Best Practices

  • Best practices are hiring a professional qualified interpreter or other accommodation service. Qualified ASL Interpreters are professionals trained in language and cultural competency, national certified, guided by a professional code of conduct outlining items such as ethics and confidentiality. Interpreters are there to act as the communication bridge between parties, this also includes Deaf specialists known as CDI’s.
  • Bilingual minors, adult family members, friends and staff prohibited from interpreting. An LEP patient’s child or any accompanying minor or adult cannot be relied on as a medical interpreter. The exception to the rule is when a medical emergency poses imminent threat to the patient or public and an interpreter is not readily available. The second exception is if the patient specifically requests the adult family or friend to be present. In this circumstance, the health care provider is not off the hook legally. An interpreter still needs to be provided.
  • If a family member can interpret, why aren’t they considered “competent?” Qualified interpreters are not only responsible for converting word-for-word conversations, they are also highly aware of specific cultural differences, including circumstances in which an LEP person may not understand a literal interpretation. For instance, in English the phrase, “an arm and a leg” is used to reference the cost associated with a product or service. However, to someone with limited English proficiency, such phrases may seem barbaric, threatening or aggressive. Interpreters are trained mediums that facilitate conversation. Although they’re present (in person or by video), they are not part of the conversation. Inserting oneself into the conversation as an interpreter can confuse the LEP patient and potentially put his/her health at risk. Most importantly, qualified interpreters are educated in the Health Information Portability and Accountability Act (HIPAA). A non-qualified person who is not aware of HIPAA provisions may accidentally put the privacy of the patient and the credibility of the health provider in legal jeopardy. Generally, no. Family members often do not possess sufficient sign language skills to effectively interpret in a medical setting. Even if they are skilled enough in sign language to communicate, family members and friends are very often too emotionally or personally involved to interpret “effectively, accurately, and impartially.” Finally, using family members and friends as interpreters can cause problems in maintaining patient confidentiality. Problems with using a friend or family member could be one or more of the following: objectivity, skill level, confidentiality, liability.
  • A bilingual staff member may be used if and only if he/she is formally trained. Oral interpretation must be included in such person’s job description and duties.
  • Competent Vs. Qualified Interpreters In the past, federal requirements only mention the use of “competent” linguists in hospitals and clinics, but the Affordable Care Act takes the guideline a step further. Section 1557 of the bill requires that federally funded healthcare organizations hire “qualified” interpreters. The important thing here is that the law provides standards hospitals and clinics can refer to when gauging the qualifications of medical interpreters. Under Section 1557, a “qualified” interpreter is someone who:
  • Abides by interpreter ethics and confidentiality
  • Has proficiency in English and at least one other spoken language
  • Has the ability to effectively and accurately use the necessary terminology required by a certain interpreting situation

The ACA also makes the  distinction between untrained and qualified bilingual medical staff. Too often, healthcare professionals are called on to interpret because they speak more than one language, but their bilingual abilities are usually subpar compared to professional linguists.

According to the law, a “qualified” bilingual staff member is someone who has:

  • Demonstrated a proficiency in speaking English and at least one other language and has a knowledge of the necessary terminology the situation requires
  • Is able to effectively and accurately communicate with LEP patients in their primary language(s)​

Using under-trained or unqualified medical staff has been shown to cause poor patient outcomes for LEP (Limited English Proficiency) individuals. But these doctors and nurses are still too often utilized when interpretation services are needed.

  • Title III of the ADA applies to all private health care providers, regardless of the size of the office or the number of employees. It applies to providers of both physical and mental health care. Hospitals, nursing homes, psychiatric and psychological services, offices of private physicians, dentists, health maintenance organizations and health clinics.
  • Places include retail stores, hotels, theaters, restaurants, doctors’ and lawyers offices, optometrists, dentists, banks, insurance agencies, museums, parks, libraries, day care centers, recreational programs, social services agencies, all types of state and local government agencies, and private schools. Also, both profit and non-profit organizations. All must give persons with disabilities an equal opportunity to participate in and to benefit from their services.
  • Who is responsible for the cost of an interpreter and/or auxiliary aids and services?

Businesses, agencies and other public facilities are required to provide accessibility for specified disabilities and for Deaf clients. This means they are being provided access to communication. Thus, the cost falls upon those who are providing the accommodations. The use of qualified sign language interpreters is a convenient, cost-effective way to provide such access. A surcharge cannot legally be imposed on an individual with a disability directly or indirectly to offset the cost of the interpreter. The cost of the interpreter should be treated as part of overhead expenses for accounting and tax purposes. The doctor may not charge the patient for the cost of interpreter service, either directly or by billing the patient’s insurance carrier: A public accommodation may not impose a surcharge on a particular individual with a disability or any group of individuals with disabilities to cover the costs of measures, such as the provision of auxiliary aids, barrier removal…and reasonable modifications… that are required to provide that individual or group with the nondiscriminatory treatment required by the Act or this part.

  • Must a health care provider pay for an auxiliary aid or service for a medical appointment if the cost of that aid or service exceeds the provider’s charge for the appointment?

All healthcare providers are expected to treat the cost of providing auxiliary aids and services as a part of the annual overhead costs of operating a business. Interpreting services should be budgeted as part of your annual planning for accessibility services. It is true that on a per-encounter basis, you may pay more for interpreting services than you generate in revenue for your company. However, if you consider the cost over the course of a year as an overhead cost of doing business, providing accessible services is quite reasonable.

  • Who is responsible for providing the interpreter? And Who should request for the sign language interpreter?

The Deaf consumer is not responsible to place a service request, but the entity (paying party) is. All places should have predetermined protocols and trained staff members to ensure they know how to obtain interpreter services and other communication aids and services when needed by persons who are Deaf or Hard of Hearing. The public entity, no matter whether they are a profit or non-profit organization. This especially holds true for any public entity who receives any kind of federal funding (including Medicare/Medicaid).

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  • 508-699-1477 (voice); answering service supports non-business hours sending messages to on call staff
  • 508-809-4894 (videophone) for ASL users