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by Adam Gurvitch and Norman Eng
In an important victory for immigrant communities in New York City and throughout the state, the New York State Department of Health has adopted regulations setting basic standards for hospitals’ communications with patients who speak limited or no English (or who are hearing- or vision-impaired).
The regulations, which went into effect on September 13, 2006, require all private and public hospitals in New York State to provide skilled interpreters, translate important hospital forms into commonly-used languages, and ensure that patients awaiting care do not face excessive delays because of language issues.
A Life and Death Matter
Millions of New Yorkers stand to benefit from the new rules. One in four New York State residents, and one in two New York City residents, speaks a language other than English at home. In the city, 1.7 million residents—one in four—are not proficient in English.
Hospital communication barriers can lead to serious problems, including misdiagnosis, failure to obtain informed consent, performance of unnecessary medical procedures, illegal delays or denial of care, and severe medical harm. In order to communicate, many patients with limited English are forced to rely on untrained and unskilled interpreters—often a minor child or stranger.
Existing federal, state, and local laws require hospitals to avoid discrimination and provide meaningful access to health care, regardless of a patient’s national origin or the languages he or she speaks. Nonetheless, advocates have documented the widespread failure of hospitals to communicate in the languages commonly spoken in the communities that the hospitals exist to serve.
In one case that was reported in The New York Times, Mr. Chul Sun Moon, a non-English-speaking Korean immigrant, died from head injuries sustained in a soccer game, despite repeated visits to Flushing, Jamaica, and Brookdale Hospitals over the course of a month. Moon never had a chance to discuss his condition or treatment with doctors in a language he could understand. He and his wife relied on strangers and on relatives in Boston, via cell phone, in their struggle to understand what was happening.
In another instance, advocates from the Latin American Integration Center monitoring St. Vincent’s Hospital in Staten Island witnessed emergency room staff using a seven-year-old child to explain to a patient in Spanish that he needed an emergency amputation.
These and many other documented cases of communication barriers led immigrant groups to file civil rights complaints with the state attorney general in 2005 against four hospitals—Flushing, Jamaica, and Brookdale medical centers and St. Vincent’s Hospital on Staten Island. The complaints helped spur the development of the new Health Department regulations, and last month, the four hospitals and the state attorney general’s office announced language assistance agreements that closely track the new regulations.
What Can Immigrant Patients Expect?
With the new regulations now in effect, hospitals are required to have an effective system in place to communicate with patients who speak little or no English. For the first time, hospitals have clear standards they must meet to ensure that the health and safety of patients will not be compromised by language barriers.
The new rules do not require hospitals to have large teams of interpreters who speak every possible language that is spoken in New York City. Hospitals are afforded great flexibility in using bilingual hospital staff, interpreters, volunteers, and telephone language assistance lines to communicate with patients. Quality matters: Hospitals are responsible for evaluating and ensuring the adequacy of language skills of all staff, volunteers, and contractors who provide communication assistance.
Hospitals are not permitted to use a patient’s family members, friends, or non-hospital personnel as “interpreters,” unless free interpreter services have been explicitly offered to the patient and been declined.
Patients who speak limited or no English should expect the following in every hospital in New York:
• The hospital must offer and provide communication assistance from fully-bilingual staff or skilled interpreters in a language that is understandable to the patient during the entire medical visit. The hospital must ensure appropriate communication when the patient calls to make an appointment, registers for care, and interacts with nurses, doctors, counselors, and non-clinical staff such as the hospital’s financial assistance and insurance enrollers.
• The hospital is responsible for identifying the patient’s preferred language and documenting it in the medical chart. Documenting the preferred language ensures that various departments will be aware of communication assistance needs when coming into contact with the patient, and makes it possible for the hospital to prepare for subsequent medical visits by having the appropriate language assistance services available at the time of the appointment.
• If the hospital fails to communicate with the patient, the patient or the patient’s representative or physician should notify the hospital of the language he or she speaks, and request an interpreter.
• The hospital is permitted to use a variety of methods to provide language assistance services to patients with limited English proficiency. While the new regulations require hospitals to manage a pool of skilled interpreters, it does not specify what form the interpretation should take in any given patient encounter. The hospital’s pool of resources may consist of full- or part-time staff interpreters, and/or bilingual health care and non-clinical staff, and may be supplemented by volunteers and contractors.
• As a backup, hospitals may contract with telephonic language assistance services. Such services may be acceptable when the hospital is interacting with patients who speak languages that the hospital encounters infrequently, or during off-hours in areas of the facility where on-site language assistance resources may be limited.
• The new regulations require hospitals to provide communication assistance to all patients within 20 minutes in inpatient and outpatient settings, and 10 minutes in emergency settings.
• Each hospital must provide key forms in a language the patient understands. Key documents include registration, billing, and consent forms for medical procedures, as well as medication and treatment instructions. Translated documents must be made available in those languages that are spoken by more than one percent of the hospital’s patients or the total hospital service area population. If translated documents are not available, a hospital should provide an interpreter to translate significant documents verbally for the patient at the time of a medical visit.
• Each hospital is required to post signs and distribute written materials notifying patients about the hospital’s free language assistance services, and provide patients and prospective patients with instructions for accessing services. These notices must be distributed in every language spoken by one percent of the hospital’s patients or service area population.
See also: Good Government Speaks Many Languages
Adam Gurvitch is director of health advocacy, and Norman Eng is communications coordinator, with The New York Immigration Coalitioion.
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