A few weeks ago, a medical interpreter at the University of Louisville Hospital says she was interpreting for a Spanish-speaking patient. As she translated the healthcare professional’s questions and the patient’s answers, it dawned on her.
“She had clear respiratory symptoms, she could hardly stop coughing, she had traveled outside the country,” said the interpreter.
She realized she was standing in close quarters with a possible coronavirus patient. She said she was completely unprotected.
Several staff interpreters told KyCIR that this experience is not unique. They say the University of Louisville Hospital is endangering them, healthcare providers and patients by not implementing appropriate protections amid the coronavirus outbreak.
Four staff interpreters spoke to KyCIR on the condition of anonymity, saying they fear retaliation for speaking out about their concerns.
They say they have been sent between units without appropriate protective gear, interacting with both potential coronavirus patients and highly immuno-compromised patients during the same shift. They have been told they cannot work remotely, either from home or from a call center at the hospital, according to emails reviewed by KyCIR.
The Certification Commission for Healthcare Interpreters, one of two certifying bodies in the field, has recommended that all healthcare providers switch to remote interpreting for most interactions, something other area hospitals have already done.
Baptist Health Louisville has stopped using in-person interpreters, according to a spokesperson, but said they would make exceptions if it is deemed essential to the care of the patient. Norton is using remote interpretation whenever possible; if an in-person interpreter is necessary, they have to follow the hospital’s new visitor rules, including going only to the patient's room and leaving the hospital immediately after.
Family Health Centers, a non-profit community health provider, has moved its staff interpreters to a call center where they can provide interpretation over the phone, a spokesperson said.
In an email Tuesday, a spokesperson said U of L Hospital is using it’s third-party video interpretation service as “the first option, before in-person interpretation” for confirmed or suspected COVID-19 cases.
For all other patients, “protocols have not changed.”
But interpreters are worried that they may be interacting with patients who are later determined to have coronavirus.
After KyCIR’s inquiries to the hospital, the director of the language access program sent staff interpreters an email saying they could continue to work in-person, or they could take an unpaid leave of absence, and their work would be outsourced to a third-party vendor.
Many of the staff are already taking unpaid leave as a preventative measure or self-quarantining due to concerns about coronavirus exposure, KyCIR was told.
One of the interpreters told KyCIR they would work around the clock if they had proper protections.
“But it’s a matter of patient safety,” she said. “How do they not see that we could be endangering everyone?”
'Super vectors'
U of L Hospital employs several Spanish interpreters and one Somali interpreter, according to interviews with staff members. They serve the whole hospital, often being called to more than 30 situations requiring interpretation in a shift.
“I could be this minute in the emergency room, finish an interpretation and go to the ICU, fly over to labor and delivery, fly in to assist in the OR, then I’m going to the [neonatal intensive care unit], or the transplant unit,” the interpreter said. “We are the perfect carriers for the virus, and we’re going into rooms with people with compromised immune systems.”
A U of L Hospital spokesperson declined an interview request, but said in a statement that interpreters, like all employees, “are expected to wear procedural/surgical face masks, at all times, while in these clinical care settings. While providing care to a confirmed or presumed COVID-19 patient, or other infectious disease, additional PPE (like N95 masks) may be required.”
The hospital told interpreters in an email Monday night that they will be provided with the same level of PPE that healthcare providers receive.
The interpreters are concerned for their own health, but several said the greater concern is for the healthcare providers and the patients.
“If we meet with a patient who is positive, we could infect the whole hospital,” another interpreter told KyCIR. “More than the doctors and nurses who work in just [one unit], we could potentially be super vectors.”
They say they have asked to stop doing in-person interpretation in wards that house particularly immuno-compromised patients, like the transplant unit and the James Graham Brown Cancer Center, but U of L Hospital told them that is not an option at this time.
Interpreters have proposed other options
The interpreters interviewed by KyCIR said they have pushed the hospital to allow them to work remotely, either from home or from a centralized call center at the hospital.
“In an ideal situation, face-to-face is better, of course,” said one of the interpreters. “But in the very real situation we find ourselves in, this doesn’t make any sense. Whatever benefit we are creating by being face-to-face is completely washed out by the risk we are also creating.”
Other local healthcare providers have found ways to accommodate these requests. At the call center set up by Family Health Centers for its 10 staff interpreters, the healthcare provider calls an extension and it rings to whichever interpreter is available at that time, allowing them to offer services without moving around the facility.
“Our interpreters know our patients, they know how we do business, and many of our patients come to us because we do have those interpreters,” said communications director Melissa Mather. “They’re part of our care team in a big way, so it was about finding a safe way for them to continue their work.”
U of L Hospital already uses phone and video interpretation if an interpreter is not available, or no one on staff speaks the needed language. That service is contracted through a third-party vendor, and uses a national bank of remote interpreters.
All of the staff interpreters have department-issued phones and they say the technology is available if the hospital implemented it to allow them to work remotely.
“In-person interpretation cannot be done remotely,” a hospital spokesperson said. “In situations where a video remote call is recommended, we already have a provider for that service.”
In a March 21 email reviewed by KyCIR, when Jefferson County already had 25 confirmed cases, language services director Christopher Burchett told the staff the hospital “will NOT be offering any work from home options for language services. It will also NOT be an option to interpret over the phone.”
Burchett said employees could choose between working face-to-face or taking vacation time, then unpaid leave. That was reiterated in the email sent Monday night.
“We all have made a commitment by joining the healthcare field,” he wrote. “We will continue this mission and be there for our patients.”
Another interpreter agreed their work is essential, but said their physical presence is not.
“We may be doing the opposite of what we are supposed to do, which is to save lives.”
Potentially overloaded systems
If U of L Hospital begins to rely fully on its third-party remote interpretation system, the interpreters interviewed by KyCIR said they are concerned it may get overloaded as demand increases across the country.
Several interpreters told KyCIR that they have raised this issue with hospital leadership and proposed different solutions, but have not seen any action.
In an email to staff interpreters, the department director said that the hospital’s vendor has assured them they will be able to handle increased volume.
A recent investigation from ProPublica found that hospitals in coronavirus hotspots across the U.S. are already struggling with long wait times for third-party interpretation services.
The U of L interpreters say their concern is that a day may come when all the staff interpreters are quarantined due to coronavirus exposure, and overloaded phone and video interpretation services are rendered useless by delays.
Usually, if there’s no better option available, the hospital relies on family members to translate, but coronavirus patients often have to be isolated to prevent the spread of disease. This will leave nurses and doctors with no options to communicate with these vulnerable populations.
“Many of these people will be alone in the last moments of life,” one interpreter said, her voice rising. “Those patients will not be able to participate in decision making in their own medical care. They will be alone and unable to communicate for their final moments on earth.”
Contact Eleanor Klibanoff at eklibanoff@kycir.org.