Medical interpreter rule to get further study from AMA board

Doctors need translators to communicate with non-English-speaking patients but question who makes the best interpreters and who should pay for them.

By Tanya Albert, amednews staff. July 9/16, 2001.

Chicago -- AMA trustees will use the coming months to take a closer look at a much-hated federal rule that requires physicians to pay for interpreters for patients who don't speak English.

Many physicians at the Association's Annual Meeting in June said they shouldn't be the ones getting stuck with the bills. But they were split on whether it would be best for someone else, such as the government, to pay for interpreter services or to just let patients bring their own interpreters to appointments.

After much debate, the House of Delegates voted to have trustees look at two resolutions that deal with medical interpreter services.

Trustees will explore shifting the interpreter responsibility from the physicians to the patient. They will also look at educating physicians about the ethical and legal implication of using informal interpreters, such as family members or bilingual staff, rather than trained interpreters.

"The basic issue is that this is an unfunded mandate," said Robert Hertzka, MD, a California delegate and anesthesiologist from Rancho Santa Fe.

In August 2000, the Clinton administration issued guidelines that more fully explain the Civil Rights Act of 1964, which guarantees that federal services can't be denied based on national origin or other factors. Courts have ruled that those factors include language.

While the Health and Human Services Dept. examines the guidelines and Congress considers a bill that would kill the policy, physicians who treat Medicaid and other patients in federally funded programs scramble to figure out how they can meet the requirements.

Some physicians believe that physicians shouldn't be responsible for providing the services.

One of the resolutions trustees must study asks that the AMA suggest to HHS that patients find someone from their community or their family to translate.

Some physicians said that would ensure that the interpreter had a similar cultural background to the patient, thus making the patient more comfortable. Other physicians believe having a family member there means better patient care in the long run.

"I'm more in favor of having family come in because patients don't always remember everything," said Hawaii delegate Calvin C.M. Kam, MD, a neurosurgeon from Honolulu. "Afterwards, others in the family might remember things the patient didn't."

"The formally paid interpreters are no better than the family," added Domenic R. Federico, MD, an obstetrician-gynecologist from Grand Rapids, Mich., and alternate delegate from Michigan.

But others say using family members could violate a patient's privacy. And in situations in which domestic violence is a factor, a patient may not be comfortable talking in front of a family member.

"Family members are a last resort," Dr. Hertzka said.

But the question of who should act as an interpreter wasn't the only issue -- delegates also discussed who should be paid for interpreter services and by whom. One resolution calls for payments to go directly to an interpreter, rather than to a doctor's office.

Physicians also called for the government, or perhaps hospitals, to pay for the services, rather than doctors.

If physicians treating Medicaid patients pay for interpreter services and the reimbursement from the government doesn't cover the interpreters' cost, let alone other costs of the visits, physicians will stop participating in government programs, some fear.

"This program will decrease access for the very people it is designed to help," said Washington, D.C., delegate Peter Lavine, MD, an orthopedic surgeon. "It's time for the AMA and physicians to stand up to HHS and just say: 'No.' "