In 2018, you may or not be surprised that in health care, many practitioners and executives remain unfamiliar with what has been known for many years – language barriers between doctor and patient present serious health risks and liability issues.
Indeed, for example, a 2011 Pennsylvania Patient Safety Authority study entitled ‘Managing Patients with Limited English Proficiency,’ concluded: “Language barriers impede access to healthcare, can compromise quality of care, and may increase the risk of adverse health outcomes among patients with limited English proficiency. “
Yet, today in 2018, the language barrier problem in health care persists, as do the dangers and poor health outcomes ineluctably connected to patients and doctors literally speaking different languages to each other. A new study from the Associated Press – NORC Center for Public Affairs Research reveals this troubling persistent reality, noting, “The language and cultural barriers in health care for Latinos are something advocates have been pointing out for years.”
According to the July 27, 2018 New York Times:
“Nearly 6 in 10 Hispanic adults have had a difficult time communicating with a health care provider because of a language or cultural barrier, and when they do they often turn to outside sources for help, according to a new study conducted by The Associated Press-NORC Center for Public Affairs Research.
The survey finds that half of those who have faced those barriers turned to a family member or to another health care provider for assistance. In addition, more than 1 in 4 looked to a translator, public resources in their community or online sources for help when they faced those issues.
Antonio Torres, 53, of Orlando, Florida, who is bilingual and legally blind, told The AP he regularly struggles to understand the medical terms used by doctors and nurses.
“When I tell them I don’t understand them, they’ll bring someone over to speak to me in Spanish and I don’t understand them, either,” said Torres, who is Puerto Rican and was raised in New York. “We didn’t grow up speaking that formal Spanish, so I have no idea what they are saying.”
At times, Torres said he even gets medicine with his name misspelled on the bottle.
“And I don’t know if I’m taking my medicine or someone else’s,”
Recognizing Language Barriers
Language barriers arise not just from the lack of appropriate language assistance. They also come from mistakes and inaccuracies in faulty translations, as occurred in 2014.
The New York Times reported:
“In 2014, for example, the Obama administration faced criticism following the roll out of the Spanish version of the federal health care website, CuidadoDeSalud.gov. The translations were so clunky and full of grammatical mistakes that critics say they must have been computer-generated. The website also translated “premium” into “prima,” the Spanish word more commonly used to mean a female cousin among Mexican-Americans and Mexican immigrants.”
In addition to language, cultural competence considerations can intrude and separate provider and patient. They may often occur with older patients, patients who have lived most of their lives in culturally distinct and different communities than those of their doctors and nurses. Such cultural barriers are not unusual in elder care and assisted living environments.
As the New York Times reported:
“Along with communication challenges, many Hispanics are concerned about language or cultural accommodations for people in their community who seek long-term care services.
Fewer than half say it would be easy for older Latinos in their area to find a nursing home or assisted living facility with staff that speaks their language, or to find a home health aide who does. Even fewer — less than 3 in 10 — say the same about finding long-term care providers who can prepare the kind of food they are used to. Some have concerns about finding nursing homes and assisted-living facilities that will respect their religious or spiritual beliefs, though fewer have the same concern about home health aides.
Torres said he’s not confident he’ll find a culturally sensitive nursing home when he’s gets older. “I’d rather just live alone and poison myself by accident rather than stay in one of those homes right now,” he said.
Like other older Americans, many Hispanics age 40 and older expect to rely on government programs like Social Security, Medicare and Medicaid to pay for long-term care services, even though Medicare does not cover most nursing care or home health aides. But only about 2 in 10 think any of these programs will still be providing at least the same level of benefits five years from now. Just 15 percent of older Hispanics are very confident they will be able to pay for their own future long-term care needs.
The survey also finds that a large majority of older Hispanics are open to using at least one type of telemedicine to receive care, including phone consultations, text messages or video services like Skype, although older Hispanics are somewhat less likely than others in their age group to say they’d be comfortable using some types of telemedicine.
Gabriel Vargas, 41, of Lancaster, South Carolina, who is from Veracruz, Mexico, said he felt these resources in his area already were helping Latino residents. The growth of online options, he said, is breaking down the stigma held by Hispanics around regular checkups and preventative care.
“There’s a nonprofit group here that goes out of its way to help,” said Vargas, whose first language is Spanish. “Maybe 10 years ago, it was tough. But today I think it’s become easier.”
In 2018, studies like the AP-NORC piece should be few and far between. The health care dangers that flow from language and cultural barriers are well documented and have been for many years. In 2018, these dangers should be reported less and solved more often given our multi-lingual, multi-cultural society. As the 2011 Pennsylvania study concluded:
“Health information for LEP patients needs to be communicated plainly in their primary language, using words and examples that make the information understandable… Providers would do well to recognize that these issues present risk and patient safety hazards in any setting… Offering materials in other languages, having access to… interpreters and bilingual staff who are trained… and ensuring knowledge of cultural competency are all ways to improve the service to LEP patients and to potentially minimize the patient safety events associated with language barriers.”
These conclusions from 2011 still remain vitally true as we await the socially inevitable lowering of language and cultural barriers to healthcare.
**Read some of Bruce Adelson’s other blog posts to learn about more developments in language access law, and be sure to contact us if you’re interested in a consultation about your own organization’s compliance with federal language access law. Also, check out the blog “Communication Equals Understanding: The Effects of Increased Language Access for Patients” for more information about this subject.
© Bruce L. Adelson, special for Bromberg. 2017 All Rights Reserved The material herein is educational and informational only. No legal advice is intended or conveyed.
Bruce L. Adelson, Esq, CEO of Federal Compliance Consulting LLC is nationally recognized for his compliance expertise concerning many federal laws. Mr. Adelson is a former U.S Department of Justice Civil Rights Division Senior Trial Attorney.
Mr. Adelson teaches cultural and civil rights awareness at Georgetown University School of Medicine in Washington, D.C.