Are You Compliant?

Information about providing language access services in healthcare settings

Is there a law that requires provision of interpreters?

Yes. The following are key laws and policy guidance concerning provision of services to people with limited English proficiency (LEP):

• Title VI of the Civil Rights Act of 1964
• HHS Policy Guidance on the Prohibition Against National Origin Discrimination as it Affects Persons With Limited English Proficiency
• DOJ Guidance to Federal Financial Assistance Recipients Regarding Title VI Prohibition Against National Origin Discrimination Affecting Limited English Proficient Persons
• Culturally and Linguistically Appropriate Services Standards for Health Care
• Executive Order 13166
• Strategic Plan to Improve Access to HHS Programs and Activities by Limited English Proficiency Persons

What is healthcare interpreting?

It is interpreting that takes place in healthcare settings of any sort, including doctor’s offices, clinics, hospitals, home health visits, mental health clinics, and public health presentations. Typically, the setting is an interview between a healthcare provider (doctor, nurse, lab technician) and a patient (or the patient and one or more family members).

What is the definition of a qualified interpreter?

An individual, who has been assessed for professional skills, demonstrates a high level of proficiency in at least two languages and has the appropriate training and experience to interpret with skill and accuracy while adhering to the National Code of Ethics and Standards of Practice published by the National Council on Interpreting in Health Care.

What is the difference between a healthcare interpreter and a bilingual individual?

A bilingual individual is a person who has some degree of proficiency in two languages. A high level of bilingualism is the most basic of the qualifications of a competent interpreter, but by itself does not insure the ability to interpret. A bilingual employee may provide direct services in both languages but, without additional training, is not qualified to serve as an interpreter.

A qualified interpreter is a person who has been assessed for professional skills, demonstrates a high level of proficiency in at least two languages and has the appropriate training and experience to interpret with skill and accuracy while adhering to the National Code of Ethics and Standards of Practice published by the National Council on Interpreting in Health Care.

What else should professional healthcare interpreters know to do a good job?

The following six components together comprise a reasonably comprehensive process for initial assessment of qualifications for health care interpreting.

• Basic language skills. General proficiency in speaking and understanding each of the languages in which the applicant would be expected to work. (If multiple languages are involved, it is essential that the applicant’s ability in each language be assessed, especially those in which the applicant may have more limited proficiency.)
• Code of Ethics. Recognition of ethical issues, knowledge of ethical standards (a code of ethics) and ethical decision-making.
• Cultural issues. Ability to anticipate and recognize misunderstandings that arise from the differing cultural assumptions and expectations of providers and patients and to respond to such issues appropriately.
• Health care terminology. Knowledge of commonly used terms and concepts related to the human body; symptoms, illnesses, and medications; and health care specialties and treatments in each language, including the ability to interpret or explicate technical expressions..
• Integrated interpreting skills. Ability to perform as required for employment, demonstrated by interpreting a simulated cross-linguistic interview with acceptable accuracy and completeness while monitoring and helping to manage the interaction in the interest of better communication and understanding.
• Translation of simple instructions. Ability to produce oral translations, or, where appropriate, brief written translations, of written texts such as signage, or medicinal labels.

Americans with Disabilities Act

The ADA applies to all hospital programs and services, such as emergency room care, inpatient and outpatient services, surgery, clinics, educational classes, and cafeteria and gift shop services. Wherever patients, their family members, companions, or members of the public are interacting with hospital staff, the hospital is obligated to provide effective communication.

Exchanging written notes or pointing to items for purchase will likely be effective communication for brief and relatively simple face-to-face conversations, such as a visitor’s inquiry about a patient’s room number or a purchase in the gift shop or cafeteria.

Written forms or information sheets may provide effective communication in situations where there is little call for interactive communication, such as providing billing and insurance information or filling out admission forms and medical history inquiries.

For more complicated and interactive communications, such as a patient’s discussion of symptoms with medical personnel, a physician’s presentation of diagnosis and treatment options to patients or family members, or a group therapy session, it may be necessary to provide a qualified sign language interpreter or other interpreter.

Hospitals may need to provide an interpreter or other assistive service in a variety of situations where it is a family member or companion rather than the patient who is deaf or hard of hearing. For example, an interpreter may be necessary to communicate where the guardian of a minor patient is deaf, to discuss prognosis and treatment options with a patient’s spouse or partner who is hard of hearing, or to allow meaningful participation in a birthing class for a prospective new father who is deaf.

Hospitals should have arrangements in place to ensure that qualified interpreters are readily available on a scheduled basis and on an unscheduled basis with minimal delay, including on-call arrangements for after-hours emergencies. Larger facilities may choose to have interpreters on staff.

Hospitals should develop protocols and provide training to ensure that staff know how to obtain interpreter services and other communication aids and services when needed by persons who are deaf or hard of hearing.

Hospitals cannot charge patients or other persons with hearing disabilities an extra fee for interpreter services or other communication aids and services.