Will greed win over quality medical interpreting in the middle of a pandemic?

September 9, 2021 § 4 Comments

Dear colleagues:

On May 15, 2021 the Certification Commission for Healthcare Interpreters (CCHI) released a study suggesting that an English-to-English exam might solve the shortage of healthcare interpreters in what they call “languages of lesser diffusion,” meaning languages other than Spanish, Arabic or Mandarin. The reason for this “sui-generis” affirmation is very simple: developing actual interpretation exams to test candidates on simultaneous and consecutive interpreting, and sight translation in both: source and target languages would be too expensive and therefore not profitable. Interesting solution: examine candidates’ English language skills (reading comprehension, medical concepts, fill-in the blanks, and what they consider can show the candidate’s “potential correlation with overall interpreting ability”: “listening comprehension.”) An English only exam will catapult an individual into an E.R. to perform as an interpreter without ever testing on interpretation!

What about native English speakers, who in the study scored an average of 87.9% compared to non-native speakers, who scored an average of 76.6%? No problem, says CCHI; passing score is 60% and Spanish language interpreters will continue to take the interpretation exam already in existence. I suppose the expectation might be that people who speak other “languages of lesser diffusion” in the United States have a higher academic background and their English proficiency is higher. Another point that makes this “solution” attractive is that most interpreter encounters in hospitals, offices and emergency rooms involve Spanish speakers, which brings the possibility of lawsuits for interpreter malpractice to a low, manageable incidence. I would add that many people needing interpreting services will not even consider a lawsuit because of ignorance, fear or immigration status. The good news: CCHI concluded that although this English-to-English exam option “is a promising measure…(it)…requires additional revision and piloting prior to use for high-stakes testing.” (https://slator.com/can-a-monolingual-oral-exam-level-the-playing-field-for-certifying-us-interpreters/)

Reading of this report and the article on Slator got me thinking about the current status of healthcare interpreting in the Covid-19 pandemic. How long will the American healthcare system ignore that the country is everyday more diverse and in need of professional, well-prepared healthcare interpreters in all languages? The answer is difficult and easy at the same time.

A difficult answer.

It is difficult because we live in a reality where every day, American patients face a system with very few capable healthcare interpreters, most in a handful of language combinations, and practically all of them in large and middle-sized cities. The two healthcare certification programs have poor exams. One of them does not even test simultaneous interpreting, and the other tests a candidates’ simultaneous skills with two 2-minute-long vignettes (one in English and the other in the second language). Consecutive skills are also tested at a very basic level with four vignettes of twenty-four 35 or fewer-words “utterances” each. It is impossible to assess somebody interpreting skills with such an exam after just 40 hours of interpreter training. (https://cchicertification.org/uploads/CHI_Exam_Structure-Interface-2020.pdf).

Except for those interpreters with an academic background or prepared on their own because they care about the service they provide, the current system provides a warm body, or a face on a screen, not a healthcare interpreter. Because the motivation is a robust profit, it is conceived and designed to protect the interests of insurance companies, hospital shareholders, and language services agencies. It has been structured to project the false impression these entities are complying with the spirit of the law; It is not designed to protect the physician or the patient.  

In 1974 the United States Supreme Court ruled that failing to provide language support for someone with limited English proficiency is a form of discrimination on the basis of national origin (https://www.federalregister.gov/documents/2000/08/30/00-22140/title-vi-of-the-civil-rights-act-of-1964-policy-guidance-on-the-prohibition-against-national-origin).  The ruling was later broadened and implemented by the Americans with Disabilities Act (ADA) (https://www.ada.gov/effective-comm.htm) and the Affordable Care Act (ACA) commonly known as “Obamacare.” (https://www.hhs.gov/sites/default/files/1557-fs-lep-508.pdf) This legislation specify that healthcare organizations must offer qualified medical interpreters for patients of limited English proficiency and those who are deaf or hard of hearing.

An easy answer.

Despite the reality we face, the answer to the question above is easily attainable because the healthcare industry has immense financial resources and a system that lets them capture money at a scale no other industry can.

The healthcare sector deals with the lives and quality of living of all individuals present in the United States. Their reason to exist is to save lives, not to produce ever-growing dividends to its shareholders every year. This is an industry that spends unimaginable amounts of money in medical equipment, state-of-the-art technology, physicians, surgeons, nurses, therapists, researchers, attorneys, and managerial staff salaries. New expensive hospitals, medical office buildings, clinics, laboratories, and rehab centers are built all the time. This industry can spend top money in those sectors because it is good for business. It is an investment that produces a profit. I am not even scratching the surface of these expenses, but even if we ignore the money spent in food, gear, vehicles (land and air), utilities, clerical staff, janitorial staff, and medical aide positions, we can safely conclude this is an industry that knows how to spend money when an expense is viewed as an investment that will produce a financial benefit.

