A limited-English proficient (LEP) patient who refuses to use a professional interpreter can put your staff in a challenging position.
First, there's legal compliance to consider: Section 1557 of the Affordable Care Act requires covered hospitals and healthcare organizations to provide qualified interpreters to patients who need them.
Patient safety is also an issue: the Joint Commission lists provider/patient communication as “a core component of health care.” A LEP patient who refuses to use an interpreter may endanger him/herself and present a liability to your facility.
So what do you do to prepare for this scenario? Here are four best practices to consider:
1. Write an organization-wide policy for treating patients who refuse interpreters
Some patients may waive their access to interpreters despite your best efforts to persuade them. And they may be within their rights to do so; it's unclear whether Section 1557 presently mandates that all LEP patients must accept the use of the interpreter you’re required to offer.
But just as a patient may have the right to refuse an interpreter, your organization can – and should – set a policy regarding interpreter utilization in your facilities.
Consult with your language services or compliance leadership to learn if a policy exists and what it is. This should be done before you find yourself face-to-face with a patient refusing your interpretation. You might learn that your organization requires an interpreter to be present as a precaution for all LEP patient interactions. Or your organization may have differing rules for phone interpreters, video interpreters, or on-site interpreters. Learning what these rules are and applying them consistently across the board will ensure you’re prepared for a patient who doesn’t want an interpreter.
2. Offer in-language collateral describing the benefits of qualified interpreters
LEP patients who turn down medical interpretation may not understand why they should use it, choosing instead to communicate through friends, family, or even with providers directly.
Effective, in-language collateral may help these patients understand how medical interpretation creates a better experience for them. Consider making a short fact-sheet on the common benefits of qualified interpreters: meaning-for-meaning communication, impartiality, and improved patient safety and satisfaction. Then, have the fact sheet professionally translated into your top languages and make it available for staff to distribute to LEP patients.
3. Consider requiring a signed waiver of interpreter services
Whatever your organization’s policy on patients who decline interpreter services, you may find it prudent to require a signed waiver of interpreter services in these cases.
If a patient’s care comes under scrutiny after the fact, a signed waiver may provide proof that two aspects of the patient’s care did take place: you provided access to qualified interpreters and the patient declined them.
Requesting a waiver may not be as self-evident as it seems: in a 2010 study, the Joint Commission found that only 1 of 14 hospitals required a waiver of patients refusing an interpreter. This despite the fact that we know Joint Commission surveys that review LEP patient files often request documentation that a qualified interpreter was offered and utilized.
4. Confirm staff members aren't steering patients away from interpreters
If you do allow LEP patients to sign a waiver and forego interpreter services, it’s critical to verify your medical staff isn’t steering patients toward that option. Some providers feel interpreters are inconvenient and prefer not to use them, and they may attempt to hoist this view onto their patients.
To avoid this scenario, some organizations require patients to use the interpretation services provided – waiving them is not an option.
If a single provider or unit at your organization produces a disproportionate number of interpreter waivers, you may wish to investigate and ensure that their limited-English proficient patients fully understand they are declining the free medical interpreters you’re offering.
Ready to learn more about Section 1557 compliance and how to ensure your organization follows the law when treating LEP patients? Download our 1557 whitepaper: