Medical Interpreters and Obama Care
There is no more vivid illustration of the urgent need for certified medical interpreters than the story of Maria Guevara, whose visit to Los Angeles County General hospital for a pregnancy test in 2008 changed her life forever. She was thrilled to learn that she was three months pregnant. When the doctor asked in English whether she wanted to keep the baby she replied without hesitation, ‘Yes.’ The doctor prescribed medication, which Maria took when she got home. She experienced violent pain and bleeding and returned to hospital where the doctor told her she was having a miscarriage. She said afterwards: ‘My baby was dead. The medication the initial doctor prescribed to me was not prenatal care but medication to induce an abortion. Not speaking any English, I was unable to understand his question to me. He did not speak Spanish and no interpreter was provided. Losing my baby forced me into a deep depression. I could not bear looking at or holding babies because the thought brought back painful emotions.’
According to the 2010 US census, 20% of California’s 6.6 million residents speak English ‘less than very well’ and have experienced problems in understanding their physician or other health care provider. The number and diversity of US residents with limited English continues to grow, putting pressure on healthcare systems and clinicians to ensure equal treatment by providing interpreters. However, those working within the healthcare system are often unclear about their legal obligations.
California is the most ethnically diverse state in the nation and is one of the most advanced in providing legal rights for patients to have access to an interpreter. The need for certified medical interpreters will increase dramatically when millions of people who do not speak English become eligible for health insurance under the Affordable Care Act (Obama Care). To address the anticipated need for medical interpreters, Assembly Speaker John A Pérez (D-Los Angeles) introduced Bill AB1263, which will significantly expand training. This was passed in Senate on September 11, 2013 and enrolled on September 18, 2013. It will ‘establish the Medi-Cal Patient-Centered Communication program, to be administered by a 3rd party administrator, to, commencingJuly 1, 2014, provide and reimburse for medical interpretation services to Medi-Cal beneficiaries who are limited English proficient.’
An improving situation
Under the Affordable Care Act, the federal government will pay most of the cost of providing interpretation for new patients coming into the system. For an investment of $200,000, California will gain $270 million in federal funds for the creation of 7,000 jobs for Certified Medical Interpreters accredited by the National Board of Certification for Medical Interpreters. Even a relatively fluent interpreter, without specialized training, may have difficulty translating the unfamiliar and complex medical terminology used in consultations. With the increasing use of advanced technology in medical procedures, and the use of medical devices in patients’ homes, this can only make the training of specialized interpreters more urgent, particularly when devices for home use arrive without multilingual instructions. On this subject, the website licensedprescriptions.
Unfair to children
Despite the legal framework, there is still a shortage of medical interpreters, and hospitals often rely on help enlisted from non-medical hospital staff unfamiliar with medical terminology, or on patients bringing in friends or family to interpret for them. This may be better than nothing, but it is a system open to errors. Unfortunately, particularly in the case of new immigrant families, it is often the children who are more fluent in English and are therefore forced to take responsibility for translation in difficult and harrowing situations that can leave the child permanently scarred.
Poulinna Po was only 15 when she was needed as interpreter for her father, who spoke only Khmer. Her father suffered from diabetes and did not understand how to take his medication. Poulinna Po understood what the doctor was saying, but did not know the Khmyer words needed to convey this to her father. He eventually died from a brain tumor and complications from a stroke for which Poulinna Po blamed herself.
Dr Hector Flores, a director of The California Endowment (whose mission is to expand affordable, quality healthcare for under-served individuals and communities) said: ‘Children do not have the maturity to understand the importance and seriousness of medical discussions. There could be misunderstandings that could lead to serious problems. Imagine a boy interpreting for a mother having menstrual problems. Parents might withhold information and think they are protecting the child, but this would hurt the medical encounter. It’s never appropriate to depend on a child to interpret.’
Looking to the future
Obama Care remains one of the most controversial federal policies of recent years, with many critics seeing it as a clear case of the federal government overstepping the constitutional limits on its power: they point to the 17 powers given to Congress in the Constitution (Section 8 of Article 1), none of which mentions medical care, doctors or insurance. In 1788 James Madison wrote in the Federalist No. 45: ‘The powers delegated to by the proposed Constitution to the federal government are few and defined. Those which are to remain in the state governments are numerous and indefinite.’ In order to protect this state sovereignty, 20 or more states have challenged the constitutionality of the new healthcare law, and several have moved to pass constitutional amendments forbidding any law that makes it mandatory for citizens to participate in a health-care system; but surely this is overlooking the enormous need of millions of people for medical care that these measures are designed to address.
With regard to the provision of interpreters, the ad hoc arrangements that for decades have been at least inadequate and at worst dangerous to patients, had to be addressed. Uniform standards, qualifications and quality measures are all provided for under the new act, as well as the setting up of the Community Advisory Committee that ‘shall include interested stakeholders that reflect the diversity of the state in terms of race, ethnicity, gender, sexual orientation, immigration status and geography,’ to create and administer a training program for medical interpreters.