Designing good medical interpreter exams in many languages is expensive, paying professional-level fees to healthcare interpreters will cost money, managing a continuing education program will not be cheap, but the healthcare sector cannot cry poverty. They have the funds to do it. It is incomprehensible how a business that bankrupts its patients after one surgery or a chronic disease can argue with a straight face, they can only pay 30 to 50 dollars an hour to a medical interpreter. This is an industry that charges you fifty dollars for a plastic pitcher of water or twenty dollars for a box of tissue they replace every day.

Quality interpreting, and living up to the spirit of the law, cannot happen when an organization spends money to look for shortcuts such as testing English-to-English in an interpreting program. Only the promise of a professional income will attract the best minds to healthcare interpreting. Current conditions, including low pay, an agency-run system, and searching for shortcuts to go around the law will never produce quality interpreters.

If those deciding understand good professional healthcare interpreters are an investment as valuable as good physicians, surgeons and nurses, the solution can begin immediately. Designing and administering a quality interpretation exam will take time, getting colleges and universities to start interpreting programs that include medical interpreting will not be easy, but there are steps that can improve the level of interpreting services right away.   

A higher pay, comparable to that of conference interpreters will immediately attract top interpreters in all languages, at least temporarily or part-time to the field. Many top interpreters see the need for quality services during the pandemic, and they feel a need to help, but they have to make a living and healthcare interpreter fees do not meet the mark.

Instead of thinking of English-to-English exams to create an illusion they are forming interpreters, stakeholders should recruit native speakers of languages where interpreters are hard to find, but they must stop looking for “ad-hoc” interpreters in restaurant kitchens and hotel cleaning crews, and start talking to college students and professors, to scientists and physicians from those countries who now practice in the United States. With current technology, hospitals should look for their interpreters among the interpreter community in the country where a language is spoken and retain their services to interpret remotely, instead of opening massive call centers in developing countries, using the technology to generate a higher profit instead of better quality.  

Hospital Boards must find the money and allocate it to interpreting services. In these cases, such as Medicaid and others, the cost of interpreter services should be considered an operating expense. Insurers do not reimburse for nursing and ancillary staff. Hospitals and practices pay their salaries.

Payers may also benefit by covering interpreter services. Although data are limited according to the Journal of the American Medical Association Forum, studies suggest that when physicians struggle to communicate with patients, they are more likely to order unnecessary tests and treatments. This not only puts patients at increased risk, but also directly increases payer spending. Limited English proficiency patients may need care more frequently or seek treatment in more expensive settings, such as the emergency room, when they cannot communicate with primary care providers. Similar to insurers in fee-for-service arrangements, risk-bearing provider groups in alternative payment models face a similar incentive to curtail unnecessary or wasteful utilization. Poor interpreting services will also result in malpractice lawsuits against hospitals, language service providers, insurance companies and medical staff. In the long run, by far, this makes investing in quality interpreter services and interpreting education/certification programs a smaller expense. “Paying for interpreter services, from cost-based reimbursement, to their inclusion in prospective payment models, to insurer-led contracting of remote interpreters, would not only address the disparities exposed by the pandemic, but also help support practices facing financial peril due to the pandemic.” (https://jamanetwork.com/journals/jama-health-forum/fullarticle/2771859) It is time to grow up and stand up to the stakeholders in the healthcare sector; it is time to unmask the real intentions of language service providers who take advantage of often-poorly prepared interpreters to get a profit. It is time to have a serious healthcare interpreter certification exam that really tests the candidate’s interpreting skills. We need university and college programs, and a different recruitment system led by hospitals and insurance companies not multinational interpreting agencies, or ill-prepared small local players. Interpreters cannot be made in 40 hours and we can’t have newly trained interpreters learning at the cost of real patients’ safety. The pandemic showed us the importance of healthcare interpreting, let’s seize the opportunity to professionalize it.

Should healthcare interpreters in the U.S. be concerned?

April 9, 2018 § 36 Comments

Dear colleagues:

For several weeks I have been contacted by colleagues who provide their services as interpreters in the health sector of the United States. They have all expressed the same sense of confusion, anguish, anger, and uncertainty many of us have noticed in social media and professional forums on line.

