ANNALS OF MEDICINE Interpreters smooth the language of health-care BY BETH SCHWARTZAPFEL

Because she happens to speak Spanish, Minerva Rojas is often asked to interpret for patients with limited English proficiency at the Capitol Hill Health Center in Providence. In the past, Rojas would typically tell the doctor the gist of what the patient was saying, rather than translating every word, assuming that since she knew the patient well, she was getting the idea across. Patients would often speak with the experienced patient-services representative, rather than the doctor, confiding and saying things like, "don’t tell the doctor." Now, though, Rojas says, "I have to be invisible, to keep eye contact between the patient and the doctor."

Rojas was part of the first class to graduate from Neighborhood Health Plan of Rhode Island’s Su Salud medical-interpreter training program, one of 10 demonstration sites funded nationwide by the Robert Wood Johnson Foundation, with the goal of helping Latinos to overcome language barriers to health-care. Now, she says, her whole approach has changed. As Rojas puts it, "Just because I speak the language doesn’t necessarily mean I’m an interpreter."

People with limited English proficiency ("LEP" in industry-speak) face so many challenges in the health-care process — from scheduling appointments and communicating their complaints effectively to understanding providers’ instructions — that the ideal of an ongoing patient-provider dialogue about lifestyle choices and health-care decisions is simply not an option. This situation has implications not just for immigrant families, but also for the health-care system. At the Women & Infants Hospital’s neonatal intensive care unit, for instance, infants of Latino families with limited English proficiency stay, on average, one to three days longer than infants from families with a comfortable grasp of the language, according to Yvette Mendez, Su Salud’s project manager at Neighborhood Health Plan. Longer hospital stays not only cause more stress for infants and their families — they also cost more money. And in health-care, as in all other things, money talks. As such, in January 2002, the General Assembly passed a law requiring hospitals to provide interpretation services as a minimum requirement of continued licensure.

However, there are no uniform statewide credentials for interpreters, so medical interpreters at different hospitals may have different skills and responsibilities. Furthermore, while all licensed medical providers — physicians, nurse practitioners, technicians — have billing codes used by insurance companies for reimbursement, no such coding system exists for medical interpreters. And how could it? As it stands, there is no such thing as a bona fide "medical interpreter" — only a disparate group of individuals who, at a minimum, speak English, plus another language. And without billing codes, clinics and hospitals cannot be reimbursed for interpreters’ services.

The Su Salud program’s several components include two 48-hour medical interpreter training sessions for bilingual staff members from these local institutions: Women & Infants; Ocean State Action Fund; Rhode Island Hospital/Hasbro Children’s Hospital; St. Joseph’s Hospital; the Rhode Island Foundation; and Providence Community Health Centers. Like others among the first 30 graduates of the program, Rojas is in the process of receiving reimbursement codes, so that her agency may bill for her interpreting services. This is a three-year demonstration project, so Mendez hopes that the reimbursement codes and credentialing framework will provide a structure for other communities around the country to use in providing immigrants better access to health-care. Ultimately, Neighborhood Health Plan will select two instructors from local universities and train them to run medical-interpreter classes beyond the three-year funding cycle of the Su Salud program.

Rojas says a common question among new patients is, "Does the doctor speak my language? How is he going to understand me?" At least now, more patients and doctors will be one step closer to hablamos juntos — speaking together.