Huffington Post - October 4, 2010

Hospitals Must Overcome Language Barriers to Save Lives, Cut Costs

More than 60 million people - about one in five legal U.S. residents - speak a language other than English at home, and it's not all Spanish, with more than 176 different languages and dialects spoken across the country. Not having the right support in place to overcome language barriers when there is a medical emergency can be the difference between life and death.

It's difficult enough to explain to the doctor what really hurts and get a resolution that gets you well, even if you do speak the language. Having to rely on a bi-lingual family member and their well-intended but often conflicting biases to translate or worse, bluffing your way through with broken English, can lead to poor medical care or worse.

That's the reasoning behind the new Joint Commission accreditation standards set to take effect in January 2011 which substantially increase the commitment hospitals must make to multiculturalism and support for numerous languages, not just Spanish.

The Joint Commission, with funding from The Commonwealth Fund, began the initiative in August 2008 to advance the issues of effective communication, cultural competence, and patient- and family-centered care in hospitals. The Patient-Centered Communication standards were approved in December 2009 and released in January 2010 (see: A Roadmap for Hospitals). Compliance will be evaluated beginning in January 1, 2011, with compliance included in the accreditation decision as soon as January 2012.

Right now, few hospitals are in full compliance with the new standards. "Most are not even close," according to Jonathan Hirsch, Director of Guest Services at Holy Name Medical Center in Teaneck, N.J., which already meets the new standards but is in the definite minority. Hirsch speaks often about the importance of language compliance for hospitals and other medical facilities. "That's why The Joint Commission is increasing the standards to finally move the needle on all hospitals becoming compliant which not only improves the quality of patient care, but trims costs for the hospitals, too."

At a time when the country is hyper-focused on equitable, affordable health care, Hirsch says language compliance is one of the critical areas to address. Holy Name, a mid-sized hospital, average's more than 5,000 interpretations per year (42 languages on a regular basis), and Hirsch credits the interpretations with dramatically cutting the amount of time patients spend in the hospital and reducing the number of patients who need to be readmitted. Both substantially lower costs. "But, most importantly, it has improved care and helped save lives," Hirsch said.

The language-related sections of the new Joint Commission standards include: developing a system of identifying the patient's preferred language; ensuring the competency of individuals who provide language services; developing a method of delivering language services; and translating materials and signage into other languages.

Some hospitals have a team of interpreters who serve a limited number of languages - again, often just Spanish - and some also use local freelance interpreters. Most facilities use a combination of on-site and over-the-phone interpreters, but full compliance with all languages under heavy traffic is unusual.

"I've seen hospitals brag about being able to interpret for 90 percent of patients who do not speak English. I always ask what they do with the other 10 percent. Charades?" Hirsch said.

Hospitals are reviewed for compliance with Joint Commission standards on an ongoing basis, with unscheduled accreditation
surveys taking place approximately every three years. Hospitals that fall short of these standards risk losing access to Medicare and Medicaid funds, as well as incur additional costs in resolving issues identified to reestablish compliance.

Louis Provenzano is President and Chief Operating Officer of Language Line Services, the world's leading provider of language-based services.

Huffington Post - July 15, 2010

As the Democrats begin to worry about the potential impact on Fall elections of the Obama administration's lawsuit against the Arizona immigration law, this is no time to back off. Decisive action and leadership from the top is a must in a country whose racial and ethnic makeup is evolving quicker than policymakers seem capable of thoughtfully and appropriately legislating.

Distraught and looking for someone to blame for illegal immigration, the public opinion poll numbers are at first glance anti-lawsuit. According to a Pew Research Center poll, 59 percent of respondents approve of the Arizona law. Another poll released Monday by TechnoMetrica Market Intelligence (TIPP) finds that although 51 percent of Americans support the law, the numbers swing drastically the other direction primarily among the people most likely to be impacted by it -- Hispanics and blacks, with 61 percent instead approving of the suit. The overall numbers are skewed by white respondents unlikely to be targeted or disenfranchised by the law with just 30 percent supporting the suit.

Right now, the suit claims only that Arizona pre-empted federal authority to police the border. U.S. Attorney General Eric Holder is already talking about additional legal action if the Justice Department determines the law condones racial profiling and is used to target Hispanics.

Of course the law targets Hispanics. The most stringent immigration law in the country requires anyone suspected of being in the country illegally to carry with them and produce a green card or other proof of citizenship, such as a passport or Arizona driver's license. Whites simply aren't going to be stopped because of the law. The problems arise for Hispanics and other minorities here legally. They may even have been born here. They risk being stopped, questioned, harassed, even arrested if they don't produce papers other Americans aren't required to carry.

