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California, USA. The hospital is on COVID lockdown, no visitors allowed. The patient had a stroke, lost her English, but seem to understand her native language; she slowly and barely coherently speaks a few words, but only in her native language. Is the hospital required to provide an interpreter to help communicating with the doctors and the therapists?

  • Seems unlikely. There are about 6500 languages spoken in the world today. Building an interpreter pool would be rather difficult – Hilmar Jul 15 at 20:11
  • A lawyer who works on this issue for the National Health Law Program has provided a useful, comprehensive and up to date summary of the language access requirements under state and federal law. You can download it here: healthlaw.org/resource/… – Just a guy Jul 16 at 0:45
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    Telemedicine, including tele-translation is all the rage these days. Maybe you could have a relative or friend translate for her over the phone? – Just a guy Jul 16 at 0:58
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    @Justaguy , telecom is controlled by nurses there. In 5 days we couldn't arrange a video chat with her: most nurses don't help, and the stroke patient is incapable of doing that herself. They do have Facetime available there, as one of the nurses told us; it's pain to have them actually use it. I imagine that arranging tele-translation seems to them a similar nuisance. – Michael Jul 16 at 1:56
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    How frustrating. I hope you find someone who can help. – Just a guy Jul 16 at 2:33
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Hospitals in the US that receive federal funding (e.g., Medicare, Medicade, FCHIP, etc.) are required to provide language services under Title VI of the Civil Rights Act of 1964, 52 U.S.C. §2000d et seq to those persons of limited English proficiency who receive services. This US Government Department of Health & Human Services page notes:

Persons with limited English proficiency must be afforded a meaningful opportunity to participate in programs that receive Federal funds. Policies and practices may not deny or have the effect of denying persons with limited English proficiency equal access to Federally-funded programs for which such persons qualify.

Many HHS documents address this requirement. An overview can be found in the HHS Language Plan (2013), which contains sections requiring translation of oral communications as well as written documents when the patient has limited English proficiency.

Given the pervasive presence of these federal programs in the provision of health care in the US, most (if not all) US hospitals will be required to comply and provide translation services.

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  • Thank you for the help and the references! There's a relevant detail that I should have mentioned: this is a Kaiser Permanente hospital; I doubt that it receives Federal funds. – Michael Jul 16 at 1:28
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    @Michael You're welcome! Kaiser is a large and sophisticated provider, which operates (at least) here in California, where there are a lot of non-English speakers. I'm quite certain it does receive Federal funds. – DavidSupportsMonica Jul 16 at 2:43
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The pertinent rule, implementing §1557 of the ACA, requires notices of nondiscrimination, which the government has made available in 64 languages, which says this or the equivalent in other languages. Assuming that the person understands one of those languages then they will know (if they can read) that they can contact the civil rights coordinator; and if the person believes they were discriminated against on the basis of race, color, national origin, age, disability, or sex, they can file a grievance (this is in the notification flier). The notice must be posted in the "top 15" non-English languages of that state, although there can be substantial dispute over what those languages are. The medicare office has a list, which is quite inaccurate but might be relied on in a legal dispute (there is no language "Cushite"). The requirement is that

Covered entities must take reasonable steps to provide meaningful access to each individual with limited English proficiency eligible to be served or likely to be encountered in their health programs and activities. In addition, covered entities are encouraged to develop and implement a language access plan.

This does not mean that a hospital is obligated to provide a translator, because it is not always reasonable to do so.

What the hospital is required to do is

make all programs and activities provided through electronic and information technology accessible; to ensure the physical accessibility of newly constructed or altered facilities; and to provide appropriate auxiliary aids and services for individuals with disabilities. Covered entities are also prohibited from using marketing practices or benefit designs that discriminate on the basis of disability and other prohibited bases.

Apart from the statutory discrimination-based requirement, there is the threat of a malpractice lawsuit based on not understanding what the patient said. There is no clear line defining what is reasonable versus unreasonable. For communications that pertain to issues of consent, the necessity for translation is higher, and failing to provide a translation between Parisian French and English would be unreasonable. Failing to provide a translation between English and the Krim language of Sierra Leone would be reasonable, and virtual necessity. Theoretically, HHS is developing a list of translation services. There are a number people who purport to provide translations, but they only cover the most popular languages, and issues of competence are prominent in this area. I would not be surprised to find a city with no medical translators for Mushunguli, and no ability to determine that the patient was speaking Mushunguli.

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In the United Kingdom - there are moral and legal reasons to provide translators to patients (a UK NHS policy is here)

Another policy makes mention of the Equality Act:

The provision of interpreter and translations services enables us to ensure equality of access to health services. As part of the General Duty of the Equality Act 2010, public sector services are required to advance equality of opportunity and eliminate unlawful discrimination between individuals who share a protected characteristic. We have a duty to provide communication support for people, where there is a need. This includes those for whom English is not their main language, and/or those who are visually, hearing or speech impaired

There are also General Medical Council requirements to "meet patient communication needs" here

Pragmatically - we have a very large shared interpreter pool as well as resources such as "The Big Word"; telephone translation services.

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    Howerer, California has never been part of the UK, and the US has not been a part of the UK for a very long time. – user6726 Aug 5 at 17:45
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    Well, indeed! But it is sometimes useful to look at comparative law and different jurisdictions. :) – DrDee Aug 5 at 17:49

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