Those working in health care settings in Oregon have limited legal protections and unreliable access to PPE
Communication Breakdown In this two-part series, we examine how the pandemic has exacerbated problems facing Oregon's interpreters. Long-standing deficiencies in state oversight of their industry, which thrives on third-party contracting and low wages, has left interpreters working in health care settings struggling to make ends meet while they serve on the front lines of the pandemic. At the same time, the vulnerability of already marginalized non-English speakers is increased in hospitals and clinics, where they are often paired with translators who don't speak their language, if provided with any translator at all.
PART I: Oregon interpreters speak out about lax regulation, low pay and a shortage of personal protective equipment.
PART II: Non-English speakers in Oregon are often denied adequate translation services in medical settings.
Communication Breakdown: Part I
Interpreters, who provide vital services for some of the communities hardest hit by COVID-19, are speaking out. They say their lack of access to personal protective equipment and language barriers their clients face are exacerbating health inequities for immigrants and people of color in Oregon.
State labor laws and the widespread practice of outsourcing language services to third-party companies has left most professional interpreters and translators on the same footing as gig economy workers who lack basic legal protections and labor rights.
While Oregon Health Authority may refer to interpreters as “critical members of the health care team,” the agency is in the dark about who is guiding patients with limited English proficiency through state health care systems.
“What I'm seeing right now is interpreters themselves really want to be interpreting,” said Helen Eby, the founder of the Oregon Society of Translators and Interpreters and vice chair of the Oregon Council on Health Care Interpreters. “But we can't provide it at the risk of our own health.”
On June 1, certified Spanish health care interpreter Felicity Ratway told state lawmakers many interpreters lack consistent access to personal protective equipment, or PPE, and haven’t received basic information or training on how to use it properly.
Work-specific training on PPE usage is a key factor in reducing novel coronavirus infections for health care workers, according to a recent study from Oregon Health & Science University .
“Interpreters need to know things like: If you don't have an N95 mask, you shouldn't be in the room while a COVID-19 test is being performed,” Ratway said during her presentation to the Senate Interim Committee On Health Care about the impact of COVID-19.
Research has found that professional interpreters and translators make fewer mistakes than ad-hoc interpreters such as family members, untrained bilingual medical staff or underqualified contractors hired by language agencies.
According to U.S. Census Bureau data, over 200,000 Oregonians speak English less than “very well” or not at all, and state and federal laws require health care providers who receive federal money to notify patients of their right to professional language assistance services at no cost.
Lax enforcement of notification requirements coupled with stiff competition among companies and nonprofits that provide interpreters has encouraged a race to the bottom.
An owner of a Portland language services agency told state lawmakers that enforcement of laws already on the books and higher wages for interpreters would cause the entire industry to “implode.”
But the lax enforcement and low wages result in barriers that restrict access to adequate medical care and public health information for vulnerable and marginalized populations that aren’t fluent in English.
Non-essential frontline workers
In a survey of 78 health care interpreters in Oregon, advocacy group Oregon Interpreters in Action found 95% of respondents reported a decrease in income and 85% of those who had filed for unemployment were still waiting for their first check.
While waiting for confirmation of unemployment claims from mid-March and more recent claims for Pandemic Unemployment Assistance, Ratway has been spending her downtime writing petitions to the Oregon Health Authority and tracking down PPE for herself and hundreds of her fellow interpreters.
She explained that the nature of her job, which revolves around piecemeal contracting work with different language staffing agencies, means she might go to eight different workplaces in one day.
That means that instead of spreading the virus to people at a single health care facility, she said, “I may be spreading it to people in Vancouver, people in Gresham.”
A week before medical and dental facilities across the state resumed non-urgent procedures on May 1, the Oregon COVID-19 Joint Information Center said the state expected to receive shipments of millions of additional masks and other PPE within the next seven days.
