Who is at fault when parents misunderstand medical instructions due to a language barrier, and their child dies as a result? Public pressure to answer that question caused laws to evolve several times recently because of such a situation.
America has been a melting pot of languages since its inception, and that is no different today. There are over 40.5 million Spanish speakers in the USA as of 2018, 3.4 million Mandarin or Cantonese speakers, and over a million each Tagalog, Vietnamese, Arabic, and Korean speakers.
Many of these millions of people are bilingual, but many more navigate life in America without the ability to read, write, or speak English. First generation immigrant parents may rely on their Americanized children as interpreters, or they may lack an interpreter altogether. In 2015, there were a record-breaking 63.2 million non-English speakers living in the United States.
When it comes to medical care, the consequences of a language barrier can be lethal. What happens when a child falls into a medical crisis, and her monolingual parents can’t understand what the medical professionals tell them to do?
Who Was Gricelda Zamora?
Gricelda Zamora was a 13-year old girl who developed severe abdominal pain one night. Her parents had relied on her as their interpreter since she was young, because they could not speak English themselves.
By the time they reached the hospital, Gricelda was too sick to interpret for her parents. They held her overnight to observe her symptoms before discharging her, providing clear instructions (in English) to bring her back with urgency if she became any worse.
If she improved, the nurses said to bring her back in three days for a routine follow-up. The Zamoras did not understand fully, and thought that the nurses were telling them to return in three days for a follow-up regardless of how Gricelda felt. They waited two days, with Gricelda’s condition steadily worsening, before they gave up waiting any longer and brought her to the hospital.
Two days of waiting was too much, and Gricelda died of a ruptured appendix within hours.It’s not common for such a miscommunication to lead to death, but language-based miscommunications do occur in a healthcare setting on a routine basis. Lack of an interpreter can lead to patients neglecting follow-up appointments, taking wrong medication doses, or failing to set up treatment, all of which have adverse effects on their medical outcomes.
The Civil Rights Act of 1964
Did Gricelda’s parents have a legal right to an interpreter? According to the 1964 Civil Rights Act, they did.
No person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving federal financial assistance.
The Department of Health and Human Services expands this statement to cover healthcare services. The Supreme Court interprets language services to fall under “national origin,” therefore, failing to provide language services in a healthcare setting is a violation of the Act.
The Health and Human Services Office for Civil Rights enforces compliance to the Act, and takes complaints from patients who have been denied language services in healthcare settings. Many hospitals across the nation have recently implemented language assistance departments in response to action taken by the Office for Civil Rights, including Boston Medical Center and San Francisco General Hospital.
Civil Rights Act Title VI
The portion of the Civil Rights Act dealing with this is Title VI.
Title VI states that healthcare providers need to:
- Provide all documentation in languages spoken by the area’s predominant ethnic group (including signs, paperwork, materials, consent forms, etc.)
- Provide written and spoken language assistance to all patients with limited English proficiency, including patients who need hearing assistance or vision assistance
- All assistance needs to be offered free-of-charge to the patient
How to Provide Compliant Language Services
The growing number of non-English speakers means a greater demand for language services in doctor’s offices, clinics, and hospitals. Because healthcare services have such a sensitive and crucial nature, healthcare providers are obligated to prioritize accessible language services for their non-English proficient patients.
There is yet another layer of obligation for providers who accept Medicaid, as all federally-funded providers legally must offer language services to their patients.
While the law is clear, many healthcare providers are still failing to provide language services to their patients. This is not likely out of malice, but out of a lack of awareness, because many states fail to enforce these laws consistently.
What can providers do to help ensure they are providing language services to their patients who do not speak English?
Seek reimbursement: Medicaid and State Children’s Health Insurance Program offer federal matching funds for language and translation services, which can ease the burden of cost on a practice considerably.
Choose a private language service provider: Choosing a private provider offers the flexibility to work within a budget without compromising quality. On-site interpreting services are a necessity, and often document translation, written language assistance, or phone interpreting may be useful as well. One high-quality provider can offer it all, simplifying the process.
Language services are a crucial part of offering healthcare to a diverse population, and they must not be neglected. Providers should take action today to ensure full compliance with Title VI.