June 15, 2001

Language Mustn't Be Barrier To Better Health Care

Interpreters Are A Critical Link Between Doctors, Non-English Speaking Patients

By Dr. Elena Rios

WASHINGTON, D.C. - As the nation becomes more diverse and multilingual so must our approach to health care. That need was dramatically illustrated recently when a 23-year-old woman gave birth in the stairwell of a downtown Bethesda, Md. restaurant while trying to get help.

Help was available. If the woman spoke English, she is from Central or South America, she would have known about available health care. She didn't have that luxury. Neither did her child.

With a 58 percent increase in the Hispanic population in the last decade, the need to help all Americans become productive members of society and fulfill the American dream is even greater.

This nation can't do that by ignoring non-English speakers. Instead we should embrace them and help them with interpreters and literature in their own languages until they can fully function in English.

But legislation introduced this year by Rep. Bob Stump (R-Ariz.) would repeal President Clinton's order directing agencies to ensure that non-English speakers have equal access to federal services.

As an organization that represents Hispanic doctors across the country, the National Hispanic Medical Association believes this legislation is shortsighted and non-inclusive at best.

This legislation goes against the very core of Title VI of the 1964 Civil Rights Act, which prohibits recipients of federal financial assistance from discriminating based on race, color or national origin. Courts have said that includes language or the ability to speak English.

It would be a costly and shortsighted mistake to eliminate the U.S. Department of Health and Human Services' Office of Civil Rights Policy Guidance on Limited English Proficiency (LEP), issued on Aug. 30, 2000. This policy will enhance the ability of LEP patients to access federally funded programs that are critical to improving the quality of health care for all Americans - and thus cut the overall costs to the health care system.

To access the health care system, people must first be able to communicate with their doctors. Otherwise, if patients and doctors can't understand each other, our health care system would be no different than veterinarian medicine. That's not acceptable.

Interpreters form a critical link in the health care chain. They prevent misinformation between doctors and patients - from a patient accurately describing an illness to a doctor giving life-saving instructions. With interpreters, patients can be candid. They don't feel as embarrassed or shy when describing their illness as they would if a family member were present.

At the National Hispanic Medical Association's recent annual conference, 700 people heard from the presidents of several medical associations as they discussed their views on providing interpreters and translated materials. They included the American Medical Association, the American Academy of Pediatrics, the American Academy of Family Physicians, the American College of Physicians, the Society of General Internal Medicine, the National Medical Association and the Association of American Indian Physicians. Several of those leaders said they were concerned about the HHS policy becoming a financial burden to health care providers and therefore a disincentive to providing care to Medicaid patients.

After hearing from those groups, the National Hispanic Medical Association appealed to HHS Secretary Tommy Thompson. We plan to meet with Thompson to talk about the reimbursement policies that currently exist in the federal government for language services. These reimbursement policies should be expanded on and publicly highlighted.

HHS also needs to start collecting data on the number of people who speak languages other than English so that we can find out how much need there is for reimbursement of language services. The government then should redirect funds for new language service programs to meet this growing need.

Also, immigrant advocates met with White House officials recently. Although they left not knowing what President Bush might do on the issue, a White House spokesman was later quoted as saying there were no plans to repeal the order.

Let's face facts. We're becoming less of a monolingual society. Spanish is thriving in this country. Univision, the top Spanish-language television network in the United States, is also the nation's fifth largest network. Chinese is predicted to be the No. 1 language on the Internet by 2007.

Some communities are already preparing for a multicultural society. Oakland, Calif., where Chinese and Spanish are often spoken, recently approved an ordinance that will require city departments that deal with the public to provide translators and translated materials. This is believed to be the first ordinance of its kind in California - and perhaps the nation - to mandate bilingual hiring in government agencies. San Francisco is looking at a similar ordinance.

To ignore what's happening in our country is not the prudent way to go. The National Hispanic Medical Association wants to work with the new administration so that language differences are no longer a barrier to health care and so that all Americans can be healthier.

Dr. Elena Rios is president of the National Hispanic Medical Association, representing Hispanic physicians around the country. The organization's mission is to improve health care for Hispanics and the underserved in the U.S. Readers may write Dr. Rios at NHMA, 1411 K Street N.W., Suite 200, Washington, D.C. 20005.

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