Medical Interpretation Resource Guide

Risk Management

Why is it important to have trained interpreters?
Health care organizations that want to provide quality care to patients regardless of their ability to speak English must assure that there is a model of interpretation available, whether it be face to face, telephonic, or another mode of delivery. Trained interpreters convey information between the provider and the patient. Not only is the trained interpreter proficient in English and the target language(s), but s/he has been educated about the role of the interpreter, and the constraints of that role. "Only people adept at representing common health complaints in a clinical setting should be allowed to do this work. The subtleties of interpretation can be lost by the less skilled interpreters and the patient can easily be misrepresented and then misdiagnosed." (Medical Interpretation : An Essential Clinical Service for Non-English -speaking immigrants, Chapter 4 Handbook of Immigrant Health, edited by Loue. Plenum Press, New York, 1998.) "Untrained interpreter, staff and family members have omitted material, and added, summarized and substituted information. In many cases they are unfamiliar with the health care system and medical terminology." (Baker et al "Use and effectiveness of interpreters in an emergency department." JAMA, March 1996)

How do I assure proficiency and competency?
The Henry J. Kaiser Family Foundation issued a report in January 1998 entitled "Ensuring Linguistic Access in Health Care Settings: Legal Rights and Responsibilities." This report concludes: "The use of trained and qualified interpreters can best help medical providers comply with professional standards of medical care, ensure the accuracy of their work and better protect themselves from medical malpractice claims." The National Council on Interpreting in Health Care (NCIHC)issued a publication in July 2004 entitled "A National Code of Ethics for Interpreters in Health Care." This paper explains that the NCIHC has "identified 3 steps that needed to take place on a national level in order to standardize the expectations that the health care industry and patients should have of interpreters and to raise the quality of health care interpreting." The steps include 1) developing a single code of ethics, 2) developing a unified set of standards of practice defining competency in interpreting, and 3) creating a national certification process. The code of ethics is one of the curricular elements included in NH's medical interpretation training curriculum. In addition, NCIHC recommends that the professional development of medical interpreters be based on content and case scenarios. Not only will interpreters learn more about medical terminology of different health topics, they will participate in case discussions of proper interpretation and how to deal with ethical dilemmas. While the national certification process is being developed, in the short run, we can assure that the organizations and individuals providing interpretation services are screened for language proficiency, demonstrate understanding of the role of an interpreter, and have the skills to accurately communicate between patients and providers. Oral and written assessments and role play scenarios in the interview process can help in determining competency.

Why can't I rely on family members or children?
Having family, friends, or children interpret is discouraged by the Office of Civil Rights. The need for accurate interpretation, without input of their own opinions is difficult for an untrained interpreter to understand. Also, there have been cases of family members withholding information that does not fit with their own value system. Patients also withhold information related to their conditions to obtain some measure of privacy from their friends and family members. Children should NEVER be used as interpreters as it disrupts the power dynamic of the family and the information is often beyond their understanding.

What kind of insurance do interpreters have?
Liability insurance for medical interpreters is an evolving area. Many language interpretation organizations are able to obtain professional liability insurance for their staff interpreters. Interpreters hired by health care organizations are also covered under the organization's policy provided that it fits within the scope of service of the policy. The challenging area is liability coverage for free lance interpreters. At this time there are few insurance companies that provide insurance coverage for foreign language medical interpreters.

How do I manage risk related to the provision of interpretation services at my facility?
Many agencies choose to hire interpreters from a language bank or other organization which has its own liability coverage. Others have determined that all interpreters are to be hired as hourly or per diem employees to assure coverage under the organization's liability policies. However, some organizations do not want the burden of assuring compliance with JCAHO and other regulations for many per diem employees. Also some interpreters choose to maintain their independence for flexibility and tax purposes. Organizations need to evaluate what is best for their institution and consider the legal risk for not providing trained interpreters.

Resources

• What a Difference An Interpreter Can Make: Health Care Experiences of Uninsured with Limited English Proficiency Access Project, www.accessproject.org
• American Translators Association, www.atanet.org
• National Association of Community Health Centers, Human Resources Series Information Bulletin #2, Classifying Workers as Employees or Contractors, March 2004, www.nachc.org
• Ensuring Linguistic Access in Health Care Settings: Legal Rights & Responsibilities, Perkins J. Youdelman, M. Wang. D. August, 2003, www.healthlaw.org/pubs/2003.linguisticaccess.html
• Providers Guide to Quality & Culture, http://erc.msh.org (Patient Provider Interaction - Working With an Interpreter)
• Errors in Medical Interpretation & Their Potential Clinical Consequences in Pediatric Encounters. Flores, G et al. Pediatrics, Vol. III, Jan 2003