- Need for Linguistic Competency
- Benefits For Language Interpretation
- Legal Requirements
- Maryland MCO's (Health Choice) -- Who to Call for Interpreters
- Medical Interpretation at the University of Maryland
Need for Linguistic Competency
Limitations in spoken and written language comprehension hamper encounters between patients and health care providers, often leading to misunderstandings as to diagnosis and treatment, which in turn may result in poor patient compliance and unsatisfactory outcomes (Carter-Pokras et al 2004).
Barriers in communication affect health care providers as well. Some physicians who cannot fully understand their patients appear to compensate for the unaccustomed lack of information by altering their management to a more cautious, conservative style: when language barriers are present, more tests are ordered, more intravenous hydration is administered and hospital admissions are more frequent, a phenomenon termed a 'language-barrier premium' (Waxman and Levitt, 2000; Hampers and McNulty, 2002).
Not addressing language barriers during the informed consent process undermines the ethical obligation fundamental to the physician-patient relationship (Woloshin et al., 1995) and has potential legal ramifications as well. The risk of medical malpractice associated with language discordance between providers and patients is reduced when competent medical interpretation is provided. Although medical liability lawsuits are most commonly settled out of court, and the terms of the settlements are not revealed, there are a few published reports that detail the circumstances leading to a medical mishap related to language barriers (Harsham, 1984;Carbone et al., 2003).
Benefits For Language Interpretation
Overcoming language discordance between patients and providers has been shown to lead to:
- Increased compliance with medications and appointments, fewer emergency department visits, better recall of information and more questions being asked
- Elimination of health-status disparities
- Increased delivery of health care services and satisfaction
- Reduced risk of medical errors due to language
- Decreases in the possibility of liability claims
Most medical interpretation schemes involve a triad of individuals including the patient, health care provider, and interpreter. This scheme relies on the interpreter taking the least invasive role as possible. To find useful tools to ensure better communication and better care, please visit the ScanHealth Plan website. Some of the tools you will find are:
- 10 Tips for Working with Interpreters
- Tips for Communicating Across Language Barriers
- Employee Language Skills Self-Assessment Tool
Legal Requirements
Federal Legislation
United States Department of Justice - Title VI of the Civil Rights Act of 1964 says “No person in the United States shall, on the grounds 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”
Office for Civil Rights guidelines define for providers what constitutes “meaningful access” for patients with limited English proficiency (August 2003).
Department of Health and Human Services regulations require all recipients of federal financial assistance from HHS to provide meaningful access to limited English proficient (LEP) persons, at no cost to the client.
State Legislation
Maryland Code Title 10, Subtitle 11 (2002) requires “each State department, agency, or program … [to] take reasonable steps to provide equal access to public services for individuals with limited English proficiency,” achieving that goal by “the provision of oral language services for individuals with limited English proficiency” and “the translation of vital documents ordinarily provided to the public into any language spoken by any limited English proficient population that constitutes 3% of the overall population within the geographic area served by a local office of a State program as measured by the United States Census” as well as “any additional methods or means necessary to achieve equal access to public services”.
Managed Care Organizations in Maryland (HealthChoice) are under contract to provide language interpretation for their LEP enrollees [Maryland COMAR, 10.09.66.01. B(1)(a)], as well as written materials “in the enrollee’s native tongue if the enrollee is a member of a substantial minority” (defined as “an ethnic or linguistic group that comprises 5% or more of the Medicaid population in the county to be served”)
Maryland MCO's (Health Choice) -- Who to Call for Interpreters
Amerigroup |
Ms. Susan Barry, Special Needs Coordinator |
The Diamond Plan (Coventry) |
Customer Service Representatives |
Helix Family Choice, Inc. |
Customer Service |
JAI Medical Systems |
Mr. Jerome Tyree, Outreach Coordinator |
Maryland Physicians Care |
Customer Service 1-800-953-8854 |
Priority Partners |
Ms. Jennifer Mayer, Special Needs Coordinator |
United Health Care – |
Adam White, Special Needs Coordinator |
Medical Interpretation at the University of Maryland
How to obtain a telephone interpreter at UMMC (Inpatient): Contact the Inpatient Unit to determine where speakerphones are located. Speakerphones will allow for both the healthcare provider and the patient to speak to the interpreter and hear the interpreter. For telephone interpretation, call 1-866-271-7830. Enter the “organization number” 1270#, then enter the “pin number” 1364#. When prompted for reference number, enter ## then the language code if known. For assistance, or to be connected to a live operator, press “0” at any time. Over 250 languages can be interpreted.
