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.’

Legal obligations

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.com says: ‘better communications [are] needed between physicians, hospitals, care givers and patient.’ They go on to say there should be constant dialogue between patients and healthcare providers to make sure the devices are always used correctly, there are no function problems and that the patient has been properly educated on what to do if something goes wrong.

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.

South Korea hopes to multiply by three the number of travelers coming for medical purposes until 2018. Outbound markets from Russia and the UAE are seen as priority.

SEOUL- Korea has ambition to become a major destination for medical tourism within the next five years. The government has been supporting the globalization of Korean medical institutions under a brand campaign “Medical Korea”, in an effort to promote its medical sector abroad. So far, according to the Ministry of Health and Welfare, total number of foreign patients who visited Korea for medical treatment surpassed 110,000 last year, up from 81,789 in 2010. If everything goes according to Korea’s ambitious development plans in this niche market, the country could attract over 150,000 foreign patients this year and target 400,000 visitors for medical purposes by 2018. By comparison, in 2007, less than 8,000 foreign travelers came to Korea for medical tourism.

The government has been making efforts over the past few years to develop medical tourism as one of its new growth engines. An agreement has been for example signed with health authorities in Abu Dhabi to allow citizens from the UAE to get treatment in four contracted local facilities in four hospitals located in Seoul. According to Korea’s Health Ministry, the agreement could generate economic benefits of US$ 52 million per year. Various programs have also been introduced by the government and related state agencies to facilitate the arrival of tourists for medical purposes. Initiatives include the issuance of medical treatment visas, operation of an around-the-clock medical call centre as well as dedicated one-stop medical tourism service centres. Special visa issuance has already helped to welcome in 2011 some 8,259 for countries such as Russia, China PRC as well as Mongolia. Russia is seen as one of the market with the highest potential. An office to promote Medical Tourism has recently been opened in Vladivostok in Siberia.

Speaking with the Korean daily “The Korea Times”, Korea Tourism Organization (KTO)’s chief Lee Charm sees medical tourism as the next big thing for the nation’s tourism industry. “The prospect for medical tourism is fantastic. The area of medical service has unlimited growth potential.” Lee said. The high level of services, the blend of traditional Korean medicines with Western medical knowledge as well as a safe and reliable environment is considered as assets to futher develop medical tourism. Korea medical services are also price competitive, especially when compared to Western European countries. “We are a bit more expensive than Thailand but our environment is much better and safer,” added Lee to the newspaper.

LA Translation has translated volumes of patents and strategic documents for Apple vs. Samsung lawsuit thazat began this month, August 2012. In a big lawsuitt, sometimes attorneys send humanly impossible volume of work two or three days before the trial. An ideal situation is to have enough time for translators, editors, and proofreaders to produce the best quality. But with such a huge volume in such a short time, maintaining a consistently high quality translation is a challenging task. Some translators drop out, some send in wrong formats despite repeated instruction by the PM on the correct format, and some send in highlighted and partially translated documents. With a team of the best translators, proofreaders, and editors, it is still a very strenuous job. The most essential are that the invidivudlas involved in the task should be reliable and responsible people. Then they would stay up for days trying to produce perfect translation. In this day and time when the trade disputes among nations are increasing, there is a high demand for well trained professional translators who know what they are doing and are responsible enough to submit a complete product by the deadline. In this project where LA translation mobilized the best of Korean translators from all over the world, three translators in particular did not meet the deadline and presented problems for LA Translation. And they were people holding MA’s and PhDs from Harvard and Standford. They just don’t submit work o time. It is too bad that their talent don’t match up with their sense of responsiblity. “There is nothing difficult to transaltor,” says Dr. Jenny Park, the lead translator of the team. “But the difficult part is always the time pressure, that you are always given so little time to proofread.”

