Patients with Limited English Proficiency

2014; Issue 3

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An 80-year-old woman was seen recently for a routine follow-up in one of the offices of a Integris Group insured provider. The woman is French-Canadian and has limited English proficiency. The patient is accompanied by her daughter to all office visits, and the daughter serves as her mother's translator. The patient has a history of moderate to severe musculoskeletal pain and has been on several medications, including opioids. During the most recent office visit the patient's daughter reported that her mother was experiencing difficulty sleeping due to an increase in pain at night and requested an increase in her mother's pain medication.

Unknown to the doctor, the newly hired medical assistant in the room with him was fluent in French and quickly identified the fact that the daughter was not interpreting for the patient, but was seeking drugs for herself. This patient encounter put this provider at serious risk for prescribing violations, and he immediately contacted the Department of Consumer Protection Drug Control Division to report the incident.

Limited English proficiency is a growing concern for healthcare providers in the United States. Title VI of the Civil Rights Act obligates medical-care givers to provide interpretation and translation services so patients with limited English proficiency can receive the same level of care that English-speaking patients receive. Unfortunately, due to the lack of well-trained interpreters during patient encounters, thousands of patients receive less than adequate care each day.

Currently, only the District of Columbia and 13 states (Hawaii, Iowa, Idaho, Kansas, Maine, Minnesota, Montana, New Hampshire, Utah, Vermont, Virginia, Washington and Wyoming) have a Medicaid program that reimburses for interpretation services. Connecticut has enacted but has not implemented a program. North Carolina is implementing a program that is based on the credentials of the interpreter, and California has established a task force to begin to address the problem of limited English proficiency interpretation.

Reducing language barriers has proven to improve healthcare outcomes, patient safety and provider/patient communication. Studies have shown that if patients understand their health care, they will make fewer mistakes taking their medications or preparing for medical procedures. Communication is vital when it comes to healthcare outcomes.

Know the law:

  • Medicaid - Medicaid regulations require Medicaid providers and participating agencies, including long-term facilities, to render culturally and linguistically appropriate services. The Heath Care Financing Administration, the federal agency that oversees Medicaid, requires that states communicate both orally and in writing "in a language that is understood by the beneficiary" and provide interpretation services at Medicaid hearings.
  • Medicare - Medicare addresses linguistic access in its reimbursement and outreach education policies. Medicare "providers are encouraged to make bilingual services available to patients wherever the services are necessary to adequately serve a multilingual population." Medicare reimburses hospitals for the cost of the provision of bilingual services to patients.
  • Title VI of the Civil Rights Act of 1964 - "No person in the United States shall, on the ground of race, color or national origin, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance."
Certified Medical Interpretation services are available through various companies and organizations. Integris Group recommends consulting your local Hospital or Medical center for recommendations.