Language Assistance for Limited English Proficient Patients: Legal Issues

CHAPTER 5 Language Assistance for Limited English Proficient Patients


Legal Issues



David Hunt



Introduction


An elderly male Hmong patient was recently admitted to a midwestern hospital. The patient spoke no English. No interpreter was provided to him. Instead, his attending nurse attempted to communicate with the patient via hand gestures. Each time the nurse spoke to the patient in English and gestured with her hands, the elderly gentleman would look at her, smile, and nod. After 3 days in the hospital, a Hmong interpreter was finally arranged. When the attending nurse was asked why she hadn’t used an interpreter, she said that she and the patient were communicating just fine and that she didn’t feel the need to call one. Under further questioning, however, the nurse acknowledged that she did not know how to access an interpreter, had received no training on how to communicate with patients via an interpreter, and had not apprised the patient of his legal right to an interpreter. Unbeknown to the nurse, the Hmong patient was blind.


This story is repeated every day in some form throughout the United States. Such stories represent an ongoing tragedy for limited English proficient (LEP) patients and their families who are denied high-quality healthcare as well as their civil rights. But they also represent a tragedy for many well-intentioned medical professionals who are unaware that their ignorance of existing laws requiring the provision of language assistance services could compromise patient care and create both legal liability and medical malpractice exposure (see endnote EN1).


Providers’ failure to ensure meaningful access to language assistance for people with limited English skills can have serious, even life or death, consequences as the following cases demonstrate:


• A hospital in South Carolina had a policy of prohibiting women with limited English skills from receiving an epidural during labor and delivery.1

• Hongkham Souvannarath, a 52-year-old refugee from Laos, was jailed by the Fresno California County Health Department for almost 11 months because she did not take medication for a case of tuberculosis that health officials feared could become contagious. Ms. Souvannarath stopped taking her medications, in part, because she understood a non-Laotian appointed interpreter to say that the medicine would kill her. Souvannarath was taken at gunpoint to the county jail after being told she was being taken to a hospital. There she was strip-searched and initially housed in a safety cell for 3 days because a Hmong officer misinterpreted her Laotian comment that she was ‘afraid to die’ as a suicide threat. While in confinement she was frequently handcuffed, shackled, and chained to her bed. Only one guard occasionally provided interpretation services and she was unable to communicate her needs to jail personnel. A subsequent lawsuit against the county was settled for $1.2 million.2,3

• A young boy in Los Angeles interpreted a consent form for his father that pertained to his ailing mother. The son thought the form meant that a nurse would make daily visits to care for his mother, and the father signed the form. Instead, the mother was sent to a nursing home.4

This chapter is organized into two parts. In Part One, we will describe the existing framework of federal and state laws that require healthcare organizations to provide language assistance services and ‘culturally appropriate care’ to limited English proficient patients. In this section, we will also describe what healthcare organizations and medical professionals must do to comply with these laws. In Part Two, we will describe a variety of policy initiatives currently being discussed to promote more culturally and linguistically appropriate care and the legal issues presented by these policies. In particular, this section will discuss legal issues associated with: (1) promoting the collection of data related to race, ethnicity and primary language by health plans, hospitals and government programs; (2) providing cross-cultural medical education to doctors and nurses; and (3) implementing a comprehensive language access agenda.



Part One: Federal and State Laws Requiring Language Assistance


The Civil Rights Act of 1964, of which Title VI is a part, created broad national powers to end discrimination in employment, places of public accommodation (such as hospitals), and programs and activities that receive federal financial assistance. The legislative history of Title VI indicates that healthcare was prominent in the minds of its authors, as passage of the 1964 Act was contemporaneous with the judicial ruling in Simkins v. Moses H. Cone Memorial Hospital.5 Simkins was a landmark case in which the courts struck down as unconstitutional key portions of the Hill Burton Act which had authorized the use of federal funds to construct and operate segregated healthcare facilities.