Copycat or competitor? A U.S. jury’s choice of descriptor for Samsung Electronics (005930) will determine whether Apple (AAPL) defeats its Korean rival in the global patent war’s biggest battle yet. For two years, Apple has fought with other mobile device makers in courts on four continents. On July 31, the Apple litigation juggernaut went before a U.S. jury for the first time in the federal courthouse in San Jose, Calif., a short drive from Apple’s Cupertino headquarters. Seeking $2.5 billion in damages, Apple has accused Samsung of unlawfully imitating the design and software of its iPhone and iPad. “As we all know, it’s easier to copy than to innovate,” Harold McElhinny, Apple’s lead trial lawyer, told jurors in his opening argument.

Samsung’s attorney, Charles Verhoeven, fired back that while his client may have been “inspired” by Apple, such imitation is perfectly appropriate. “Being inspired by a good product and seeking to make even better products is called competition,” Verhoeven said. “Everybody does it in the commercial marketplace.” Then he foreshadowed evidence that purports to show that the iPhone, introduced in 2007, itself resembled earlier products designed by Sony (SNE) and others.

Apple filed the case as part of a much broader offensive against Samsung, Motorola Mobility, and HTC—all device makers that use Android, a mobile operating system made by Google (GOOG) that competes with Apple’s iOS. Apple says that Samsung infringed patents for the design of its devices, as well as for functions such as “rubberbanding,” the way the screen on an Apple device seems to bounce back when the user scrolls to the bottom of a file.

The animus driving the litigation runs deep, especially on Apple’s side. In the last 18 months of his life, founder Steve Jobs, who died last fall, was obsessed with crushing Android, which Google gives away to manufacturers—and which challenges Apple’s pitch that its exclusive, walled-garden offerings are different and better. According to his authorized biographer, Walter Isaacson, Jobs swore: “I’m going to destroy Android, because it’s a stolen product. I’m willing to go to thermonuclear war on this.”

The emotion on the other side was evident in the San Jose courtroom even before opening arguments. John Quinn, another Samsung lawyer, reiterated its desire to use evidence it says would show that it was developing rounded rectangular-shaped phones before Apple introduced the iPhone. Quinn told U.S. District Court Judge Lucy Koh that in 36 years of law practice he had never begged, but was “begging now.”

Koh rejected the request for what she said was at least the third time. “Don’t make me sanction you, please,” the judge said when Quinn persisted. “I want you to sit down, please.” The judge based her ruling on Samsung’s failure to disclose the evidence in a timely way.

Samsung said in an e-mailed statement that Koh’s procedural decision meant that “Samsung was not allowed to tell the jury the full story and show the pre-iPhone design for that and other phones that were being developed by Samsung in 2006, before the iPhone.” Also included in the release: Pictures of some of the evidence that Koh had disallowed.

McElhinny, the Apple lawyer, told Koh the release appeared to be “an intentional attempt to pollute this jury,” rising to “contempt of court.” In response, Samsung’s legal team said in a court filing that the company’s statement was merely intended to answer questions from the media. The trial is expected to continue through August.

The bottom line: Apple is trying to convice a jury that Samsung is copying its innovations. Samsung says its devices were “inspired” by, not a ripoff of, Apple.

South Korea hopes to multiply by three the number of travellers coming for medical purposes until 2018. Outbound markets from Russia and the UAE are seen as priority.

by Luc Citrinot

Read more: http://traveldailynews.asia/news/article/49911/korea-is-looking-to-become

by Maria Lenhart

The pending implementation of the Affordable Care Act, aka Obamacare, will not stop or even slow down the moving train that is medical travel and tourism, say experts in the field.

Just days before the Supreme Court’s June 28 ruling giving a thumbs-up to most of the Affordable Care Act, David Boucher, president of Companion Global Healthcare, commented that regardless of the court’s decision, the major factors driving medical tourism would continue.

“The escalating cost of (U.S.) medical care and the continued decline in quality is ensuring the future of medical travel,” Boucher said during a presentation at the recent Well-Being and Medical Travel Conference.

