The Conventus Practice Advice Hotline has experienced an uptick in practices calling and asking about their responsibility in providing interpreters for patients with Limited English Proficiency. Many believe they have no responsibility at all; but this is not the case.
Providers should be familiar with federal and state requirements regarding LEP (Limited English Proficiency) patients and develop an effective language access plan to meet the needs of their patients. This is especially important because of the increasing number of patients who may not speak English. Depending on where you live, it’s possible that more than 20% of your region’s population may have limited proficiency in English.
Even worse, patients with LEP experience a higher rate of medical errors and use fewer healthcare services. During the COVID-19 pandemic, patients who spoke little to no English had a 35% greater chance of death because medical professionals weren’t able to communicate clearly with patients. All this is to say it’s more important than ever to adequately support LEP patients who walk through your doors. Here’s what you need to know.
What are the legal requirements for providers regarding LEP patients?
Under Title VI of the Civil Rights Act of 1964 as well as other regulations, including Executive Order 13166, Improving Access to Services for Persons with Limited English Proficiency, providers are prohibited from discriminating based on race, color, or national origin, with language being a proxy for national origin. Title VI and its supporting regulations guarantee “meaningful access” to healthcare and social services to all individuals by requiring recipients of Federal funds to provide language access services.
The requirements for treating patients with impaired communication because of disabilities, including hearing impairments are guided by the Americans with Disabilities Act and the New Jersey Law Against Discrimination (LAD). Similar to caring for LEP patients, medical professionals have obligations regarding communicating with the hearing impaired.
Why is this important?
Beyond the legal requirement to do so, there are important and practical reasons for patients and physicians to communicate effectively. Consider this well-known real-life example often cited in risk management literature:
On his initial medical history, a Spanish-speaking boy aged 18 years, of Cuban descent, presented with abnormal mental status complaining of “intoxicado.” An untrained interpreter understood this to mean that the boy was intoxicated – though in the Cuban dialect, the boy was actually saying that he was nauseous. He received care for a drug overdose attributed to substance abuse but developed paraplegia, subsequently found to be due to a ruptured intracranial aneurysm. The case led to malpractice lawsuit with a $71 million award to the plaintiff.
While extraordinary and sensational, this case study and countless others reinforce the need for effective communication, including LEP patients.
There is no lack of research demonstrating that communication failures can and do result in:
- inaccurate health histories
- uninformed diagnoses
- misunderstandings of prescription drug or other treatment instructions
- the inability to provide informed consent
- unnecessary tests
- medical errors
Among LEP patients, there are longer lengths of stay, a greater number of falls and medication errors, and an overall lower perception of the quality of care delivered.
Regardless of an adverse event resulting in a malpractice claim, this issue does have other financial implications for all providers. As our healthcare system moves toward aligning reimbursement with quality and cost, key elements such as length of stay, excessive readmissions, and effective management of chronic conditions are cornerstones of the shift from volume to value. Successful and effective communication plays a central role in the delivery of high-quality, cost-effective care for all patients.
Treating Patients with Limited English Proficiency
Since patients may not always feel comfortable revealing that they have trouble communicating in English, providers should assess the communication needs of each patient. Knowing “enough to get by“ should not suffice when making this determination.
For LEP patients:
- Physicians must provide language assistance services that are free of charge, accurate and timely, protect patient confidentiality and provided by qualified interpreters. The State of New Jersey mandates the use of “certified or competent” interpreters but does not specify standards.
- Practices should always inform a patient of the interpretative services available and may not require a patient to provide his/her own interpreter. Providers are discouraged from relying upon an adult or child accompanying a patient to interpret/translate, even if it is the patient’s desire to do so.
- Providers may use bilingual staff for interpretation but should not rely solely upon this in every circumstance. Use of outside interpreter services or a telephonic oral interpretation service may be more appropriate to meet the needs of your practice.
- New Jersey’s Department of Human Services, Division of Deaf and Hard of Hearing provides listings of sign language interpreters
- Use of any language assistance services should be noted in a patient’s record. A patient’s refusal to use language assistance services should also be noted.
- Ensure that written materials routinely provided in English are also provided in other languages encountered in your practice.
- The State of New Jersey requires that physicians and other health professionals receive training or continuing education that addresses language access and/or cultural competency.
Support for Conventus Members
As always, Conventus members can call our Practice Resources Department at (877) 444-0484 ext. 7466 to speak with a member of our team to discuss your obligations regarding interpretation services, continuing medical education requirements, or any other practice-related questions.
