Medical Interpretation signing

Washington CAN!: Medical Interpretation Victory Empowers Patients and Workers

For eight years, I was the interpreter for my father while he was sick. At the age of 14, I was more his interpreter than his daughter. I worried about how I would tell my father that another part of his leg would be amputated or whether he was going to survive another surgery. Sometimes I would spare my father bad news despite the doctor’s orders. I would decide whether or not to tell the nurse if my father had eaten that day based on the pain the IV would cause him.

Imagine that you just learned that your father is going to die from cancer. Now imagine that you had to be the one to tell him. This is the impossible situation Amal Abdulrahman, a young Somali woman, was put into because her father did not speak English well.

Amol, a member of Washington Community Action Network, was one of several Washington CAN! members who have testified over the last few years in front of the Washington State Legislature on the importance of medical translation. No child, Amol insisted, should have to be put in the emotionally devastating position of having to help their dying parent communicate about complicated medical matters. Thanks to Amol and others, this year Washington CAN! helped secure a historic legislative victory that secures better access to health care for people, as well as higher standards and pay for medical interpreters.

Medical care cannot be delivered effectively through a language barrier. For some patients, the lack of understanding is a matter of life and death. Interpreters are a necessary part of the care team for patients with limited English-speaking skills. They are just as vital to people’s health and well-being as doctors, nurses, and pharmacists. And while these tenets are already set forth by federal civil rights law, there is startlingly little compliance with these laws. In many hospitals and clinics, the law sits up on a shelf, ignored and gathering dust, while the care that vulnerable people deserve falls by the wayside. According to the Department of Social and Health Services, in 2009, 43 percent of all interpreter services were provided to children and pregnant women, with a significant number also being lower-income people of color.

NWFCO and its partner organizations are leading the way to correcting this on securing quality medical translation for everyone who needs it, and correcting the disparity that disproportionately leaves immigrants, lower-income people, and people of color sick and vulnerable.

In 2007, Idaho Community Action Network and Washington Community Action Network ran successful campaigns with local hospitals to increase language access for patients with limited English, from securing hospital signage in multiple languages to establishing toll-free phone interpretation for both medical and non-medical needs.

While these campaigns were successful, they were highly localized. So in 2008 and 2009, Washington CAN! advocated for legislation to increase language access in health care throughout the state. A primary goal was to require insurance companies to reimburse hospitals for translation and interpretation services, and to have the Washington state Basic Health program cover the cost of medical translation and interpretation services. For hospitals, medical interpretation is one of the costs of doing business, but if they’re not getting reimbursed, there’s less incentive for them to provide language services.

Bills were introduced in the 2008 and 2009 legislative session, and were heard in committee. Washington CAN! members testified before the state legislature, telling powerful stories about the need for medical interpreters. While Amal and other members made a strong case for the passage of a bill last year, the effects of the recession were being felt in a state budge crisis, and the bill died because the legislature was unwilling to fund any new programs.

Undaunted, in 2010 Washington CAN! focused on advancing policies that would improve access to medical interpretation without creating a financial burden for the state. Washington State utilized an inefficient brokerage system for medical interpretation in which hospitals contracted with brokers, who then contracted with interpreter agencies, who then contracted with individual interpreters. Brokers were taking up to 50% of the money and agencies were taking up to another 50% of what was left, leaving medical interpreters with very little pay for their work, and patients with fewer qualified medical interpreters than needed.

Washington CAN! partnered with the Washington Federation of State Employees to win a historic legislative victory that eliminates the brokerage system and gives medical interpreters collective bargaining power as state employers to negotiate wages and benefits with the Governor. The results are win-win all around: no additional costs for the state, higher pay for medical interpreters, and, most important, better health care for everyone.

At the emotionally charged bill signing ceremony in April 2010, some 50 medical interpreters—among them, Somali, Vietnamese, Russian, and Mexican—wearing green Interpreters United t-shirts crammed into a conference room as Governor Chris Gregoire signed the bill. A Washington CAN! member who was present at the ceremony remarked that it was “probably the most diverse group ever to stand behind the governor” for any bill signing.

After the campaign, WFSE noted that interpreters are “an inspiration to all Federation members because sometimes we take for granted the voice we have at the table that the interpreters until now didn’t have and craved so much.” WFSE and Washington CAN! learned a valuable lesson from this year’s campaign: Medical interpreters are a growing number of extremely motivated and passionate people, many of whom are immigrants and people of color, with a huge potential for organizing. Though their work is essential, they have not been represented in public policy decisions that affect them and their clients. Working and organizing medical interpreters can benefit and empower lower-income communities and communities of color.

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