Practice of Medicine

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Caring for Patients with Limited English Proficiency

Executive Summary 

Many patients’ communications are restricted if English is not their primary language or their ability to read, write or speak English is limited. Covered entities must provide patients with Limited English Proficiency (LEP) free language assistance services in an accurate and timely manner. They also must post information telling patients with LEP about the right to receive communication assistance, including taglines in the top 15 languages spoken by individuals with LEP. 

Recommended Actions  
  • Implement protocols to accommodate a patient’s request for language assistance services within three business days in advance of their appointment. 
  • Consider using a reputable healthcare language assistance service or free services provided by insurance companies for patients with LEP. 
  • Post information telling patients with LEP about the right to receive communication assistance. 

Under the Section 1557 Affordable Care Act, healthcare organizations must take reasonable steps to provide meaningful access for and cannot discriminate against patients with Limited English Proficiency (LEP). 

A patient with LEP is one whose primary language for communication is not English, and whose ability to read, write, speak or understand English is limited (i.e., a non-English-fluent patient or a deaf or blind patient). What constitutes “reasonable steps to provide meaningful access” for a patient with LEP varies, but generally involves providing services such as oral language assistance or written translation. 

Language assistance services must be provided free of charge and in an accurate and timely manner. If a patient calls before his or her appointment and requests interpretation or translation services, the practice is allowed a reasonable amount of time to accommodate the request. It is generally agreed that 72 hours is reasonable; therefore, healthcare organizations should have protocols in place to accommodate a patient’s request for language assistance services within three business days. A healthcare organization is not required to provide in-person interpretation services; video remote interpretation (VRI) or telephone interpretation may be sufficient. 

When an interpreter is provided, he or she needs to be a qualified language interpreter — not the patient’s friend or family member. The patient will need to truly understand the risks, benefits and alternatives of treatment to adequately give their informed consent, and a qualified interpreter can ensure that occurs. It’s also worth noting that inconsistent use of an interpreter or not using interpreters at all can lead to adverse outcomes and a greater risk of malpractice liability. Some of these adverse events include delays in care, inaccurate assessment of the severity and duration of symptoms, and the inability of the patient to inform clinicians of duplicate doses and procedures. 

A covered entity cannot require LEP individuals to use children as interpreters when there are serious concerns such as competency, confidentiality and conflicts of interest. Sometimes, a patient prefers and requests to have a family member or friend interpret for them. A covered entity may allow the patient’s adult companion to interpret if the companion agrees to interpret, the covered entity’s reliance on the companion is appropriate under the circumstances, and there are no competency or confidentiality concerns. The patient’s agreement to having a companion interpret, and the absence of competency or confidentiality concerns, should be documented in the medical record.   

The Office for Civil Rights (OCR) is designated to enforce compliance with Section 1557. If a healthcare organization is not compliant, the OCR can require corrective actions such as revising policies and procedures and implementing training or monitoring programs. If the required actions are not implemented, the OCR can suspend or terminate federal financial assistance from HHS. 

A noncompliant healthcare organization may also be required to pay compensatory damages. For example, a hospital had to pay $80,000 in damages and a $5,000 civil fine after failing to provide interpretive services, and a medical center paid $200,000 in damages and a $75,000 civil penalty for failing to provide an interpreter in advance of a patient’s scheduled medical procedure. 

Access to Language Services 

Many health insurers, such as Blue Cross Blue Shield, Cigna and Aetna, provide language assistance services free of charge to providers. The patient or the provider can call the number listed on the insurer’s website and request an interpreter or written language translation services. 

Although a variety of healthcare language assistance services exist, not all of them are reliable. The following are some reputable service providers you may want to consider using: 

  • CyraCom (offers language assistance services in-person or via phone, video, mobile app or written text) 
  • Stratus Video (products include video remote interpretation, over-the-phone interpretation, onsite interpretation and telehealth interoperability) 
  • LanguageLine Solutions 
  • Canopy Speak (good option for small providers — their app offers translations in over 15 languages) 

Notifying LEP Patients of Their Rights 

  • Covered entities are required to post information telling patients with LEP about the right to receive communication assistance. 
  • Taglines (short statements in non-English languages) must be posted in the top 15 languages spoken by individuals with LEP in the states in which the covered entity operates (see website links below). These taglines serve to advise patients of the availability of free language assistance services and should be published in significant publications and posted in prominent locations and on a covered entity’s website. 

OCR has prepared translated materials that include model notices, model nondiscrimination statements, and taglines that covered entities can use. These are available at www.hhs.gov/civil-rights/for-individuals/section-1557/translated-resources/index.html. 

A list of the top 15 languages spoken in each state is available at: www.hhs.gov/sites/default/files/resources-for-covered-entities-top-15-languages-list.pdf 

Additional Resources 
Lessons Learned  
  • Use high-quality video remote interpreting services and ensure that your practice has sufficient wi-fi connectivity. We recommend testing the system a few hours before the patient comes in. If the system is not working, then you will have time to schedule an in-person interpreter.  
  • Don’t rely on unqualified staff, minor children, accompanying adults or the patient to provide translation in replace of LEP language assistance services.  
  • Ensure that translators or interpreters meet specific minimum qualifications, including ethical principles, confidentiality, proficiency, effective interpretation and the ability to use specialized terminology as necessary in the healthcare setting. 
  • When providing interpretation services, document the company used, the interpreter’s name and ID number, and if applicable, whether an interpreter was offered and refused.  
  • Develop and implement a language access plan to ensure that reasonable steps are taken to provide meaningful access to each individual who may require assistance. 
Potential Damages 

When a violation occurs, OCR can require a covered entity to take corrective actions or pay compensatory damages. While the frequency of such action is relatively low, if a covered entity refuses to take corrective actions, OCR may suspend or terminate federal financial assistance from HHS and may refer the matter to the U.S. Department of Justice for possible enforcement proceedings.  

Quiz 

Answers are provided below. True or false? 

Question 1: Inconsistent use of an interpreter or not using interpreters at all can lead to adverse outcomes and a greater risk of malpractice liability. 

 Question 2: Providers can tell a patient with LEP to seek treatment at another practice. 

 Question 3: Healthcare organizations are required to post a notice of individuals’ rights to language assistance services. 

Answers 

Question 1: True. The adverse effects of inconsistent interpreter use or lack of a necessary interpreter include delays in care, inaccurate assessment of the severity and duration of symptoms, and the inability of the patient to inform clinicians of duplicate doses and procedures. 

Question 2: False. Healthcare organizations must take reasonable steps to provide meaningful access to language assistance services and cannot discriminate against patients with Limited English Proficiency. 

 Question 3: True. Healthcare organizations must post a notice providing information about communication assistance for individuals with LEP, including taglines indicating the availability of free language assistance services in at least the top 15 non-English languages spoken in the state. 

12/22

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Disclaimer

The information provided in this resource does not constitute legal, medical or any other professional advice, nor does it establish a standard of care. This resource has been created as an aid to you in your practice. The ultimate decision on how to use the information provided rests solely with you, the PolicyOwner.