“I am confident the supply chain is in much better shape,” Oregon Gov. Kate Brown said April 23. “If dentists or doctors need (PPE), they can purchase it.”
More than two weeks later, Portland-based language agency Linguava said health care providers who paid the agency to provide interpreters still faced shortages of PPE.
Interpreters reported some Portland area hospitals have provided only cloth masks, which have not been proven to be effective in medical settings, according to the Centers for Disease Control and Prevention .
Some clinics aren’t providing anything at all.
In a May 11 email, Linguava told interpreters they would have to provide their own masks during onsite appointments at some medical facilities.
Health care providers Legacy Health and OHSU told Street Roots they provide PPE to interpreters. The Portland Clinic and Providence did not respond to questions about whether they provided PPE to medical interpreters.
Several language agencies have provided contractors a form with which workers can request free PPE from Multnomah County Emergency Operations.
Ratway, who created the form after spending weeks reaching out to Oregon Health Authority, Metro regional government, and the emergency operations centers for the city of Portland and Multnomah County, said that as of June 2, the form had been used 438 times.
Ratway said Oregon Interpreters in Action can’t afford to ship PPE to interpreters who have requested it and instead is distributing the equipment at Woodstock Park on weekends and arranging hand deliveries to interpreters at their homes.
Among Benton, Curry, Deschutes, Marion, Clackamas, Washington, Lane and Umatilla counties, none have approved or have yet responded to Oregon Interpreters in Action’s requests for PPE from early to mid-May, according to emails reviewed by Street Roots.
Not one county has been able to provide interpreters with N95 masks, Ratway said.
A recent World Health Organization-sponsored review published by OHSU on May 5 found proper training on how to use PPE is instrumental in reducing the rate of infection among health care workers, who have suffered a significant number of COVID-19 infections.
“It's not just about providing the equipment, but helping health care workers understand how they need to use it,” said Dr. Roger Chou, director of the Pacific Northwest Evidence-based Practice Center at OHSU and senior author of the study. “Training and education were consistently associated with decreased risk of infection.”
OHSU told Street Roots it provides interpreters with written information on proper PPE usage, while Legacy said interpreters receive instruction “by a specially trained team on how to correctly put on and take off PPE” before entering rooms with patients.
“PPE training for non-employed interpreters should initially come from their employers,” a Legacy spokesperson said.
Portland language agencies Linguava and Passport to Languages told Street Roots they have been providing written guidance on proper PPE usage but have not provided any equipment directly to interpreters.
“As interpreters are not employees, we are not able to provide mandatory training,” Linguava CEO David Brackett said.
Portland-based nonprofit Immigrant & Refugee Community Organization includes translation and interpreting services among the 200 programs it offers to the region’s immigrant and refugee community. A spokesperson said IRCO provides its interpreters with information and resources about COVID-19, including guidance from Oregon Health Authority on PPE usage.
Ratway told Street Roots she found out through her own research that the CDC recommends wearing N95 masks during aerosol-generating procedures, such as treatments where medicine is vaporized and inhaled through a breathing device held up to the face.
“Some mask you found in your garage from when you were painting a couple years ago is not going to cut it,” she said.
On June 10, Linguava announced one of its interpreters had tested positive for COVID-19 the day before.
Ratway, who worked at the same facility on the same day as the person who tested positive, said Linguava didn't notify her that she'd been exposed.
“I found out only because the interpreter told me herself,” Ratway said.
According to Linguava, interpreters will only be notified about their potential exposure if they partnered with someone who tested positive within 14 days prior to their positive test.
Ratway said all interpreters are put in the break room or the social workers' office when not with patients.
“I feel like they should be notifying other interpreters who worked at the same clinic as the person who is sick, not just interpreters who did simultaneous appointments with them. ”
Lost in misclassification
Before the pandemic, Ratway said, she worked 12- to 14-hour days in order to earn eight hours’ worth of pay.
