By far the most common cause of regulatory ding or financial penalty is the failure of the organization to secure or provide language support. These cases come to light when either the patient was harmed, or the patient complained. Many additional instances of failure to provide language support crop up when onsite regulatory surveyors use the patient tracer method to evaluate compliance by reviewing a number of random patient files to see if all processes were followed, and find that the patient that they are tracing needed language support and failed to get that at some point.
Moving beyond these instances of failure to provide language support, however, there are many ways in which the language support that WAS provided can cause legal or regulatory repercussions for the organization.
Hospital surveyors are alerted to language support problems that require review by several triggers.
- They review Patient Safety events with documented harm to patients. A nurse may have documented in the Harm Events data base that a patient who had a hysterectomy, after an interpreted consent session with the provider, went into emotional shock to find out after the surgery that she had been sterilized. A doctor may have documented that she had dismissed an onsite interpreter for refusing to tell the patient about her cancer diagnosis, making do with a remote interpreter instead.
- They review known legal actions against the organization related to patient care, such as complaints to the federal watchdog agencies on use of unqualified interpreters in order to save money.
- They may have access to the comment section of the patient satisfaction survey and the patient relations records, in which patients or family members have complained about particular interpreters.
- Using the tracer method, surveyors review the entire episode of care for a number of randomly picked patients. They now routinely require that a certain percentage of those are language need patients. HR must provide the personnel records for nurses, therapists, interpreters, and other staff who provided service to the patient.
- Surveyors also spend several days walking through the various clinical units of the organization, observing staff, including interpreters, doing their job. Surveyors can stop any staff person to ask them how they are qualified to do their job or why they are managing their present encounter the way they are. When this happens, the specific interpreter is added to the list of personnel that the surveyors will do a detailed review on.
The Language Program Manager can expect to be called into the regulatory review meeting related to reviews of:
- staff interpreters – qualifications and performance
- contracted agency interpreters – qualifications and lack of complaints
- contracted language companies – quality of contract and performance on the contract
There is a much higher expectation of compliance with credentials and professional competence requirements from staff interpreters than from contracted interpreters. They see a lot of patients and they do so in the name of the organization. The organization is at risk if staff interpreters cannot be proven to comply medical interpreting quality requirements, or if they have ongoing or serious performance issues which are not resolved.
Interpreter Services Manager and Human Resources must provide surveyors with information on:
Personnel jacket items related to hiring and ongoing education: resumé indicating education level, proof of linguistic competence, interpreter experience, interpreter training, interpreter certification in some cases, continuing education, signed ethics statement on file, references, etc.
Personnel jacket items related to performance evaluations or complaints. Interpreters ARE now included in spot checks of correct behavior on part of hospital staff, such as using hand sanitation and infection control protective garments correctly. Commendations from care teams and patients are an important part of the staff interpreter personnel jacket.
Contracted agency interpreters
Surveyors have a very sharp eye out for both the qualifications and performance of non-staff independent professionals working on assignment through agency, be it Traveler nurses or interpreters.
Obviously, agency interpreters are not employees, and the Language Program Manager does not have a personnel jacket on each person. The agency through which the interpreter is offered assignments also is not the employer and does not exercise employer functions such as training or oversight. However, the agency is expected to assure that its sub-contracted interpreters are both qualified to do the job and ensure compliance at all times with the local safety, security, and professional development norms. These vary from state to state and from hospital to hospital, but often include:
- Full health worker immunizations for vaccine-preventable illnesses
- Annual flu shot by October 31
- Annual TB testing or equivalent assurance by Quantiferon Gold
- Annual State Patrol background check
- Current state or national interpreter certification (if applicable)
- Proof of language proficiency
The Language Program Manager is advised to have ironclad documentation available on-hand on key qualifications and compliance of interpreters who have worked onsite during any past year. Some hospitals require that the key qualifications and compliance items of interpreters given assignments are faxed from the agency to the hospital with every confirmation! Another way of making sure to not be caught flat-footed when a surveyor asks for documentation on an agency interpreter is to require the key qualifications and compliance items to be added to the monthly agency bill for services on each line item.
Because agency interpreters are not staff, and therefore do not go through annual safety training, background check, immunization campaigns, and performance evals which assure signing of ethics statement and continuing education, surveyors ask to see proof that the interpreter is safe to be in the physical environment and fully compliant with professional interpreter norms.
If the individual interpreter has been chosen to review because of a complaint, additional documentation will be required from agency and from the Language Program Manager, related to the interpreter’s language proficiency, training, work history, previous performance issues, and resolution decisions.
Agency interpreters are most likely to have received complaints about the following from staff, provider, family, or patient. In many cases the complaint turns out to not be justified, upon investigation by the Language Program Manager. It is therefore very important to maintain all records of investigations to show to surveyors, who wish to see that perceived compliance violation was thoroughly resolved.
- Failure to interpret accurately and completely.
- HIPAA compliance violation such as not protecting privacy of patient information.
- Keeping documentation on patients in own records.
- Tardiness, particularly if repeated.
- Acting in unsafe way, such as breaking infection protocols during the encounter.
- Taking assignments when infectious.
- Giving back assignments after committing to them in order to accept better paying assignments.
- Sleeping on the job. Unprofessional dress.
- Not presenting at hospital with proper badge.
- Inappropriate treatment of hospital staff.
- Side conversations with one of the parties, angering the other parties present.
- Turning in fraudulent records of time worked.
- Proselytizing for own religion.
- Not observing ethical boundaries with any one of the parties.
- Talking on the phone or texting during encounter period.
- Driving the patient somewhere.
- Making the patient’s next appointment based on interpreter convenience.
- Requesting that the clinical team contact the interpreter directly or request the interpreter for future jobs (self-promotion).
Performance on the contract as a whole
Surveyors review the Language Program Manager’s annual review of all of the language company contracts that are active. This includes remote and onsite interpreter contracts, translation contracts, and disability accommodation contracts. The annual review includes a listing of any problems that came up such as failure to fill requests, filling with unqualified people, poor technology interface, lack of responsiveness to complaints or problems, and improper billing.
Surveyors expect each contract to be rated as a good or poor contract each year, and most importantly, to act on any poorly performing contracts. Be sure to resolve issues with contracted agencies in a documented manner so that you can present all the fact if asked by a surveyor.