This environment started after the decision by the National Board of Certification for Medical Interpreters (NBCMI) to not renew the accreditation of their Spanish language interpreter certification program by the National Commission for Certifying Agencies (NCCA) effective January 1, 2018, and it ballooned after the video of a speech during the California Healthcare Interpreters Association (CHIA) annual conference in Irvine, California in early March was uploaded to the web and watched by interpreters all over the world. Apparently, most interpreters were upset about four things: (1) The decision to terminate the NCCA accreditation; (2) That many learned of this decision by the NBCMI at this conference; (3) That the NBCMI authorities did not informed those candidates scheduled to take the certification exam that the exam they would be taking in 2018, although the same test taken by interpreters certified in the past, was being offered after the Board had quit their accreditation of their Spanish language interpreter certification program by the NCCA; and (4) That many did not like NBCMI’s decision to change the wording on their website portal to show in a casual way, hidden in the text, or at least not highlighted, that they had not renewed said accreditation, and the unofficial explanations and assurances by apparently some people associated with NBCMI that such change would not impact their certification.

I am a veteran of the profession, but like many of you, even though I have interpreted my share of medical events as a conference interpreter, I have never been a healthcare interpreter. Let me explain the healthcare interpreting scenario in the United States.

Healthcare interpreting is an essential part of the health sector in modern society, but despite this and the need to elevate this service to a professional level, healthcare interpreting had a later start than other community-based fields of interpreting like court interpreting.

The United States was no exception, until finally, a few years ago, two organizations took the lead towards the professionalization of the field. Embracing the basic principles and values of the certification program the National Council on Interpreting in Health Care (NCIHC) had written about, the Certification Commission on Healthcare Interpreters (CCHI) and the National Board of Certification for Medical Interpreters developed and implemented two interpreter certification programs. Both understood the overwhelming need to certify interpreters in the most widely spoken foreign languages in the United States, and they both developed a program for interpreter certification in Spanish (there are other languages now. Please visit their websites to learn about the languages covered by each program).

Unlike court interpreting, which developed certification programs sanctioned by the government at its different levels (federal, state, and initially sometimes local), the healthcare sector had no government authority sanctioning the validity of its certifications; and even though this brought healthcare interpreters a professional freedom enjoyed by other professionals like physicians and lawyers, and denied to court interpreters who have no control over the administration of their certification exams, it also created an uncertainty about the validity of their interpreter certification programs.

Because in a private sector-oriented society like the U.S., the situation healthcare interpreter certification programs were facing is not the exception, but the rule, there is a reputable trustworthy entity that solves this problem: The Institute for Credentialing Excellence (ICE).

The Institute for Credentialing Excellence, or ICE, is a professional membership association that provides education, networking, and other resources for organizations and individuals who work in and serve the credentialing industry. ICE is a leading developer of standards for certification and certificate programs and it is both, a provider of and a clearinghouse for information on trends in certification, test development and delivery, assessment-based certificate programs, and other information relevant to the credentialing community. ICE created the National Commission for Certifying Agencies (NCCA) in 1987.

The NCAA’s Standards for the Accreditation of Certification Programs, which were created in the mid-1970s, were the first standards developed by the credentialing industry for professional certification programs. The NCCA Standards were developed to help ensure the health, welfare, and safety of the public. They highlight the essential elements of a high-quality program.

The NCCA standards follow The Standards for Educational and Psychological Testing (AERA, APA, & NCME, 1999) and are applicable to all professions and industries. Certification organizations that submit their programs for accreditation are evaluated based on the process and products and not the content; therefore, the Standards are applicable to all professions and industries. Program content validity is demonstrated with a comprehensive job analysis conducted and analyzed by experts, with data gathered from stakeholders in the occupation or industry.

NCCA accredited programs certify individuals in a wide range of professions and occupations including nurses, automotive professionals, respiratory therapists, counselors, emergency technicians, crane operators and more. To date, NCCA has accredited approximately 330 programs from over 130 organizations.

Accreditation for professional or personnel certification programs provides impartial, third-party validation that your program has met recognized national and international credentialing industry standards for development, implementation, and maintenance of certification programs. This solved the problem for both programs and two certification programs were born:

The Certified Healthcare Interpreter credential (CHI) developed by the Certification Commission on Healthcare Interpreters (CCHI) that offers a certification exam in Spanish, Arabic and Mandarin in 2 steps: First, a core exam consisting of 100 multiple-choice questions, to be answered in English, on medical terminology, healthcare scenarios and ethics; and to those who pass the core exam, an interpreting exam that tests the candidate’s skill on sight and written translation, and simultaneous and consecutive interpreting.

