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[Editor’s note: This column is part of an ongoing series that will address reader questions about the Emergency Medical Treatment and Labor Act (EMTALA). If you have a question you would like answered, contact Joy Dickinson, Senior Managing Editor, ED Management, P.O. Box 740056, Atlanta, GA 30374. Fax: (404) 262-5447. E-mail: email@example.com.]
Question: When performing a transfer, is it necessary to have an interpreter along for the transfer of a non-English-speaking patient, assuming that an interpreter was available for performing the medical screening examination?
Answer: If it is medically necessary to have verbal communications with the patient, for example, to evaluate neurological status or pain level, then it would be appropriate to send an interpreter, according to John Lipson, MD, MBA, principal of Columbus, IN-based Medical Staff Support Services, which assists medical staff leaders and administrators with EMTALA compliance. If the patient’s medical condition does not require verbal communications — for example, the patient had a dense stroke or a simple ankle fracture — then an interpreter would not be necessary, Lipson says.
He notes that the transferring physician is responsible to make sure that the patient is transferred in an appropriate medical environment.
Although EMTALA doesn’t directly address interpreters for patients with limited English proficiency, other federal regulations do, notes Jonathan D. Lawrence, MD, JD, FACEP, an ED physician and medical staff risk management liaison at St. Mary Medical Center in Long Beach, CA. He points to the Civil Rights Act of 1964, which requires hospitals that receive federal funds to provide non-English-speaking patients with oral and written language assistance. "EMTALA is silent on the issue, but the law is clear that translators must be available in the ED," he says.
In addition, Title VI prohibits discrimination against people based upon their nation of origin, Lawrence explains. "This is the reason hospitals have signage in their EDs advising patients of the availability of translators," he says.
The federal government has made it plain that it will seriously consider anything that discourages a patient from receiving his or her medical screening examination to be an EMTALA violation, he adds. "That would most certainly include a lack of ability to timely understand what the patient’s chief complaint or history is," says Lawrence. In some instances, federal authorities have indicated that a family member or nontrained interpreter is not sufficient to provide the degree of assistance required, he notes.
Still, it is unlikely that the lack of a translator during a transfer would constitute an EMTALA violation, Lawrence says. By the time a transfer takes place, medical personnel have a fairly good understanding of the patient’s condition and stabilizing treatment has begun or has been accomplished, he explains.
"Also, practicality plays a necessary role," adds Lawrence. "For the less-common languages, many hospitals use a commercial telephone-based service. This would be difficult to accomplish in an ambulance setting unless cell phones were used." The receiving facility must be made aware of the patient’s language needs, and any changes in the patient’s condition during transport probably would not require detailed translation, he says. "Of course, a translator would be a nice touch and greatly appreciated by the patient," Lawrence adds.
For more information, contact:
• Jonathan D. Lawrence, MD, JD, FACEP, Emergency Department, St. Mary Medical Center, 1050 Linden Ave., Long Beach, CA 30813. Telephone: (562) 491-9090. E-mail: firstname.lastname@example.org.