united-states medical health language
Are hospitals required to provide language interpreters to patients?
<p>California, USA. The hospital is on COVID lockdown, no visitors allowed. The patient had a stroke, lost her English, but seem to understand her native language; she slowly and barely coherently speaks a few words, but only in her native language. Is the hospital required to provide an interpreter to help communicating with the doctors and the therapists?</p>

<p>Hospitals in the US that receive federal funding (e.g., Medicare, Medicade, FCHIP, etc.) are required to provide language services under Title VI of the Civil Rights Act of 1964, 52 U.S.C. §2000d <em>et seq</em> to those persons of limited English proficiency who receive services. <a href="https://www.hhs.gov/civil-rights/for-individuals/special-topics/needy-families/civil-rights-requirements/index.html" rel="nofollow noreferrer">This US Government Department of Health &amp; Human Services page</a> notes:</p>
<blockquote>
<p>Persons with limited English proficiency must be afforded a meaningful opportunity to participate in programs that receive Federal funds. Policies and practices may not deny or have the effect of denying persons with limited English proficiency equal access to Federally-funded programs for which such persons qualify.</p>
</blockquote>
<p>Many HHS documents address this requirement. An overview can be found in the <a href="https://www.hhs.gov/sites/default/files/hhs-language-access-plan2013.pdf?language=es" rel="nofollow noreferrer">HHS Language Plan (2013)</a>, which contains sections requiring translation of oral communications as well as written documents when the patient has limited English proficiency.</p>
<p>Given the pervasive presence of these federal programs in the provision of health care in the US, most (if not all) US hospitals will be required to comply and provide translation services.</p>

<p><a href="https://www.hhs.gov/sites/default/files/2016-06-07-section-1557-final-rule-summary-508.pdf" rel="nofollow noreferrer">The pertinent rule</a>, implementing §1557 of the ACA,
requires notices of nondiscrimination, which the government has made available in 64 languages, which says <a href="https://www.hhs.gov/sites/default/files/sample-ce-notice-bantu-kirundi.pdf" rel="nofollow noreferrer">this</a> or the equivalent in other languages. Assuming that the person understands one of those languages then they will know (if they can read) that they can contact the civil rights coordinator; and if the person believes they were discriminated against on the basis of race, color, national origin, age, disability, or sex, they can file a grievance (this is in the notification flier). The notice must be posted in the &quot;top 15&quot; non-English languages of that state, although there can be substantial dispute over what those languages are. The medicare office has <a href="https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/Appendix-A-Top-15.pdf" rel="nofollow noreferrer">a list</a>, which is quite inaccurate but might be relied on in a legal dispute (there is no language &quot;Cushite&quot;). The requirement is that</p>
<blockquote>
<p>Covered entities must take reasonable steps to provide meaningful
access to each individual with limited English proficiency eligible to
be served or likely to be encountered in their health programs and
activities.  In addition, covered entities are encouraged to develop
and implement a language access plan.</p>
</blockquote>
<p>This does not mean that a hospital is obligated to provide a translator, because it is not always reasonable to do so.</p>
<p>What the hospital is required to do is</p>
<blockquote>
<p>make all programs and activities provided through electronic and
information technology accessible; to ensure the physical
accessibility of newly constructed or altered facilities; and to
provide appropriate auxiliary aids and services for individuals with
disabilities.  Covered entities are also prohibited from using
marketing practices or benefit designs that discriminate on the basis
of disability and other prohibited bases.</p>
</blockquote>
<p>Apart from the statutory discrimination-based requirement, there is the threat of a malpractice lawsuit based on not understanding what the patient said. There is no clear line defining what is reasonable versus unreasonable. For communications that pertain to issues of consent, the necessity for translation is higher, and failing to provide a translation between Parisian French and English would be unreasonable. Failing to provide a translation between English and the Krim language of Sierra Leone would be reasonable, and virtual necessity. Theoretically, HHS is developing a list of translation services. There are a number people who purport to provide translations, but they only cover the most popular languages, and issues of competence are prominent in this area. I would not be surprised to find a city with no medical translators for Mushunguli, and no ability to determine that the patient was speaking Mushunguli.</p>

<p>In the United Kingdom - there are moral and legal reasons to provide translators to patients (a UK NHS policy is <a href="https://www.meht.nhs.uk/EasysiteWeb/getresource.axd?AssetID=14511&amp;type=full&amp;servicetype=Attachment" rel="nofollow noreferrer">here</a>)</p>
<p><a href="https://www.wwl.nhs.uk/Library/FOI/Requests/2017-2018/June_2017/Interpreting%20and%20Translation%20Policy.pdf" rel="nofollow noreferrer">Another policy</a> makes mention of the Equality Act:</p>
<blockquote>
<p>The provision of interpreter and translations services enables us to
ensure equality of access to health services.  As part of the General
Duty of the Equality Act 2010, public sector services are required to
advance equality of opportunity and eliminate unlawful discrimination
between individuals who share a protected characteristic.  We have a
duty to provide communication support for people, where there is a
need. This includes those for whom English is not their main language,
and/or those who are visually, hearing or speech impaired</p>
</blockquote>
<p>There are also General Medical Council requirements to &quot;meet patient communication needs&quot; <a href="https://www.gmc-uk.org/gmpinaction/case-studies/amber/case-notes/" rel="nofollow noreferrer">here</a></p>
<p>Pragmatically - we have a very large shared interpreter pool as well as resources such as &quot;<a href="https://en-gb.thebigword.com/interpreting-services/telephone-interpreting/" rel="nofollow noreferrer">The Big Word</a>&quot;; telephone translation services.</p>
