The United States is more diverse than it has ever been. Rapidly changing demographics create a specific set of challenges for healthcare providers serving Limited English Proficiency (LEP) patients. Interpreters and translators already work with information and conduct confidential conversations on a daily basis. In the medical field, however, a high degree of accuracy in interpretation is paramount for good patient health. Confusion over a single word or phrase could mean the difference between life and death for many LEP patients.
Such was the case with Willie Ramirez, when his family used the Spanish word “intoxicado” while attempting to communicate with Willie’s doctor. Although “intoxicado” sounds similar to the English “intoxicated”, a linguistic idiosyncrasy known as a “false cognate” or “false friend”, it refers to anything ingested that could have made someone sick, not just drugs or alcohol. This false friend caused confusion in the doctor’s office because the family thought that Willie may have eaten something that made him ill, but the doctor heard “intoxicado” and made the diagnosis of a drug overdose.
Later, the medical team realized that bleeding in Willie’s brain had caused his illness but it had gone untreated for so long that Willie became paralyzed. Willie’s case demonstrates the importance of accuracy in medical interpretation between doctor and patient. Additionally, according to Section 1557 of the Affordable Care Act (ACA), language services performed by a qualified medical interpreter are required by law.
Who is “Qualified” as a Medical Interpreter and Who is Not?
It might be instinctual to turn to the closest person who speaks both the patient’s native language and the doctor’s native language for interpretation services. In many medical scenarios, this might be a family member or friend of the patient. However, using family or friends to interpret between doctor and patient raises its own set of concerns.
First, in the instance of a traumatic event, many people will automatically revert to their native tongue. This means that many people may have difficulty communicating in their second language, even if they normally have no trouble doing so. Aside from concerns regarding the accuracy and one’s ability to interpret under pressure, they may undergo significant trauma or stress due to the health complications of their loved one. If the family member or friend is forced to interpret under such circumstances, it will only make the experience more stressful.
Finally, in some instances, the only family member available might be a minor child, which may not be appropriate for the situation. A minor child cannot be expected to interpret accurately, especially when using medical terminology. Also, the doctor’s office might not be an appropriate place for the child. This would be the case if, perhaps, the mother were visiting a gynecologist’s office.
We have determined that friends and family members are not appropriate interpreters, but what about bilingual or multilingual staff members? The keyword to acknowledge in Section 1557 of the Affordable Care Act is QUALIFIED medical interpreter. When using bilingual or multilingual staff members, the staff member must have formal training in medical interpretation.
What is required by law regarding Medical Interpretation?
Section 1557 of the Affordable Care Act is intended to prevent discrimination in healthcare. While this section includes a wide array of non-discrimination policies, we focus on those specifically related to LEP patients and their rights.
The old standard for medical interpreters was defined as “competent”, but the ACA upgraded this term to “qualified”. This change in terminology increased the required standard of care and legal duty of healthcare providers to their LEP patients. The difference between “competent” and “qualified” is that “qualified” implies formal training specific to the healthcare field for the interpreter.
- Family and Friends
- This provision bans the use of minor children as medical interpreters due to the reasons outlined above. Additionally, it bans the use of adult family members and friends. Both of these restrictions have some limited exceptions.
- Bilingual or Multilingual Staff
- This provision restricts the use of bilingual and multilingual staff who do not have formal medical interpreter training. For a staff member to perform as a medical interpreter, they must be orally proficient and understand both spoken English and at least one other spoken language. This includes any necessary specialized vocabulary, terminology, and phraseology in the LEP patient’s primary language.
- Can LEP Patients be Required to Provide their own Interpreter?
- This Section of the ACA specifically states that it is illegal to require an LEP patient to provide their own interpreter. It is also illegal to coerce an LEP patient to decline language services.
What about the Translation of Medical Documents?
Section 1557 of the ACA requires translation of medical documents, as well as the language interpretation services explained above. Whether speaking to an LEP patient or giving out a pamphlet or other written materials, accuracy in translation and interpretation is important for proper care.
We provide HIPAA compliant over-the-phone interpretation (OPI) and video-remote interpretation (VRI) services for healthcare providers across the US. Our OPI and VRI services are available 24/7/365 in over 200 languages so that you can provide the highest quality care to your LEP patients. We also provide accurate medical document translation in any format that you need.
We are happy to find a language services solution that works best for your healthcare practice. Reach out to us at +1.281.607.2505 or our Contact Us Form. Your information is never shared with any third-party vendors.