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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 NYU’s 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 don’t outline what makes a certified or “experienced” medical interpreter – it’s 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 didn’t 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.
“We’ve felt it’s 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 can’t 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 won’t 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 who’s 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 NYU’s 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 services.
“It’s 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 heart instead of the stomach [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 hospital’s 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 don’t think any interpreters yelling on the phone could do the job,” she said.