"Language Access - A Matter of Equity and Fairness"

Good afternoon everyone, and thank you, Izabel Arocha and the IMIA.

It is a pleasure and an honor to be here with you all once again – and once again to discuss how we can work together to make medical interpretation accessible and available for all who need it.  Dr. Peter, Dr. Joe thank you for your important perspective and for sharing with us today.

It is an honor to be sharing this stage with you today.

Of course, as the title of this year’s conference suggests, the question of whether or not a patient has access to language services is really, at its root, a question of whether that patient has equal access to health services.  

Ultimately, in the medical setting, language access is a matter of equity.  It is a matter of fairness. And in many cases, it is a matter of life and death. 

You know, it’s fitting that we are all here to engage in a dialogue today and this weekend.  It is fitting that we are going to be doing a good amount of talking. 

It is fitting that there are speeches, panels, workshops and more. And hopefully, after we are done talking with each other, we will leave here and find more willing listeners -- so that we can talk to them, and tell them just how important the work of medical interpretation is.

Through our dialogue, through our discussion, we are illustrating an essential truth, which is -- despite the old expression, talk is not cheap.

Our talk here this weekend is designed to achieve real results. It is designed to affirm the direction of our advocacy, to give voice to our common goals, and to organize our ideas and our ideals. 

That is valuable talk.

Similarly, when it comes to good communication in the medical arena, words have a real value, as all of us who have made language our vocation know very well.

But most Americans would have difficulty assigning a monetary value to words. 

After all, speech is free, cost-free talk radio is available 24/7, and this time of year, political promises are everywhere. 

However, in reality, the words we use, and the bridge that interpretation provides, can be worth as much as an MRI image, a cast on a patient’s broken arm or, very appropriately, a hearing aid for those with hearing impairment.

The big difference is: insurance will cover the cost of the MRI, the cast, and even the hearing aid.  But insurance does not recognize the monetary value of words, and the intrinsic importance of life-saving communication.

And so, when we talk about addressing the disparities that exist in the delivery of health care, we need to start with the obvious financial disparities that devalue the importance of language. 

We need to start by convincing policy makers, insurers, and health care providers that words do matter, and that talk has value. 

We need a nationwide recognition that medical interpretation must be a reimbursable expense and treated as a healthcare necessity.

The problem is that while the legal requirement for language assistance exists in publicly-funded medical settings, the funding generally does not. 

In essence, access to language assistance for non-English speakers is an unfunded federal mandate in many situations.

Physicians know that good communication with patients can save lives.  Administrators know that it can also save health care dollars, by encouraging the right course of treatment in a timely fashion; by targeting the correct diagnosis; by alleviating busy emergency departments; by facilitating preventive treatments. 

If so many key health care stakeholders know the value of clear communication, then why is that knowledge not backed up with financial support? 

Why does good communication not seem to matter as much in cases where LEP patients are involved?

Perhaps the reason is as simple as the unspoken bias that I mentioned – the one that says that talk is cheap, and speech should be free. 

More likely, it stems from the complicated reality that drives cost-cutting in the medical setting.  It stems from an overall approach to health care financing that seeks a quick fix to skyrocketing expenses. 

It stems from a health care system that sometimes prioritizes the task of managing care over the task of providing it.  And of course, it stems from all of the political strife that the issue of immigration can stir.

In order to make medical interpretation more available, we must address the funding issue.  And so we must ask and answer the question: who will pay for interpretation? 

I believe that the only way to find a clear answer to that question is to demonstrate, over and over again, that interpretation is a life-saving and cost-saving medical tool that must be used consistently by experienced and trained experts. 

We need to illustrate the incredible and unique skills that interpreters have and we need to demonstrate our own commitment to standards.  

And then we need to showcase the real and very human importance of applying those skills and standards.

We need to say to providers and the general public: imagine arriving at a hospital with shooting pain in your abdomen, but being unable to tell physicians and nurses what you are experiencing, or how it relates to your personal medical history.

Even worse, imagine trying to explain your symptoms, but having your description completely misinterpreted, leading to the wrong treatment.

We need to ask: How much would you be willing to pay for the right words in this situation?   

As we know, unfortunately for those with limited English skills, this nightmare scenario is all too real.  And these difficult stories need to be told.

Take the high-profile case of William Ramirez.  Many of you may be familiar with this case, but many outside this room have not heard about this preventable tragedy, when twenty years ago, paramedics in Miami defined Ramirez’s word “intoxicado” as “high on drugs” instead of “nauseous.” 

His care was delayed as a result of a series of related emergency room miscommunications, and now a quadriplegic, he has been awarded a $71 million malpractice settlement. 

$71 million!

There are lots of other similar cases, all equally tragic. Especially when you consider that many incidents of miscommunication in hospitals, emergency rooms and doctor’s offices could be avoided if state and federal health agencies, along with private insurers, were willing to pay for trained medical interpreters to be available for those with limited English skills. 

Certainly the argument for Medicare, Medicaid and private insurance coverage of language interpretation is very similar to the argument for coverage for preventive care. 

Being able to communicate with medical providers is really the first rule of preventive care.

Language assistance, like preventive care, saves money and lives in the long run.

We know that some states already recognize their responsibility to pay for language access, along with the simple moral responsibility that exists to provide equal access to health services. 

