Erlanger Health System Language Services Program. A Presentation by Erlanger s Diversity Department

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Beverly O’Connor’
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1 Erlanger Health System Language Services Program A Presentation by Erlanger s Diversity Department

2 Interpreting Services at Erlanger There are on site Spanish interpreters Monday through Friday, 7:00am - 6:00pm. Dial ext for the on site Spanish interpreters For deaf and hard of hearing patients, in person ASL interpreters are available with advanced notice by calling Health Link At 778-LINK (5465), and the Video Remote Interpreter (VRI) is available 24/7. For languages other than Spanish, we have the language phones (the black dual handset or cordless phones), and the VRI. The language phones support over 200 languages.

3 When to Call an Interpreter Per title VI of the Civil Rights Act of 1964 all federally assisted programs must provide reasonable accommodations for participants with limited English proficiency (LEP). This means any provider who receives federal funds by law must provide competent interpreters at no cost to their patients who have limited English Proficiency.

4 When to Call an Interpreter Anytime a PT has limited English proficiency (LEP). If a PT speaks some English, but is not fully fluent, this is limited proficiency and an interpreter must be called. Many times a PT will speak enough English to communicate in many situations outside of the hospital, but will lack the vocabulary and skills necessary to communicate in a medical setting.

5 Examples of LEP Example #1: PT speaks enough English to give address and work information to nurse, but is unable to effectively discuss medication instructions, treatment options, diagnoses, etc. Example #2: PT speaks enough English to understand that they are going to have surgery, but does not understand what a gallbladder removal means.

6 Family Members Even if a family member or friend that speaks fluent English is present, an interpreter must be called. By law, family and friends cannot be used to interpret. A competent interpreter must be used.

7 Family Members Family members may not be proficient enough in English to interpret accurately. Even if they are fluent in English, family members may not interpret everything that is said. Family members should not have to interpret while also being there emotionally for their loved one. Interpreting is not their job. It can be traumatic for children and teenagers to interpret for their loved ones.

8 Family Members Providers must also remember that many times victims of human trafficking will be accompanied by a friend or family member who offers to interpret for the victim. This is done with the purpose of hiding the abuse. You can help victims of human trafficking by calling a qualified interpreter.

9 Scenarios Example #1: A child interprets during an abuse investigation case for the parent that is abusing them. Example #2: To avoid scaring their aunt, a family member does not interpret when the doctor says that her aunt has a malignant tumor. Example #3: A family member does not tell the doctor everything that the patient has said, so the doctor never finds out that the patient is allergic to codeine. Example #4: A victim of human trafficking is accompanied by a male friend who interprets for her and thus hides all signs of abuse from the provider.

10 Consequences Serious mistakes have been made in the past due to miscommunications that resulted from a trained interpreter not being used to communicate with an LEP patient. Misdiagnoses, medication and surgical errors, and unnecessary tests occur frequently when interpreters are not called. Doctors and other medical staff are liable for mistakes made due to language related miscommunications.

11 Consequences: Case Study In 1980, a teenage boy was brought to the ER in a comatose state. No interpreter was called, so a family member who spoke some English was used to communicate. She told the ER doctor that Willie was intoxicated, and so the doctors treated Willie as though he had overdosed on drugs. He was actually suffering from a brain bleed, and spent the next two days in a hospital bed with the bleed untreated, which left him quadriplegic.

12 Consequences: Case Study His family member was trying to say that Willie was poisoned, which is intoxicado in Spanish. She did not speak English well enough to know that intoxicated meant under the influence, and assumed it to mean the same in English as it did in Spanish. It was later determined that had a neurology consult been called earlier, surgery could have been performed to treat the bleed. The mistake could have been avoided had a trained interpreter been called. The hospital was sued, and the law suit resulted in a 71 million dollar settlement over Willie s lifetime.

13 Conclusion The doctors should have called a competent clinical interpreter to speak with the family.

14 Providers If a doctor, nurse, tech or other provider is fluent in their patient s native language, they may speak with their patient without an interpreter. However, they may not act as an interpreter for another provider s patient, unless they have received training as an interpreter.

