Medical Interpreters can be a Health Risk
Directly and Indirectly
When it comes to LEP patients — how much effort and thought does a healthcare institution but into it? Do they think of the patient’s safety beyond the language barrier?
In the US, rapid growth of limited-English-Proficient (LEP) is still a pain point for the healthcare industry and in turn the actual quality of care LEPs are receiving. We all know, that the right to quality care is innate for all US citizens regardless if their native language is other than English. In about 30 years it is expected that the minority groups in the US will be the English speakers!
For a few years now, there is actually a national board that certifies interpreters in healthcare- CMI and CCHI. Overall there are over 80 million Americans that are LEPs- and there are only a few thousand certified medical interpreters! So how do these patients communicate their health concerns today? They have family, friends and bilinguals that speak for them, but are not nationally board certified.
When you go to the hospital or the doctor’s office, you expect that your nurse, your physician, nurse tech, etc. are all Nationally Board Certified to do their job. Though, in order for them to provide you quality and informed care they require that you are able to communicate. They can’t provide accurate treatment if medical history, concerns and symptoms aren’t correctly conveyed. So in essence, communication is KEY.
Still, right now, as you read this — there is someone in a hospital or a doctor’s office that is speaking with a doctor and being spoken to by a non-Nationally Board Certified Interpreter.
What’s wrong with this picture?
Nationally Board Certified Healthcare professionals executing quality care with NON-Nationally Board Certified Interpreters?
Here are a few stories to make this entry’s point. The names of all individuals and healthcare organizations are fictional for the purpose of maintaining their anonymity.
Maria Hernandez (Indirect Risk Example)
Maria is 42 years old that has tremendous lower abdominal pain and needs to go to the ER, because the pain is unbearable. She is a LEP. Her English is good enough for casual conversation and decides to go to the hospital. Dr. Wan is her doctor. As he begins to ask her questions, he realizes that he must bring someone in as an interpreter. He contacts patient services and requests an interpreter. Meanwhile, Maria’s daughter has made it to the hospital. Erica, Maria’s daughter, speaks fluent English and Spanish.
As the doctor returns to examine Maria, he realizes her daughter is present. The interpreter walks in — and stands “professionally” next to the doctor and begins to interpret and the doctor asks Erica to wait outside in interest of Maria’s privacy. Maria doesn’t feel comfortable. She asks the doctor to speak through her daughter. The doctor dismisses the interpreter and, as his patient requested calls Erica back in. He proceeds to ask her questions to asses and determine her prognosis so she can get the care she needs. The doctor began asking questions about Maria’s sexual activity — which Maria quickly said NO to everything and was quite uncomfortable with the doctor asking all this in front of her daughter. She indicated to the physician that she had not had any sexual activity in over 4 years since her husband left her. The doctor begins to run some tests. The general urinalysis conducted on all patients coming into Hospital XYZ, also checks for HCG (pregnancy hormone).
Maria was pregnant, and because she was not allowed the option of privacy or anonymity during her admission, she was not honest with the physician, thus potentially putting herself and her unborn child in harm’s way.
Dr. Gonzales was on call that evening and was approached by Dr. Wan for a consult as he is the on call Obstetrician. He walks into her room with Dr. Wan. Erica says, “My mother would like to know what is going on? Why are we waiting here? She is in pain.” Dr. Gonzales asks Erica to identify herself. “I am her daughter, she didn’t want the in person interpreter to know her business- she is not a medical professional and might tell someone — what if they have common friends? I am speaking for her.” Dr. Gonzales begins to speak in Spanish and asks Erica to step out of the room to offer Maria her prognosis. He advises her that they know she is pregnant and that she should not have lied and that her prognosis is that she has an Ectopic Pregnancy.
Maria responded:
“When the interpreter came in — she looked at me all “nose up”. She is local. She might go to the same church as me or know someone I know. I don’t want her talking about my business.”
Dr. Gonzales assured her that the interpreter has to abide by a specific code of ethics. “No, no. She is not a nurse or doctor that have laws. I cannot prove she said something if she does. When I went to the clinic they had some guy on the phone talking for me — it was nicer — he doesn’t know me — all he knows is my first name. I feel more comfortable. I can’t tell anyone that I have had sex. I am a mother. I have an image to keep.” Dr. Gonzales states “I can’t get you someone on the phone because they are not medically certified.” Maria then said “Well, then get a medically certified interpreter on the phone”.
Moral
The more anonymity you provide for your patients, the more comfortable they will be discussing their personal information and health history.
What happens when you address the patient risk of communication but put them in all sorts of other risks???
Oksana Rominakov (Direct Risk Example)
Oksana has an autoimmune disease. She is very vulnerable to infections. She visits ABC clinic every 90 days to check her white cell count and tweak her treatment plan with her Immunologist if needed. Oksana, speaks English, but doesn’t speak it well enough to discuss her health in detail. Dr. Kitz always has an interpreter for Oksana. Oksana is always uncomfortable with a member of her community in the room with her, but sacrifices her sense of privacy for the sake of her health. Her visit went well and Oksana went home.
A week after her visit, Oksana was rushed to the ER because she was coughing up blood. It was a small cold when it started on Thursday, a bit of coughing. On Friday morning she called her Primary Care Doctor and booked an appointment for Tuesday, since her cough was worse and felt she was getting a fever. She was diagnosed with TB and died a week later due to her compromised immune system. Her whole family was checked and screened. During the time of Oksana’s exposure, which was estimated to be possibly within a three-week time frame, her family was in Russia, visiting relatives while Oksana stayed home to keep an eye on the remodeling of their home. Thus, this would mean that interactions that Oksana had during that time would have contributed to her death. Her husband sought legal remedy and filed a malpractice suit against the clinic and the hospital claiming she must have contracted TB during her hospital visits. By routine all medical staff were checked and came back clear. When the Rominakov family’s attorney looked at the documentation of the investigation conducted by the hospital he realized that there was a few people at the hospital and the clinic that were not tested.
The interpreters.
The attorney contacted the Supply Chain department to track down the interpreters that the hospital used from a local agency. To no great surprise, the interpreters are not tested for immunizations, TB or any other diseases, even if they come in contact with patients. The hospital paid a $15 million dollar settlement outside of court to avoid the negative publicity.
Imagine how many malpractice claims are happening daily that are settled out of court and away from the media?
Moral
National Board Certified Interpreters utilized in Healthcare — if they have interactions with patients MUST be screened like all other hospital staff.
Conclusion
To provide effective, professional and safe communication with LEP’s using interpreters, an institution must:
1. Utilize a service that is telephonic to satisfy the right for anonymity when the need for a third party is present and to ensure that a patient’s health is not at risk.
2. Ensure that the interested on the phone is Nationally Board Certified to avoid issues of quality and effective communication
CMI is doing just that. How can you offer quality healthcare if you can’t offer privacy and safety in your communications?