In New York, for instance, the Legislature in 2007 included a $38 million allocation for hospital services and a reasonable accommodation for all Medicaid patients that need language assistance when seeking care in non-public hospitals in New York City. 

But because reimbursement for language assistance is still inadequate, and its availability is far from uniform, there is much work to be done.

At Language Line Services, we employ more than 5,000 interpreters world-wide, with many of them trained and tested to provide quality interpreting for healthcare customers. 

We hire on average 60 interpreters per week and by 2010 we will have almost 10,000 interpreters around the world.

Our interpreters speak more than 170 languages.  We certify through Language Line University in 22 languages and our list continues to grow.  

We also provide training and other educational resources to hospitals’ internal language access staff and have long promoted the importance of clear standards to strengthen the value and effectiveness of interpretation.

But for all of the numbers and statistics that show that language access is a growing field; for all of the data and research that prove, beyond a doubt, that more and more people in this country will need interpretation services, I am most struck by the individual stories that I hear from interpreters on the job about the limited-English speaking patients who are helped. 

Stories of crises averted, and problems solved.

That is why I think that our job is above all to talk.  To tell the stories that show what medical interpretation achieves for patients, and what its absence will mean in terms of financial and human difficulties. 

If we can effectively equate medical interpretation to the medical benefits that are achieved for LEP patients, I believe we will be further down the road to a higher level of equity in care.

Language Line Services is talking, and spreading the message of the good work medical interpreters do every day, in big and small ways.

One example is the podcast on patient safety we recently participated in with Izabel Arocha of International Medical Interpreters Association, Dr. Angood of the Joint Commission, Sandra Sanchez of Grady Health Systems and language access consultant Linda Joyce.  We hope you’ll visit the IMIA website and listen to this cast.

Another example is our soon to be launched online registry of certified medical interpreters, a free industry resource. This registry will be open to all organizations and we hope this will raise the profile and understanding of the importance of the medical interpreting profession.

By talking and telling the stories of medical interpretation, good or bad, we can begin to show why providers should not make do with using untrained bi-lingual staff and family members or others not qualified to be precise and accurate in a medical interpretation setting. 

We can demonstrate that it is not acceptable for a hospital to trade quality for cost. 

We can explain the importance of the medical interpretation profession in a way that will, ultimately, increase the value of your work and, of paramount importance, the availability of new jobs.

To do this, we must all take on a stronger role as individual advocates – within our hospitals, within our associations and within our community and let our states and federal policymakers know that on a financial and human level, it simply makes sense to improve access to health care all around.

Medicare, along with state Medicaid programs and private insurers need to prioritize funding for language assistance. 

It’s time to reimburse for trained, professional interpreters who serve as the lifeline between patients and doctors. 

In this campaign season, words may seem like hot air, but in the health care setting, they are as vital as oxygen.  That is our message.

We at Language Line Services intend to carry this message of vital oxygen all the way to Washington, D.C. I know all of you support this important journey. I believe we are together in this sea of change.

Now ladies and gentlemen, this may come as a surprise to many of you. I am NOT running for President of the United States of America. 

I am however an American President running the world’s largest language access company.

As you know we have many many interpreters, a good number of lawyers, lobbyists and publicists. If I have to, I will bring every one of them with me to Washington D.C. and will invite each and every one of you here in this room to plead our case together.

Whether it is an Obama administration or a McCain administration, they will be hearing loud and clear from all of us and in 176 languages.

This country deserves, no wants, actually no demands, National Medical Certification and we ARE going to get it.

As the eldest son of immigrants from Italy and Ireland who just happens to speak six languages, and who happens to have studied 11 languages and who happens to have the responsibility of so many our employed interpreters in this industry wanting certification, failure is never an option. It is not even open for discussion.

I told you last year this time that I was serious about national medical certification. We sponsored our second May 1st National Medical Certification Symposium in Portland for all stakeholders.

At that meeting I announced a Global Advisory Council funded by a grant from Language Line Services with 15  subject matter experts from all over the world.
I also announced that this would be an annual event hosted by Language Line Services and we would together seek to get the appropriate proclamations announcing this special day.

I will tell you that this year more progress has been made with IMIA and Language Line University’s Global Advisory Council on the topic of national certification than has been done in the last 15 years. 

Please join me in giving Izabel Arocha and the amazing members of the IMIA a great round of applause for their leadership, bravery and persistence on this important initiative.

I am also proud of the role Language Lines Services plays in our mutual endeavor to eliminate language barriers.
To me, our work is not really work at all – it is a pursuit, a passion, a mandate that must be carried out.

Today, the country is in a state of financial crises and political change.

Through this time, though, we all need to be clear about our goals for change: our national push for quality initiatives, certification and our advocacy of funding for medical interpretation.

If we all continue to use our voices, I strongly believe we can convince more and more people that talk really isn’t cheap, and that when it comes to our health, it is worth every penny.

I wish to personally thank each and every one of you for your exceptional and extraordinary commitment to your profession and being a part of this much-talked about journey to national medical certification.

Ladies and Gentlemen.—fasten your seatbelts. It’s going to be a very bumpy flight to “Certification-ville”.

But after all the turbulence subsides, and the jet stream winds of change are all moving in the same direction, and more clearer skies can be seen by all, I can assure you that our arrival on National Certification Flight #1 will be safe, smooth and finally on time.

Thank you! May God Bless America and May God bless this country’s national medical certified interpreters!

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International Medical Interpreters Association (IMIA) Website