Speaking the Language of Care
by Jody Joiner
Language barriers are a painful reality for healthcare providers and their patients. A widely reported incident of a teenage boy in Florida who complained that he was “intoxicado” resulted in tragedy. The boy meant that he was “nauseous” but the term was interpreted by a paramedic as “high on drugs.”
After initially treating him for a drug overdose, doctors realized he was suffering from a brain aneurysm that left him a quadriplegic.
To meet the healthcare needs of an increasingly diverse patient population, healthcare providers are focusing on the need for “culturally and linguistically appropriate care.” When healthcare providers are able to communicate effectively with their patients and recognize cultural differences that may affect patient care, the result is fewer unnecessary diagnostic tests, fewer medical errors, less frequent use of emergency care, more effective use of primary care, and better follow-up care. As in the case of the Florida boy, the risks of not being able to communicate effectively can be tragic.
In a 2006 survey by the Health Research and Educational Trust (HRET), 63% of hospitals reported treating patients with limited English proficiency either daily or weekly. In 2005, the combined number of interpreting requests or encounters from two Kansas City public hospitals exceeded 60,000.
The Civil Rights Act’s protections against discrimination based on race, color and national origin have been interpreted to require healthcare providers to offer language assistance services to individuals with limited English proficiency. Because language is an indicator of national origin, failure to provide language assistance could be deemed discrimination. Federal guidance interpreting Civil Rights Act protections emphasizes culturally as well as linguistically appropriate care.
Because the cost of language assistance services often exceeds the reimbursement healthcare providers receive for the medical care provided, some providers actually pay to treat a patient.
To help hospitals meet their obligations to provide language assistance services, the Missouri Hospital Association created a web site (HealthTranslations.com) as part of a proactive effort to make resources available to hospitals and other healthcare providers. The site provides translated documents such as consent forms and public health literature, lists of interpretation and translation service providers and other resources. In addition to the financial burden, it is often difficult to find a qualified interpreter. There is no nationally recognized certification for interpreters. Although the National Council on Interpreting in Health Care (NCIHC) recently published national standards for interpreters, they are merely voluntary standards and are not tied to certification or licensure.
Ideally, healthcare providers would always use professional healthcare interpreters. In many instances, however, they must use bilingual employees, community volunteers, or family and friends of patients. Although a bilingual nurse could be an effective interpreter, a bilingual employee in the housekeeping department of a hospital would likely lack the necessary skills to effectively interpret in a medical setting. Using family or friends as interpreters also has its disadvantages. For example, due to a lack of emotional and intellectual maturity, a minor child may have difficulty interpreting for a parent, particularly when the physician is communicating that the parent has a serious illness.
Organizations such as the Missouri Hospital Association and the NCIHC are valuable resources as healthcare providers seek to provide quality care to an increasingly diverse patient population. To ensure compliance with laws relating to language assistance and appropriately manage risk, it is important to consult an attorney familiar with this area of law so that cases like the Florida teenager do not occur in the Midwest.
Jody Joiner is with Polsinelli, Shalton, Flanigan, Suelthaus.
P | 816.360.4182
E | jjoiner@polsinelli.com