The Medical Interpreter credential (CMI) developed by the National Board of Certification for Medical Interpreters (NBCMI) that offers a certification exam in Spanish, Russian, Mandarin, Cantonese, Korean, and Vietnamese to those who pass (with a score of 70 percent, 80 percent in Mandarin) an interpreting exam that tests skills on sight translation and consecutive interpreting (no simultaneous interpreting or written translation).

Besides competing for interpreter candidates in the same market, both programs needed to convince healthcare providers, insurance companies, patients, and attorneys, that their credentials were reliable, trustworthy, and standard. They started an intensive and successful education campaign that used the NCCA accreditation as one of its most valuable resources.

Even today, CCHI’s website proclaims the validity of its program and skill of its certified healthcare interpreters:

“…Just as healthcare interpreters work hard to get credentialed as “certified healthcare interpreters,” certification programs can also “get certified!” The process is called “accreditation” and, today, it is administered by the National Commission for Certifying Agencies (NCCA), the accreditation arm of the Institute for Credentialing Excellence (ICE). Accreditation is the process by which a credentialing or educational program is evaluated against defined standards by a third party and is awarded recognition when found in compliance with these standards. It’s more than just a voluntary membership in an association. Accreditation (and renewal of accreditation) involves a rigorous process that ensures the quality of examinations and certification offered by organizations like CCHI. In fact, NCCA accredited programs certify individuals in a wide range of professions and occupations, including nurses, pharmacists, counselors, EMTs, HR professionals, defense security specialists, and more. CCHI is proud to represent the healthcare interpreter profession as equal among other allied health professions…today, CCHI is proud to offer the only nationally accredited certifications in the interpreting industry. NCCA’s accreditation validates all aspects of CCHI’s certification programs and CCHI as a certifying body…”

To this day NCCA accreditation continues to be a crucial element of the CCHI program.

Apparently, the National Board of Certification for Medical Interpreters (NBCMI) disagrees with this principle, and even though their website lacks detailed explanations or reasons for the decision not to renew accreditation; some colleagues claim they have unofficially argued that continuing NCCA accreditation is unnecessary because their program is now well-established, the accreditation only covered the Spanish certification program, and their exams have not changed from the ones offered during the accreditation era. Several interpreters have indicated that NBCMI claims that a renewal was too expensive; that they had spent fifty thousand dollars on the initial accreditation, and that their Board had directed those financial resources to the development and administration of certification exams in other languages; activity that would be more profitable.

On its official website, NBCMI addresses its decision to end NCCA accreditation:

“…Prior to 2018, the Spanish CMI certificate was subjected to an additional level of NCCA accreditation, but while the National Board remains a member of the Institute of Credentialing Excellence (ICE), each of the National Board programs have been standardized to ensure the CMI certification in each offered language best meets or exceeds nationally accepted standards, including transparency, inclusion, and access…”

It mentions they continue to be members of the Institute for Credentialing Excellence (ICE), the parent entity of NCCA, and adds a self-serving statement where they praise their own CMI certification. They emphasize their continued ICE membership adding this statement to their official website:

“…As a proud member of ICE, we stay informed on best practices in developing and administering quality certification [certificate] programs so that we may better serve you…” 

This could be a simple statement of facts, but unfortunately, it could also be misunderstood by some who may think that continued ICE membership affects their CMI program after January 1, 2018.

ICE clearly tells us what membership means:

“…An organization may join ICE at any time whether or not it has any programs accredited by the National Commission for Certifying Agencies (NCCA).  Membership in ICE does not mean that an organization or any of its credentialing programs have been accredited, approved, or otherwise endorsed by ICE…”

Membership in ICE does not mean that an organization or any of its credentialing programs have been accredited, approved, or otherwise endorsed by ICE. We can see this means more than no more accreditation. According to ICE itself, membership means no approval or any other endorsements.

As I write this post, my only goal is for NBCMI to published a written detailed explanation of the reasons they abandoned the NCCA accreditation, the potential consequences this decision can bring to certified medical interpreters, and why candidates scheduled to take the exam in 2018 were not informed of this important change so they could decide to either pursue the CMI certification or perhaps take the CHI exam instead. Spanish language CMI interpreters have a right to know why a certification exam after the NCCA accreditation ended has the same cost as the one offered when the accreditation was in place. How does a business decision to add more languages to the certification program benefit the Spanish language CMIs whose credentialing program lost NCCA accreditation? So far, NBCMI has limited its answer to a statement posted on their newsletter that repeats what they previously said about the validity of the exam and CMI certification, but the explanation of the reasons to discontinue the accreditation have not been disclosed. Dismissing social media as myths and misinformation does not answer the questions so many interpreters want answered.

