Mara Youdelman, Staff Attorney at the National Health Law Program (NHeLP) and Director of the National Language Access Advocacy Project
As immigrant communities expand across the United States, many healthcare providers and patients have encountered communication barriers making it difficult for patients to receive proper care. We think Mara has a better grasp on this issue than just about anyone so we asked her to join us as a guest blogger to explain the need for improved access to language services.
We need to think of language services as important to healthcare as a stethoscope, you can't listen to someone's heart or lungs without one, how can you listen to a patient without being able to effectively communicate?
Many limited English proficient (LEP) individuals do not have access to competent interpreters and translated materials. When healthcare providers do not use interpreters, they often resort to pantomime or using untrained interpreters - including children or those without training in interpreting or medical terminology - to try to explain complicated diagnosis and treatment options. Without effective communication, serious harm can occur, such as the case of a young Florida man left quadriplegic after healthcare providers failed to diagnose a subdural hematoma. The clinicians thought they understood enough Spanish to accurately diagnose him. The result was a $71 million settlement.
A recent Washington Post article, "Speaking the Same Language" underscored the need for improved language services to ensure that LEP patients can effectively communicate with their healthcare providers. Some states - including the District of Columbia, Virginia but not Maryland - pay for interpreters for patients enrolled in Medicaid and the Children's Health Insurance Program. The recently enacted Children's Health Insurance Program Reauthorization Act provides additional funds to states to pay for language services for children in Medicaid and all CHIP enrollees. But Medicare and most private insurers do not pay for interpreters and often only translate materials, if at all, into Spanish.
The lack of language services is especially striking more than 40 years after the enactment of Title VI of the Civil Rights Act of 1964. This law prohibits anyone who accepts federal funding - virtually all health care providers - from discriminating based on national origin, which includes language. Guidance issued by the Department of Health and Human Services' Office for Civil Rights in 2003 outlines clear expectations for how healthcare providers should ensure language services.
The picture is not entirely bleak. The National Committee for Quality Assurance, the primary accrediting organization for health plans, and the Joint Commission both recently drafted standards to focus on language access and cultural competency. The National Coalition on Health Care Interpreter Certification is developing standards for the certification of interpreters to ensure the competency of those providing language services. (Full Disclosure: NHeLP is a subcontractor for the Joint Commission on its project and is a member of the National Coalition on Health Care Interpreter Certification.)
Too often, the question of whether to use an interpreter comes down to one of money rather than necessity. Just ask the Florida man and his doctors whether an interpreter would have been a cost-effective expenditure by the hospital and paramedics. We can do much better for our patients and healthcare providers. Let's hope that the current health reform discussions will address the need for improved access to language services.
For more information, see NHeLP's resource list on language access.
The views expressed by guest bloggers do not necessarily reflect the views of the Center for Children and Families.
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