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Diane Sussman In an effort to serve an increasingly polyglot nation, healthcare providers in need of an instant interpreter often find themselves turning to the nearest bilingual nurse, aide, or therapist. Often, however, these convenient recruits are pressed into service without consideration for their workload, level of expertise, or willingness to take on the job. “Once I had to pull the maid off the floor to interpret for a patient who couldn’t speak English and couldn’t read Spanish,” said Judy Kirtley, RN, president of the Austin chapter of the American Association of Legal Nurse Consultants. “I still don’t know what they said to each other.” Everyone in the United States—regardless of national origin—is guaranteed equal access to any healthcare institution supported by federal funds, thanks to the Civil Rights Act of 1964. Because nearly every healthcare institution receives federal funding, the act has come to mean having an interpreter on hand to help patients who don’t speak English gain access to appropriate medical care. “The law is very clear: You have to treat everyone the same way,” said Julia Puebla Fortier, director of Resources for Cross Cultural Health Care in Silver Springs, Md. “What you should expect [as a patient] is that the institution should be able to deal with you the minute you walk in the door.” Possible pitfalls Many hospitals view the practice of drafting nurses and aides as a fast and easy way to communicate with patients, but a closer look might give them pause, said Jack Nelson, law professor at Samford University’s Cumberland School of Law in Birmingham, Ala. “It raises questions about potential liability,” he said. Although there have been no lawsuits in this area yet, using informal translators has enough pitfalls to warrant concern, particularly when consent forms and procedures are involved. Ordinarily, in nursing malpractice suits there has to be negligence, and that would be hard to prove with a translation error, Nelson said. “Still, there is a theoretical possibility,” he said. That theoretical possibility has been enough to prompt some healthcare workers to retract their services. “I used to interpret, but not anymore,” Puebla Fortier said. “ I just don’t have a complete understanding of the medical terms in Spanish.” Troubles with translating While lawsuits pose only a theoretical problem, nurses called in to interpret often face real troubles on the job. “I have had several conversations with healthcare workers who have had their names taken off the interpreters’ list because they no longer want the headaches,” said Linda Okahara, community services director of Asian Health Services, a federally funded health clinic in Oakland that provides a language bank of interpreters for area hospitals and clinics. “We have one man, an interpreter, who believes he developed a stutter because he felt like so much of the responsibility of people’s welfare depended on his interpretation.” Sometimes the headaches come in the form of resentment from other staff members who must fill in during their co-workers’ absence. “There’s a real burden placed on bilingual staff who interpret,” Okahara said. “It creates tension among the staff and raises issues of compensation for time spent interpreting. In an effort to be helpful, you put people at risk.” A different kind of problem can arise when co-workers assume that every bilingual healthcare worker is equally proficient in both languages. “A lot of times, you have people who are very skilled in English because they use it all the time, but their other language is only what they use at home, or with their family,” Puebla Fortier said. “Bilingual isn’t always completely bilingual, especially when it comes to medical terms.” Yet, as paradoxical as it sounds, a nurse’s medical knowledge can sometimes contribute to an interpreting error. “The danger with health professionals who aren’t specifically trained as interpreters is that they can overstep the boundary of an interpreter and take on the role of diagnosing or prescribing,” Okahara said. “Interpreting is just that—interpreting.” Setting standards Healthcare institutions need to recognize that interpreters, particularly medical interpreters, need to be specially trained, experts caution. “Interpreting is key to good health care,” Okahara said. “It’s too important to be haphazard.” Advocates are calling on states to come up with stricter standards for certification and to begin offering certification programs. Currently only one state, Washington, certifies medical interpreters, while California is the only state that certifies interpreters working in workers compensation programs. Some experts say hospitals and clinics also need to head off the possible legal threat hanging over staff who pitch in to interpret when asked. “If you’re going to use bilingual nurses, the best way to handle it is upfront, with a policy,” Nelson said. “Institutions should indemnify their staff so they feel protected.” |