Title VI of the Civil Rights Act of 1964 prevents federal money from being used to support activities and programs that discriminate on the basis of race, color, or national origin. Section 601 of Title VI states that no person shall ‘on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance.’6 Under section 602, the Department of Health and Human Services (HHS) has issued regulations that say recipients of federal funds can not:



[U]tilize criteria or methods of administration which have the effect of subjecting individuals to discrimination because of their race, color, or national origin, or have the effect of defeating or substantially impairing accomplishment of the objectives of the program as respect to individuals of a particular race, color, or national origin.7


In 1974, the US Supreme Court affirmed these regulations in Lau v. Nichols.8


Lau involved a San Francisco, California, school district that was desegregated under court order in 1971. The desegregation process left 1800 Chinese-American students who did not speak English in schools without supplemental English language courses. The Court recognized that ‘there is no equality of treatment merely by providing students with the same facilities, textbooks, teachers and curriculum, for students who do not understand English are effectively foreclosed from any meaningful education.’9 The Court held that the school district’s failure to take affirmative steps to provide language assistance constituted national origin discrimination under Title VI.10


Significantly, the key provisions of Title VI of the Civil Rights Act of 1964 have gradually been incorporated into virtually every major federal statute of significance to healthcare. For example, Title VI’s provisions have been incorporated into Medicaid, Medicare, Medicare Plus Choice, the State Children’s Health Insurance Program (SCHIP), the Hill Burton Act, the Community Health Centers Act, and the Maternal and Child Health Block Grant Programs. As a result, nearly every state and local government, health plan, hospital, and physician that receives federal monies is bound by Title VI. The requirements of Title VI apply to all recipients of federal funds, regardless of the amount of federal funds received. Further, HHS has enforced Title VI against healthcare organizations and providers that have failed to provide language assistance to LEP patients. The rationale for doing so is virtually the same as the Supreme Court’s analysis in Lau. According to HHS, ‘a recipient of Federal financial assistance that does not have the ability to communicate with LEP persons deprives such persons of an equal opportunity to participate and benefit from the federal program.’ As a result:



No persons may be subjected to discrimination on the basis of national origin in health and human services because they have a primary language other than English.11



Litigating language assistance requirements under federal law


Title VI addresses two types of discrimination. The language of Title VI plainly addresses intentional discrimination. However, regulations issued pursuant to Title VI also address policies or practices that may be neutral on their face but have the effect of discriminating on the basis of race, color, or national origin (the ‘disparate impact’ theory or ‘effects’ test).


Until recently, immigrants and other private litigants were permitted to sue to enforce Title VI regulations prohibiting acts with discriminatory effects. However, the United States Supreme Court in the 2001 case of Alexander v. Sandoval ruled that there is no private right of action under the Title VI regulations.12 Sandoval involved a class of non-English-speaking residents of Alabama who alleged that the state’s policy of offering the driver’s license exam only in English amounted to national origin discrimination under the previously mentioned ‘effects’ provision of the Title VI regulation. While the Court of Appeals for the Eleventh Circuit agreed, the Supreme Court ruled that private parties lacked the authority to file a lawsuit to enforce the effects provision of the Title VI regulation.


In the aftermath of Sandoval, immigrants and other private plaintiffs must now establish that the conduct in question amounts to intentional discrimination under Title VI (see endnote EN2).13 Significantly, however, while Sandoval applies to private parties, it has no effect on the federal government’s ability to pursue civil rights cases using the effects test under the Title VI regulation. The authority of agencies such as the Office for Civil Rights at the Department of Health and Human Services remains unchanged.


Immigrants can invoke the protections of Title VI in one of two ways. First, one could file a written complaint with the Office of Civil Rights (OCR). Alternatively, one could file a lawsuit under Title VI. From the standpoint of the immigrant plaintiff, there are many advantages to filing an OCR complaint. Filing an OCR complaint does not require a lawyer. If OCR becomes involved it can investigate both allegations of intentional discrimination under Title VI and disparate impact under the Title VI regulations. If OCR investigates and makes a finding of discrimination, that can be very powerful evidence against the defendant. Moreover, the involvement of OCR frequently results in a resolution of the case, sparing both the expense and uncertainty of protracted litigation.


Once a complaint is filed, OCR will investigate its merits by reviewing the pertinent practices and policies of the hospital or provider that is the subject of the complaint, the circumstances under which the possible non-compliance occurred, and other factors relevant to a determination of whether the defendant has failed to comply with Title VI. If OCR finds non-compliance, it will first seek voluntary compliance by the provider. OCR’s ultimate sanction is to terminate federal funding to the provider, either in an administrative proceeding or by referring the case to the Department of Justice for litigation.


