Culturally and Linguistically Appropriate Services

The following article is about providing culturally and linguistically appropriate services.

Please do not hesitate to contact us with comments, questions, or requests for additional information.
Elizabeth E. Hogue, Esq.
(877) 871-4062
The U.S. Department of Health Human Services (HHS), Office of Minority of Health, requires all health care organizations to provide culturally and linguistically appropriate services. The concept of culturally and linguistically appropriate services is consistent with good risk management. That is, providers will undoubtedly have difficulty rendering services consistent with applicable standards of care if they cannot communicate appropriately with their patients, both culturally and linguistically. Vital information may be omitted in encounters with patients. Lack of understanding may also result in misdiagnoses, inappropriate treatment, or lack of compliance. 

An article entitled “The Lonely, Vital Work of Medical Interpretation” by Clifford Marks; which appeared in The New Yorker on April 29, 2021; says that a survey of malpractice cases paints a grim picture. In one case, for example, a misinterpretation of Spanish led physicians to assume that an eighteen-year-old patient had suffered a drug overdose. In fact, he had a brain bleed. By the time the mistake was identified, the patient was paralyzed from the neck down.

From the point of view of good risk management, it is also clear to many practitioners that reliance upon family members to translate in health care settings is a potentially risky proposition. Interpreters are supposed to translate, not editorialize. It may be more difficult for family members to avoid this pitfall.

In his article, Marks describes a simulation involving an interpreter who assisted via telephone. The patient in this simulation tried to tell physicians that she had been cooking on a makeshift stove in her apartment when she began to feel lightheaded. The interpreter told her, “Shut your mouth – the doctors don't want to hear about the stove.”

In order to avoid these problems, providers are required to:             
  • 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.
  • Provide, in their preferred language, both verbal offers and written notices to patients/consumers informing them of their right to receive language assistance services.
  • 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 if requested by the patient/consumer.
  • 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.
The following practical suggestions should be emphasized in this effort:
  • Providers should routinely ask patients about their preferred language and record patients' responses in their documentation.
  • When patients want to use family members or friends to interpret for them, as opposed to other interpreters supplied by providers, practitioners should document these requests in patients' records.
Regulatory burdens are significant and have taxed the resources of many providers. As our society becomes ever more diverse, however, the necessity of these requirements is clear.

©2021 Elizabeth E. Hogue, Esq. All rights reserved.
No portion of this material may be reproduced in any form without the advance written permission of the author.


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