This series of blog articles were written in 2011. Since that time Jeff has become a CCHI certified Healthcare interpreter. Although we respect IMIA and the code of ethics are very similar, we have now adopted the CCHI code of ethics not mentioned in this blog. What shocks me is that after all this time, the same problems in the industry are still the same.
Why are Workers Comp Interpreters Hated?
I realize that hate is a strong word. Most people, in fact, appreciate the badly needed interpreting services they provide. There are, however, some very clear problems in the area of workers’ comp medical interpretation.
Recently I spoke with someone in charge of language services at a nearby hospital and was immediately impressed by the passion she had for quality, professional medical interpretation. She was quick to explain how the hospital had embraced the International Medical Interpreters Association Code of Ethics (IMIA).
She specifically focused on the need for the interpreter to be unbiased without developing emotional involvement. Experience has demonstrated how easy it is for an interpreter to encounter an emotional attachment, especially in an intense, triadic setting. For this reason, some hospitals have a policy of limited contact. The interpreter will enter the room with a health care professional to interpret. If the health care professional leaves the room, the interpreter will wait outside the room.
In workers’ comp, often an interpreter is assigned to a patient from the beginning of his or her care until its conclusion. An advantage is that it allows the patient and interpreter to develop familiarity. There is time to notice differences in vocabulary. The patient becomes at ease with his interpreter. The patient develops trust that his assigned interpreter will faithfully discharge those duties.
Nevertheless, this can be a dangerous two-edge sword. From the vantage point of that hospital professional, “how in the world could a workers’ comp interpreter stay unbiased?” In her mind, that level of long-term personal interaction would make it impossible to maintain impartiality.
She had also observed people who claim to be workers’ comp interpreters dressed in jeans and appeared more like family members. These interpreters have no form of identification. Unqualified interpreters fraternize with the patient in a very close and personal manner. Workers’ comp interpreters argue with hospital staff. The combined lack of professionalism does not instill confidence that the interpreter can even perform his assigned duties.
Another very real fear is that, because of the perceived deep involvement, some workers’ comp interpreters seem to cross their boundaries and give medical advice.
These common industry issues are undeniable. I have heard similar comments from doctors, nurses and often therapists. The question begs, why? Why are there so many routine problems with workers’ comp interpreters?
Why are problems with workers’ comp interpreters so prevalent?
As already mentioned, there are many common problems in the industry with workers’ comp interpreters. They have been observed and commented on by hospital staff, doctors, nurses, and therapists.
The International Medical Interpreters Association Code of Ethics (IMIA) points out the need for interpreters to be unbiased and professional, interpreting faithfully everything being said.
The following are commonly heard complaints:
- Interpreters are not dressed professionally and carry no ID to prove who they are.
- They are on the phone or iPad and not attentive to the client.
- They summarize instead of repeating everything.
- They fraternize with the client, often seen talking loudly and laughing, appearing more like family than that of a professional; and
- They have been seen arguing on behalf of the client, taking the role of advocate.
Obviously, these are serious issues that compromise the ability of the interpreter to do his job correctly. So, the logical question is, why are these problems so prevalent?
Part of the answer might be found in the way the system is set up. There are a small number of national language agencies in the United States. Most large insurance companies utilize these national language agencies.
It would take massive time and resources for the insurance companies to find an interpreter in every little city, town and region. It seems to make much more sense for them to call one agency and let it provide the interpreter wherever needed. The agency is also fully insured in case of a costly mistake.
Competition is fierce among these agencies. When given an assignment, they must ensure that they can quickly provide coverage, or the competition might just snatch it away. They must also have competitive pricing.
While under pressure to find coverage quickly at the right price, oftentimes standards degrade. It might not be easy to find a qualified interpreter in Ridgeland, SC, for example. Often, they might settle for a bilingual person looking for work in the area. The contract usually reviews ethical conduct, and it is understood that before signing, it should be read. However, there isn’t much of an interview process to verify qualifications, no training, and no continuing education. Often, these companies will remove someone after complaints, when the damage has been done. Mind you, this does not need to be is not always the case as there are some well-qualified medical interpreters in workers’ comp.
The complaints listed in the paragraph above come from medical professionals. It is no surprise considering that often unqualified bilingual individuals are used at sweatshop rates. Being bilingual does not qualify one to be a medical interpreter. Future blogs will detail this. Obviously, something should be done. At this moment, I am sharing a reason why, not assigning blame to anyone. The problem is systemic, and I have no solution. I do, however, have control over what my company does.
What we do
As previously mentioned, there are serious problems in the industry. The larger the agency, the more difficult it is to maintain quality control. Due to these problems, there is real danger for trouble to brew.
First, the patient can be at great risk. Incorrect interpreting can lead to misunderstanding and errors in treatment. Although some interpreters may mean well, coaching can influence a patient to make inappropriate decisions. They can unwittingly create bad will between the patient and the medical professional. Some have coached patients in order to continue treatment or undergo unnecessary procedures.
Second are the disastrous monetary consequences that affect everyone else. Costly legal fees, interpreter liability, and higher medical insurance expenses impact us all as rate increases are passed down to the consumer.
When one considers the liability issues involved, it seems to me that the policy to only use large language companies can incur its own heavy burden. Longer claims, legal issues, and appointment problems all carry a price tag.
We have chosen to limit our coverage of service to South Carolina and parts of Georgia and north Carolina in order to assure greater control over quality. In this way, we personally meet and interview each independent interpreter we use. This affords us the opportunity to evaluate skill level, discuss ethical conduct, and review our company’s expectations.
Once an independent interpreter is on board, we provide regular training sessions. Training helps improve interpreting and addresses issues that might arise. The IMIA Code of Ethics is regularly considered and brought to life with real-life examples and skits. The independent staff is also encouraged to continue professional education and development.
Our independent interpreter team must follow a professional dress code and have a name badge for identification.
Because workers’ comp interpreters do spend an extended period with a patient, what steps do we take to maintain impartiality?
- We regularly review the IMIA Code of Ethics and discuss the importance of being unbiased. Our interpreters understand that if they feel compromised, we will simply reassign them. (Now we follow the CCHI code of ethics)
- If one of our interpreter’s requests to not work with a certain patient, we respect that wish. By paying close attention, we can catch any potential problems before they arise.
- Usually, a claimant will meet two to three interpreters on our team; this provides for familiarity at a distance.
We also remind our team that interpreters are not doctors or lawyers; there is no room to dispense medical or legal advice. The role in our chosen profession is to facilitate clear communication.
The size of our company is manageable. Our focus is on the state of South Carolina, not the entire nation. This makes a dramatic difference in the quality of our interpreters and our ability to handle issues as they turn up. Perhaps some of the large insurance companies should take notice; it would be wise to for them to review their policies of using national agencies only and include state agencies as well. Although said posture would require them to deal with more companies than just a handful, there would also be more options for quality control, thereby lowering expenses.