The Justice Department argues the law would divert federal and local law enforcement officers by making them focus on people who may not have committed crimes and has asked for a court injunction to prevent the law from taking effect on July 29. Signed by Arizona Gov. Jan Brewer on April 23, the law makes it a crime to be an illegal immigrant in the state and requires officers to determine the immigration status of people they stop for another offense.

An article in the New York Times on Sunday highlighted reaction from governors throughout the country at the National Governors Association meeting in Boston. The consensus: Bad timing for the suit."Universally the governors are saying, 'We've got to talk about jobs,'" said Gov. Phil Bredesen of Tennessee, a Democrat, calling immigration "a toxic subject."
 

Addressing illegal immigration may have consequences, and it should. It is a very real issue that needs to be confronted at the highest levels of government with broad, sweeping implementation for the sake of the nearly 200 languages and cultures, and more than 24 million of us speaking a language other than English. Laws like the Arizona one paint targets on the foreheads of millions of us. It sets a dangerous precedent for other states to do the same, muddying the waters from state to state in creating a whirlwind of confusion and danger for far too many law-abiding citizens.

Immigration is an explosive subject that raises many questions with no clear resolution. It is clear this law and other pending state laws like it are not the answer.

No one here legally should be a target in the United States. Not in Arizona. Not anywhere.

Louis Provenzano is President and Chief Operating Officer of Language Line Services, the world's leading provider of language-based services.

The case of Francisco Torres, a Spanish-speaking patient in Riverside, Cali., who had the wrong kidney removed during surgery, once again gives the medical community reason to pause and consider the absolute necessity clear communication plays in avoiding catastrophic medical errors. While wrong-site surgery can happen without a language barrier, the fact that Mr. Torres was not provided a medical interpreter prior to major surgery is deeply concerning.

Statistics show that language is a major factor in cases of misdiagnosis and instances of poor treatment at hospitals, and delays in service or access to preventive care. Medical error in general is a troubling issue, but patients with limited English proficiency are almost twice as likely to suffer adverse events in U.S. hospitals, resulting in temporary harm or death, according to a pilot study by The Joint Commission – an independent, not-for-profit organization that evaluates and accredits more than 15,000 health care organizations and programs in the United States.

The fact is, the medical system is failing those who have limited English skills – and there are many people who fall into this category. According to census data, over 47 million people in the U.S. speak a language other than English at home, and nearly 23 million are considered limited English proficient (LEP). Overall, more than 176 different languages and dialects are spoken across the country.

Given the growing number of LEP patients across the country, we need a federal call to action that includes a nationally recognized process for certifying medical interpreters, a requirement that only certified medical interpreters may be employed by health care organizations, as well as funding to help hospitals pay for these vital patient safety measures.

While we are still waiting for this sweeping federal mandate that requires trained and tested medical interpreters, the good news is that there is now a nationally available procedure in place that can help determine whether medical interpreters are adequately prepared. After years of research and development by different organizations, the independent National Board of Certification for Medical Interpreters launched the Certified Medical Interpreter (CMI) program in October 2009. With this independent certification process, developed by leading industry professionals from a range of organizations and specialties, hospitals, physicians and even individual patients can now begin to ascertain whether or not the interpreters they rely on are in fact experienced and qualified.

Despite this progress, the lack of reimbursement is seen as a huge roadblock for many hospitals and providers in their ability to offer patients a comprehensive language access program, contributing to health care disparities and a waste of health care dollars. Many in the medical interpreter profession have been advocating for patient safety and the need for both reimbursement for medical interpretation services and a federal requirement that only certified interpreters may be employed. Our effort included a recent Medical Interpreter Advocacy Day on April 30, where more than 200 meetings were held on Capitol Hill on this very issue.

Until steps are taken at a national level to protect LEP patients from painful, disabling and even deadly medical errors, we will continue to see the consequences of language barriers in medical settings, including the tragic case of Mr. Torres, whose quality of life has been irrevocably harmed.

A qualified medical interpreter is quite literally the bridge to potential life-saving care for LEP patients. As a nation, we must work together to build a strong foundation for that communication bridge – a nationally recognized procedure to ensure that every interpreter on the job is really and truly up to the task. And that reimbursement for language access services for hospitals becomes a reality.

It is a matter of life and health.

Louis F. Provenzano, Jr.

President and Chief Operating Officer

Language Line Services

***************

Bio for Louis F. Provenzano, Jr.

