California Emergency Rooms Hang Up on Linguistic Competence

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Eight years after the Department of Health and Human Services’ Office of Civil Rights issued a guidance outlining health care providers’ responsibilities to provide linguistically competent services to patients who don’t speak English—responsibilities that are mandatory for any health care facility that receives federal funding—a new research study reveals that many hospital emergency rooms in California are still not adequately meeting the needs of the linguistically diverse communities they serve.

In the study, conducted by the Discrimination Research Center (DRC), trained testers placed more than 550 calls requesting emergency service to 12 hospitals in Alameda County, Calif., where more than 30% of the residents speak a language other than English at home. The calls were made in five languages: English, Spanish, Cantonese, Vietnamese and Tagalog. In addition to the federal law, California state law also mandates that patients with limited English proficiency (LEP) are entitled to the same level of health care services available to English-speaking persons.

But the results of the DRC study clearly show that this is not always the case. Some of the key findings were:

Only 41% of the calls made in languages other than English were properly transferred or referred to the appropriate staff member or interpreter who could assist using the caller’s language.

In about two out of three test calls conducted in Cantonese or Vietnamese, hospital personnel either hung up, disconnected the call when transferring or placed the caller on hold for more than 10 minutes.

Only 62% of the test calls conducted in Spanish resulted in the caller being connected to a Spanish speaker, even though more than 14% of Alameda County residents speak Spanish.

More than one out of four calls made in Tagalog resulted in a hang-up or disconnection by the hospital employee who answered the phone.

None of the test callers speaking English were hung up on, disconnected or put on hold for over 10 minutes.

"These findings are particularly noteworthy," the study concludes, "because [the emergency room is] a common hospital entry point that also serves as the access point for patients who are most in need of urgent care. Although some hospitals used recognized practices to improve health access for LEP patients, many still relied on an ad hoc system of language access. Having a clear, uniform system for addressing language barriers is critical to ensuring equitable access to services."

The complete study report, Unequal Access to Health Care: A Test of Language Services at Alameda County Hospitals, is available online at the DRC’s Web site, www.drcenter.org. The report includes a list of recommendations to help hospital administrators, human resources offices and training departments improve LEP patients’ access to care, both over the phone and in person.

—compiled by the editors of Minority Nurse magazine