Despite the stated advantages of filing a complaint with OCR, substantial evidence suggests that this route has severe limitations. OCR has consistently lacked the funding and the staff for conducting systematic compliance reviews (see endnote EN3). As a result, the agency has frequently been criticized as being reactive rather than proactive. Moreover, the complaint approach used by OCR has several specific problems when it comes to addressing racial and ethnic disparities in healthcare. First, immigrants generally are not prone to file complaints, whether out of fear of possible retaliation or possible deportation in the case of illegal aliens. Second, with some notable exceptions, the advocacy community has not been focused on this issue since the Supreme Court issued the Sandoval decision. Third, OCR’s lack of technical expertise in the medical area results in few complaints being upheld. Finally, even after a complaint enters the system, OCR’s investigative processes are inadequate and slow in finding violations, resulting in inordinate lengths of time for case resolution and a finding of compliance in most race-related cases. (OCR has never terminated federal funding for any provider no matter how egregious the offense.)


Although OCR’s track record of effectiveness may be less than inspiring, providers dare not take it for granted. According to Thomas E. Perez, Former Director, Office for Civil Rights at the US Department of Health and Human Services, language access cases are easily OCR’s most frequently encountered type of Title VI case.14 (Ironically, as Perez notes, the large number of OCR complaints may actually understate the true extent of the problem, as many immigrants are reluctant to file complaints.)


Over the last 30 years, OCR has undertaken thousands of investigations and reviews involving language differences in healthcare. A sampling of recently settled OCR cases shows that intentional discrimination against immigrants and/or LEP patients is hardly a thing of the past:


• OCR settled a case involving Visiting Nurse Services, a home healthcare agency in western Massachusetts. Although the agency is located in an area with a significant Spanish-speaking population, complainants alleged that the agency would not provide interpreters to LEP patients and refused to accept patients for home care services if they did not speak English.

• OCR reached a settlement with the Rancho Los Amigos Rehab Hospital, a county-run hospital in Los Angeles. Complainants in the case alleged that the hospital discriminated against LEP patients by failing to provide free interpreters and by routinely requiring LEP clients to bring a family member or friend to interpret for them and routinely requiring LEP clients to pay for services.

• OCR reached a settlement with a hospital located near the US–Mexico border in McAllen, Texas, that ordered its security personnel to dress up in uniforms that closely resembled the US Border Patrol. This policy had the effect of deterring Latinos in the area from using the facility.15

The National Health Law Program has researched many of the formal complaints between OCR and providers. The overwhelming majority of these reviews involved hospitals. However, recently the subject matter of OCR reviews has broadened, to include investigations regarding:


• RENAL DIALYSIS: for failing to provide qualified interpreters (Cook County Hospital Renal Dialysis Center);

• MANAGED CARE: for failing to ensure that Medicaid health maintenance organizations did not engage in marketing practices which deny information or enrollment opportunities to LEP persons (Illinois Department of Public Aid);

• STATE DEPARTMENT OF HEALTH: A preliminary assessment found that the North Carolina Department of Health and Human Services has turned LEP clients away because no interpreters were available; required LEP clients to use family members and friends as interpreters; and failed to assess language needs of national origin groups, evaluate interpreter competency, have procedures to determine when written materials need translation, train staff on language access requirements, and notify LEP persons that interpreter services are available to them at no cost.

OCR representatives have indicated that the most frequently encountered language access problems are providers who: (1) directly or indirectly require patients to provide their own interpreter service, through family or friends; (2) fail to provide interpreter service, or provide untrained personnel; and (3) subject people with limited English skills to lengthy delays as a result of the lack of readily available interpreter services.16


Although they involve a range of providers and situations, the OCR cases share a number of common features. Specifically, they require providers to:


• Develop a written plan for providing LEP services;

• Designate a staff person to coordinate Title VI activities;

• Provide information and training to staff on these policies;

• Post translated notices that contain information on the availability of no-cost interpreters;

• Maintain effective interpreter services by emphasizing in-person interpretation and, to the extent possible, minimize telephone interpretation;

• Provide translation of important forms and documents;

• Collect and analyze data to determine if interpreter services are effective; and

• Monitor subcontractors and include a non-discrimination clause in all contracts for services.17


Recent developments: Executive Order 13166 and DHHS guidance


In recent years, with immigration at record highs, there has been a spate of new federal developments with respect to the provision of language assistance services to immigrants. On August 11, 2000, President Clinton issued Executive Order 13166, entitled Improving Access to Services for Persons with Limited English Proficiency. Executive Order 13166 required every federal agency that provides federal assistance, including HHS, to publish a Title VI guidance to explain to recipients of federal funds how to provide access to LEP persons and achieve compliance with the Title VI regulations. The HHS Office of Civil Rights issued an initial guidance on this topic on August 30, 2000. Subsequently, on August 4, 2003, HHS published a revised Guidance to Federal Financial Assistance Recipients Regarding Title VI Prohibition Against National Origin Discrimination Affecting English Proficient Persons (2003 HHS LEP Policy Guidance).18 The Guidance made clear that it did not create new obligations, but rather clarified existing Title VI responsibilities.