Some changes have already been impacting those who hold a CMI certification: Some institutions stopped reimbursing the certification exam fee to certification candidates taking the exam in 2018. It has been reported that some clients are now preferring those interpreters holding a CHI certification over a CMI credential; and, a good possibility is that in the future, CMI credentials will be questioned and tested by attorneys who will cross-examine NBCMI certified medical interpreters in the presence of a jury during a medical malpractice trial.

NBCMI needs to explain why NCCA accreditation went from being something they were proud of a few years ago to something no longer needed:

“…The National Board of Certification for Medical Interpreters (NBCMI) is pleased to announce that its Certified Medical Interpreter (CMI) program has been accredited by the National Commission for Certifying Agencies (NCCA), thus joining an elite group of certifying bodies dedicated to public protection and excellence in certification… NCCA accreditation was one of the objectives the National Board set for itself at the very outset…” (NBCMI press release dated January 18, 2013 at Miami Beach Convention Center)

These are valid questions we hope NBCMI will officially address, and they are all legitimate reasons in a free market economy like the United States’ for any interpreter working on the healthcare sector to think very carefully about which one of the two certifications she or he should hold. Let’s hope that at the end of all the confusion and uncertainty the answer is either one of the certifications, but as of today, we do not know if that will be the case, even if both certifications were equally recognized, because one continues to have an accredited certification program and the other one does not. Many of our colleagues would like to know the reason for the changes that both, NBCMI and its parent organization IMIA experienced just now: a new president for NBCMI (we wish her well) and the resignation of IMIA’s president-elect before he officially took office. Interpreters want to know if these changes at this confusing times are related to the decision to end accreditation, or it is just a coincidence.

I now invite you to share your thoughts on this issue, and please, do not write personal attacks, and unless you are officially commenting on behalf of NBCMI, please abstain from sending surrogate comments defending the Board.

U.S. Immigration Court interpreters’ other enemy.

October 18, 2016 § 4 Comments

Dear Colleagues:

About two months ago the California immigration court interpreters started a movement to force the hand of SOSi and the EOIR with the goal of achieving better work conditions, a professional pay for the services rendered, and to keep the authorities from hiring new interpreters and interpretation students for a lower fee.  This entry will not deal with the merits or the outcome of such movement. We will talk about the elephant in the room: the big obstacle to the professionalization of the interpreting services in American immigration courts that can be changed by the interpreters themselves.

I know that this blog entry will make some uncomfortable, and I do not like to do that. Unfortunately, my life-long effort to fight for the professionalization of interpreting does not allow me to keep silent. To me, that would be equivalent to betraying my own professional standards. I write this piece with respect and with no desire to offend, knowing that by the time some of you finish reading this article, you will feel offended. I only ask you to reflect on what bothered you, and honestly acknowledge, at least to yourself, that you are not really up to save the profession (as a true profession, not as a laborer’s occupation) in the immigration court arena.

For several years now, there has been a tendency to credentialize interpreters who provide services to the public, who perform a fiduciary function.  Because of the wide variety of languages regularly spoken in the United States, and due to the millions of people who do not speak English at all, or at least good enough to go through a legal or medical process, most efforts have been applied to the certification of Spanish interpreters, by far the most popular foreign language nationwide, and finding other solutions for the other languages.

Court interpreters had an early start and developed the federal Spanish court interpreter certification exam. Many States followed and the States’ Consortium for State Court Interpreter Certification was born, later taking us to the current Language Access Advisory Committee (LAAC) and Council of Language Access Coordinators (CLAC).

Healthcare interpreters followed suit and developed two different interpreter certification programs (the Certification Commission for Healthcare Interpreters: CCHI, and the National Board of Certification for Medical Interpreters’ CMI program) both of them widely spread and recognized throughout the United States. Granted, the term “medical interpreter” to describe the functions of these professionals is less accurate that “healthcare interpreter”, and compared to the court interpreter certification federal and state-level exams, both healthcare certifications are way behind in content and degree of difficulty; but unlike court interpreter certification programs, healthcare interpreters have achieved something extremely valuable that court interpreters can only dream of: an examination administered by an independent entity, just like lawyers and physicians, instead of the uncomfortable government-run court interpreter programs that always raise the issue of the real conflict of interests when the entity certifying interpreters is the same one who hires them.

