Harold F. Schiffman haroldfs at
Tue Jan 9 13:08:15 UTC 2007

City Limits WEEKLY Week of: January 8, 2007 Number: 569


New rules require hospital interpretation services for non-English
speakers, but dont specify what makes a qualified interpreter. > By
I-Ching Ng

When patients walk into the lobby of Elmhurst Hospital Center in Queens,
they are greeted in Spanish, Chinese, Korean or Hindi by staff in
teal-green uniforms. These language assistants wearing rainbow-colored
badges are there to assist immigrant patients who cannot communicate well
in English. The specialists hand patients a pocket-sized language
identification card and ask them to point to one of the ten languages
printed on it, so that they can be directed right away to hospital staff
or medical interpreters who speak their language. In the hospital
corridors and elevators, posters listing patients rights in 16 languages
are prominently displayed. These multi-lingual efforts come courtesy of
New York state regulations that went into effect in September, requiring
hospitals to provide interpretation services for patients with limited
English proficiency (LEP). The new regulations provide some obvious
benefits for patients, but they come with challenges for hospitals and the
interpreters themselves.  Hospitals are struggling not only to cover the
hefty price tag of medical interpretation services in the most diverse
communities, up to $1 million a year but simply to determine what makes a
qualified interpreter. At present there is no definition, either for
language proficiency or medical knowledge. (See Universal Translator, City
Limits Weekly #536, May 22, 2006.)

To serve non-English speakers, hospitals often use a mix of live,
telephonic and video interpreters, freelancers, trained bilingual staff
and volunteers. The increased demand has led to a boom in training
programs for new interpreters. But the programs vary widely, and no
standardized assessments are in place, leading some experts to worry that
the new law could unleash interpreters ill-equipped for the job. Patricia
Moreno, a Spanish interpreter for major city hospitals, said that to
ensure quality, training schools need to implement a standard policy to
screen students for language proficiency before enrolling them. Moreno is
also an instructor in the Medical Interpreting Certificate program at the
NYU School of Continuing and Professional Studies, which provides the most
comprehensive training available in the city. The program is 160 hours
long and includes an internship at a city hospital.  Hunter College has a
course called Interpretation in Medical/Clinical Settings, offering
40-hour courses in Spanish and French, while Queens College offers
100-hour classes in Spanish, Russian, Chinese and Korean.  Each curriculum
is different, and the certificates do not equate to each other.

Demand for training continues to grow as the new regulations increase
public awareness of the importance of quality medical interpretation.
Enrollment for NYUs program doubled last year, with 18 Spanish-speaking
and six Russian-speaking students currently learning interpretation
skills. To meet the growing demand and save the cost of hiring freelance
interpreters, many hospitals have also started their own in-house training
programs. Commonly known as language banks, hospitals such as New York
Hospital Queens in Flushing offer 40 to 80 hours of medical interpretation
training to bilingual hospital staff identified by their human resources
departments. To increase the pool of linguists, many hospitals also use
volunteer interpreters or bring in outside trainers.

Meanwhile, New York Downtown Hospital provides a six-week, 240-hour
in-house training program in Chinese and Spanish. All expenses are covered
by the 1199 SEIU local. The state Department of Health regulations dont
outline what makes a certified or experienced medical interpreter its up
to each hospital to decide. And since there is no national certification,
healthcare institutions are responsible to assess the skills of the
medical interpreters they hire or contract with, said Sandhya Parathath,
associate director for health care quality and clinical services at the
NYC Health & Hospitals Corporation (HHC).

HHC does require any bilingual staff interested in attending the medical
interpretation training program to take the pre-screening test to check
their proficiency in English and the foreign language. The screening tests
are given in-house by screening tools or by outside vendors, Parathath
said. Before the rules took effect this fall, it was customary that ad-hoc
interpreters would enter the hospital wards, sometimes getting involved in
dramatic scenarios. They could be children accompanying their sick
parents, or relatives and acquaintances who could communicate in English
but didnt have the adequate medical knowledge to comprehend the complexity
of an operation or understand medical jargon. Miscommunications and
medical errors occurred, some resulting in costly lawsuits.

The New York Immigration Coalition was a major advocate for the new state
requirements. Adam Gurvitch, director of health advocacy there, says the
coalition sees progress being made, both in increased access to
interpretation services and in slowly moving toward the establishment of
state and national standards. Weve felt its appropriate to give the
hospital industry a bit of time to staff up and get trained ... to put the
appropriate systems in place to make this really work, Gurvitch said. But
as time goes by, our patience will diminish. If people are still pulling
their kids out of school, or their family out of work, because they cant
communicate, then clearly the system is not working.

John Tsoi, director of patient advocacy of New York Downtown Hospital,
said his hospital deals with the lack of certification by putting all
medical interpreters on three-month probation, and they are regularly
tested on the job to make sure they are competent with medical terminology
and their customer service skills are up to the standard. Monthly review
meetings are also held to discuss ways to improve their techniques. During
the current transitional period, Tsoi said providing more training to
interpreters would be a better way to solve the problem. If we rush to
come up with a standard certification now and set the bar too high, we
wont have enough medical interpreters to do the job. We have to do it a
step at a time, he said.

Reaching consensus on a standardized certification process seems to many
to be a long, uphill battle. Each language has specific cultural and
linguistic issues we need to address, so we pretty much have to set a new
standard for each language, and that will take a long time to complete,
said Bruce Merley, regional manager of Pacific Interpreters, a nationwide
telephonic agency which serves 16 major NYC hospitals and clinics,
including Mount Sinai and Memorial Sloan Kettering Cancer Center. Right
now only Washington State has a certification process and each state has
different guidelines, Merley said. Apart from issues about whos qualified
for the job, those presently doing the work also are concerned about other
side effects of the new state rules. Few full-time positions have been
created since the new law took effect, and some hospital staff complain
about the extra workload as they have to fulfill their work duties and
handle interpretation assignments.  Many experienced interpreters also
worry that new entrants into the field will drive wages down.

An experienced freelance medical interpreter could earn between $35 to $40
an hour, while a student who finished a certificate program would start at
about $15 an hour, said NYUs Moreno. Existing interpreters expected more
job opportunities would become available, but instead many feel their
livelihood is threatened as more hospitals opt for more convenient
telephonic interpretation service.  Nonetheless, some hospital
administrators argue that on-site interpreters provide indispensable

Its better when interpreters can pick up the visual cues. We have to make
sure the quality of interpretation is guaranteed, said Tsoi of New York
Downtown Hospital. For instance, the phrase heartburn could not be
translated literally as a burn in the heart in Chinese if a doctor sees
the interpreter pointing to the stomach instead of the heart [for acid
reflux], he can prevent medical error from occurring right there, and make
sure the interpreter is doing a proper job. Otherwise the patient would be
mistakenly sent to the cardiac ward, he said.

Almost half of the hospitals patients are Chinese-speaking. Therefore, it
hires a team of four full-time, on-staff Chinese interpreters to provide
24/7 coverage. Elderly people especially need the human touch - a smile or
a pat can make them feel secure and help them navigate the complicated
medical system, said Linda Tsui, one of the Chinese interpreters. Besides,
she said elderly people are often hard of hearing and she had to speak
into their ears. I dont think any interpreters yelling on the phone could
do the job, she said.

- I-Ching Ng


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