Hospital Language Access is a Matter of Life or Death

By Carol Velandia

Approximately 25 million people in the United States are defined as being Limited English Proficient or LEP. A LEP person cannot speak, read, write, or understand the English language at a level that permits them to interact effectively with English speakers.

In the hospital setting, good communication is crucial; it is actually a matter of life and death. Limited English proficiency and failure to provide professional medical interpretation and translation leads to medical errors based on poor communication during diagnosis and care. The LEP population presents disproportionately longer lengths of stay at the hospital, more surgical delays, surgical infections and falls than the rest of the population[1]. They often fail to understand how to take their medications, prepare for surgery or understand what is involved in the procedure that they are about to undergo[1][2][3][4].

Both providers and patients feel frustrated with the communication barrier, and they try to work with the resources that they have, such as bilingual family members, machine translation, and their limited language skills. They mean well, but the results of this informal interpretation or translation could be disastrous. It can put patients at risk for medical errors and expose hospitals to very costly lawsuits.

Language access is an elemental service in every hospital. Title VI of the Civil Rights Act states:

Hospitals that receive federal funding, including Medicare and Medicaid, must provide culturally and linguistically appropriate services. These are also referred to as CLAS (Culturally and Linguistically Appropriate Services) standards. These include but are not limited to professional medical interpretation and translation. Patients and clinicians have the right to receive information in a language that they can understand.

Hospital administrators often feel burdened by the expense of culturally and linguistically appropriate services. The perception is that these services are an empty cost for hospitals. However, the truth is that it actually saves them money. How? It reduces waste represented by overtreatment and medical errors. According to the Centers for Medicare and Medicaid Services, this waste amounts to 50% of the healthcare costs and it is generated by 5% of the population[2]. If hospitals devote some of their efforts in providing appropriate access to information and care, patients will be more likely to follow instructions and take better care of their own health, and hospitals will reduce the costs by increasing patient safety and quality. These elements are highly valued.

From the hospital perspective, the best strategy to follow is to implement CLAS standards. They offer a clear road map to fulfill Title VI and implement Language Access Plans.   https://www.thinkculturalhealth.hhs.gov/Content/clas.asp#clas_standards

From the patients and LEP citizens perspective, they should know that they have a right to receive information in a language they can understand. It sounds simple, but it will require the will of hospital leaders, administrators and language services providers.

Carol Velandia M.B.A, C.H.I. P.M.P. is a healthcare and judiciary interpreter and also a Social Work student. In her dual role as an interpreter and as social worker in training, she works with culturally diverse populations, especially the limited English proficient (LEP) population. Her professional goal is to find avenues to bring about adequate Language Access Services and promote the Cultural and Linguistically Appropriate Standards (CLAS) and thus facilitate equal access to justice, healthcare and education to individuals with LEP. As the Administrator of the Interpreters Division at ATA she has advocated to raise the standards for interpreters of all tracks of the profession. She was an expert panelist at the Department of Homeland Security in 2014 on the topic of Language Access where she provided a definition and a profile of the professional interpreter. Simultaneously, she promoted ATA’s position paper on this topic, a team effort. In her role as a healthcare interpreter at Johns Hopkins, she created and directed the video: “Saving Lives in Many Languages”. The video was awarded with the first prize in the Patient Safety National Summit held at Johns Hopkins Institutions in 2013. The video was later endorsed by the institution on their “The Promise of Medicine” campaign. She is also the recipient of the President’s Fellowship on Cultural Competency at the University of Maryland and is working on a white paper on this topic.