At any rate, healthcare interpreters in the United States now have a way to prove that they are minimally qualified to do their job, that they adhere to a code of ethics, and that they comply with continuing education requirements that will keep them current in language, interpreting, terminology, and medical issues. In other words, healthcare interpreters sitting at the table with court interpreters can now bring up their credential and feel at the same professional level than their legal colleagues, instead of having to give a speech about how certifications do not mean a thing, that it is working in the trenches that makes you a good interpreter, and that your field is so unique that no existing certification exam could test what is needed to work in that field.

Well, dear friends and colleagues, this takes me straight to a very real, and somewhat uncomfortable problem, faced everyday by immigration court interpreters in the United Stets: They have no certification program requirement to work in court, and for that reason, there is no way to prove a certain minimum level, thus allowing bad interpreters to work in the immigration court system for years.

Court interpreting is a highly skilled occupation that requires of a professional provider. By its nature, it is also a fiduciary function where a judge, attorneys, respondents and witnesses must trust the knowledge and skill of the interpreter who will speak throughout the proceedings while at least half of those present will not understand a word of what was said. It is an awesome responsibility that cannot be left to the paraprofessional or the untested.

Presently, all Article Three courts in the United States, at all levels (federal and state) have a Spanish language court interpreter certification program that includes minimum requirements to take the exam, passing a comprehensive and difficult test (at least at the federal level), observing a code of ethics, and (with the exception of the federal program) complying with continuing education in the legal, interpreting, and language fields to be able to keep the certification. These courts are part of the Judiciary Branch of government.

Immigration Courts are not a part of the Judiciary. They are in the Executive Branch of government and are referred to as Article One courts because of their legal basis in the U.S. Constitution. The thing is, my colleagues, these courts deal with societal, family, and personal values and interests as important as those heard by Article Three judges. They are courts of law that abide by a set of substantive and adjective laws.  For practical reasons, they operate just like any judicial court: there is a judge, there are parties (one of them will be the government just like in criminal law), there are witnesses, and there are attorneys.  Although the controversies are different, immigration proceedings also include a first appearance, motions hearings, a court trial, and a verdict. There is a burden of proof, rules of evidence and procedure, and the possibility of an appeal to a higher court (Board of Immigration Appeals). The fact that the terminology calls these hearings “master calendar”, “bond redetermination”, “credible fear”, or “individual hearing” does not make much difference.   The cases are as different from those interpreted in an Article Three courtroom, as a criminal case differs from a civil or a family law proceeding.

The skills required to interpret are the same as in any other type of court proceeding: There is a need for simultaneous and consecutive interpreting, as well as sight translation. Interpreters use equipment just the same (in fact, in many cases even the same brand), and the expected ethical and professional conduct of the interpreter is the same.

It is a fact that immigration court interpreters are disrespected by their client: the EOIR on a daily basis. There is no denial that they make little money, work long hours, and they do it solo, regardless of the complexity or duration of a hearing. It is also well-known that they are treated in humiliating fashion by being forced to jump through many administrative hoops that no other court interpreter will ever face, in part because they are subcontracted by a multinational agency that tries to keep control over the interpreters without physically being at the courthouse, but also in part because interpreters are not considered professionals, they are not acknowledged as officers of the court.

I firmly believe that the only way to earn the credibility they need so much, Spanish language (for now, and ideally all widely used language combinations later) immigration court interpreters in the United States must demand a court interpreter certification requirement to be able to work.  They need it for their credibility among their peers and with the public opinion.  Once they have a credential, together with a code of ethics and continuing education requirements, they will be in a much better position to negotiate with anybody.

Because immigration court is a federal matter, and the services provided by the interpreter are the same as the ones in all federal courts, I think that the certification they need to have is the already existing FCICE. It would be very simple, all they need to do is convince the EOIR of this need. The exam already exists, all these interpreters would need to do is register and take the test. Then, if both, EOIR and the immigration interpreter community think it is appropriate, there could be a short immigration terminology exam (although I don’t think it necessary just like current certified court interpreters do not need to test every time they interpret a different kind of hearing. Part of an interpreter’s duty is to get ready for an assignment and that professional obligation should be enough).  This would be the best way to demonstrate that their simultaneous, consecutive, and sight skills are at a minimum level to deserve that trust we discussed above. In fact, by getting EOIR to agree, immigration interpreters would have until the Summer of 2018 to take and pass the written portion of the federal exam, and then until the Summer of 2019 to take and pass the oral test. In the meantime, it could be agreed that those currently working would continue to do so until the Summer of 2018.

This solution would immediate put immigration court interpreters at the same negotiating level as their Article Three federal counterparts; In fact, it would benefit everyone: Currently federally certified Spanish court interpreters would consider working in immigration court as the pay would be the same (or almost), and newly federally certified immigration court interpreters would have the opportunity to broaden their professional horizons and work in federal courts.

