By Kirsten Ballard
In the United States, an estimated 25 million Americans—8 percent of the population—are Limited English Proficient, or LEP, meaning they are not fluent in English.
Studies show that LEP individuals face disproportionately negative health outcomes, including high rates of medical errors. And while there are laws and policies protecting those who face language barriers when seeking health care-from the Civil Rights Act of 1964 to the Affordable Care Act (ACA)—they don’t offer full protections and both providers and patients aren’t necessarily aware of them.
For example, federal law requires hospitals that receive federal funding take “reasonable steps” to provide “meaningful access” to care for LEP individuals at no additional cost to the patient; but “reasonable” and “meaningful” are both subjective. In addition, several provisions of the ACA were recently rolled back, including a requirement to notify patients of their right to language services on important documents.
Gustavo Negrete, secretary of the National Board of Certification for Medical Interpreters, admits the laws are falling short. In fact, a 2016 survey of 4,586 hospitals by the American Hospital Association reported that only 56 percent do offer some sort of linguistic and translation services.
“It’s not that they’ll necessarily get bad treatment, it just leads to a bad outcome in the end,” said Negrete. In many cases, providers may try to interpret themselves, find a bilingual colleague to help, or ask a family member to assist. But none of these solutions are ideal. Each leaves room for unintended errors or editorializing. For example, a family member trying to serve as an interpreter, wanting to protect a loved one, may downplay a doctor’s concerns.
“The optimal thing would be for the interpreter to be present, whether it’s an in-person interpreter, a video-remote interpreter, or even a telephonic interpreter,” said Negrete. Certified interpreters have completed at least 40 hours of training that include learning medical jargon and a code of ethics. The governing tenants require accuracy, impartiality, and advocacy.
“As interpreters, it’s our job to make sure that information is actually understood. Even if we interpret the medical jargon and it goes over the LEP’s head, or it’s not understood, then we have tools at our disposal to say ‘okay, that wasn’t understood,’” he said.
The ACA has provisions for assessed bilingual staff members to provide minimal interpreting services. These trained staffers can handle basic things like telling a patient they’re being admitted to the hospital, but Negrete urges using certified interpreters for more complex translations like surgical consent forms. He also does not recommend using artificial intelligence to translate.
“Simple phrases are completely misconstrued or completely butchered where they’re not understandable at all,” he said. “It’s not a critique, it’s just that language is so fluid that even the algorithms that they use in the development of these apps isn’t enough.”
For more information about LEP patients’ rights and other helpful resources, visit bit.ly/lepresources or bit.ly/ocrresources. In addition, if you feel your rights were violated, you can file a complaint at lep.gov/file-a-title-vi-complaint.