September/October 2010


For the Sake of Patient Safety, Medical Interpreters Must Be Trained and Tested

Given the amount of education and training that physicians, nurses, and other medical professionals are required to undertake, many Americans would be shocked to find that there is one critical medical job that is completely devoid of any kind of federal oversight, regulation or, until recently, recognized national standards. The title of the job in question is “Medical Interpreter,” and the responsibility of the interpreter is to allow the millions of individuals in the United States with limited English skills to communicate with doctors, nurses, and other medical staff. The interpreter is quite literally the bridge between a patient and potential life-saving care, and while there are thousands of highly trained interpreters who have special knowledge of medical terminology and processes, there has been no nationally recognized procedure to make sure that every interpreter on the job is really and truly up to the task.

Likewise, many hospitals and other medical facilities that hire medical interpreters by contracting with outside professional interpretation companies—companies that profess to provide trained medical interpreters—would be surprised to learn that their interpreters are actually outside contractors with no special training or knowledge. While some professional interpretation companies adhere to specific testing and standards, others simply do not. As a result, hospitals and other facilities may be putting the safety of their patients at serious risk.
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, more than 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 and the troubling lack of government standards in the area of medical interpretation, it is clear that hospitals, medical professionals, and the public must demand a new approach to the task of training and testing those who are responsible for communicating vital medical information in life and death situations. They must demand a national process for certifying medical interpreters; a federal requirement that only credentialed interpreters may be employed; and reimbursement to help hospitals pay for medical interpretation services.

While we are still waiting for a sweeping federal mandate that requires trained and tested medical interpreters—one that comes with funding to help hospitals meet this patient safety requirement—the good news is that there is now a nationally available procedure in place that can help determine whether medical interpreters are adequately prepared. The independent National Board of Certification for Medical Interpreters has recently announced a new milestone in the creation of a national standard for certifying medical interpreters. After years of research and development by different organizations, the National Board created, piloted, and tested the first Certified Medical Interpreter (CMI) program, and in July 2010, the first two medical interpreters were awarded the CMI designation. 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.

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 by an untrained interpreter, leading to the wrong treatment. For those with limited English skills, this nightmare scenario is all too real; for hospitals and physicians who want to protect their patients from painful and even deadly medical errors, taking steps to avoid this scenario should be a top priority.

The fact is, professional interpreter organizations and companies should all be working to make sure that their medical interpreters are trained, and the new Certified Medical Interpreter test and designation from the National Board provides an effective, proven path toward this goal. Medical facilities should require that their medical interpreters and medical interpretation provider companies offer proof of training, and they can look to this new certification process for guidance.

Hospitals would not think of hiring a physician or nurse who could not prove their training and credentials. They should accept nothing less from the professionals who translate their important medical instructions and advice. It is a matter of life and health.

Louis Provenzano is president and chief operating officer of Language Line Services, a leading interpretation company that provides language services to thousands of hospitals and health care organizations across the country. Language Line® University, the globally recognized interpreter testing, training, and certification division of Language Line Services, is a co-founder of the National Board of Certification for Medical Interpreters. Provenzano has been a leading advocate for the advancement of quality and availability of language services in healthcare. He holds a bachelor’s degree from Boston College and is fluent in several languages. Provenzano may be contacted at