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Lines of Communication: Linguistic Competence & Interpreter Services in Healthcare Settings. JOHANNIE RESTO, BSB MANAGER OF INTERPRETER SERVICES VANDERBILT MEDICAL CENTER. Covered Topics Why the Provision of Interpreter Services ? Compliance Requirements Medical Interpreting Overview.
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JOHANNIE RESTO, BSB
MANAGER OF INTERPRETER SERVICES
VANDERBILT MEDICAL CENTER
A LEP individual is a person who is unable to speak, read, write or understand the English language at a level that permits them to interact effectively with health care providers and social service agencies.
Under Title VI of the Civil Rights Act of 1964 the denial or delay of medical care because of language barriers is discrimination.
Any medical facility that receives Medicaid or Medicare must provide language assistance to patients with LEP and take steps to ensurethat persons have meaningful access to the health services that they provide.
“No person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance.”42 U.S.C. Section 2000d
of Healthcare Organizations
The national standards issued by the U.S. Department of Health and Human Services’ (HHS) Office of Minority Health (OMH) respond to the need to ensure that all people entering the health care system receive equitable and effective treatment in a culturally and linguistically appropriate manner.
Language Access Services (Standards 4-7)
Standard 4Health care organizations must offer and provide language assistance services, including bilingual staff and interpreter services, at no cost to each patient with limited English proficiency at all points of contact, in a timely manner during all hours of operation.
Health care organizations must provide to patients/consumers in their preferred language both verbal offers and written notices informing them of their right to receive language assistance services.
Health care organizations must assure the competence of language assistance provided to limited English proficient patients/consumers by interpreters and bilingual staff.
Health care organizations must make available easily understood patient-related materials and post signage in the languages of the commonly encountered groups and/or groups represented in the service area.
Inadequate communication can have tragic consequences
A high profile case in Florida in 1984 were Spanish-speaking 18-year-old had stumbled into his girlfriend’s home, told her he was “intoxicado,” and collapsed.
When the girlfriend and her mother repeated the term, the non-Spanish-speaking paramedics took it to mean “intoxicated”; the intended meaning was “nauseated.”
After more than 36 hours in the hospital being worked up for a drug overdose, the comatose patient was re-evaluated and given a diagnosis of intra-cerebellar hematoma with brain-stem compression and a subdural hematoma secondary to a ruptured artery.
Misinterpretation of a single word led to a patient’s delayed care and preventable quadriplegia.
The hospital ended up paying a $71 million malpractice settlement because of one word that was misinterpreted in the Emergency department, causing permanent damage to the patient.
The New England Journal of Medicine; Language Barriers to Health Care in the US by Glen Flores,MD. Volume355:229-231 July 20, 2006 number 3
(Harsham.P. - A misinterpreted word worth $71 million. Med Econ 1984; June:289-292.)
An untrained bilingual staff, misinterpreted for a nurse practitioner, told the mother of a seven-year-old girl with otitis media to put (oral) amoxicillin “in the ears”.
A Spanish-speaking woman told a resident that her two-year old had “hit herself” when she fell off her tricycle; the resident misinterpreted two words, understood the fracture to have resulted from abuse, and contacted the Dept. of Social Services (DSS). DSS sent a worker who, without an interpreter present had the mother sign over custody of her two children.
Clearly, Catastrophes can and do result from such miscommunication.
Reference- The New England Journal of Medicine; Language Barriers to Health Care in the US by Glen Flores,MD. Volume355:229-231 July 20, 2006 number 3
To render messages orally, from one language into another.
To render written text from one language to another.
Is to facilitate understanding in communication between people who are speaking different languages.
VANDERBILT UNIVERSITY MEDICAL CENTER
15 full-time interpreters (13 Spanish, 2 Arabic)
35 plus temporary interpreters (Spanish, Arabic, Bosnian, Burmese, Chinese, Kurdish, Russian, Somali, Swahili, Farsi, Japanese, Portuguese, Vietnamese, Amharic, Urdu, Harraric)
Interpreters are assessed, trained, follow National Standards for Healthcare interpreters and Code of Ethics
Telephonic Interpreter line 24/7 “OPI” Staff calls 1-877-746-4674 Patient calls 1-866-675-2040 (If pt needs to call VUMC)
After hours (message center) has a list of the VTS temporary interpreters 2-7378
INTERPRETER SERVICES DEPARTMENT
National Council on Interpreting in Health Care (NCIHC) http://www.ncihc.org/
Common cross-cultural communication challengeshttp://www.wwcd.org/action/ampu/crosscult.html#COMMUN
OCR list of “vital” Documents.
Office of Minority Health CLAS standards Final Report http://www.omhrc.gov/assets/pdf/checked/finalreport.pdf
Addressing Language Barriers in Health Care: What’s at Stake, by Robert Wood Johnson Foundation . March 2007
Navigating Language Barriers under difficult circumstances Annals of Internal Medicine- American College of Physicians by Yael Schenker, MC,;Bernard Lo, MD; Katharine M. Ettinger, JD; and Alicia Fernandez, MD
Language Barriers to Health Care in the United States by Glenn Flores, MD.