What providers must do to comply with federal language access laws


The Office of Civil Rights’ 2003 LEP Policy Guid-ance outlines the responsibilities of health and human service providers under Title VI to ensure that people with limited English skills can meaningfully access health and human services. It also provides a roadmap to assist providers in meeting their legal obligations. Providers who are subject to these obligations include hospitals, nursing homes, state Medicaid agencies, managed care organizations, home health agencies, state, county, and local health agencies, and physicians and other providers who receive federal financial assistance from HHS.


The Guidance defines a limited English proficient individual as ‘individuals who do not speak English as their primary language and who have a limited ability to read, write, speak or understand English.’ Significantly, LEP individuals may not only be the patient themselves but also parents and legal guardians of minors eligible for coverage.



Four-factor test to determine language assistance obligations


The Guidance states DHHS’s intent that recipients of federal funds take reasonable steps to ensure that LEP persons have ‘meaningful access’ to programs and activities. ‘Meaningful access’ means that communications between the LEP patient and the provider are effective in promoting mutual understanding. The following four factor test will be used to evaluate whether a provider has a legal obligation to provide language assistance and, if so, whether it is providing meaningful access:


1. The number or proportion of LEP persons eligible or likely to be served by the program as determined by program-specific data along with census, school, or other community-based data from the relevant service area;

2. The frequency with which LEP individuals have or should have contact with the program;

3. The nature and importance of the program, activity, or service to people’s lives; and

4. The resources available to the provider and the costs.19

In applying the four-factor test, providers should keep the following general principles in mind. The greater the number or proportion of LEP persons served or encountered in the eligible service population, the stronger the provider’s legal obligation will be to provide language assistance services. The more frequent the contact with a particular language group, the more likely it is that enhanced language services will be needed in that language. The more important or urgent a provider’s service is (e.g. a hospital emergency room), the more important language services become to help the LEP person and their families access them. Smaller providers with more limited budgets are not expected to provide the same level of language assistance as larger providers with larger budgets.


If providers have an obligation to provide language assistance, there are two major ways to discharge it:


1. ORAL LANGUAGE SERVICES: Where oral interpretation is needed, providers should develop procedures for providing competent interpreters in a timely manner. When the timeliness of services is important and delay would result in the effective denial of a benefit, service, or right, language assistance likely cannot be delayed.

2. TRANSLATION OF WRITTEN MATERIALS: An effective LEP policy ensures that vital written documents are translated into the language of each regularly encountered LEP group eligible to be served and/or likely to be affected by the recipient’s program. (Technical or linguistic competence can often be assured by back translation.)20


Guidelines for providing oral interpretation services to LEP patients


Where oral interpretation is needed, providers should develop procedures for providing competent interpreters in a timely manner. The DHHS Guidance describes various options for providing oral language assistance, including hiring bilingual staff or qualified staff interpreters, contracting for interpreters, using telephone interpreter lines, and using community volunteers. The Guidance makes clear that while providers may choose the means of communicating with the LEP patient, the result must be effective communication. While LEP patients may elect to use an interpreter of their own choosing, providers may not require LEP persons to use family members as interpreters.21


Irrespective of who is chosen to interpret, providers have a legal duty to assure that a competent interpreter is provided at no cost to the patient. According to the DHHS Guidance, competence requires more than self-identification as bilingual. Competency to interpret does not always mean formal certification, although certification is helpful. At a minimum, however, providers should insure that interpreters: demonstrate proficiency in both languages; are bound by confidentiality and impartiality; have knowledge of specialized medical terms/concepts; demonstrate the ability to convey information in both languages accurately and avoid other roles such as that of counselor or legal advisor.


