Interpreting from one language to another is a tricky business. But when it comes to interpreting between a doctor and patient, the stakes could hardly be higher.
Consider the story of 18-year-old baseball player Willie Ramirez.
Oregon certified medical interpreter Helen Eby said Ramirez was taken to a South Florida hospital in a coma. “He wasn’t able to speak for himself,” Eby said. “His family apparently used the word ‘intoxicado’ to talk about this person. Well, ‘intoxicado’ in Spanish just means that you ingested something. It could be food, it could be a drug, it could be anything that has made you sick.”
But, Eby continued, “the interpreter interpreted this as ‘intoxicated’ so the doctor immediately made a diagnosis of drug overdose. They had him in the hospital for two days before they figured out they should call in a neurologist and found that he had a couple of hematomas in his brain. The guy ended up quadriplegic.”
You might think nothing like this could happen in Oregon. Thirteen years ago, Oregon passed a bill requiring the use of certified medical interpreters when treating patients who aren’t proficient in English.
But wages aren’t great and there are fewer than 100 fully-qualified interpreters to cover the whole state.
Isidro Hernandes is 48 and lives in Cornelius. Recently, he was a patient at Hillsboro’s Tuality Hospital. Speaking through an interpreter, who was present in the hospital room, he said he keeps his family fed by working as a landscaper.”One day I was working and I started to feel a little bit that something was wrong with my heart,” he said. “I began to worry a little bit as I was operating some machinery and I didn’t want anything to happen.”
For small talk, Hernandez didn’t seem to need an interpreter. But then his doctor, Angela Alday, started asking more complicated questions: “Do you feel like it’s the IV medicine that helps or it’s the pain medicine that helps?” she wanted to know.
“I feel like IV pain medication is more effective because it takes effect quicker,” Hernandes said, again speaking through the interpreter.
Tuality Hospital has been using a phone service to provide qualified interpreters. But the director of corporate communications, Gerry Ewing, said they’re planning to use more in-person interpreters.
“We’re trying to reflect the demographics of our community, which is changing rapidly,” he said.
“Washington County is around 25 percent Hispanic, so we need to reflect that in the services we provide our patients.”
The interpreter on duty in Hernandes’ hospital room is Armando Jimenez.
The hospital paid for him to go through the interpreter certification process. Is he being paid extra for the work?
“Not quite yet,” Jimenez said, adding, “so that’s something that the organization is working on is to create that incentive so that people who are internal and would like to get that professional development would get that incentive to do it.”
But what about the patient? What kind of interpreter does Isidro Hernandes prefer?
“A lot of times the over-the-phone interpreter can’t see what you’re doing, can’t describe or relay that message. And sometimes they might have errors or mistakes in communications,” Hernandes said.
Tuality Hospital is ahead of the pack when it comes to using in-person medical interpreters, said Helen Eby. She’s the president of the Oregon Society of Translators and Interpreters.
She said that despite Oregon’s requirement for medical interpreters, many hospitals and doctors’ offices still rely on family members.
“You know, you’ve got a 10-year-old in a gynecology appointment. Is this where you would normally take a 10-year-old? Not likely,” she said.
She continued: “Or have a child, an adult child even, interpret a parent’s cancer diagnosis. That’s got to be highly traumatic. I mean, I had to interpret as a professional a “do not resuscitate” appointment. I can’t imagine having to do that for a family member. It was really hard as a professional.”
Hernandes’ doctor, Angela Alday, said that five to 20 percent of her patients require an interpreter. She said the hospital encourages her to use a phone service when necessary, which she does. But she said sometimes, when dealing with a touchy issue, she’ll use a family member.
“One problem that I run into the with the translator phone is a lot of our elderly patients seem to be kind of confused by it,” she said.
“You know some of them don’t hear very well so that can be a problem with the phone translator. And then, particularly if the patient has dementia, sometimes using the telephone translator is confusing. They don’t know what’s going on. But I feel like if there’s a family member standing there beside them, then they understand more what’s happening.”
She’s pleased the hospital is planning to use more in-person interpreters in the future.
Oregon has about 3,500 medical interpreters. But Eby said only 32 are certified and another 64 qualified, “So you have a three percent chance of getting a qualified or certified interpreter in Oregon right now,” she said.
“That’s pretty low, in my opinion.”
A study by the American College of Emergency Physicians in 2012 looked at interpreter errors.
It found that the error rate was significantly lower for professional interpreters than for ad hoc interpreters — 12 percent as opposed to 22 percent. And for professionals with more than 100 hours of training, errors dropped to 2 percent.
Eby said that now the Affordable Care Act is penalizing hospitals for readmissions, such a reduction in errors could save them significant sums.
She said the lack of certified interpreters is a result of several issues: the wages are low and the state doesn’t have an effective system for providing a ready supply.
Tricia Tillman is the director of Oregon’s Office of Equity and Inclusion. She said her agency has seen some gains in the number of interpreters over the past few years, but levels are not where she’d like them to be.
“We’ve been able to work with a number of training sites to put trainings in place, both on line and in person,” she said. “There was also some challenge in getting certification programs established in the languages that we have, so now we have seven languages for which certification is possible.”
Tillman hopes new training efforts will help 150 interpreters become newly qualified in Oregon over the next couple of years.