lunes, 4 de mayo de 2009

Medical Interpreters and Their Limited Role

On Tuesday, April 28th, 2009, three medical interpreters employed by XXXX were called to testify in a court case involving Child Protective Services and a XXXX’s former patient’s family.

While their experience cannot possibly be considered enjoyable, it was not overly onerous, and seems at the present to have been concluded with no negative sequels in store for those interpreters, or the hospital, in the foreseeable future. The interpreters in question were subpoenaed to appear before the court for having rendered their services in their capacity as medical interpreters in said case. XXXX’s staff had requested the interpreters to help the CPS agent, sometime back in the year 2007. Nonetheless, whether the situation was actually burdensome or not might be a matter of personal perspective. The interpreters in question provide a statement about their experience, appended to this essay at the end.

Whereas the current view of the hospital leadership is that the medical interpreters employed by the hospital should render their services to CPS agents or police officers, it has been long contended by many of the interpreters themselves that the specific situation creates a conflict of interests. While it may seem that this is an issue in which anyone could wax philosophical, there are some concrete facts that give validity to the interpreters’ perspective.

First, as an organization that receives federal monies, CPS must abide by Title VI of the of the Civil Rights Act of 1964, which requires that state and local governments must ensure that their programs and activities normally provided in English are accessible to persons with limited English proficiency (LEP) and that they do not discriminate on the basis of national origin. CPS, of course, has established guidelines to ensure that their activities comply with the law. Some of those measures are illustrated below:

From the CPS handbook, section 1516:

“Family Members / Child Victims as Translators

CPS does not use family members or friends to interpret, translate, sign, or read for LEP clients, except at the client's specific request. Child victims should not be used as translators except for brief interaction to ascertain the client's request and/or arrange requested translation services. Ideally, interpreters and translators will be professionally trained or will be a CPS staff person who is fluent in the client's preferred language.”(1) (Emphasis added)

From the “A Parent's Guide to a Child Protective Services (CPS) Investigation”

“Please note:

o If you have a hearing impairment or limited English proficiency, please let your caseworker know so that CPS can provide an interpreter.”(2) (Emphasis added)



From the CPS handbook, section 8000:

“Purchasing Interpreter Services

Purchasing interpreter services to enable a client to understand court proceedings is a court responsibility.

Interpreter services for CPS workers are not a client service and are not purchased under these guidelines. Contact the regional business office to purchase interpreter services for CPS workers.”(3) (Emphasis added)

As the sentences highlighted indicate, CPS has procedures in place that define the use of an interpreter and the methods of obtaining one. Of important significance is the phrase, “Ideally, interpreters and translators will be professionally trained,” because it is clear that a medical interpreter does not have the necessary training.

At the present time, there is not a National Certification for Medical Interpreters. Neither is there a statewide certification. In fact there are no certifications of any kind. However, the professional panorama is changing. Part of the effort by several professional associations to promote a National Certification for medical interpreters is the need to provide higher standards of quality in interpretation. In the following paragraphs, two aspects of these higher standards are delineated:

From the NCIHC’s “National Code of Ethics for Interpreters in Health Care”:

“To work within the professional boundaries of the interpreter role also means that interpreters are aware of the limitations of their duties as well as the limitations of their abilities as a health care interpreter.”(4) (Emphasis added)

From the NCIHC’s “National Standards of Practice for Interpreters in Health Care”:

“21. The interpreter discloses skill limitations with respect to particular assignments.

24. The interpreter advocates for working conditions that support quality interpreting.”(5)

Thus, medical interpreters who have interpreted for CPS and Police officers’ interviews are clearly out of their depth, and find themselves in a situation where their main training is not appropriate for the task at hand. The issue of conflict of interests arises as the medical interpreter should decline out of ethical considerations, but finds himself obliged to attend the interview regardless.

Another aspect to consider about this situation is the often overlooked fact that the medical interpreters working for XXXX are in fact a service for the hospital’s staff, and not a service for the LEP parents or the patients. For example, a parent or patient cannot initiate an interview with a medical interpreter on their own, but the staff must assess the need for interpretation and request the services of a medical interpreter. Therefore, the line of thought that the parents of XXXX’s patients might need an interpreter for their interviews with CPS or Police officers, and consequently XXXX must provide said interpretation because it is one of their patients, is an incomplete or faulty rationale, and not the best use of the hospital’s limited resources.

Respectfully, this essay is presented in order to urge the XXXX leadership to revisit the decision to use of the hospital’s medical interpreters in interviews for external agencies, and hopefully reach the conclusion that such practice is not in the best interest of all the parties involved, especially the patient.