The DHHS Guidance discourages the use of family members, friends, and especially children as interpreters. ‘Extra caution’ should be taken when the LEP person chooses to use a minor to interpret.22 The use of family members and friends as medical interpreters is highly problematic and can compromise many aspects of patient care. While family members and friends may know more English than the patient, they may not understand medical terminology, and ad hoc interpreters are more likely than professional interpreters to commit errors of potential clinical consequences. (One case that exemplified this situation occurred in Minneapolis, Minnesota, where a 14-year-old Hmong girl tried to interpret for an older family member. The attending physician explained to the girl that further X-rays were needed, but the girl misunderstood and explained to the family that the physicians were planning to ‘microwave the patient.’) Using a family member or friend as an interpreter risks breaching patient privacy and confidentiality; patients may be less inclined to reveal sensitive personal or medical information when relatives or friends are present. Using minor children to interpret also upsets the traditional family hierarchy and can subject children to information that they are not emotionally or intellectually prepared to handle.


Providers are asked to verify and monitor the competence and appropriateness of using the family member or friend to interpret, particularly in situations involving administrative hearings, child or adult protective investigations, life, health, safety or access to important benefits; or when credibility and accuracy are important to protect the individual. Moreover, if the provider determines that the family member or friend is not competent, the provider must provide competent interpreter services in place of or as a supplement to the LEP person’s interpreter.



Legal duty to provide written translated materials – safe harbors


With respect to written translation, DHHS says it will determine compliance on a case-by-case basis, taking into account the ‘totality of the circumstances’ in light of the four-factor test. However, the DHHS Guidance makes clear that providers have a legal obligation to translate ‘vital written documents’ into the languages of the most frequently encountered LEP populations eligible to receive its services. ‘Vital documents’ may include: consent and complaint forms; intake forms with the potential for important consequences; written notices of rights, denial, loss, or decreases in benefits or services; notices of disciplinary action; applications to receive services or benefits; and notices advising LEP persons of their right to receive free language assistance services.23


Significantly, DHHS also designated two ‘safe harbors’ that, if met, will provide ‘strong evidence’ of compliance with the provider’s written translation obligations:


1. The [provider] provides written translations of ‘vital documents’ (e.g. intake forms with the potential for important consequences, consent and complaint forms, eligibility and service notices) for each eligible LEP language group that constitutes 5% or 1000, whichever is less of the population of persons eligible to be served or likely to be affected or encountered. Translation of other documents, if needed, can be provided orally; or

2. If there are fewer than 50 persons in a language group that reaches the 5% trigger above, the recipient provides written notice in the primary language of the LEP language group of the right to receive competent oral interpretation of vital written materials, free of cost.24

Where providers have determined that they have a legal obligation to provide language assistance, they should develop a written LEP policy/plan. Effective plans typically have five elements:


1. Identify LEP individuals who need language assistance.

2. Provide appropriate language assistance measures.

3. Train staff on LEP policies and procedures.

4. Provide notice to LEP persons about available language assistance services at no charge.

5. Monitor and update the plan – at a minimum once every 3 years.25

DHHS also notes that an effective plan will set clear goals and establish management accountability for achieving them. Providers may also want to provide opportunities for community input and planning throughout the process. The August 2003 LEP Guidance notes that systems will evolve over time, and DHHS will look favorably on intermediate steps that recipients take that are consistent with the Guidance.



Office of Minority Health cultural and linguistic access standards


Title VI is the only federal law that directly supports any aspect of cultural competency in healthcare. As currently applied, Title VI only requires language assistance for LEP patients. While the absence of language assistance is a major source of racial and ethnic disparities in healthcare, many healthcare advocates, civil rights organizations, and others have encouraged HHS’ Office of Civil Rights to adopt additional recommendations including guidance on cultural competence.


In fact, HHS has already developed standards for culturally and linguistically appropriate services in healthcare. The Office of Minority Health began the process of developing national standards in 1997. On December 22, 2000, following a lengthy period of public comment and collaboration, the HHS Office of Minority Health issued National Standards on Culturally and Linguistically Appropriate Services (CLAS) in Health Care.26 The standards ‘are especially designed to address the needs of racial, ethnic, and linguistic population groups that experience unequal access to health services … [and] to contribute to the elimination of racial and ethnic health disparities.’


