Healthcare Hurdles for Limited English Proficient Patients

by Ingrid Cruz

People whose first language is not English deal with additional hurdles to their healthcare. For non-native English speakers, talking to a doctor or dentist can mean listening to unfamiliar medical terms that may be difficult to understand. Trained medical interpreters can bridge the gap between patients, doctors, nurses, and hospital staff.

Often, unqualified but well-intentioned friends and relatives help limited English proficiency (LEP) patients navigate the healthcare system. This often means that immigrant children serve as translators for parents whose English is limited, or who don’t speak it at all.

LEP patients often don’t know laws exist that allow them to obtain qualified language assistance. Title VI of the Civil Rights Act of 1964 ensures the right to medical interpretation in a patient’s language, including the right to documents containing information in all programs that receive federal funding. However, Title VI didn’t specify who would fund interpreters and services for people who are LEP.

To try to solve the problem, President Bill Clinton signed Executive Order 13166 in 2000. It called for federal agencies to look at their current programs, find gaps in access for those who are LEP, and create plans to help the LEP community participate in these programs in a meaningful way.

Supervision of programs for LEP beneficiaries of programs with federal funding was never standardized because all federal agencies have a Civil Rights division that oversees the enforcement of the Civil Rights Act of 1964.

Section 1557 of the Affordable Care Act (ACA) further clarified that healthcare institutions can’t deny or stall language assistance to people with LEP. Regulation for the implementation of Section 1557 was issued in 2016 and required that medical interpreters be trained, important documents were to be translated into the 15 most spoken languages in a given state, and family or relatives could only act as translators per patient request.

Once again, the lack of a central measure to ensure the right to language assistance for the LEP community affects the life of patients and medical staff every day. This is especially the case in rural areas. Hannah Bascomb is a nursing professor at the Mississippi University for Women who spoke about her experience as a bedside nurse for labor and delivery in northeast Mississippi. Of her experience working interpreters, she says circumstances were best when a translator could arrive in person “[You] could go to a room and ask questions on the spot.”

Things got more complicated when patients spoke a language other than Spanish, something that complicated Bascomb’s job. She stated that staff often had to use a Dictaphone machine, which was usually locked and required the user to push correct buttons and wait until an interpreter could answer.

The good news is that at least, in Bascomb’s experience, it seems as if medical staff and patients did what they could to ensure patients had some language assistance. However, until governmental agencies, state governments, and medical professionals can decide who pays for interpreters, discrepancies in service will continue to exist.

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