“Excuse me, speaking as the interpreter, could you please move the phone closer to the patient? The interpreter is struggling to hear everybody.”
That was me, a week ago, attempting to provide telephonic medical interpreting services. The nurse complied, and the quality of the call improved…a little. That is, except for the fact that I was still lacking all visual reference cues and there were four people in the room, only one of whom spoke only Spanish. I could not switch into simultaneous to interpret when the nurse spoke to the LEP’s children in English, and I couldn’t actually hear the children very well at all. These were not, I would say, ideal circumstances for a telephonically interpreted encounter. But why was this appointment taking place over the phone at all?
The field of medical interpreting is not very old. Just a short time ago, very few standards existed at all for medical interpreters, and it was fairly common for family members or bilingual staff with little-to-no training to provide crucial life-and-death interpretations. This has resulted in more than one tragic mishap, such in as the case of Willie Ramirez.
These days, things are looking up. Medical interpreting has the trappings of a profession. We have standards, national organizations, conferences, trainings and certifications. More importantly, there are laws in place that require competent interpreting services to be made available at no cost to those who need them. But what defines “competent,” and who pays for it?
Not just a good idea, it’s the law
Let’s have a little history lesson. Title VI of the Civil Rights Act of 1964 prohibited any publicly-funded institution from discriminating on the grounds of, among other things, national origin. National origin was interpreted to include language. Therefore, any hospital receiving government money was required to provide language access to LEPs.
In 2000, Executive Order 13166 strengthened Title VI, increasing federal oversight to ensure compliance. At the same time, the Culturally and Linguistically Appropriate Services (CLAS Standards) were issued. Their Principal Standard is to:
“Provide effective, equitable, understandable and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy and other communication needs.”
It’s true that standards and oversight have gone up, even since I became a Certified Healthcare Interpreter a decade ago. The medical profession is beginning to understand that professional interpreters are important. But somebody still has to pay for them. And I would venture to say that that is why telephonic hotlines are being used for appointments that would absolutely be better-served by an in-person interpreter. The COVID crisis has only served to exacerbate the problem.
These hotlines pay shockingly little to their interpreters, who are remunerated by the minute. The pay certainly doesn’t encourage well-trained interpreters to work for them. This, in turn, attracts people who are less qualified. But even when the interpreters are competent, the conditions are less than ideal. Meanwhile, the health of LEP people is at stake.
The bottom line is quality of care
There is a time and a place for telephonic interpreting. But sound quality, lack of visual cues and inability to switch modes when necessary (not to mention the surplus of untrained interpreters being paid pennies per minute) are serious problems that need to be addressed. When an in-person interpreter is available for a complex medical appointment, it makes common sense that they should be used, even if they are paid by the hour and I, the long-distance interpreter, am out of a job that one time.
Fifty-seven years have passed since Title IV. Twenty-one years have gone by since the CLAS Standards were issued. Perhaps the time has come for something new.