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

Language Barriers at the Drugstore

When
Catalina Martinez of Ridgewood walks into a
pharmacy to get a prescription, the task may not be as easy as it seems.

Beyond
the long lines and their physician’s unintelligible handwriting, Martinez, like thousands
of other New Yorkers, faces a seemingly insurmountable wall at their local
drugstore: a language barrier.

"When
I go to the pharmacy, I see that the bottles are in English and I want to know
what it says on the bottles," said Martinez,
who was interviewed through a translator. "So many times I leave the
pharmacy without knowing what it is saying. That’s scary for me."

According
to immigrant and health care advocates, the majority of pharmacies,
particularly in the outer boroughs, do not provide translation services to
their customers. This leaves thousands of New Yorkers with limited proficiency
in English to fend for themselves. Labels remain untranslated, so crucial
instructions from the pharmacist may be incomprehensible.

Unlike
hospitals, which, under state regulations, must provide translators, pharmacies
are under no such requirement. That, some city leaders say, may soon change.

Where
Regulations Stand

For the
hundreds of thousands of New Yorkers who do not know English, the local
pharmacy and its rows of bottles with labels reading Zoloft or Ambien can be
baffling. With Americans increasingly reliant upon prescriptions, advocates say
an inaccurate translation — or none at all — can pose a significant danger.

The 2000
Census showed that nearly half of New
York City households speak a language other than
English, and one out of four New Yorkers do not speak English at all. That
leaves 25 percent of the city’s population scrounging for health care in their
own language or care at a facility offering translation services.

While the
state approved regulations in 2006 that set out language requirements for
hospitals, pharmacies were overlooked, said some advocates. According to a
recent report by the New York Academy of Medicine, two thirds of city
pharmacies do not translate prescription labels, despite the fact that 88
percent said they served limited English proficiency patients daily.

A report
released late last year by the advocacy groups New York Lawyers for the Public
Interest and Make the Road by Walking details nearly a dozen anecdotes
from Brooklyn and Queens residents who do not
speak English.

Catalina
Martinez is one of them. She suffers from gastritis and has a 14-year-old son
prone to allergies, forcing her to visit the pharmacy often. A native of Mexico who has lived in Ridgewood for a decade, Martinez sometimes stops
strangers on the street, hoping to get her prescriptions translated since the
pharmacies she frequents do not provide language assistance. Sometimes, she
said, she will not give her son medication for fear of administering it
incorrectly.

"Maybe
I have to give him this much medicine, sometimes I have to give less,"
said the 49-year-old. "Sometimes I won’t even give it to my son because I
won’t know how to do it."

Martinez’s apprehension is shared by many
immigrants, said Nisha Agarwal, a staff attorney with New York Lawyers for the
Public Interest. To address this, the lawyers group, along with City
Councilmember Eric Gioia and Public Advocate Betsy Gotbaum, is drafting
legislation that would require translation services be provided at all city
pharmacies.

"Giving
New Yorkers access to the information they need starts with simple, common
sense steps, like providing translation services and extra medical instruction
for those with limited English proficiency who are filling prescriptions,"
said Gotbaum in a prepared statement. "Our proposed legislation will help
break down the barriers many currently face when seeking health care and ensure
that no New Yorker is left guessing when it comes to questions about their
medication."

Other
council members have also expressed support for the measure. "Although I
appreciate the efforts already taken by a number of pharmacies to help their
customers read their prescription label in a more familiar language, these
businesses still have more work to do," said Councilmember Joel Rivera,
chair of the Health Committee, in an e-mailed statement. "People should
not have to guess how to administer their medicine just because they can’t read
the directions. Clearly the consequences can be devastating. The translate of
drug labels by pharmacies is not only a good idea, it is the right thing to
do."

What
Advocates Want

Advocates,
like Agarwal, believe the city’s existing human rights law, which prohibits
discrimination based on race or ethnicity in public places, requires pharmacies
to translate. So far, though, pharmacists do not interpret the law that way.

Both New
York Lawyers for Public Interest and Make the Road by Walking filed a formal complaint with the
state attorney general’s office, claiming 16 pharmacies in Queens and Brooklyn
routinely failed to translate drug labels or provide instruction to non-English
speakers, thus violating their statutory duty. That complaint is pending, said
Agarwal.

They hope
the legislation currently being drafted will replicate what the state required
from hospitals in 2006, making language access a requirement of quality health
care. Agarwal said the legislation should be introduced in the coming weeks.

The
specific standards for pharmacies would strengthen the current requirements
under the human rights law, said Theo Oshiro, the director of health advocacy at Make the Road by Walking.

Oshiro said his group has already seen some success. Pharmacies
in Bushwick, for example, stepped up their language education campaigns with
signs announcing translation services behind some counters.

"I
guess there has been spotty results; there has not been a whole chain setting
out clear guidelines," said Oshiro. "We’re still looking for that kind of sweeping
solution, not only in Bushwick and in Woodside."

City
officials spearheading the legislation say the proposal would simply turn an
assumed right into an explicit one. Business leaders, however, disagree.

Business
Barriers

James
Detura owns his own pharmacy in the South Bronx
where the population is predominantly Spanish speaking. Detura, who is
president of the New York City Pharmacists Society, said a translation mandate
would be catastrophic. It is already difficult to find any pharmacist — due to
a nationwide shortage of pharmacists — let alone a bilingual ones, he said.

For
communities that do not have one or two dominant languages, but three, four or
even five, it could be next to impossible to meet strict language access
guidelines. "What about a pharmacy that is in certain area of New York City when you’ve
got Spanish and Russian?" asked Detura. "What do you do in a case
like that? Are you going to have a separate pharmacist for each one?"
There are enough pharmacies in the city, especially locally owned businesses
that cater to certain communities, that customers who cannot find the services
they need at one pharmacy can always find another one a block or two away, he
said.

Detura
also fears inaccurate translations. He said it may be easy to translate
"one pill a day," but more complicated instructions may not be as
readily interpreted — especially if there are no services available for a
local pharmacist to double-check a phoned-in translation.

But
advocates said there are plenty of accurate resources for a local pharmacist,
such as subscriber hotlines that can translate at the click of a dial. Oshiro also said they were not looking
to require bilingual pharmacists.

Like
Detura, others question whether the legislation would put an unreasonable
burden on small, independent pharmacists. In response, Oshiro said the smaller pharmacies
already do a better job accommodating immigrant populations’ needs.

Instead,
advocates argue that it is larger chains, such as Duane Reade and Rite Aid that
fail to translate. Even if the big chains have the ability to provide the
service (some have telephone translation networks or bilingual staff), they
often do not advertise it to their customers.

A
Bilingual Call

While
many of the details must still be worked out, immigrant and health care
advocates said they are keeping both business and health interests in mind. The
idea is to save people’s lives, or at the very least prevent confusion and
sickness.

Convinced
she became ill after incorrectly taking medication with a label she couldn’t
understand, Martinez
said she cannot, nor can she give her son, medication with an easy mind.

If
pharmacies cannot provide bilingual or trilingual employees, they should at
least provide labels in other languages, Martinez
said. That way, she added, she and thousands of other New Yorkers can take
their medication with confidence.