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Lost In Translation: The Need for Interpreter Certification

Cheryl Clark, for HealthLeaders Media, October 14, 2009

"Whether they simply fear a difficult medical encounter due to language issues, or whether they are receiving substandard care due to miscommunication and delays caused by language gaps, the end result is the same: language barriers are clearly resulting in the unequal delivery of medical care, and in physical harm," according to the 2005 report.

In fact, Provenzano wrote, "The argument in favor of . . . coverage for language interpretation is very similar to the argument for coverage of preventive care, something that insurance companies are beginning to actively promote and embrace."

Yes, Language Line Services, which has 8,000 medical interpreters, wants to market its business. But I spoke with Martin Conroy, the company's senior manager, and he makes some excellent points about the true need for such a national certification standard.

Today, health providers, including physician practices, clinics, and hospitals, often rely on the patient's family members or on untrained members of the staff to provide interpretative services, Conroy says. Each hospital has different ways of handling the issue, each physician practice and each clinic. Some are formal and include contracts with translation services by phone or on site while some are far more haphazard, he says.

Among the many large companies similar to his that offer translation services for medical settings, there are usually established criteria that employees are required to meet. But among the many companies, the criteria can have wide variation, he says.

The only state with a true certification process for medical translators is Washington, which has it for eight languages, Conroy says. "All states have some regulation and oversight, but they use terms like 'competent' or 'quality' that are not very well defined. What we're trying to reach to is have a certification, have a national credential that would apply to all."

Without a national testing or certification process, he says, "there's no way to assure that a person who has worked for three years in Nevada and then goes to California will have the same level of skills."

He gave some examples of how healthcare can go terribly wrong when provider and patient can't understand each other:

  • A doctor told a Spanish speaking patient he should take the medication "once" a day, and then wrote down "once a day." But in Spanish, the English word "once" sounds like the Spanish word for number 11. So the patient took the medication 11 times a day.
  • After a child rode her bike into a wall and ended up in the emergency room, the parent tried to explain what happened. But a misunderstanding led hospital personnel to call social services and investigate the parent for child abuse. The emergency staff thought the mother said she had hit the girl.
  • A Spanish-speaking patient told paramedics he was "intoxicado," which was interpreted as being high on drugs. What the patient meant was that he was sick to his stomach from food poisoning. As a result, his care was delayed and he is now a quadriplegic. The mistake resulted in a $71 million malpractice settlement.

There's another reason to have a national certification program. By federal law, health providers who accept federal reimbursement must offer language interpretation services for their patients. But federal funding to pay for such services is partial and spotty.

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