15 Providers Examples Example #1: A native Spanish speaking doctor explains the outcome of a surgery to her patient. This is perfectly fine. Example #2: A native Spanish speaking doctor is called to interpret for another doctor. An interpreter should be called instead.

16 Trained Interpreters A trained clinical interpreter will have knowledge of medical terminology in both languages, as well as training in interpreter ethics and standards of practice. A trained interpreter will interpret everything that is said by the patient and the provider, without adding, omitting, or substituting. Trained interpreters have a much higher level of accuracy (less errors) when interpreting than ad hoc interpreters (i.e. Family member and staff).

17 How to Work with an Interpreter Speak directly to the patient as though they spoke English. Example #1: say I m going to give you a shot and not Tell her I m going to give her a shot Speak clearly and pause every 2-3 sentences to allow the interpreter to interpret. Try to avoid idioms. Although some do, many do not have equivalents in other languages. Example #2: say good luck instead of break a leg

18 If an Interpreter is not Available If you page for an in person interpreter and none are currently available, use your department s language phone until the on site interpreter arrives.

19 A Note on Mayan Languages In Chattanooga there is a large population of Guatemalan immigrants. Many people from Guatemala speak a Mayan language as their native language, and may or may not speak Spanish proficiently. If phone interpretation is unsuccessful in Spanish, and the patient is Guatemalan, it is likely that they speak a Mayan language. Although there are no on site interpreters at the hospital that speak a Mayan language, interpreters are available on the phones for the 4 most common Mayan Languages: Mam, K iche, Q anjob al, and Akateko. The in person Spanish interpreters here at Erlanger can assist you with figuring out which one of these 4 the patient speaks.

20 A Spanish speaking patient shows up at the ER and speaks a little bit of English. They also have a friend with them who is fluent in both languages. What do you do? A. Try and use the Spanish that you know & the English the patient knows to get by B. Use the friend to interpret since it will be faster for the patient C. Call #4025 for a hospital interpreter D. Use the language phones E. Both C & D 0% 0% 0% 0% 0% A. B. C. D. E.

21 What do you do if you find out that your patient is Deaf? A. See if the PT has a friend or family member that can interpret B. Call health link at for an ASL interpreter C. Communicate with the PT using notes and drawings D. Assume that PT can read lips, and begin speaking to them 0% 0% 0% 0% A. B. C. D.

22 What do you do if you have a patient with limited English proficiency that speaks a language other than Spanish? For example Vietnamese or Swahili. A. Use one of the many translation/interpreting apps available on your smartphone B. Try to find an English speaking friend or family member that can interpret C. Contact a friend of yours at the hospital who you know speaks that language D. Use the department s language phones to get an interpreter for the PT s language 0% 0% 0% 0% A. B. C. D.

23 What do you do if you need a Spanish interpreter before 7am, after 6pm, or on the weekend? A. Use the department s language phones or VRI to get a Spanish interpreter. B. See if the PT has a friend or family member available to interpret. C. Use the Spanish that you know, combined with a translation app on your phone, to communicate with the PT. D. Contact a staff member that speaks Spanish to have them interpret for you. 0% 0% 0% 0% A. B. C. D.

24 Remember Providing an interpreter (either in person, or with the phone or VRI) for LEP patients is required by law. Difficulty communicating means that the patient is LEP, and interpreting services must be offered. Family members cannot interpret. Providers may only speak to their LEP patient if they are fluent in the patient s language. Providers cannot interpret for another provider s LEP patient unless they have received training as an interpreter. Language phones and VRI available 24/7 and should be used if the on site interpreter is occupied.

LEGAL IMPLICATIONS OF LANGUAGE SERVICES. Liz Swan, RN, BSN, MBA, CPHRM Marisa Hernandez, BA

LEGAL IMPLICATIONS OF LANGUAGE SERVICES Liz Swan, RN, BSN, MBA, CPHRM Marisa Hernandez, BA OBJECTIVES Title VI of the Civil Rights Act of 1964 ADA requirements for language services The Joint Commission