How to obtain a telephone interpreter at UMMC (Outpatient): Contact your administrator to determine where speaker phones are located. Speaker phones will allow for both the healthcare provider and the patient to speak to the interpreter and hear the interpreter. To obtain a telephone interpreter, call 1-866-271-7830. Enter the “organization number” 1270#, then enter the “pin number” of your department. When prompted for reference number, enter ## then the language code if known. For assistance, or to be connected to a live operator, press “0” at any time. Over 250 languages can be interpreted.
How to obtain an in-person interpreter at UMMC (Inpatient and Outpatient): If a telephone interpreter cannot be utilized, contact the paging system at 410-328-2337 and enter code #8255 to request an in-person interpreter. A call back number is required.
For further information, please call Ms. Odetta James Harlee at 410-328-8777.
Citation References
- Shin H., Kominski R. Language Use in the United States: 2007. American Community Survey Reports 2010. Available at http://www.census.gov/prod/2010pubs/acs-12.pdf
- Accreditation Council for Graduate Medical Education. Common Program Requirements. February 2002. Available at http://www.acgme.org/acWebsite/dutyHours/dh_dutyHoursCommonPR.pdf
- Anderson LM, Scrimshaw SC, Fullilove MT, Fielding JE, Normand J, Task Force on Community Preventive Services. Culturally competent healthcare systems: a systematic review. Am J Prev Med 2003;24(3S):68-79.
- Agency for Healthcare Research and Quality. National Healthcare Disparities Report, 2003. Rockville, MD. Available at http://www.ahrq.gov/qual/nhqr03/nhqr03.htm
- Agency for Healthcare Research and Quality, National Healthcare Disparities Report, 2005. Rockville, MD. Available at http://www.ahrq.gov/qual/nhdr05/nhdr05.htm
- Carter-Pokras O, Baquet C. What is a health disparity? Public Health Reports 2002;117:426-432. Available at http://www.ohsu.edu/xd/research/centers-institutes/institute-on-development-and-disability/public-health-programs/project-intersect/upload/Carter-Pokras.pdf
- Cross T, Bazron B, Dennis K, and Isaacs M. Towards a culturally competent system of care. Volume 1. Washington DC: Georgetown University Child Development Center, CASSP Technical Assistance Center 1989.
- Harsham P. A misinterpreted word worth $71 million. Med Econ. 1984 Jun;61:289-292.
- Institute of Medicine. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Smedley BD, Stith AY, and Nelson AR, Editors, Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care. 2003. Available at http://www.nap.edu/openbook.php?isbn=030908265X
- Liaison Committee on Medical Education. Functions and Structure of a Medical School: Standards for Accreditation of Medical Education Programs Leading to the M.D. Degree. September 2003. Available athttp://www.lcme.org/functions2003september.pdf
- National Standards for Culturally and Linguistically Appropriate Services in Health Care Final Report, OMH, 2001. Available at http://minorityhealth.hhs.gov/assets/pdf/checked/executive.pdf
- Physicians for Human Rights. The Right to Equal Treatment: An action plan to end racial and ethnic disparities in clinical diagnosis and treatment in the United States. September 2003. Available athttp://physiciansforhumanrights.org/library/report-equaltreatment-2003.html
- Waxman MA. Levitt MA. Are diagnostic testing and admission rates higher in non-English-speaking versus English-speaking patients in the emergency department? Ann Emerg Med. 2000 Nov;36(5):456-61.
- Woloshin S, Bickell NA, Schwartz LM, Gany F, Welch HG. Language barriers in medicine in the United States. JAMA 1995;273(9):724-8.