In the wake of the Supreme Court’s ruling, Travel Market Report asked Boucher and other medical tourism experts for their perspectives on the impact of the Affordable Care Act on the future of medical travel.

If, as the Affordable Care Act promises, almost all Americans are covered by health insurance, will fewer people travel to save money on medical procedures?

Josef Woodman, publisher of Patients Beyond Borders medical travel guides: The answer is yes, no and neutral. On the one hand, those who are currently uninsured – a huge component of medical travel – will gain access to covered healthcare. Some may be able to stay in the U.S. for an orthopedic procedure that they were previously not insured for. Some of this will take away from medical travel.

On the other hand, you can’t have 30 million Americans (the currently uninsured who are expected to gain coverage) entering our already broken system without a tradeoff in the form of longer waits for specialty care.

If you look at Canada and the U.K., where there are long-established healthcare systems, this has been the case. So the people who can afford to travel for specialty care to places like the Cleveland Clinic or Sloane-Kettering will do so. Those who can’t will be stuck with long waits.

Boucher: Americans and Canadians will continue to travel abroad and domestically for healthcare, whether it’s to a Cleveland Clinic, Johns Hopkins or other facility. They are looking for safety and service, which are both leading motivators to travel for healthcare. Price is only the third consideration.

Most employers indicate that they continue to be interested in the right services for their members at the right place and right price. If that means changing their benefit plans to cover travel to the Cleveland Clinic, they are increasingly open to it. Nothing in (the Affordable Care Act) will change this.

We will see more companies following in the path of Pepsico and Lowes in this regard.
(See story, PepsiCo Med Travel Benefit Expands Market for Agents, December 22, 2011

Kiana Bright, vice president, Thailand Medical Travel and Tourism: More Americans will travel overseas for healthcare. Accessibility of care will be a long-term problem if more people are brought into the healthcare system. Canada has universal healthcare and is a perfect example of this. Many Canadians have to wait up to seven months or more to receive knee replacement surgery.

In addition, the healthcare cost will be increased for employers. This will drive them to find creative options to save money. Medical tourism can be the answer for that.

Are there areas of medical tourism that will not be impacted by the Affordable Care Act?
Boucher: It should have no impact at all on dental coverage and therefore dental tourism. In fact, a lot of Americans are dropping their dental coverage. Even if you are covered, most dental premiums have a $1,500 or $2,000 a year maximum at best. So if you need $15,000 worth of dental work and you are only covered for $1,500, it still pays to travel for dental care.

Woodman: There is a vast landscape that will not change at all. Dentistry is not covered (under the Affordable Care Act), neither are cosmetic surgeries and some bariatric procedures. Dentistry and cosmetic surgery comprise over half of all medical travel – and if you add in elective surgery, that’s about 75%.

What other factors beyond cost and insurance coverage are driving the future of medical tourism?
Boucher: With the increasing shift toward greater transparency and consumer awareness, there will be an increase in Americans traveling for healthcare as they learn more about the high quality care available overseas.

There’s so much more information out there on the safety, quality and service provided by medical institutions. More consumers are sharing their experiences. It’s no longer just what the medical facility wants to tell us. People will increasingly be able to make educated decisions.

Woodman: Global options for healthcare will be something that more people are comfortable with. People are growing savvier about these options already – there are people who are getting off a cruise ship and getting an MRI while in port.

We haven’t yet reached a critical mass on healthcare transparency but it is coming. More patients will be rating their experiences online. It will be like hotels on TripAdvisor.

Hospitals are offering packages and special deals, but not enough yet and they are not posted on their websites. The next phase is to pry all this information loose and aggregate it. It will be easier to shop and compare.

The global potential for medical travel is huge – and increased global activity will lead to improvements in healthcare. There’s a huge growth of the middle class in other countries, which means more people can travel for healthcare. Hospitals will be forced to compete.

TWIN FALLS, Idaho (AP) — Erica De La Rosa is in court nearly every day, but she never speaks for herself.

