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Know Your Rights
Source: Gotham Gazette
Subject: Health Justice & Access
Type: Media Coverage

Language Barrier Begins to Fall at City Hospitals

A trip to
the hospital poses challenges for everyone — stressful conditions, baffling
paperwork, unfamiliar terms and frightening circumstances. People with limited
English proficiency often find the situation even more daunting. For years, New
Yorkers who did not speak English well often had to enlist family members or
friends as interpreters, sometimes requiring them to miss a day of school or

Now, though, that may be starting to change,
according to a recent study. Since the New York State Department of Health
adopted new regulations on language access and patient rights more than a year
ago, hospitals have improved their communications with patients who speak
limited or no English, particularly those who speak Spanish.

For the
study, Make the Road New York, the New York Immigration
Coalition and Korean Community Services of Metropolitan New York monitored 10
private and public hospitals in New
York City in late 2007 and early 2008. They focused on
Spanish and Korean-speaking patients. The study found that there is significant
progress with Spanish-speaking patients but communications with Korean-speaking
patients remain a problem.

impossible to provide quality health care unless patients can communicate their
symptoms clearly, understand their diagnosis and knowingly consent to medical procedures,"
said Andrew Friedman, co-executive director of Make the Road New York, a citywide civil rights
organization, in a press release. "We are impressed by the improvements at
these hospitals for Spanish speakers, and we applaud them."

found that 79 percent of the patients interviewed in four hospitals had
received assistance in their language from a bilingual doctor, nurse, other
staff member, interpreter or telephonic interpreting service. It was a
significant improvement from two years ago when only 29 percent of the patients
received assistance in their native languages.

About 31 percent of all patients reported knowing they had the right
to language assistance services, although that figure reached 76 percent among
Spanish speakers at Woodhull Medical and Mental Health
Center. Half of the
patients at Flushing
Hospital Medical
Center also reported
being told about the availability of free language assistance.

Services for Spanish Speakers…

The study
found many language assistance services for the Spanish-speaking community. At
Woodhull and Wyckoff Heights hospitals in Brooklyn,
nearly nine of out 10 Spanish-speaking patients said that they were helped by
Spanish-speaking staff.

At Queens Hospital
Center, 84 percent of
Spanish-speaking patients said they saw signs about free language assistance
services. More than 50 percent reported receiving translated written materials
at Elmhurst Hospital Center,
while at Woodhull, 45 percent received telephonic interpretation, a service to
meet the need for spontaneous, unscheduled access to an interpreter over the

…But Not Koreans

findings were not so positive for the Korean speakers. In Queens, where Koreans
make up about 3 percent of the population, the two monitored hospitals — Flushing Hospital
Medical Center
and Queens Hospital Center
— failed to provide sufficient language assistance. Only 25 percent of the
patients interviewed received some form of hospital-based interpretation, and
none received general translated written materials.

As few as
35 percent of Korean-speaking patients said they understand hospital forms and
many of them rely on family members and friends to translate for them. About a
third of them bring their own interpreters to hospitals.

found some improvements at the hospitals compared to the past, but it’s not
nearly enough," said Grace Lee, health advocate for Korean Community
Services. "There are 80,000 Korean speakers in the city, and hospitals
need to be prepared to find an interpreter."

Dozens of

The New
York Health and Hospitals Corp., which administers all public hospitals in New York
City including Queens, Elmhurst and Woodhull, provides many hospital forms and
instructions printed in 12 languages, including Korean, Chinese, French, and

to Stefanie Trice, HHC’s senior director of the Office of Culturally and Linguistically
Appropriate Services, all the corporation’s employees have access to an online
database providing those forms and are trained to use them.

meets 98 percent of our needs but we would translate any language that is
needed by request," said Trice. "Last year we had requests for
interpretation in 118 languages." She added that signs offering free
language assistance are printed in 16 languages and are posted everywhere in
all HHC hospitals.

Public vs. Private Hospitals

Among the
10 hospitals in the study, public hospitals appear to out-perform the private
ones. While 31 percent of the patients said they are informed of the free
language services in public hospitals, only 23 percent of private hospital
patients said they had received this information. In addition, 53 percent of
the patients reported seeing signs about free language service in public
hospitals, but only 39 percent saw the signs in private hospitals. Patients in
public hospitals also were less likely to say they had problems making
appointments and understanding their medical bills than those at private

private hospitals have established special programs to serve people from
immigrant communities. Beth
Israel Medical
Center, which was
surveyed in the study, established its Asian Services Program and Latino Health
Institute to address the needs of those two groups. Flushing Hospital
Medical Center’s
psychiatry department offers Asian and South Asian behavioral programs and a
Spanish-speaking program.

the positive findings, the study found persistent problems. Almost half — 48
percent — of patients surveyed said they wanted to ask questions but could not
because of language barriers. In addition, 28 percent said they did not
understand follow-up instructions, and 21 percent believe that their medical
care was affected by the language they speak.

What the New Rules Are

The new
regulations, adopted in September, 2006, require all hospitals to develop a
language assistance program to ensure all patient have access to the hospital’s

Under the rules, hospitals must:

* Provide
ongoing education and training for administrative, clinical and other employees
who have direct contact with patents on providing service with regard for
cultural and language differences;

* Identify
the language of preference and needs of each patient upon initial visit to the

* Post
signs in public locations, including at entrances, informing visitors that free
language assistance is available;

* Document
patient’s language of preference, language needs and the acceptance or refusal
of language assistance.

language assistance should be available to patients needing emergency services
within 10 minutes of when they request it and to other patients within 20
minutes. The new regulations also forbid the use of family members or friends
as interpreters, unless the patient agrees to it or refuses to use the free
service offered by the hospital. Hospitals should also provide translations and
transcriptions of important hospital forms and instructions in any language
spoken by more than 1 percent of people in the medical center’s service area.

PHOTO: By and
large, hospital communication services have improved for patients who speak
languages other than English.