A few weeks ago at Toronto's Hospital for Sick Children, ear, nose and throat specialist Sharon Cushing was treating 11-month-old Santiago Alemán Contreras for hearing loss.
As Santiago wriggled around on his mother's lap, a clip-on hearing aid dangling from one ear, Dr. Cushing drew a diagram of the way she would surgically implant a hearing aid into Santiago's skull. The mess of ballpoint pen lines would have been meaningless to Iliana Contreras, Santiago's Spanish-speaking mother, without Anita Tancredi, a medical interpreter, translating Dr. Cushing's explanation.
Ms. Tancredi is a rarity. Canadian hospitals - unlike the courts - are not legally required to provide professional interpreters for patients who don't speak either official language.
While a few facilities such as SickKids and the University Health Network have in-house interpreters who provide services by phone or in person, many patients at facilities across the country rely on family, friends and bilingual staff to deliver diagnoses, obtain consent and give post-operative care instructions.
Patient advocates say there isn't just a strong ethical case for providing professional interpretation services in hospitals, but also an economic one. Data collected in U.S. and Canadian hospitals suggest language barriers have been responsible for longer hospital stays, misdiagnoses, and unnecessary, expensive courses of treatment.
Noting this, the Toronto Central Local Health Integration Network - one of Ontario's 14 non-profit corporations that finance local health services - plans to buy over-the-phone interpretation services so that, beginning this summer, the nine hospitals it oversees can have access to trained interpreters versed in more than 100 languages. After the pilot, the program will be rolled out to other community health organizations. It's the first funding directed by a government agency for the delivery of medical interpretation in the province.
"Most of the social determinants of health we really have no control over ... but in terms of a language barrier, we have a solution, and really, the cost of supplying medical interpretation is a fraction of the cost of providing care without one," says Elizabeth Abraham, manager of interpretation and language services at University Health Network (UHN), which oversees three downtown Toronto hospitals.
A 2004 study at UHN found that the hospital stays of patients with limited English skills were six per cent longer than those of other patients - a finding researchers attributed to language barriers. Similarly, an April, 2012, study from the University of Massachusetts looked at patients who were admitted to hospital for tertiary care (mainly performed by specialists) and found those who did not receive professional interpretation when admitted and discharged stayed longer and were more likely to be readmitted within 30 days compared to their counterparts who received interpretation.
While the diversity of its population should make it a leader in the field of medical interpretation, Canadian hospitals lag behind some U.S. counterparts. Boston Medical Centre, considered the birthplace of medical interpretation, launched its in-house service in 1968 after an influx of Spanish-speaking Puerto Ricans in the city; now, with the help of phone and video interpreting, the hospital handles more than 200,000 interpretation sessions per year. Massachusetts now requires health-care practitioners to use a medical interpreter in emergency and mental-health departments when treating a patient with limited English, and five other states have language service-related legislation.
Ontario Health Minister Deb Matthews - who has made access to care a priority - said the Toronto Central LHIN's funding for medical interpretation is an exciting project and that she would be "watching very, very closely." But she would not say if positive results would mean that the province would direct funds to medical interpretation in the future, nor whether she'd advocate for making access to medical interpreters in ERs a legal requirement: "I don't really want to speculate on that, on a hypothetical question."
While Ms. Tancredi and others in the field say face-to-face interpretation is ideal, the cost can be high and logistics difficult. SickKids has four interpreters on staff who speak Cantonese, Mandarin, Spanish, Portuguese, Urdu, French and Italian, while UHN has six who speak Cantonese, Mandarin and Portuguese. UHN has started to shift the focus of its operations to phone interpretation, which can handle similar volumes of work for less money.
"The thing that's most striking to me is the change in the parents when an interpreter walks in or we get an interpreter on the phone and they start speaking to them in their language," Dr. Cushing says. "You can feel their blood pressure go down, you can feel their heart rate go down."