Language Barrier Hinders Provision of Medical Care to Non-English Speakers

As health care providers see more and more patients with limited English-language skills, hospitals and doctors are in the process of determining how best to solve the communication barrier that often leaves non-English-speaking patients without proper medical attention, the AP/Contra Costa Times reports. According to 2000 U.S. Census data, 21.3 million people in the United States speak English "less than very well," and health care without translations for these residents is "at best, inconvenient, and at worst, life-threatening," advocates say. Federal civil rights law requires that federally funded health care providers offer services that can be understood by non-English speakers, and doctors cannot refuse to see or treat patients simply because they do not speak English. Even so, a recent Brandeis University study of 4,000 uninsured patients found that approximately 8% reported instances of needing but not receiving an interpreter, and one-quarter reported that they did not understand how to take prescribed medication. Although many doctors want to provide translation assistance to their patients, a hired translator can cost $30 to $400 and can "far exceed" the $30 to $50 Medicaid reimbursement for an uninsured patient. Doctors may instead rely on "a patchwork of methods" to communicate with their patients, including enlisting the translation help of janitors, receptionists, other patients and relatives.

Some providers have undertaken more comprehensive policies to help address the language barrier. A "sophisticated" pilot program at Gouverneur Hospital in New York provides simultaneous interpretation via headset of Spanish, Mandarin, Cantonese and Fukinese in order to communicate with non-English-speaking patients. At the request of students, Wake Forest University School of Medicine in Winston-Salem, N.C., now requires medical students to learn Spanish. In addition, California Sen. Martha Escutia (D) has proposed a state measure that would more "strict[ly] enforc[e]" a 1973 law mandating that state and local agencies provide bilingual services if they serve "a substantial number" of non-English speakers. During his administration, former President Bill Clinton signed an executive order stating that programs provided in English that are inaccessible to non-English speakers are "discriminatory." Members of Arlington, Va.-based ProEnglish, an organization that opposes multilingualism, and four doctors have filed a lawsuit to attempt to block Clinton's executive order. The HHS Office for Civil Rights this fall plans to issue guidelines regarding services for non-English-speaking patients (Kong, AP/Contra Costa Times, 6/23).