Of course, this means that two things must happen: First, the certification exam cannot be a “Mickey Mouse test” like the ones offered to immigration court interpreters by multinational agency contractors; they have no scientific value and a very poor reputation. And second, immigration court interpreters need to understand that those who do not pass the exam must go, regardless of the time they have been a fixture at the immigration courthouse. Any other “solution” would defeat the purpose and discredit the credential. This, my friends, is the “other” enemy of the U.S. immigration interpreter: the bad interpreter who has never been able to pass a court certification exam, knows that they never will, and spend all their time and energy trying to convince others that certifications are worthless, exams are rigged, and that the only way to learn the profession in in the courtroom.  These people have to go away. They are like a cancer that is slowing down the progress of the rest of their colleagues.

To argue “unity” to protect and keep these individuals is misleading. Professional unity can only happen among professionals, and the individuals I just described above may be paraprofessionals but they are definitely not professional material. Imagine for one moment going to the hospital for emergency surgery and being told that the person who will operate on you has never taken or passed the Board, but has a lot of experience. Would you let this non-doctor cut you open?

I understand it is very hard to set aside our emotions and empathy for these individuals, but it is time to think of yourselves, your families and your peers. Unless you want to continue to struggle as an immigration court interpreter, you have to get certified. A decision to dodge the certification issue, or to settle for a lower standard of certification, because someone who cannot pass the test convinced you to support other options, will be a vote for the status quo, sacrificing the good ones to protect those who do not deserve to be there.

Is it medical interpreter, or healthcare interpreter?

June 26, 2014 § 5 Comments

Dear colleagues:

I have struggled with the issue of how to refer to a growing number of our colleagues whose work mainly takes place in hospitals, clinics, or medical and dental offices. Their primary function is to enable communication between a person who does not speak the language of the land and a healthcare provider: physician, dentist, nurse, psychologist, paramedic, and other support staff. As you all know, this area of interpretation has been around for some time, but it has just become formally regulated in the recent past. Because of globalization and its migration consequences, now many countries experience the need to have somebody to bridge the gap of communication that has developed between native speakers and immigrant communities. These developments have augmented the need for court interpreters, legal translators, school interpreters and many others; the healthcare field has not been an exception; in fact, this is the area where we can appreciate the most dramatic changes to the old “business as usual” format. Unlike other interpreting specialties, like conference, military and court interpreting, which have been around for a long time, these new service providers just organized a few years ago. Great efforts and devotion on the part of some individuals have produced important results like the creation of professional associations, the adoption of ethical and professional responsibility canons, and the development of certification programs and examinations. This is truly admirable.

There are two organizations in the United States that have emerged as standard-bearers of this profession: The International Medical Interpreters Association (IMIA) which endorses the National Board of Certification for Medical Interpreters exam, and the Certification Commission of Healthcare Interpreters (CCHI).

Keeping in mind the services provided by these professionals (based on the organizations’ websites, several hospitals’ information, and conversations with many of my esteemed colleagues) I reviewed all information I could find on the two certification exams that test English, professional conduct and ethics. To a lesser degree they test some medical-related vocabulary that a true bilingual individual should know, without any medical or pharmacological terminology studies, and they include very short paragraphs, or vignettes as one of the test refers to them, where patient and healthcare provider communicate regarding the symptoms that the non-native speaker is experiencing. The dialogue is an everyday conversation at a moderate to low register. Finally, I also noticed that the main part of the score overwhelmingly goes to the consecutive interpretation, leaving simultaneous and sight translation at about 10 to 15 percent each.

I am convinced that the work these colleagues do is essential to the healthcare industry and well-being of those individuals who otherwise would see their chances of receiving appropriate services diminished by reason of the language they speak. Nobody is disputing this. I also applaud the conditions under which they constantly work in hospitals, emergency rooms, and urgent care facilities where people perform under great stress. The writing of this post was simply motivated by my need to find a term I can feel comfortable with when referring to my colleagues, but before I am ready to form an opinion I should also consider what the rest of the world is doing and saying on this issue.

In Europe the services performed by our medical interpreters are part of what is known as public service interpreting or community interpreting in some countries. This public service interpreting also covers legal interpreting but not court interpreting as I will explain in a moment.

Public service interpreting refers to those services provided by an interpreter to help two individuals who speak different languages so they can communicate regarding everyday affairs, personal issues, including important topics, in cases when individuals who speak the same language would usually speak for themselves, but in this particular situation, because of the language difference, and cultural considerations, an interpreter is needed.

