Language Access

The Right to Communication

Assuring that patients, their families, and healthcare providers can communicate with each other is not only a principle of good medical care, but also a legal right in the United States. Every patient and his/her family or caregiver, has the right to receive healthcare communication in language that they can understand. Healthcare facilities that receive federal funding are required to ensure language access services to all patients and families who need them, at no charge to the patient.  (This requirement is based on whether or not the facility receives funds from Medicaid,  the Children’s’ Health Insurance Program, Medicare, or other federal programs, not whether the individual patient in need of language services is a recipient of federal funds). Among the provisions of Title VI of the Civil Rights Act, is a ban on discrimination on the basis of national origin. The need for oral and/or written communication in a language other than English is considered to track with one’s national origin.

The need for different methods or languages of  communication on the basis of disability is guaranteed by another law, Americans with Disabilities Act ( ADA). The ADA  covers special language needs related to deafness or hearing impairment; blindness, deaf-blindness, as well as literacy level, or cognitive impairment.  In the medical setting language access is essential , as according to Census data, some  9%, or 25 million people,  of the US population speaks English less than very well.   Patient families in which one parent or caregiver is fluent in spoken/written English and the other is not, or in which a child is proficient in English but their parent is not, need to know that they too are entitled to the communication access protections of these laws.

Medical Interpretation and Translation

During any type of  medical care, including conferences with the BMT team, one family member  should never be expected to interpret for another, nor should children ever serve as interpreters for themselves or for other family members. This is essential  for both quality of care and ethical reasons. While federal laws do not specify which type of language services a facility must offer,  current best practice is to utilize the services of  a professional medical interpreter and/or translator. ( While these terms are commonly confused, interpretation refers to verbal communication or sign language, while translation refers to  written forms of communication). Courses in general and specialty medical  terminology, understanding of procedures, and ethics are all part of the training of medical interpreters, who generally must pass both written and oral tests  to demonstrate skills in the target language and English. Due to the high skill level required for this specialty profession, and it cannot be assumed that any  untrained individual (including hospital staff)  who happens to be  bilingual  is capable of interpreting. The sensitive and personal nature of medical care also requires the utmost protection of ethical principles. That is why it is not appropriate for a family member or friend, especially not a child or child’s siblings, to serve as interpreters.

BMT facilities typically utilize the services of trained  and tested medical interpreters who are present at the various appointments and procedures, and remotely over the telephone. Facilities utilize qualified  interpreters to serve their providers as well , to assure accuracy of communication. Families may request an interpreter if one has  not been offered to them. Parents need to  be able  to focus their attention on what is  being said during each of the many appointments and meetings. In the case of  dual-language families, in which one has limited-English  proficiency,  the other should not  be expected to  serve as interpreter;  is the job of the interpreter, who also checks with each parent in each  language to make sure they understand everything being said. Typically major medical centers have their own staff interpreters for the most commonly-spoken  languages here, and contract with qualified interpreters for other languages. They  utilize telephone interpreters  to help  with logistics, and to enable patients to contact staff quickly. Written translations of patient care  instructions and key  treatment protocol documents are another service offered.

Work is now underway to create a system for official nationally-recognized certification for medical interpreters.  As of January 2011,  a national-level certification is available for Spanish medical interpreters. Washington was the first, and still the only, state, in the country to create its own  certification for interpreters and translators for the eight most commonly-spoken  languages other than English: Spanish, Vietnamese, Russian, Cambodian, Laotian, Mandarin, Cantonese, and Korean.    Washington interpreters of other languages receive a credential  as authorized interpreters.  These credentials are required for  interpreters serving the  WA Department of Social and Health Services and  the court system;  many health care facilities and social service agencies in WA also require these credentials.