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New Joint Commission Standard Defines Medical Interpreters

Heather Comak, for HealthLeaders Media, February 24, 2010

One of the most vital parts of providing adequate healthcare is the exchange of information between patient and caregiver. Without clear communication, it can be difficult, and even dangerous, to treat a patient.

For patients who have limited English proficiency (LEP), as well as providers, the presence of a medical interpreter can allay fears about care. Most importantly, using a qualified medical interpreter to assist with communication keeps patients safe.

Until recently, however, there has been no national standard by which to evaluate medical interpreters. Even national requirements on the part of hospital accreditors were lax. In January 2010, however, The Joint Commission released new standards concerning patient-provider communication, that will be implemented no sooner than January 1, 2011. One standard specifically will address qualifications for language interpreters and translators.

Certification opportunities are opening up as well. In October 2009, the National Board of Certification for Medical Interpreters (NBCMI) launched the National Medical Interpreter Certification and hopes to have the first 500 interpreters certified by June. The certification helps define a qualified, proficient medical interpreter.

"The fact that diversity is a national issue, it really does need a national response," says Louis F. Provenzano, Jr., president and chief operating officer of Language Line Services in Monterey, CA. "There hasn't actually been, up until we launched, a single industry-wide standard for training, education, and evaluation of medical interpreters."

Language Line University, along with the International Medical Interpreters Association (IMIA), was a founding board member of the NBCMI.

In addition, the Certification Commission for Healthcare Interpreters (CCHI) will launch its own separate certification for medical interpreters. CCHI expects its first certification exams to be available in the fall. CCHI's process for establishing a certification has been similar to that of the NBCMI.

These certification opportunities for the estimated 15,000 to 17,000 medical interpreters will bring the field up to par with their court interpreter and sign language interpreter counterparts. It will also provide a national standard in the face of many dozens of smaller certificate programs available that do not have one defined level of achievement.

The need for qualified medical interpreters
As the link between an LEP patient and his or her physician, nurse, or other care provider, the medical interpreter has long had a place at the patient's bedside or patient procedure. However, in the past, the interpreter might have been the only person without a credential.

"In healthcare, credentials are very important—not only for professionalization, but for patient safety's sake," says Izabel Arocha, MEd, president of the IMIA. "What we've seen in all these years is that in an operating room, they might be doing a catheterization with all sorts of professionals there that are credentialed according to their specific boards, except for the medical interpreter, who's always been the missing link, the one individual who has been completely unregulated."

There have been a few highly publicized incidents of medical interpretation gone wrong, one being the 1980 case of Willie Ramirez, a Spanish-speaking teenager from southern Florida. Ramirez reported feeling dizzy and having a headache—the result of an intracerebellar hemorrhage—to doctors at an area hospital.

However, because, among other reasons, he and his family insisted he was intoxicado, his original ailment was diagnosed as an intentional drug overdose. The word intoxicado in Spanish, however, can mean feeling dizzy or nauseous. Ramirez became a quadriplegic as the result of the misdiagnosis.

This case is often referred to as one example of the need to have qualified medical interpreters available in the hospital. It is also a federal requirement. Hospitals that accept federal funding are required to comply with Title VI of the Civil Rights Act of 1964, which prohibits discrimination based on race, color, or national origin. This includes providing a translator for those patients who are not proficient in English.

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