APPENDIX:

Three Personal Perspectives on Taking the Stand in a CPS-related Court Case.

“My experience as witness in this trial was definitely not a pleasant one. Although the 3 hour seclusion was less traumatic than my previous one years ago for a similar situation, my appearance was almost as traumatic as the one in the past. Since attorneys seem to be unable to ask simple, direct questions, to avoid objections (I guess), they elaborate on double-negative construction in order to confuse you, or get from you the answer they need for their benefit. In my case, the questioning lasted about 25 minutes, going back and forth between all four attorneys.
My impression is that our ability to interpret, our interpreting process, and our professional and ethical behaviors were questioned by the defense attorneys. I think I was able to provide some good points about the quality of our process at XXXX. However, the complicated semantics of court language made me feel confused about wether or not my answers communicated the appropriate ideas.
I have expressed in the past, and firmly believe, that the Medical Interpreter at XXXX is here to interpret medical related information between XXXX's providers and LEP patients (or their parents), in order to comply with Title VI, and for the successful treatment of the patient's medical conditions in a collaborative environment. That is what we are trained for. Agencies and companies other than XXXX may have different goals, and their interactions with the public may not be collaborative relationships, but adversarial ones. Those independent entities are equally responsible for providing communication services to LEP people, by using qualified and trained interpreters in their own fields, or bilingual staff members capable of providing their services directly.

In my opinion, this is a good opportunity to review XXXX policies about using XXXX staff in the provision of services to outside companies or agencies, and consider the implications of this practice.
Thank you,
M.V.”


“This was my first time taking the stand in a court of law. The proliferation of TV shows and movies involving the glamorous world of the judicial system in action left me with wild expectations that have nothing to do with reality.
To begin with, I wasn't rushed into the chambers to offer my expert testimony. Instead, they made me languish in a 5' by 8' room for five hours before they could ask me questions for fifteen minutes.
Then, there's the unexpected protocol and patterns of speech, very particular of the courts. I had worked myself up to avoid taking anything personally, and adopt the poised aloofness of a movie character. However, it is difficult to avoid feeling insulted when one's intelligence is put on the spot by clever and manipulative semantic maneuvers on four fronts: the prosecutor, the parent's lawyer, the CPS lawyer, and the child's lawyer.
Lastly, this experience left me feeling certain ambivalence towards the morality of my professional detachment. While an absolute requisite as an interpreter, I felt lessened to realize that I have no memory at all of an incident that has reshaped a whole family, and that I really do not care.

I rather not repeat the experience.
D.F.”


“[…] My experience was intense and negative.
First, there is the fact of having taken us out from our jobs and making us travel to Denton. Then, that they would put five people in a small room and wait for over three and a half hours, feeling hot, hungry, and suffocated.
As I entered the chambers, I felt like a puppet strung between two parties fighting for their rights while I was their target.
I felt as if the lawyer that was with the parents tried to manipulate me to demonstrate that I was inept in my job, and that I did not dominate English enough in order to appropriately help the parents at XXXX.
I felt used, manipulated, attacked, and very angry, furious!
The lawyer for the parents used her prattle to confuse me.
I felt nervous all the time, since they stuck us in the small room for many hours until they sent us home, saying that there was the possibility that they might call us back again during the week.
All that experience was like a horrible nightmare.
When we finished, I felt physically exhausted, a bit dizzy and with a slight headache.
I was furious because I felt used and outraged for no reason at all.
I think that we interpreters at XXXX should not interpret for any other external organization. Those agencies should bring their own interpreters, trained for the discipline they practice, be it Law practice, police, etc…
I.M.”


Notes:

1. CPS handbook, section 1516 (http://www.dfps.state.tx.us/handbooks/CPS/Files/CPS_pg_1516.jsp#CPS_1516)
2. “A parent’s Guide to a Child Protective Services (CPS) Investigation” (http://www.dfps.state.tx.us/child_protection/About_Child_Protective_Services/parentguide.asp)
3. CPS handbook, section 8000 (http://www.dfps.state.tx.us/handbooks/CPS/Files/CPS_pg_8000.jsp)
4. NCIHC’s “National Code of Ethics for Interpreters in Health Care,” pp. 16 (http://data.memberclicks.com/site/ncihc/NCIHC%20National%20Code%20of%20Ethics.pdf)
5. NCIHC’s “National Standards of Practice for Interpreters in Health Care,” pp. 9 (http://data.memberclicks.com/site/ncihc/NCIHC%20National%20Standards%20of%20Practice.pdf)

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