Unlike interpreters for the state court system, most medical interpreters are not reimbursed for the time spent in transit from one worksite to another, nor are they compensated for transportation costs like gas or parking fees at the hospitals where they work.
“A typical day for me might be working from 7 a.m. to 7 or 9 p.m.,” Ratway said. “That's just what you have to do.”
Companies consider interpreters and translators independent contractors, but state law says they are not — a result of language inserted into a 2007 bill ostensibly concerning terminology for landscaping businesses.
This legal gray area means interpreters working for agencies have less freedom and control over their working conditions than typical independent contractors, while retaining none of the legal protections and benefits that accompany a customary working relationship with an employer.
Oregon interpreters, along with janitors, home health aides, drywall workers, cable installers, cooks, rideshare drivers and loading dock workers at distribution centers are currently at the center of a nationwide battle over the way labor relationships are defined.
In 2016, a federal court threw out a $100 million settlement between Uber and 400,000 drivers in California and Massachusetts, saying the compensation offered by the company was not “fair, adequate and reasonable."
David Weil, who collaborated with 36 states to tackle the issue of worker misclassification while serving as head of the U.S. Department of Labor’s Wage and Hour Division under the Obama administration, illustrated the consequences of improperly defined workers in a 2017 article for the Harvard Business Review .
“Though its form varies, the impacts of misclassification are almost always the same: the underpayment of wages, absence of benefits, and increased exposure to a variety of risks,” Weil wrote.
Worker classification played a role in 2016 when American Sign Language interpreters at public schools in Eugene, who said they couldn't afford their student loan deductibles, packed 100 people into an auditorium to advocate for higher wages .
“We don’t work in the school district for the money,” ASL interpreter Samantha Eilert said at the time. “We do it for the kids.”
A bill backed by California Gov. Gavin Newsom could usher in a wave of legislation that defines employment primarily based on a worker’s freedom from the control of the hirer.
Eby, who fought for more than 15 years to secure a raise for court interpreters after they became mandatory in 1995, isn’t waiting for that to happen.
While her colleagues wait for Pandemic Unemployment Assistance from the state’s embattled Employment Department, Eby has been encouraging them to file for federal relief as small businesses.
“Let’s beat on those doors; crack ’em open,” Eby said. “We’re professionals.”
Interpreters in Oregon won the right to unionize in January, and the following month, union representatives, nurses and professional associations of medical interpreters all testified in favor of House Bill 4115 , which would aim to establish enforceable requirements that health care providers work with professional medical interpreters.
But in written testimony to lawmakers , Passport to Languages owner Robin Lawson characterized increased regulatory oversight of companies like her own as an existential threat to the industry.
“Agencies certainly do not need to be regulated to the extent that their very own business licenses and ability to operate are at stake; lying in the whimsical hands of a state agency that has no tangible plans to explain how they would operationalize this bill,” she wrote.
Lawson also said the company received more complaints about interpreters who were certified with the state than those who were not, a claim later walked back by the company’s compliance director, Shirley Smythe.
Movement on the bill stalled after Republican lawmakers walked out of the Capitol in February, and the current pandemic has postponed any efforts to reform Oregon’s system for language access services.
“I feel like (recent months) have been really chaotic and disorganized and I have done as much as I can like on my own,” Ratway said. “But, I am one person.”
Update June 11, 12:07 p.m.: This story has been updated with new information about an interpreter testing positive for COVID-19.
Email Street Roots Reporter Chris May at chris@streetroots.org .
Street Roots is an award-winning, nonprofit, weekly newspaper focusing on economic, environmental and social justice issues. Our newspaper is sold in Portland, Oregon, by people experiencing homelessness and/or extreme poverty as means of earning an income with dignity. Learn more about Street Roots . Support your community newspaper by making a one-time or recurring gift today .
© 2020 Street Roots. All rights reserved. | To request permission to reuse content, email editor@streetroots.org or call 503-228-5657 , ext. 404.