In his speech to Congress in 2009 President Obama said: ‘Too many have used this as an opportunity to score short-term political points, even if it robs the country of our opportunity to solve a long-term challenge. And out of this blizzard of charges and countercharges, confusion has reigned. Well the time for bickering is over. The time for games has passed. Now is the season for action. Now is when we must bring the best ideas of both parties together, and show the American people that we can still do what we were sent here to do. Now is the time to deliver on healthcare.’
– Clare Heel –
LA Translation and Interpretation provides Certificate in 40-hour Training in Medical Interpreting in Korean, Mandarin and Spanish, among others. Call 1-866-327-1004 for more information
Medical interpreters on demand
As the nation becomes more diverse, demand for trained, skilled interpreters to help doctors and patients communicate — and avoid potentially deadly misunderstandings — is growing.
Health care regulations require medical providers who receive federal funding to provide interpreters. There’s also growing research on the effects of bad communication on patient safety, said Izabel Arocha, executive director of the International Medical Interpreters Association.
“There’s just been a huge increase in awareness that has changed these practices,” Arocha said.
However, there aren’t always enough medical interpreters to go around, said Rosemond Owens, health literacy and cultural competency specialist at CentraCare Health System in central Minnesota. CentraCare contracts for interpreters from three organizations including The Bridge−World Language Center. Top languages in demand in central Minnesota are Spanish and Somali.
“We don’t have to look too far for what needs there are,” said the Bridge’s CFO and trainer Jan Almarza. “The needs just hit you in the face.”
Programs around the nation that train and certify interpreters in medical terminology, ethics and cultural differences are seeing rising enrollment.
Training at LA Translation and Interpretation takes about 40 hours and outlines best practices and ethical guidelines as set by the National Council on Interpreting in Health Care. There are also oral and written tests to verify people really understand what they claim to know.
Certified interpreter Danny Kim was among the first to go through a training at LA Translation and Interpretation in 2013. A native of Korean, Kim had recently been laid off after working 16 years at the same company and was looking for a career change.
“I simply fell in love with it,” he said. Naturally curious, Kim spends a lot of time learning about medical conditions and treatments and has even observed surgeries to improve his knowledge.
Kim said it’s important but sometimes challenging to maintain professional distance while on the job. He sits to the side of but a little behind the patient and keeps his head down. He must remain impartial, even if the doctor is delivering bad news.
“When I put my interpreter hat on, I’m a machine,” he said.
Still, Kim feels good knowing that he’s helping people. He’s interpreted for children, mental health patients and even a woman giving birth when no female interpreters were available.
“There’s never a dull moment,” he said.
The National Board of Certification for Medical Interpreters has about 500 certified interpreters, said Tina Peña, board president. The program is offered in Spanish and is expanding to Korean, Mandarin, Russian and possibly African languages, said Peña, who is also an instructor at Tulsa Community College.
More hospitals and clinics are realizing the need to use trained interpreters, Peña said. In some cases, hospitals have had to pay to settle lawsuits because of errors attributed to language barriers, she said.
Peña teaches her students not only about medical terminology and privacy laws but also familiarizes them with home remedies popular in Hispanic cultures, such as passing an egg over a sick person to chase away evil spirits.
“She is like a cultural broker, and will explain quickly to the doctor what happened,” Peña said.
Students learn medical terminology and practice typical scenarios, Chesley said. The program also spends a lot of time on ethics, she said.
“You can’t get empathetic with your client,” Chesley said. “You have to be very precise and do exactly what’s required at that particular moment.”
In some cities with a large non English-speaking population, hospitals have added their own interpreters on staff.
At UC Davis Medical Center in Sacramento, Calif., 30%-35% of patients have limited proficiency in English, said Elena Morrow, manager of interpretive services. The hospital has 41 staff members who interpret 16 different languages, she said.
Spanish is the most popular language, followed by Mandarin, Korean, Russian, Ukrainian, Hmong and Mien. The interpreters handle about 37,000 encounters every year, Morrow said.
“We do see the demand is quite steady and increasing little by little every year,” she said.
The salaries interpreters earn vary depending on whether they work on their own or for a hospital or an agency, what part of the country they are in and what language they speak, said Joy Connell, president of the National Council on Interpreting in Health Care.
There are even some interpreters who can work in more than two languages. Those interpreters are in high demand, Connell said.
The U.S. Bureau of Labor Statistics reports interpreters and translators in hospitals earn a national average of $21.43 an hour and $44,570 a year.
Technology is helping health care providers meet the demand for interpreters. Using phone or video conferencing allows hospitals and clinics – including those in rural areas – to provide interpreters for patients, even if they speak a rare language.
Video systems are growing in popularity, Arocha said, because “it allows for that very quick access, but it also allows for the face-to-face interaction.”
“There are situations where you can’t just rely on audio,” she said.
LA Translation and Interpretation provides Certificate in 40-hour training in medical interpreting in Korean, Mandarin and Spanish, among others. Call 1-866-327-1004 for more information.