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Patients who are not proficient in English are entitled to a medical interpreter by law.
(Eric Gay / AP)
Cornelia E. Brown, Ph.D., is executive director of the Multicultural Association of Medical/ Legal Interpreters (MAMI) in Syracuse. MAMI is a not-for-profit providing translation services in medical and legal settings in Syracuse, Utica and Albany.
By Cornelia E. Brown
Fifty years ago, Martin Luther King Jr. championed the right of African-American minorities to have a voice in the voting booth. If he were alive today, King would also champion the right of non-English-speaking refugees and immigrants to have a voice at the doctor's office, in schools and in court.
In the 1970s, the U.S. Supreme Court extended the protection of minorities under the 1964 Civil Rights Act, to guarantee the right of non-English speakers to a competent interpreter free-of-charge to access essential services.
A 2013 census found that the number of people speaking a language other than English in U.S. homes had climbed 158 percent in the past two decades.
Courts have progressed faster than medical facilities in giving a voice to limited-English-proficient people. The state pays for court interpreters but not medical ones. Health care facilities and independent doctors' offices have been saddled with what's called "an unfunded mandate," providing and paying for medical interpreters. Nor can patients be billed. "Civil Rights law prohibits health care facilities from asking patients to pay for translation services, and they may not receive adequate or in some cases any other reimbursement," according to Kaiser Health News.
Until 2004, the American Medical Society promoted use of friends and family as interpreters - they're easily available, they care (and are free). Indeed, children may seem the best interpreters, often learning language faster than adults. In one case, 15-year old Poulinna Po interpreted multiple times in Cambodian for her dad, who had diabetes and didn't understand how to take his medications. Although Poulinna understood the doctor's English, she couldn't convey his instructions in Cambodian. Adherence to treatment is crucial for a diabetes patient, but her dad could not understand what to do. He died of a brain tumor and multiple strokes. To this day Poulinna blames herself for his death.
At the Multicultural Association of Medical/ Legal Interpreters (MAMI), a non-profit since 1998, we have seen leaps ahead by hospitals and clinics in Upstate New York. Most now offer interpreting, either on-site or via telephone or video, as part of a comprehensive language access program. Some have interpreting staff, others an extensive set of contractors.
But we still must heed King's cry for equal access. As King said, "there is no gain without struggle."
Federal and New York state law on language access calls for "qualified" interpreters without requiring specific credentials; although, interpreters work in realms where understanding can be the difference between life and death. Research suggests that many of those interpreting in a medical settings are not truly qualified to give another a voice. A 2013 study in the journal Pediatrics found that 57 percent of pediatricians in the US still use friends and family to communicate across the language barrier, even when professional interpreters are available. Even paid staff and contract interpreters may have minimal or no training.
Using under-qualified interpreters saves money up front but will likely incur large costs later. California State Assembyman Phillip Y. Ting, explains the financial risks of unskilled interpreting: expensive emergency care, higher diagnostic and testing costs, increased liability. The greatest risk is a poor health outcome for patients like Poulinna's dad.
Research by Dr. Glenn Flores lights a way forward. The more medical interpreter training, the fewer medically significant errors, like omitting allergies or misstating drug dosages. Compared to interpreters with over 100 preparation hours, less well-trained interpreters make six times more medically significant errors, and untrained interpreters, 10 times more. How many errors would you accept?
If training is the first step, certification is the second. Certification provides objective proof of competency. We wouldn't dream of using an unlicensed nurse, doctor or lawyer. Statistically verified exams now exist on the national level for medical interpreting. Surprisingly, few health care facilities require certification, and interpreters are reluctant to spend the time and money needed to get it. Could we fear that a certified interpreter will cost more?
Unless certification brings status and pay, interpreters will likely not invest the time and money required. The missing piece appears to be reliable funding for medical interpreting. The current practice requiring the health care provider to pay does not seem fair - or productive. "Physicians don't deny the need for effective communication. But, they say, the unfunded legal mandates leave doctors to bear the expense," American Medical News reported.
Many recommend shifting the funding burden to health insurers, private and governmental. Already, insurers reimburse preventive care: immunizations, screenings, regular check-ups; interpreting may be added. Some insurers like Health Partners in Minnesota offer interpreting directly. Medicaid covers a portion of interpreting costs in DC and 13 states, including New York. Under the Affordable Care Act, California is now proposing a bill to provide a state/ federal match - anticipating a thousandfold greater contribution from the federal government. We in New York must explore these payment options - without delay.
"Of all the forms of inequality, injustice in health care is the most shocking and inhuman." Dr. King said this in 1964. Let's take action.