HHS has spoken, this time about what hospitals and other healthcare providers must do to meet the needs of patients with limited English skills.
Providers must take steps to ensure that non-English-speaking patients receive the same quality of care as English speakers, the guidelines say. These steps include hiring bilingual staff members trained to provide medical interpretation, contracting with paid services or volunteer groups to provide on-site translators and using telephone interpreters.
The guidelines put 30 years of practice in writing, said Kathleen O'Brien, special assistant to the director of HHS' Office of Civil Rights, which wrote the guidelines.
The 13-page set of guidelines, published in the Aug. 30 Federal Register, makes clear what healthcare and social service providers need to do to comply with Title VI of the Civil Rights Act of 1964, O'Brien said. The act requires all groups receiving federal funds to provide equal access to all people, regardless of race, creed, gender or national origin.
The guidelines affect any healthcare provider that receives money from a federal program, but the point is more to educate than to regulate, O'Brien said. Investigations, begun after a complaint is lodged with HHS, only rarely result in the ultimate penalty, the forfeiture of federal money, O'Brien added. Providers that don't comply can lose their funding under Medicare, Medicaid and other federal programs. The law doesn't authorize HHS to levy civil fines or pursue criminal charges.
Most cases are settled by an agreement between the hospital and HHS, O'Brien said, with the hospital establishing policies, training workers and making arrangements for translation services.
On July 17, for instance, HHS' civil rights office reached an agreement with 602-bed Maine Medical Center, Portland. The agreement settled a 1998 complaint brought by two patients who alleged they could not communicate with hospital staff and that no arrangements were made to help them do so, said Caroline Chang, regional manager of the Boston office of HHS' Office of Civil Rights.
Maine Medical Center agreed to provide interpreting services in eight languages, provide an hour of training for managers and all staff members who work directly with patients, and make annual reports to the Office of Civil Rights until 2004, said Judy Stone, the hospital's vice president of nursing and patient services. The hospital remains eligible for federal money.
The hospital plans to spend $500,000 for both on-site and over-the-telephone interpreters, Stone said.
Maine Medical Center also has conducted a series of cultural seminars for staff and is encouraging staff members to attend community events where they can learn more about the non-English-speaking populations the hospital serves, Stone said.
The new guidelines make it clear that providers can choose from a wide range of options to comply with the law, O'Brien said. Federal officials also consider the size of the provider and the size and diversity of the non-English-speaking population when considering a complaint, she said.
Rigorous interpreter training is needed for non-English-speaking patients to receive the care to which they are entitled, said Lyn Hainge, executive director of the Northern Virginia Area Health Education Center in Annandale.
The not-for-profit center provides a 40-hour training course in 12 languages for its interpreters. Providers should remember that "being bilingual is not the same as being a trained interpreter," Hainge said. Employees must have the proper background to fully explain medical procedures, the bedside manner to relay sensitive news to patients and their families, and a knowledge of medical ethics, Hainge said.