My dear friends and colleagues, conference interpreters provide their services to make it possible for individuals who do not speak the same language to communicate, by interpreting almost exclusively on the simultaneous mode, complex information at a high register. Their audience is usually formally educated. Court interpreters provide their services in cases when one or more individuals do not speak the language employed in court, to make it possible for officers of the court, litigants, jurors, and others, to communicate on the simultaneous, consecutive, whispered, and sight translation modes, everyday information, complex legal concepts and terminology, and expert witness testimony, at a variety of register levels.

Now I ask you to contrast these job descriptions with the job that public service interpreters such as school interpreters, welfare services interpreters, church interpreters, and community organization interpreters do. These professionals (and sometimes paraprofessionals that may include a family member) provide their services so that individuals who do not share the same language can communicate about important everyday matters such as parent-teacher conferences, services provided by religious organizations, and dealings with government agencies at the customer service window or over the phone. This work is almost exclusively performed on the consecutive mode, unlike court interpreting, and there are no formal rules to keep the interpreter from asking questions and give explanations to facilitate the communication. The main objective is to bridge the language gap without any consideration for rules of evidence or procedure. These interpreters can interrupt the parties and ask them to speak slower or in shorter sentences. While conference and court interpreters work with complicated and sometimes rarely used words as part of their everyday job, public service interpreters work with common vocabulary; not simple words, but words that anyone with a certain level of formal education, regardless of any interpreting training, should know.

This explains why we occasionally see conference interpreters in the courtroom and court interpreters in the booth. It also explains why conference interpreters, and not medical interpreters, interpret medical and pharmaceutical conferences; and why court interpreters, not medical interpreters, interpret the expert testimony of a pathologist or other medical professional during a trial.

I mentioned earlier that there was a difference between court and legal interpreters in many countries, and why the latter are considered public sector interpreters: A court interpreter provides her services in a formal court setting and during out of court events that are related to a current or future court or legal proceeding. A legal interpreter assists an individual who needs help with his dealings with the authority, such as getting a driver’s license, applying for government benefits, or requesting government documents. These interpreters are clearly outside the scope of the very strict canons of ethics and professional responsibility that govern the activity of court interpreters. Just as we may encounter a conference interpreter in court or a court interpreter in the booth, we may find a school interpreter or a medical interpreter in a government agency assisting a foreign language speaker with some excruciating government administrative process. I hope the example clarifies the issue, but I also ask you to look at this very carefully, because there are some who would like to assimilate the services provided by a court interpreter outside a courtroom to those of a public service or community interpreter; they would argue that these services are “legal” and not court services. They are wrong.

They are wrong because the terminology of legal versus court interpreter that was valid in the past does not apply to our globalized world. When most countries had a written legal system there was very little work for a court interpreter. In those days legal translators did most of the court work because everything was done in writing. Legal interpreters were then relegated to in-office interviews and customer service windows. If you consider that migration was less popular than it is now, then you would have a very low demand for court or even legal interpreters. Lack of migration did not impact legal translators who had to translate official documents, contracts, deeds, and many other written statements that originated within the other country. At the time the legal interpreter was really a community or public service interpreter. That reality is so different from ours. Presently, an interpreter who works before an administrative law judge, such as an immigration court, workers’ compensation court, or social security court, is subject to the same ethical and professional rules as the court interpreter who appears before a traditional court. The fact that some jurisdictions allow for non-certified or licensed interpreters to provide their services in administrative law courts does not mean that community interpreters should do the job. These courts still abide by rules of evidence and procedure, the interpreter has to act as if working before the traditional judiciary, the job must be done at a higher register, with specialized complex legal terminology, and on a simultaneous interpreting mode that does not allow to stop the procedure so the interpreter can request the litigants to slow down, or a consecutive rendition where the interpreter cannot ask the parties to speak in shorter sentences. The same can be said for civil depositions, jailhouse visits, and the transcription of wiretaps. On the other hand, those individuals who are appearing before the motor vehicle office are better off employing the services of a community interpreter because this professional knows more about handling situations where the interpreter has the freedom to step outside the box to achieve communication between the parties.

After considering all of these concepts and possible scenarios, and after reviewing the materials I have mentioned before, I understand that there are arguments to be made for the term medical interpreter, but I just do not believe that in my book that would be accurate. I think that the appropriate and accurate way to describe this very important segment of our profession is the one adopted by the Certification Commission of Healthcare Interpreters (CCHI). For this reason, I believe that we should call our colleagues Healthcare Interpreters instead of Medical Interpreters. Please let us all know your comments on this issue that to some may seem irrelevant, but is actually very important.

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