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Limited English Proficiency Shouldn’t Mean Limited Health Care

It’s impossible to know exactly what shape healthcare will take for Americans as Congress and President Obama struggle with reform measures in the coming months. But one thing is certain: Those who have limited English proficiency will continue to have more health care services they can understand. Though the U.S. has prohibited discrimination, including language access for limited English proficient persons, since the passage of the Civil Rights Act of 1964, the reality in the healthcare industry is very different. Whether insured or not, those who don’t speak or read English “very well” tend to have care that’s not as good as those who do.  The Agency for Healthcare Research and Quality (AHRQ) reported that in 2005 only 54 percent of Latinos experiencing an injury or illness had timely access to healthcare, compared to 65 percent of whites. And if uninsured, Latinos got care in only 27 percent of cases.


It should be pointed out that “treatment” extends clear through medication, and here also, there’s room for improvement as many pharmacies fail to provide prescription information in a language other than English. A recent study by the Albert Einstein College of Medicine in New York of all 161 pharmacies in the Bronx, N.Y. (a borough with a large Spanish-speaking population) revealed that 31 percent could not provide prescription labels in Spanish. And one pharmacy used translation software that couldn’t translate common prescription terms like “dropperful.” Miscommunications in healthcare can have dire results. A child given a tablespoonful of medication when a dropperful was prescribed could wind up poisoned or worse. And then there’s the simply spoken miscommunications that can be deadly, such as the 13-year-old Phoenix girl whose ruptured appendix was initially mistaken for gastritis because no one could question her Spanish-speaking parents. Her death in 1984 sparked a lawsuit resulting in a $71 million malpractice award against the hospital and physicians involved. Such horror stories simply don’t have to happen if health care professionals take care to make themselves understood — in everything they do, from spoken to written patient materials and prescriptions. The Civil Rights Act of 1964 pointed out that language barriers are a form of discrimination. But it wasn’t until August 2000 when President Clinton signed executive order 13166 to remind federal agencies to “examine the services they provide, identify any need for services to those with limited English proficiency (LEP), and develop and implement a system to provide those services so LEP persons can have meaningful access to them.” The state of California followed the federal mandate with Senate Bill 853. Officially signed in 2003, insurance companies had until January 1, 2009 to comply with Senate Bill. 853. The law requires health, dental and specialty insurers licensed in California to have services, information and materials available to LEP members in a language they can understand. Other states are considering similar legislation. Healthcare organizations that are making real strides in translating materials for non-English speakers are not only fulfilling the laws, they’re fulfilling their mission to improve health. It’s been shown that if people get healthcare information in own language, the care gets better, whether it’s understanding health insurance policies to taking medicine. Chanin Ballance brings a wealth of expertise in language translation services and multicultural communications to viaLanguage. She co-founded viaLanguage in 2000 and served as the Chief Operating Officer prior to her appointment as Chief Executive Officer in 2003. Previously, Chanin co-founded The Language Company, a language and cross-cultural training school and translation service provider.

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8 replies »

  1. boo hoo. learn OUR language. do you want us to chew your food for you too? where does one get this extravagant sense of entitlement?

  2. After citing a tragic outcome due to communication problems, the Chanin Balance, the author states the following;
    “Such horror stories simply don’t have to happen if health care professionals take care to make themselves understood — in everything they do, from spoken to written patient materials and prescriptions.”
    The bold lettering above is my emphasis, which clearly imply 1. that health care providers currently are neglectful by not doing what is “simply” done, 2. that health care providers are responsible for making themselves understood “in everything they do” to foreign speakers, that 3. this communication should be in all spoken and written material, that 4. the non-English speaker plays no substantial role in this process. It is unrealistic, unfair, and grossly misguided to think that we should harshly criticize the health care system on the issue of communicating to foreign speakers in their own language. Do we no longer expect that immigrants to this country learn the language. In my opinion it is a courtesy for health providers to make the effort to provide foreign language materials. How far should they go to accommodate? Where is the expectation of residents of our country to learn English? If I go to France to visit, the French expect me to speak French, not English, for example. Shouldn’t any of us feel responsible for learning the local language where we are living? Apparently not? It’s not an unreasonable burden and will increase the quality of life and safety of those who know the language. There are here even free language lessons readily available. Immigrants in the past have always integrated into our culture, INCLUDING the language. They have accepted it and we have all gained so much from the experience of their cultures. Can we afford to continue to lower more and more standards of PERSONAL responsibility? My grandmother learned English by reading grocery adds in the newspaper. Health care is an important asset. There is this assumption that health providers should be able to take on things which frankly are not their responsibility. Health care is already expensive enough. Should we hold our health system responsible for pamphlets being translated and reviewed by health care attorneys, for interpreters upon request, and who knows what else is entailed by “everything they do” described above? There is an obvious and simple solution…people, thus patients, in the United States should learn the language. It should be very uncommon for people to not know the language (good reasons might include being in the process of learning, limited intellect, advanced age, etc.). Accommodation for these non-English-speaking patients should be made between the care providers and the person’s family (as it has been in the past). Rarely should another party be needed to provide this service. Health care providers are not language specialists, will never be able to communicate the details of care completely to non-English speakers. Health systems should not be obligated to inefficiently put more resources forth than those for whom they provide service. The provision of health care is complex enough, so why detract attention from the true task of preventing and treating medical illness. Let’s encourage what is clearly the best way to improve communication, by learning the language.
    Those who would like to say, “Well, it’s in the Civil Rights Act and President Clinton’s Executive Order” Unfortunately , legislation, like media opinion, might be gospel to some of us. The fact is, if it’s not right, it’s not right, whether it’s written on a Kleenex or on parchment with the Presidential Seal.

  3. It’s good to be true, since many people need proper care and can not move especially if the case is of lower back pain or a terminal case, I think is the most advisable that this is so and benefit many people who happen thus, it must provide immediate solutions to the sick and targeted as does findrxonline with health issues.

  4. as politically unpopular as it seems, I agree with ‘MD as HELL’. The burden for communication has to be on the receiver, there is no other logical approach. Rather than a translator, I would hope for a teacher. We need to include those that cannot speak perfect english by teaching them english, not by reinforcing their other language. The statistics shared in the post illustrate the problem with building a support network around a second (third? fourth?) language.

  5. I can see how having a health network that offered bilingual services would be beneficial to the community. Latino families should have access to translators, as this is the best way to communicate important information properly. The Community Health Network is as multicultural as it gets. We need more organizations like this. Community health network

  6. I will not sign anything I cannot personally read. I will not give insructions to a patient who is not English proficient without an interpretor. I will not treat a non-English speaking patient in the ED without an interpretor ,live or over the phone via AT&T (for less common foreign languages).
    Having said that, I will not bear all the burden of communication responsibility. Our citizens and long term guests who are not English proficient should get proficient expeditiously (pronto). I will give written instructions in English, for that is what I can read.
    My bilingual friend, a surgeon born in India has convinced me that if you have two languages then you have two classes. We are one melting pot with one class and one official language.
    Aviation worlwide has one official language, English. If is works there, it should work anywhere.

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