Alice Huan-Mei Chen, MD, MPH

Abstract:

Over the last three decades, immigration has accounted for over one-third of total population growth in the United States.  According to the 1990 census, 31 million residents speak a language other than English at home, and of these, 14 million were considered to be “Limited English Proficient” (LEP).  The 2000 census shows that the two groups which comprise the majority of LEP persons – Latinos and Asian Americans – have increased by 58% and 48% respectively since 1990.  Add to these immigrants from Africa, the Caribbean and Europe, and the present day number of LEP residents will be substantially higher.

Effective communication between patients and their health care providers is vital to achieving access to quality health care and ensuring good outcomes.  For LEP patients, this process is often compromised.  The use of professional interpreters is standard practice in international business and diplomacy, and is required by U.S. law for defendants with limited English capacity.  In health care settings, however, professional interpreters are not yet the norm.  Patients frequently must rely on family and friends, or ad hoc interpretation.  This is often provided by the nearest available bilingual person, be it a stranger in the waiting room, or staff who are called away from their usual responsibilities to interpret.

In April 2000, the Massachusetts Legislature enacted Chapter 66 of the Acts of 2000, “An Act Requiring Competent Interpreter Services in the Delivery of Certain Acute Health Care Services,” which mandates that “Every acute care hospital… shall provide competent interpreter services in connection with all emergency room services provided to every non-English speaker who is a patient or seeks appropriate emergency care or treatment.”

Hospital compliance with the law is a requirement of licensing or relicensing by the Department of Public Health.  The law also includes a definition of “competent interpreter services,” describes the legal recourse of LEP patients who are denied appropriate emergency health care services due to a “hospital’s not having exercised reasonable judgment in making competent interpreter services available,” and stipulates that the Division of Medical Assistance include as an operating expense the reasonable cost of providing competent interpreter services.

The Massachusetts Department of Public Health is responsible for developing regulations related to the enacted law for acute care hospitals.  Best Practice Recommendations have been developed in conjunction with these regulations.  The Recommendations are intended as a reference guide, to assist acute care hospitals in developing interpreter services best suited to their particular circumstances.

Method:

The Massachusetts Department of Public Health convened an expert Working Group to provide guidance and input for a Best Practice consensus document.  Working Group members included representatives from Massachusetts organizations active in promoting the provision of competent interpreter services, such as Boston Medical Center, the Boston Public Health Commission, Cambridge Hospital, Caritas Good Samaritan Medical Center, Health Care for All, the Massachusetts Division of Medical Assistance, the Massachusetts Hospital Association, the Massachusetts Medical Interpreter’s Association, New England Medical Center, and the Massachusetts Department of Public Health.  Over a four month period, the Working Group met multiple times to review, discuss, augment, and edit the document.  The Best Practice Recommendations will be reviewed by the policy and legal departments prior to dissemination to all Massachusetts acute care hospitals in July 2001.

Recommendations:

Given the differing needs and resources of each institution and the various populations and communities it serves, flexibility is important in designing a program that provides meaningful access to LEP persons.  With this in mind, the Working Group identified the following five key components of an optimal interpreter services program for hospitals:

•     The program is structured rather than ad hoc, with comprehensive written policies and procedures;
•     The program includes regular, systematic assessment of the language needs of people in the service area;
•     The program uses the community needs assessment and an assessment of its own resources in determining what types of oral language assistance to include in its delivery system;
•     The program establishes specific training and competency protocols for both interpreters and providers;  and
•     The program has a monitoring and evaluation system in place.

Please see the draft document for further discussion in each of these areas.

Preceptor:

Howard Koh, M.D., M.P.H., Commissioner of Health, Massachusetts Department of Public Health
Brunilda Torres, LICSW, Director, Office of Minority Health, MA Department of Public Health

Advisors/Collaborators:

Kathy Atkinson, Jennifer Cochran, Ben Cook, Quyen Dang, Carla Fogaren, Anuj Goel, Eric Hardt, Beth Jacklin, Bob Marra, Gisela Morales-Barreto, John Nickrosz, Loretta Saint-Louis, Sheila Sullivan, An TonThat, Tony Winsor