Louis F. Provenzano, Jr. is President and Chief Operating Officer of Language Line Services, the world’s leading provider of language-based services, is a trusted partner to thousands of organizations whose focus is to effectively serve the rapidly expanding market of limited English speakers. The company delivers a dynamic suite of solutions spanning translation, transcription, phone and video interpretation, interpreter certification, localization and localized software and devices, enabling clients to communicate with customers in their preferred language. Through its leading-edge technology infrastructure, Language Line Services provides support for more than 170 languages to its industry-leading portfolio of clients across markets including healthcare, financial services, government, telecom, manufacturing, insurance, entertainment, travel, and more.

He is the recipient of the “Friends of CHIA” (California Healthcare Interpreters Association) and the Hispanic Leadership Award from the San Francisco Hispanic Chamber of Commerce. Mr. Provenzano has served on the Board of Directors of CHIA and is an active participant in the Monterey Language Capital of the World Advocacy Council, Economic Development leadership of the Monterey Chamber of Commerce and a member of the Board of Directors for the United Way of Monterey County. He is also a member of the 2010 United Way Campaign Fund and is actively involved with fund raising for the business sector.

Mr. Provenzano is a member of the Global Advisory Council of Language Line University’s medical certification body and is a frequent speaker around the world on immigration and language access issues.

Mr. Provenzano holds a bachelor’s degree in Romance Languages from Boston College and nominated Scholar of the College. He speaks several languages and lives in New York City and Monterey, California –The Language Capital of the World. (www.montereylanguagecapital.org)

He writes his own blog at www.louisprovenzano.wordpress.com, “Tweets” @louisprovenzano (www.twitter.com/louisprovenzano) and is currently writing a book to be published in the fall on the pathway to National Medical Certification and Medical Interpretation Reimbursement for Hospitals and Healthcare organizations around the country.

September 2009 - Nashville, TN

Report on the Tennessee Association of Professional Interpreters and Translators (TAPIT) Conference Nashville – Sept. 11-14, 2009

Linda Joyce, Language Access Consultant September, 22nd 2009 “National Medical Interpreter Certification is right around the corner…” So started the first day of the conference, known as “Medical Friday,” as Espi Ralston, an interpreter at St. Jude’s Children’s Research Hospital and interpreter trainer, talked about TAPIT’s Healthcare Interpreter Certificate Program. She advised everyone to get ready for certification and to get training.

Marvyn Bacigalupo-Tipps, the president of TAPIT https://www.tapit.org , announced that this was the best attendance for “Medical Friday” ever, with 85 people in attendance – a big increase from the first time they held a special day for medical interpreters four years ago when 35 people came. There were participants from Tennessee, Ohio, Georgia, Alabama, North Carolina and beyond. Linda Joyce attended representing the National Board of Certification for Medical Interpreters (NBCMI) http://www.certifiedmedicalinterpreters.org .

According to Marvyn, who did a lot of work this summer promoting the conference, many participants came this year specifically to hear about the progress toward certification, and although TAPIT has not endorsed any medical certification program at this time, it strongly supports the concept of national certification for health care interpreters.

Linda gave an update on the progress toward national certification from the NBCMI at the noon luncheon. When she asked, “Who’s ready for national medical interpreter certification?” the majority raised their hands. She announced that the National Board was launching a written pilot exam at the conference, and there was a great response to this call, with 30 people signing up. Dandra Whaley, Executive Director of the Health Assist Tennessee program, was one of the providers who came for this update, and she congratulated the NBCMI for their work.

There was an NBCMI table prominently placed in the exhibit area. It became a central focus for many, as interpreters signed up for the written exam pilot and promised to get the word out and pass out the fliers with the information on how to register for the pilot. They picked up information on advocacy for medical interpreters, Lou Provenzano’s letter to the editor of the New York Times on the “Case for National Certification of Medical Interpreters”, and the latest information on NBCMI’s progress toward the certification process. Everyone received an invitation to the Fourth Annual May 1 National Medical Interpreters Certification Open Forum in Washington, D.C. and picked up NBCMI tee shirts.

There was tremendous interest in not if, but when will we have certification, and lots of discussions. Here are some important highlights:

Get certified! Kerri Banks, an interpreter at Knoxville’s East Tennessee Children’s Hospital, said that their supervisor of interpreter services is also the supervisor of the social workers. All the social workers are certified, and their supervisor had told them to “stay on top of certification.” She wants all the interpreters to get their certification as soon as possible.

