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Improved Medical Interpreters: Solving the Language Barrier Issue In Improved Medical Interpreters: Solving the Language Barrier Issue in Healthcare Establishing a Model Medical Interpreter Certificate Program at Rutgers University New Brunswick that can be Adopted Nationally Tag Words: medical interpreters, interpreter certification, undergraduate certificate programs, Rutgers University, language barrier, language, healthcare Authors: Aaron Wu, Ife Aridegbe, Vincenzo Cimino and Julie M. Fagan, Ph.D. Summary: The Patient Protection and Affordable Care Act has increased availability and access to health care in medically under-served communities; however, language barriers exist between patients and physicians, causing avoidable consequences such as malpractice lawsuits, unnecessary emotional and physical distress, unwanted procedures, and deaths (1). Currently, each state has its own legislated requirements for medical interpreters, yet in most cases training methods and supervision of practicing interpreters are lacking. In order to combat future problems, our project analyzed the financial cost and consequences that the current interpreter programs fail to address. The successes, failures, mission, goals and structures of existing national, regional, and local translator/interpreter certificate programs were reviewed and analyzed. The resourced information was used to construct a model of our proposed Medical Interpreter Certificate Program to be offered to Rutgers University New Brunswick students enrolled in the School of Arts and Sciences, School of Environmental and Biological Sciences, and Ernest Mario School of Pharmacy. The long term goal of the incorporation of this certificate program into the Rutgers University New Brunswick’s curriculum is to increase the marketability of Rutgers University and its students and to participate in the initiative to decrease the prevalence of language barriers in future healthcare services. Video Link: https://www.youtube.com/watch?v=ppbGtL62Q8U&feature=youtu.be The Issue: Language Barriers in Health Care (IA) The United States is becoming more culturally and linguistically diverse. With an increasing number of individuals that have limited English proficiency and/or speak a language other than English residing in the United States, the language barriers in the nation’s health care institutions become even more prevalent and costly, both medically and financially. In 2008, approximately 20% of US residents spoke a non-English language at home, with 44% of this population lacking the ability to effectively communicate in English (1). These individuals, categorized as LEP or “limited English proficient”, would encounter additional communication issues with their primary care physician or medical specialist. The US Census Bureau’s statistics show that the number of individuals that have limited English proficiency and/or predominantly speak a non-English language at home has been increasing significantly since the 1990s (2). Yet contrary to these increasing percentages, with fast paced hospital environments and time restricted patient visits, there is often limited availability and access to interpreters in the clinical setting. Discouraging statistics of one study showed that in 46% of cases involving an identified emergency department, no interpreters were used with LEP patients (2). In most instances where no certified medical interpreter is available, bilingual clinical staff or ad hoc interpreters like family members or patients’ friends provide interpretation services. In either of these groups of individuals are not likely to be a trained or certified interpreter (2). With this use of untrained ad hoc interpreters, chances of misinterpretation and therefore, provision of inaccurate medical information involving diagnosis and treatment options to LEP patients are likely to increase. Often times, family members who are used as interpreters have different values, concerns and medical priorities than the patient, which may cause selective interpreting. Using children as interpreters can have even more disastrous results, since most are extremely unlikely to have an expertise on two different languages or medical terminology (2). Deleterious outcomes of ineffectively addressing language barriers include LEP patients having decreased compliance to medications regimens, not receiving the expected level of care, and having reduced opportunities for preventative services. Any of these outcomes can lead to an overall unnecessary increase in hospitalization and/or drug complications for these LEP individuals (2). Florida Case (VC) A specific case to note occurred in Florida when an 18-year-old man collapsed, fell into a coma, and was subsequently unable to convey his medical condition to paramedics. These same paramedics and emergency medical staff, failed to provide both the man’s girlfriend and his mother with an appropriate interpreter. In turn they conveyed to healthcare professionals, that the man had been “intoxicado”—Spanish for nauseated; however, those professionals misunderstood the word to mean that the man had taken drugs and had become high. He was subsequently treated for a drug overdose over the next thirty-six hours. The patient showed no signs of recovery so healthcare staff performed a neurological examination, but after the initial misdiagnosis excessive damage was done: the 18-year old was left a quadriplegic after enduring a severe subdural hematoma (3). Responsibilities of Medical Interpreters Today (AW) In order to fully understand the gravity of the situation and the concern that revolves around the quality of current medical interpreters, it is important to understand the full responsibility of this profession and the services they provide in the healthcare field. Currently there are two different types of interpreters: telephone interpreters and on-site interpreters. Both services are offered at a fee in many hospitals and are expected to provide high quality interpretation; however both differ in their effectiveness in enhancing patient-physician relationships. The primary role of medical interpreters is to support and strengthen the relationship between the patients and their assigned healthcare providers (4). This includes being the patient advocate and actively supporting change in patient health with clear rationale, being message clarifiers who facilitate communication between patient and provider, and being a message converter who follows standard health care practices along with upholding laws, regulations and policies. In conjunction, interpreters must provide some clarification about cultural norms, conveying such discrepancies to healthcare professionals in order to assure effective treatment (4). Charged with the responsibility of being the liaison between patient and healthcare provider, medical interpreters are trusted with vast amounts of personal information and the duty of providing a professional and unbiased line of communication to improve the patient’s overall wellbeing. Language Rights in Healthcare (VC) According to Title VI of the Civil Rights Act proposed in 1964, no individual can be excluded from participating and/or benefitting from programs that receive federal financial assistance including health care (5). Furthermore the Supreme Court has rules that discrimination based upon language spoken is tantamount to discrimination based on nation of origin. Later, in the 1980s the Department of Health and Human Services issued requirements targeting health care providers specifically, completely banning discrimination in health service programs. (5). There are many factors that influence which languages should be offered to persons with Limited English Proficiency (LEP), including but not limited to, the number of LEP persons speaking a particular language and the frequency of contact with each LEP language group in the healthcare system. Furthermore, the more funding an institution receives from the federal government the greater its obligation to provide services to LEP persons. Although legislation has been passed, there are few instances in which health care service providers (specifically larger institutions receiving the most federal funds) have been held accountable for inadequacies in such programs through the consistent failure in enforcement of these laws (5). State Legislation and Their Attempts to Provide Language Access (VC) As of 2006, at least 43 states had issued at least one legislative measure to deal with language access in the health care setting (5). However, it is important to note that half of these states enacted between one and four laws while the other half have enacted ten or more. California continues to be a leader in addressing these language access issues and, as of the same date, had issued over 70 of such legislations. These individual state legislations have proven beneficial to language access for people with LEP, yet they have also created an environment wherein different inadequacies have arisen from state to state (5). For instance, these legislative measures depend greatly upon the underlying political climate in each state, and which languages persons with LEP statewide speak (despite there being different needs between counties in the same state). These measures might attempt to address problems arising from such language barriers but results vary greatly between institutions (within the same state). Most legislation deals with health care rights involving informed consent, patient education, or notification. Most of these attempts only concern themselves with
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