The CLAS standards contain 14 standards, organized into three themes: culturally competent care, language access services, and organizational supports for cultural competence. The 14 standards can also be categorized by their stringency as mandates, guidelines, and recommendations.27 Significantly, all of the mandates (Standards 4–7) deal specifically with language access. These standards are essentially restatements of existing Title VI law for purposes of recipients of federal funds and provide as follows:


• STANDARD 4: Healthcare organizations must offer and provide language assistance services, including bilingual staff and interpreter services, at no cost to each patient/consumer with limited English proficiency at all points of contact in a timely manner during all hours of operation.

• STANDARD 5: Healthcare organizations must provide to patients/consumers in their preferred language both verbal offers and written notices informing them of their right to receive language assistance services.

• STANDARD 6: Healthcare organizations must assure the competence of language assistance provided to limited English proficient patients/consumers by interpreters and bilingual staff. Family and friends should not be used to provide interpretation services (except on request by the patient/consumer).

• STANDARD 7: Healthcare organizations must make available easily understood patient-related materials and post signage in the languages of the commonly encountered groups and/or groups represented in the service area.28

Aside from its language assistance mandates, the CLAS Standards also include ‘guidelines and recommendations.’ The guidelines are activities the Office of Minority Health recommended for adoption by federal, state, and national accrediting agencies. The recommendations are suggestions the Office of Minority Health made for voluntary adoption by healthcare organizations. The guidelines and recommendations are not legally enforceable at this time, but they provide strategic direction for addressing some of the causes of racial and ethnic disparities in healthcare.


The CLAS standards are independent of DOJ and OCR guidance documents. However, because they address many of the same issues in great detail and are aimed at healthcare providers, these standards are proving helpful to providers as they devise and implement language access plans. Already, the CLAS standards are being used widely. For instance, George Washington University Center for Health Service Research and Policy has released and widely circulated model cultural competence purchasing specifications for Medicaid managed care that are based on the CLAS standards. HHS has also made cultural and linguistic competence the focus of Medicare + Choice quality improvement projects and has encouraged health plans to use CLAS standards in developing their projects. While aimed at healthcare organizations, the standards are also presented as guidelines for accreditation and credentialing agencies such as the Joint Commission on Accreditation of Healthcare Organizations, the National Committee on Quality Assurance, and peer review organizations. Finally, to the extent that the CLAS standards represent the first national standards on culturally and linguistically appropriate healthcare services, it could be argued that these standards represent a new community standard for medical malpractice purposes.



State laws requiring language access


According to a National Health Law Program survey, 43 states have laws that address language access in healthcare settings.29 At least 26 states and the District of Columbia have enacted legislation requiring language assistance such as interpreters and/or translated forms and other written materials for LEP patients. For example, California statutes require interpreters or bilingual staff at general acute care hospitals, county medical health programs, and intermediate care facilities.30 Idaho requires interpreters for the purpose of obtaining consent from patients in the state’s Medical Assistance Program. Massachusetts enacted the ‘Emergency Room Interpreter Bill,’ effective as of July 1, 2001. The law requires all public and private acute care hospitals to provide ‘competent interpreter services’ for all emergency room services. Rhode Island requires hospitals to provide a qualified interpreter when a bilingual clinician is unavailable for all services given to every non-English-speaking patient. This law became effective January 1, 2002.31


Many states have addressed linguistic access in their contracts with healthcare providers. According to George Washington University’s Center for Health Services Research and Policy, the majority of Medicaid managed care contracts or requests for proposals require managed care organizations to provide materials in other languages (38 states), require services for persons whose primary language is not English (31 states), or include a cultural competency requirement (27 states).


A few states have used the law to implement broader cultural competency efforts. Recently, California has acknowledged the need for cultural competency by adding state administrative support for such efforts. A 1999 statute established an Office of Multicultural Health. The Office’s duties includes performing ‘an internal assessment of cultural competency, and training of healthcare professionals to ensure more linguistically and culturally competent care.’ A 2000 California law established ‘The Task Force on Culturally and Linguistically Competent Physicians and Dentists.’ The Task Force’s work has already generated additional legislation, including a bill to provide language and cross-cultural training to California physicians.32


Other state approaches to cultural competency vary widely. Some laws use linguistic access and cultural competency program requirements as licensing conditions. Some require managed care organizations to develop written cultural competency plans to provide effective healthcare services to members. Others establish service standards, pilot programs, research priorities, and specific programs aimed at particular racial and ethnic communities.

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Aug 11, 2016 | Posted by in INFECTIOUS DISEASE | Comments Off on Language Assistance for Limited English Proficient Patients: Legal Issues

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