The oral pilot: Geraldine Spurgin of the Hamilton County Health Department in Chattanooga gave some feedback on the oral exam pilot. She said five of them took the test, and realized that although it was challenging for them, it was a test at a necessary level to put medical interpreters anywhere, in any setting. They decided they needed to study and prepare themselves to pass the actual exam when it becomes available. They began a program of self study on medical terminology, memory retention and note taking. As a consequence of taking the pilot, they started a newsletter that will go over the various body systems, talk about medical terms, put in information on cultural issues, sight translation, note taking and more.

The Job Analysis survey: Kurt Snyder, an enthusiastic interpreter from Vanderbilt said that when he took the survey, he thought, “Wow! These people are serious!” He took fliers with the information on how to sign up for the written exam pilot to pass out to all his colleagues. He said he would try to come to the May 1 events in D.C.

Eta Trabing, Director of the Berkana Language Center, was the featured guest presenter and keynote speaker, giving a number of skills workshops on Medical Friday and some on Saturday, the start of the actual Conference. On Sunday, Nancy Schweda Nicholson from the Department of Linguistics and Cognitive Science at the University of Delaware gave a popular presentation on Processing Strategies for Interpreters. Both of them expressed keen interest in the march toward certification.

September 2009 - What to look for when you hire an Over the Phone Interpretation Firm
--A white paper assessing the risks to your organization. Written by Jackie McManus, Fenton Keller 

July 2009 - My letter to the editor
Referencing pending "English-only" law in violation of Civil Rights Act

White Paper click here

National Medical Interpreter Certification Testing Enters Pilot Phase

BOSTON, May 22 /PRNewswire/ — The National Board of Certification for Medical Interpreters will begin the pilot phase of the performance exam that will be part of the testing for National Medical Interpreter Certification. Over the next few weeks, 300 interpreters will “test the test” designed to verify the ability of interpreters to apply their knowledge and skills in real-life medical interpreting scenarios. This process will provide additional input to the assessment tool’s design, allowing test developers to make final adjustments before its national implementation.

The National Board of Certification for Medical Interpreters program, founded by Language Line(R) University and the International Medical Interpreters Association (IMIA), is a single certification entity that will award individuals with the credential “Certified Medical Interpreter” (CMI) in a specific language. To qualify for the CMI credential, a medical interpreter will have to pass the prerequisites, the National Board Written Exam, and the National Board Performance Exam.

“This new National Board is committed to bringing to fruition a national certification that recognizes the professional achievements necessary to provide quality language assistance in healthcare settings,” said Louis Provenzano, President and COO of Language Line Services. “Accurately assessing an interpreter’s knowledge and skills is essential and every measure has been taken to ensure that the National Board’s written and performance exams accomplish that goal.”

A call for subject matter experts and pilot participants was sounded at the Third Annual National Medical Interpreter Certification Forum, May 1, 2009, in Denver, Colorado, where interpreter organizations were also invited to participate in the pilot. Medical interpreters interested in volunteering to take the exams should email info@certifiedmedicalinterpreters.org.

“I would certainly encourage interpreters to become part of this process,” advised Orlin Marquez, President of the Medical Interpreter Network of Georgia. “Certification has been a long time coming. We are thrilled that this effort is finally making significant progress, and we eagerly await a recognized national certification for the valuable services provided by medical interpreters on a daily basis.”

The National Board Written and Performance Exams were developed under the guidance of PSI Services, an industry-leading provider of professional testing services. Interpreter focus groups, a national job analysis survey, and input from subject-matter experts helped define the test content in this complex statistical and scientific process. Test scoring guidelines were also established. A report on the test development and validation process will be provided following the analysis of the pilot results on the National Board website at http://www.certifiedmedicalinterpreters.org.

“This pilot phase is critical to the test certification process as a key component in ensuring the reliability and validity of the test instruments,” said John Weiner, Chief Science Officer with PSI Services.

The test design team included medical interpreters who hold medical degrees, professionals with medical interpreter test design experience, those involved in establishing national interpreter standards, medical interpreting trainers, and testers with experience administering interpreter testing.

About the National Board of Certification for Medical Interpreters

The National Board of Certification for Medical Interpreters will be a non-profit organization, formed from an independent group of industry professionals that represent all stakeholder groups including professional medical interpreters, trainers, employers, and regulators. The Board will be the certifying entity and will be given independent authority over all essential certification decisions. It will not be responsible for accreditation of educational or training programs or courses of study leading to the certification. The formation and structure of the National Board of Certification will adhere to the standards and requirements for certification program governance mandated by the National Organization for Competency Assurance.

