Drive for skilled translators in hospitals increases
Drive for skilled translators in hospitals increases
NY the latest to legislate interpreters
New York has become the latest state to enact a law requiring hospitals to provide language assistance, or translators, to patients with limited English proficiency — specifically, translators who are not family members, friends, or hospital staff unskilled in translating.
Health care providers often turn to family and friends of patients to translate the patient's history and presenting complaint, as well as to relay the physician's orders to the patient in the patient's native tongue. Advocates of requiring skilled interpreters say relying on friends or family can interfere with medical care by placing those people in the position of sharing upsetting news or learning information that the patient does not want disclosed. In reverse, a patient may hesitate to disclose troubling symptoms or injuries (from domestic violence, for example) if the translator is his or her child.
Relying on a family member to translate can result in instructions and information from the medical provider being garbled — a potentially dangerous complication.
Depending on possibly unreliable translations interferes in the flow of information and violates patient confidentiality laws, according to Adam Gurvitch, director of health advocacy at the New York Immigration Coalition. The coalition was a driving force behind enactment of the new regulations, which took effect in September.
Gurvitch says while the new law requires hospitals use skilled translators, there are no standards at the state or federal level that define what a "skilled" medical interpreter is. Hospitals in New York will, for the most part, rely on volunteer translators, fluent bilingual staff, and telephonic translation, he adds.
In addition to requiring all private and public hospitals in New York to provide skilled interpreters, the new statute mandates that hospitals translate important forms into commonly used languages and ensure that patients awaiting care do not face excessive delays because of language issues.
The regulations were spurred by civil rights complaints filed with the state attorney general against four New York hospitals in 2005, after communication barriers directly led to serious medical harm in a number of cases. Calls for voluntary improvements in language assistance at the state's hospitals were not successful, leading to the introduction of a state law addressing the issue.
Unskilled translators risky
A 2003 study examined transcripts of 13 taped encounters between pediatricians and patients of limited proficiency in English. Six of the encounters involved professional hospital interpreters, and seven included "ad hoc" interpreters, who included nurses, social workers, and in one case, an 11-year-old relative of the patient.
In the 13 encounters, a total of 396 errors of interpretation were detected, the most common being errors of omission. False fluency, substitution of a less-accurate word, editorialization, and addition of extra words were also detected. The researchers concluded that 63% of the errors carried the possibility of leading to errors of clinical consequence.
Some examples detected in the study included omission of instruction on dose and frequency of therapies, telling a parent not to answer questions, and instructing a parent to apply an oral antibiotic to the ears of a child with otitis media.
The authors of the study found that the errors made by the ad hoc translators were more significant than those made by hospital interpreters.1
Gurvitch says regulations such as those enacted in New York "make it clear what hospitals need to do to avoid costly misdiagnosis and medical harm. Patients will see the difference in improved care."
Such legislation removes an unnecessary burden placed on non-English-speaking patients — having to find their own interpreters — advocates say.
"From now on, hospitals have to identify the language spoken by patients and provide appropriate help in languages that patients can understand," says Theo Oshiro, a health care advocate with Make the Road by Walking, a nonprofit group in Brooklyn, NY, "People are not supposed to pull their children out of school and friends away from work in order to communicate at the hospital."
Cost offset by reduction in risk
While hospitals note that requiring medical interpreters costs money, some studies — such as 2002's Access Project, (www.accessproject.org) — demonstrate that patients who have a bad experience with a provider are more likely never to return to that hospital. According to the Access Project, nearly one-third of patients studied who were not provided with needed interpretation services indicated they would not return to that hospital. Less than 10% of those who were provided interpreters said they would not come back to that hospital.
New York is one of 43 states that have at least one law addressing language access in hospitals and other health care facilities. A few of the states' laws tell hospitals exactly what to do, in terms of providing language assistance, while other states acknowledge the difficulties posed by language but do not specify what kind of services should be provided.
Some hospitals have relied on bilingual employees, but critics say using hospital employees to act as interpreters raises questions about patient privacy and confidentiality, and because the employees are not always medically fluent (for example, housekeeping staff or business office personnel), their translations could contain inaccuracies.
Health care interpreters are trained in how to accurately and reliably translate information to and from the patient and how to maneuver through cultural differences and ethical complexities that may accompany the case.
Reference
- Flores G, Laws MB, Mayo SJ, et al. Errors in medical interpretation and their potential clinical consequences in pediatric encounters. Pediatrics 2003; 111:1,495-1,497.
Resource
Adam Gurvitch, director, health advocacy, New York Immigration Coalition, 137-139 West 25th Street, 12th Floor, New York, NY 10001. Phone (212) 627-2227. On the Web: www.thenyic.org.
New York has become the latest state to enact a law requiring hospitals to provide language assistance, or translators, to patients with limited English proficiency specifically, translators who are not family members, friends, or hospital staff unskilled in translating.Subscribe Now for Access
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