Building the Language Wall in Healthcare
If you do not know how to speak English in the United States, you are as good as dead — at least that is the case in healthcare. The COVID-19 pandemic has magnified this tragic trend.
A limited English proficient (LEP) woman entered a hospital with coronavirus in March and the staff mistakenly placed her with non-coronavirus patients. Due to her cough and fever, a doctor transferred her into a coronavirus unit, cautioning other physicians: “Good luck. She speaks Hungarian.” The medical resident treating her noted that no one wanted to arrange an interpreter to record her medical history. The resident proceeded to call the interpreter service as his N95 mask muffled his voice and his helmet blocked his ears. After spending five minutes yelling “Hungarian!” on the phone to get the appropriate interpreter, the service representative still thought he said “Spanish.” She died the following night.
Deficiencies in providing quality translating and interpreting services in healthcare have left LEP patients with worse outcomes: longer hospitalizations, more readmissions, and more medical errors. Yet the Trump administration reduced free access to language services and thereby explicitly undermined civil rights laws. The Civil Rights Act of 1964 established LEP individuals’ right to receive free language assistance. In 2010, the Affordable Care Act (ACA) clarified that language assistance must be meaningful—a standard evaluated by timeliness, accuracy, and efficacy. The Centers for Medicare and Medicaid Services (CMS) was authorized to assure these rights in 2014. Too bad they were all talk and no action.
CMS teased that by 2016, LEP patients would receive information about language services and have access to qualified interpreters. But that year, nearly a third of U.S. hospitals still failed to offer interpreters. Without normalizing the use of language services in patient treatment, physicians risk n
eglecting their patients. Clinicians mistakenly accept nods and smiles as the equivalent of health literacy, when patients actually nod in fear of burdening their physician. They do not know they have the right to communicate with their health providers, no matter their English fluency. I did not even know this myself.
I am a Vietnamese American immigrant. Yet until I took a science law class during my freshman year of college, I did not know that my grandpa deserved to hear his paralysis diagnosis in Vietnamese. Does this mean I did not have to play doctor, interpreter, and the bearer of bad news for my family members? It only took 15 years in the states and a fortune in tuition to figure out the answer: No.
But the availability of medical interpreters and funding is deficient. Even when facilities provide language assistance, the shortage of professional interpreters delays procedural practices. However, medical facilities’ non-compliance is not completely intentional. The government mandates language access for LEP individuals, but provides the minimum in resources. Only 3% of medical facilities receive reimbursements from the government or Medicaid systems for language services they provide. Thus, hospitals treat language services as another item on the budget. In an attempt to reduce expenditures, healthcare facilities rely on untrained family members and bilingual staff to bridge the communication gap, resulting in the improper use of medications, incomplete medical histories, and poor adherence to post-operation instructions.
The health system has failed to acknowledge the severity of the language barrier as a challenge to quality health care. Thus, the integrity of healthcare for LEP individuals has been deteriorating for decades, and the pandemic has exposed this inequity. The Hungarian woman may have died even if she spoke English, but her experience exemplifies how LEP patients suffer from poor quality of care. Healthcare workers have adapted to the pressure with a utilitarian approach whereby the patients presenting minimal challenges to care are the ones who receive the best care. No one expects fluent English speakers to comprehend the extent of COVID-19, so how are LEP individuals expected to without language assistance?
Even though COVID-19 collapsed America’s healthcare system, Donald Trump decided to exacerbate the condition for marginalized communities. He justifies his xenophobia because of “high costs.” In reality, when hospitals consistently use language services, they offset interpreting expenditures with the money they save from fewer hospital readmissions.
It is futile to expect change from a government that continues to systematically oppress its people. Clinicians, take it upon yourself to normalize informing patients of language services and using those services. Check in with the patient and interpreter to ensure vital information is absorbed. If you cannot communicate with your patient, then you cannot provide care.
Community-based organizations are also critical in connecting LEP patients to physicians by reducing fear of health institutions and standardizing language and cultural competency. If the health sector does not meet the needs of the expanding demographic landscape, ten percent of our American population is as good as dead.
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