Contact:

The National Board of Certification for Medical Interpreters
info@certifiedmedicalinterpreters.org

Press contact:

Abbott Thayer
617-636-1798

This release was issued through eReleases(TM). For more information, visit http://www.ereleases.com.

Airport Taser Tragedy Highlights Need to Bridge A Dangerous and Growing Language Divide

While the tragic tasering incident at Vancouver International Airport in October was no doubt the result of a combination of unfortunate circumstances, one element of the situation seems clear: communication, or more precisely miscommunication, played a role. Distraught and unable to speak to airport staff in English, Robert Dziekanski’s erratic actions were left to speak for him, with an ultimate and devastating effect. Today, the Vancouver Airport Authority has already introduced new tools to improve communication with people with limited English, including mobile access to translation services for airport patrons and guests, as well as new double handset telephones that connect to 24-hour customer care in more than 170 languages. With more than 176 languages spoken in North America, it is time for more public institutions, emergency services providers, and private businesses that want a wider audience to embrace language access programs to bridge a growing linguistic divide.

Providing translation and interpretation services in emergency situations must clearly be a priority. While the end results may not always be well-publicized, instances of miscommunication between limited English speakers and police, fire, rescue, and other first responders are all too frequent. To avoid future tragedy, language services must be provided when emergencies occur. Just as importantly, those that work on the front lines, including police, fire, and medical emergency officials, must be trained to use the services that are available. Finally, the public needs to be educated and involved, so that individuals facing critical situations know how to access help in any language.

Some community-based emergency communications centres have already instituted programs to communicate in multiple languages with limited English speakers. They hire more bilingual staff, and turn to professional language interpretation services, which can provide immediate verbal translation via the telephone in hundreds of languages. But when it comes to emergencies, when split-second decisions make all the difference, it is not enough just to have language access services on hand. What matters is that these services are understood, relied upon, and openly available to the public.

With language tools now readily available and identified, the Vancouver Airport is changing the way that communication will happen. In addition to access to language translation services, the airport is waging an effort to let passengers and guests know what options are available to them. Language identification cards will tell passengers in the 20 most requested languages that free interpretation services are available. Customer service representatives will carry brochure versions of these cards to distribute to passengers.

In the city of Toronto, public education has become a key component of available language access programs, and this effort should serve as a model for others. In 2004, a Cantonese-speaking grandmother in Toronto faced a terrible emergency when her young granddaughter began to drown in a backyard pool. Because she believed that 9-1-1 would not speak her language, she did not call, but instead went to a neighbour’s house for help. The result was devastating, and highlighted the need to let the public understand that Toronto’s emergency communications system did in fact have language interpretation services available. Toronto has pursued a comprehensive and successful public awareness campaign, developing multilingual posters with the message “9-1-1 = Emergency, Speak Your Language,” and targeting limited English speaking residents in their own neighbourhoods.

Encouraging these individuals to call 9-1-1 when they have a true emergency is the first step, and public awareness plays a vital role. But what happens when a call does come in, and it is clear that the emergency in question involves someone who does not speak English? At this point in the scenario, preparation and training are paramount.

Emergency call centre dispatchers must be trained to identify the language of the person in distress. If the caller does not speak English, then the dispatchers can use a “key phrase” chart to identify the language in question; they can also use pre-recorded phrases that can be provided by a telephone interpretation service. At this point, the dispatcher can turn to in-house bilingual staff or professional interpreters to communicate with the caller. If the emergency call is made by an English speaking caller, but involves someone who does not speak English, dispatchers must be trained to proceed accordingly. They must determine the language of the person in distress if possible, and should always alert first responders to the fact that interpretation services will be needed.

In an emergency or crisis situation, the importance of good communication can never be underestimated. As government officials, emergency experts and public personnel seek out ways to improve and solidify their communications processes; they should embrace language interpretation programs, and prioritize public awareness and professional training. Only then can we turn more potential tragedies into real success stories.

---Louis Provenzano is president and COO of Language Line Services. Language Line Services helps organizations worldwide quickly and efficiently meet the needs of their community’s growing numbers of limited English proficient residents ensuring service availability through critical events. The company delivers a dynamic suite of solutions, in more than 175 languages, including phone and video interpretation, document translation, interactive software-based translation, and interpreter training and certification programs. For more information about Language Line Services' suite of telephone and video interpreting services, document translation, and language testing and training programs, please call 1-877-886-3885 or visit www.languageline.com.