for more than 15 years. Once, she walked into a clinic and overheard a Qualified Rehabilitation Counselor (or QRC) talking to a man who spoke no English, but had his English-speaking daughter along.
“The father was answering through his 14-year-old daughter,” says De La Torre, and the QRC asked, ‘Have you ever had an MRI?’ The daughter turned to her father and said, ‘She wants to know if you’ve ever had hemorrhoids.’”
It’s not just the patients who are vulnerable. Failure to use competent interpreters who possess at least base knowledge of medical ethics and patients’ rights can harm providers, too.
A study by the University of California’s School of Public Health looked at 35 medical malpractice claims between 2005 and 2009 where a language barrier was involved. In all but three of the cases, researchers found that health care providers had failed to give patients access to competent interpreters.
The field of medical interpreting has been professionalizing one slow step at a time. Today, health care providers can look to standards of practice and standards of training that didn’t exist ten years ago. There has been national certification for medical interpreters in place since 2011.
Still, the field is in something of a Wild West phase, with vast differences in regulation and practice from one state or health care provider to another.
Right now, a patient walking into a health care setting who struggles with English has no guarantee of working with a competent, trained medical interpreter. Those services could be provided by a nurse who happens to be bilingual. In some cases it might be a child, a relative, or even the hospital or clinic janitor.
Joyce Denn has seen that kind of recruitment up close. She is a labor and delivery nurse at St. John’s Hospital in Maplewood, Minn., where there are trained interpreters on staff. But 10 years ago, she worked in a hospital in Queens, N.Y., where things were different.
“We got patients from all over, particularly from Russia, Uzbekistan, Tajikistan,” says Denn. “We had a lot of patients from Iran and Haiti, and there was no system for interpreters there. None. If we had a patient who spoke no English, there would be overhead paging throughout the hospital: ‘If there is anyone in the house who speaks this language, please report to whatever unit needed it.’ So we would get visitors, we’d get people from housekeeping. I mean, when I think back on that, it’s terrible.”
Medical professionals today understand that being bilingual hardly qualifies a person for the work of medical interpreting. Trained interpreters are expert at visual cues, dialects and complex medical jargon and terminology — and they operate within a strict ethical framework that protects the privacy and rights of the patient.
A slew of state and federal legislation offers legal promises of protection to patients, beginning with Title VI of the Civil Rights Act of 1964, which prohibits any institution that uses federal funds from discriminating based on “race, color, religion or national origin.”
What this means, according to Mara Youdelman, a managing attorney with the National Health Law Program in Washington, D.C., is this: “If a hospital or other health care provider is taking federal funds — which virtually every hospital does because they participate in the Medicaid and Medicare programs — they need to provide services to ensure that limited English proficient patients can communicate with their providers, access the health care system and receive similar treatment to those who speak English as well.”
It is difficult to find meaningful national data on the cost of interpreter services. Just 13 states and the District of Columbia reimburse health care providers for the cost of interpreter services from Medicaid and the federally funded Children’s Health Insurance Program.
Reimbursements for interpreter services range from $12 per hour in Idaho to $190 per hour in the District of Columbia. States offering these reimbursements typically log tens of thousands of in-person and phone sessions every year. That’s hundreds of thousands and in some cases millions of dollars. In states that don’t reimburse, the cost falls entirely on the provider.
Glenn Flores is director of the general pediatrics division at Children’s Medical Center in Dallas. He’s studied the role of medical interpreters and has counseled providers who are considering a larger investment in interpreter services. He’s heard the objections of providers concerned about cost.
But, he says: “I think it’s pennywise and pound foolish, because sure you can save money by not having a group of professional interpreters always available for your patients, but if that leads to even one major medical error or patient death — and of course there are probably untold numbers of preventable or even inappropriate hospitalizations — if you think about it really is not a wise way to approach this issue.”
Even with national certification and all that has spun up alongside it — including hospital regulations, state laws and parts of the Affordable Care Act that address language access issues — the best protection for patients, according to those in the field, is not coming from state or federal government, or even national certification. Instead, hospitals and clinics are deciding that ensuring access to competent, trained interpreters is worth the extra expense in an already expensive business.
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