By Sarah-Claire Jordan
Medical interpretation, also known as healthcare interpretation, is an essential service that everyone in the U.S., should they need it, should be able to easily access. Healthcare interpreters relay information back and forth between the LEP (low English proficiency) party and the medical personnel. Unfortunately, not all healthcare facilities provide sufficient services, and sometimes a family member who speaks good enough English is used as an interpreter. This is wrong for several reasons, one being that the family member probably doesn’t have a medical background and may have difficulties interpreting certain terms.
Thankfully, there is some legislation that deals with language access in a healthcare setting in the U.S. Here are nine things to understand about this legislation.
1. The first piece of legislation to address language access rights in healthcare was the Civil Rights Act of 1964
Title VI of the Civil Rights Act passed in 1964 provided the foundation for all future legislation relating to language access, including the healthcare field. The legislation asserts that discrimination based on national origin, color, or race will not be allowed in any program that receives funds from the federal government. Essentially, the interpretation of “national origin” includes anyone who doesn’t speak English as a first language. This is the first bit of legislation in the history of the U.S. that deals with the issue of linguistic discrimination and created the groundwork for later additions and laws.
2. In 1980, a notice regarding Title VI was issued
The Department of Health and Human Services decided to issue a notice in 1980 as a way of clarifying that “national origin” did indeed imply discrimination based on someone having a native language other than English. The notice was specifically meant to address issues of that particular kind of discrimination in the health and human services field, and so further set the bar for future modifications. The Department of Health and Human Services receives medical funding in the form of Medicaid, Medicare, different grants, and more.
3. The Office of Civil Rights of the Department of Health and Human Services oversees discrimination issues in the healthcare field
Every single U.S. federal department has an Office of Civil Rights to enforce the Civil Rights Act and all other legislation related to civil rights and discrimination. The OCR (Office of Civil Rights) makes sure that any party that receives money from the HHS (Department of Health and Human Services) is doing everything in accordance with civil rights legislation. Basically, anything from health departments, nonprofit organizations related to health, and the doctors themselves are all entities that the OCR of the HHS oversees. If there are any issues regarding linguistic discrimination, like if someone is not provided the language assistance they have a right to, the OCR can go in and investigate. Unfortunately, this doesn’t happen as often as it should, but at least the OCR of the HHS exists as well as legislation that protects the rights of those who are not proficient in English in a healthcare setting.
4. Executive Order 13166
Once in a while, someone with the power to create change uses this power for good. That’s what happened on August 11, 2000 when President Bill Clinton issued Executive Order 13166. This executive order demanded that all federal agencies make sure that they provide services for people with low English proficiency, and develop those services if they don’t already provide them. In this way, Title VI of the Civil Rights Act was brought back into the public eye and more emphasis was placed on the importance of providing proper services to people whose native language is not English.
5. OCR Policy Guidance for Executive Order 13166
In order to help healthcare providers and anyone else who receives federal money for health related services, the OCR of the HHS created the Policy Guidance. It included ways to implement services for low English proficiency as well as information about how those services should work in order to meet government requirements. After George W. Bush was elected president, some changes were made to the OCR Policy Guidance. The revisions made were intended to keep nonprofit organizations and small businesses from carrying too much of a load in terms of complying with all requirements with the federal money they receive.
6. State legislation regarding language assistance varies
Though you can see that there is at least some legislation on a federal level that regulates language access services in healthcare, it isn’t something that is regularly enforced. Individual states don’t have any obligation to pass their own legislation, but many have and it has helped immensely. Over 40 states have established at least a few laws that regulate how those with low English proficiency are treated in the realm of healthcare. Unfortunately, since it’s up the state to create these laws or not, the type and number of laws vary quite a bit from one state to another. Some have upwards of 70 laws enacted to date, while others only have a handful. One problem seems to be that certain information is provided in different languages, but not all information, and it is only provided in some languages. The same goes for interpretation services, so essentially the state legislation, in general, is full of holes that need to be filled.
7. Training/education for healthcare professionals about language access/cultural competency
Continuing with individual state legislation, there are three states that currently have laws requiring health professionals to receive some sort of training in how language access services work and why they are necessary. The main purpose is to show those who work in healthcare how much a language barrier can impact whether a patient is properly diagnosed and gets the right treatment or not. Not knowing enough English can even determine whether someone goes to a hospital or not, because they might feel like it’s useless if they won’t be able to communicate properly with the staff. These laws are in effect in Washington, California, and New Jersey and are helping to create a more equal healthcare environment. There are pushes to modify these laws and make the required training and education more than just a one time thing, so that health professionals have a better understanding of how to implement this training in their everyday practices.
8. There are no federal standards for healthcare interpretation certification
Across the board, it is understood that being bilingual isn’t enough to be a medical interpreter. If you don’t know the proper medical terminology in both languages, aren’t familiar with how hospitals and other healthcare facilities work, don’t have experience in the field, or aren’t certified, you technically shouldn’t be working as a medical interpreter. The ideal candidate has a vast knowledge of medicine, experience, and a certification, as well as being bilingual. Unfortunately, there are no standards put forth by the federal government that medical interpreters must meet, so many times individuals who are unqualified for whatever reason end up interpreting in medical facilities. This, of course, can lead to misdiagnosis and all kinds of other issues. In order to deal with this problem, some individual states have taken it upon themselves to set up state standards for medical interpretation certification. The first state to do this was Washington, with some other states later following their example.
9. Some states pay for interpretation services, while others don’t
One of the major issues keeping individuals from getting the interpreting services they deserve is money. Though programs like Medicaid and some healthcare organizations have made it clear that federal funding can easily be obtained to pay for interpreting services, it depends on the state. To put it simply, some states decide whether the interpretation services will be paid for or not. So far, twelve different states as well as the District of Columbia provide reimbursement for interpreting and other language access services in the area of healthcare. Among the states that do pay for these services, details like who is paid and how much they are paid can vary greatly from one state to the next. In some cases, services are only paid for if it is on an outpatient basis. Ultimately, the chances that someone will get the services they need in order to overcome the language barrier in terms of healthcare depends on which state they are being treated in.
As you can tell, there is not nearly enough legislation in terms of medical interpretation services provided to people living in the U.S. The federal government has passed some laws in an attempt to remedy the situation, but without proper enforcement (like regular inspections, evaluations, federal standards, etc.), individual states have to take it upon themselves to improve the situation for people with low English proficiency. This results in a lot of variation from state to state in terms of laws and regulations. Hopefully more states will get on board and realize they need to make sure they are providing adequate medical interpretation services, but in the meantime we can only hope for the best in some cases.
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