“We’re not supposed to exist,” she said.

De La Rosa is a court certified Spanish interpreter for Twin Falls County 5th District Court. Interpreters are not lawyers or advocates and don’t give legal advice or even explain to defendants possible outcomes in their case.

“You say what they say,” she said, no matter how shocking or strange it might be.

Idaho law requires that courts ensure access to all people, including those with limited English proficiency or those who are deaf or hard-of-hearing. The courts meet these requirements by developing programs that improve the quality of interpretation and increase the number of qualified interpreters in the courts, according to the Idaho Supreme Court website.

Interpreters are under oath to completely and accurately translate what is said in court to the best of their ability, said Mary Jo Palma, the coordinator for translators in Twin Falls County, and a certified Spanish interpreter.

“If an interpreter becomes aware they’ve made a mistake they’re under obligation to correct it,” Palma said. “If an interpreter is challenged, the judge will rule accordingly.”

One case where an interpreter was questioned is currently making its way through court in Twin Falls County.

Valentin Calvillo was sentenced to serve 15 to 30 years in state prison in November 2011 after being convicted by a jury of eight counts of lewd conduct and sexual abuse of a minor in November 2010. His sentence was delayed for a year because Calvillo, 50, skipped his trial after showing up for the first few days.

When he returned, Calvillo petitioned for a new trial, arguing he misunderstood instructions from his defense counsel when he was told to leave and seek medical treatment. With a new attorney, Calvillo unsuccessfully argued for a new trial during the summer and fall of 2011.

Calvillo’s attorney, Virginia Bond, was in court again two week ago asking Judge Richard Bevan for an independent translator to go over transcripts from the case and look for errors in translation.

During one hearing, Calvillo’s family began gesturing to say there was a mistranslation about why Calvillo felt sick the day of the trial, Bond told the court.

Twin Falls County Chief Criminal Deputy Prosecutor Suzanne Craig said Calvillo claimed he didn’t feel good about being in front of a jury, not that he was actually ill.

Since Bond wasn’t the attorney during the hearing when the exchange occurred and doesn’t understand Spanish herself, she wanted someone else to listen to the audio recording of the hearing to see if the transcript matches up.

Bevan agreed to take the request under advisement and a new court date was set for Aug. 2.

When a translation is questioned, it can be a bit embarrassing, De La Rosa said.

“You just say, ‘excuse me your honor, the interpreter made a mistake,'” she said. “If it’s a simple mistake it’s not a big deal, but it’s humbling.”

Occasionally interpreters have to translate for someone in a language other than the one they know best. A person might speak a language that’s difficult to find an interpreter for, with Spanish being their second language and English their third.

The judge speaks in English, the interpreter translates to Spanish and the defendant must translate in their head to their own language and then the process starts again.

“It’s an art,” De La Rosa said.

To see original story

This glossary of key election terminology is prepared by U.S. Election Assistance Commission. This glossary includes a total of 1,843 terms and phrases used in the administration of elections in the United States. This will be a good source for Korean to English translators and interpreters.

Download the Glossary of Key Election Terminology

Medical interpreters and Obama Care

Medical interpreters on demand

Medical interpreters on demand

Medical trip to Korea

South Korea hopes to multiply by three the number of travelers coming for medical purposes until 2018. Outbound markets from Russia and the UAE are seen as priority.

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Korea is looking to become a hot destination for medical tourism

South Korea hopes to multiply by three the number of travellers coming for medical purposes until 2018. Outbound markets from Russia and the UAE are seen as priority.

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Court interpreters hold critical role

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OECD English / Korean Glossary of Terms

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Medical interpreters on demand

South Korea hopes to multiply by three the number of travelers coming for medical purposes until 2018. Outbound markets from Russia and the UAE are seen as priority.

South Korea hopes to multiply by three the number of travellers coming for medical purposes until 2018. Outbound markets from Russia and the UAE are seen as priority.