A 9-year-old girl, misdiagnosed with the stomach flu, died after a doctor failed to communicate to her Vietnamese-speaking parents that the drug he prescribed for her could have dangerous side effects.
A 78-year-old stroke victim had to have her leg amputated after doctors and nurses didn't understand her when she complained, in Russian, of pain and numbness.
And a 7-year-old boy suffered organ damage because his pediatrician mistakenly diagnosed him with strep throat, having struggled to communicate with his Spanish-speaking father and grandparents during repeated visits over several weeks.
New federal rules requiring thousands of hospitals, doctors and dentists to provide free interpretation and translation services for people who don't speak English aim to prevent tragedies like these, which were among those included in a study of interpretation-related malpractice cases in four states.
The new rules, which apply to providers who receive
"The language services are going to keep people healthier and that will end up saving health care dollars down the road," said
But some struggling rural hospitals and smaller medical and dental practices are worried about the cost of following the new rules, which require them to offer interpretation and translation services for the most popular 15 languages in their state.
In a letter to the
Some states have their own laws related to language services. A number of states, including
Some states, such as
Speaking Swahili in
The Civil Rights Act of 1964 prohibits discrimination on the basis of race, color, religion, sex or national origin. In 2000, President
But Clinton's order didn't specify how to do so. Without any guidance, many providers have been relying on family members -- even minor children -- to serve as interpreters.
An article published in August in the journal Health Affairs found that a quarter of the hospitals with the greatest need for language services (based on the surrounding population) did not provide such services in a systematic way, and nearly a third of all
"The services are definitely not matching the need," said
Using an interpreter unfamiliar with medical terminology can produce dangerous misunderstandings. A study published in 2012 found that serious medical errors were less likely to occur with professional health care interpreters than with interpreters who don't have special training, such as bilingual friends or family members, or no interpreters at all.
A provision in the 2010 Affordable Care Act (ACA) aimed to shore up interpreting services and this month the federal government is finally rolling out rules that detail the specific steps that health care providers must take. The rules apply to about 900,000 physicians, and 133,343 hospitals, home health agencies, nursing homes and other health facilities. It also applies to at least 180 insurers.
Under the rules, health care providers must post notices telling patients and their families that language services are available. Websites and other written materials must be translated into the 15 most frequently used non-English languages spoken in the state.
The rules require that providers offer interpretation services during direct encounters and translations of vital written communications, including discharge and medication instructions, explanations of benefits and appeal notices.
They also require that interpreters be trained in medical terminology and health care ethics. Family members or friends may not substitute for a trained interpreter unless requested by the patient, and bilingual staff members can only interpret in an emergency.
The new regulations apply to all hospitals and other health care providers -- doctor's offices, dental offices, and clinics -- that take federal money. Doctors who see patients on
Health policy experts say the new rules will improve the health of non-English speakers by making it easier for them to get preventive care, helping them avoid more serious -- and costly -- health crises. Studies have found that language barriers prevent patients from receiving regular checkups, cholesterol and cancer screenings, breast exams and flu shots. When they do visit a doctor, non-English speakers often misunderstand their doctor's advice, or struggle with prescription directions.
"If someone can't understand what their doctor says or what they are signing in a consent form, that is not considered equal access to health care," said
The requirement also may save money by making it less likely that non-English speakers will be readmitted to the hospital after they are released, and by reducing the likelihood of malpractice claims.
One analysis of medical malpractice claims found that 2.5 percent of the reviewed claims were the result of inadequate language services.
Paying for It
For patients who are not covered by
The hospital system has 100 in-house interpreters, and in the last year they provided help in 80 languages. The hospital receives about 2,000 requests a month, most frequently for Spanish, Mandarin and Arabic.
Like many others, the
That's how hospitals in less-populated areas frequently meet their language service needs.
"They have to have notices in the top 15 languages spoken in the state," Blackmon said, "but we have counties that probably don't even have a single person who speaks a foreign language."
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