Template for article published in Apuntes

InTradES Attends NY State Assembly Hearing on Interpretation and Translation in Hospitals

Representatives of InTradES attended a hearing of the New York State Assembly on interpretation and translation in the state's hospitals, on November 24, 2003. Intrades-Apuntes thought we should be present in order to learn of the current situation concerning language issues in the state and, in particular, in the City of New York. We are also interested in finding ways to provide professional guidance to the hospitals, agencies and community groups currently involved in recruiting and training persons to serve as interpreters.

<> Our attendance vividly confirmed our view that there is a huge vacuum to be filled and enormous problems in this critical area of community services. We believe, therefore, that our community of professional translators and interpreters should be part of the discussions - and the solutions. With this in mind, we collected information and initiated contacts that may allow us to pursue a constructive dialogue.
   The hearing consisted of 47 presentations by individuals and associations representing different interests. These included the NYC Health and Hospitals Corporation (the governing body of all public hospitals in New York City), the Greater NY Hospitals Association (a coalition of non-profit and publicly-sponsored hospitals), and several groups of Limited English Proficiency (LEP) patients who have been victimized by language barriers. NYS Attorney General Eliot Spitzer was the first to testify. He highlighted the importance of providing more specific guidelines to address the increasing need for translation and interpretation services in all areas of healthcare.
   NYS Attorney General Eliot Spitzer was the first to testify. He highlighted the importance of providing more specific guidelines to address the increasing need for translation and interpretation services in all areas of healthcare. Among the steps he suggested was the "training of interpreters," clearly an area open to discussion and guidance.
    Another area requiring guidance from professional translators is the lack of consistency in the documentation handled by hospitals and medical centers. This point was underscored by Karen Scott Collins, MD, MPH, Deputy Chief Medical Officer of the NYC Health and Hospitals Corporation. Key documents such as informed consents, HIPPA notices, patient instructions and patient education suffer from lack of consistency and quality. Concerning interpreter capacity, she noted a lack of consistency in the capabilities of staff interpreters and volunteers and the need to assess basic language/literacy skills and training in medical interpretation. Obviously, none of these skills may be easily acquired by hospital staff who are mainly involved in other functions. However, the recommendations fall short of designating a budget for contracting professional translators and interpreters. There seems to be always a gray, not well-defined area, reserved for the training of staff or volunteers.
     Dr. Collins presented a long list of problems directly related to language barriers in the quality of care, such as fewer physician visits, medical errors, excessive or inappropriate use of resources, reduced compliance with medications, patient self-management, lower satisfaction with care, and sadly, reluctance to seek needed care. On the other hand, when patients presented their perspectives and described their experience and the consequences of such barriers, the human dimension of these problems acquired a more dramatic resonance - from total frustration with procedures that cannot be understood to unnecessary mastectomies and abortions.
      New York City Councilman Adriano Espaillat, appalled at some of the horrific results of these experiences, asked representatives of the patient groups if lawsuits had been brought against medical providers. None was brought, they said, thus showing another dimension of the knowledge vacuum in which most LEP survive in this country.
     The Immigrant Health Access and Advocacy Collaborative stressed the urgency of solving the language problem in hospitals. They regard the situation as "extremely serious, extremely widespread," and stated that "immigrant New Yorkers demand change." Most hospitals, they reported, suggest that patients bring their own interpreters. Rarely, however, are these "volunteers" trained, professional interpreters. "It's not better when an untrained, unskilled staff person or volunteer tries to fill the communication gap," they noted.
      The Collaborative conducted a survey of 108 LEP patients in four major hospitals in Queens. Their preliminary findings are:

21% of respondents did not understand their diagnosis or treatment

14% indicated that they did not understand their prescribed follow-up treatment

9% of respondents had medical decisions made without their consent

75% of respondents who signed hospital forms did not understand what was written on those forms

They also reported that of those who had informal interpreters:

40% indicated that their informal interpreter did not translate information accurately or did not translate everything they said, and

35% indicated they were upset that others learned about their personal information, or were uncomfortable disclosing personal information.<> The Collaborative described the situation as follows: "Many hospitals rely on volunteer language banks, which are generally unreliable. Many of us accompany patients to the hospital in order to make communication possible. There is no compensation for this work. Our community based organizations have tiny resources and staffs compared to the hospitals, and yet we shoulder this burden. We know that it is the hospitals that are responsible for ensuring meaningful communication, but our experience with volunteer language banks is that they are a farce. (…) In some cases, even though the hospital's language access policy appears strong on paper, non-English speaking clients continue to face obstacles to access services. When we hear hospitals say that they are doing all that they can, and that language assistance is an endless, un-funded mandate, we can only assume that hospitals are not aware of how serious the problems really are, or are refusing to make this a priority."

The Collaborative presented seven recommendations, of which we highlight the following:

Recruit, hire and train bilingual staff who reflect the communities they serve.

Hire trained medical interpreters to meet needs that can't be met by staff.

Assess the language ability of all bilingual staff to ensure that they are proficient in both English and the other language(s). Implement a system of providing language services that is not dependent on volunteers to be interpreters.

Volunteer-based programs do not provide reliable and consistent services for LEP patients.

    If hospitals must rely on community-based organizations to translate for LEP patients, hospitals should develop paid-contractual relationships with community-based organizations that have the needed language skills, and provide them the necessary training to serve as interpreters in the medical setting."
    The National Health Law Program (NHLP) has also assessed the impact of language barriers on providers of health care, including potential liability (lack of informed consent, malpractice, negligence), and on their clients, including denial of needed benefits and services, and provision of ineffective or less effective services. Their surveys show that the rate of errors of potential medical consequence was significantly lower for those encounters using a professional interpreter - about 12 percent - as compared to those using an ad hoc interpreter - 22 percent - and those using no interpreter - 20 percent.
     The NHLP proposes an effective linguistic access program based on 5 elements which include the "training of staff" and "notify LEP persons of available language assistance services free of charge and how to obtain such services."
      When it comes to determining what funding is available for providing linguistic access, five major sources are cited: federal agencies, Offices of Refugee Resettlement, State/County Departments of Health/Social Services, Local foundations, and non-profit organizations. In our view, notably absent from this list are hospitals and the insurance companies that should cover linguistic access as a basic benefit.
     The language barrier in our health-care system nationwide has reached critical proportions. The community of professional translators and interpreters should be aware of the issues and be prepared to meet its demands. To this end we invite our members, and other readers who might be interested in pursuing this dialogue, to contact us at info@intrades.org.