Required translators missing from many U.S. hospitals

(Reuters Health) - Nearly one-third of U.S. hospitals fail to offer interpreters to patients who speak limited English, although federal law requires it, a new study shows.

“People have a right to hear a cancer diagnosis in a language they understand, not through hand gestures,” lead author Melody Schiaffino said in a telephone interview.

One in 10 adults in the U.S. struggle to communicate in English, census data show.

When hospitals don’t make interpreters available, much can be lost in translation, said Schiaffino, who is an epidemiologist at San Diego State University’s Graduate School of Public Health in California.

She was surprised to find that one-fourth of hospitals in areas with a high or moderate need for language services didn’t offer them. The same was true for more than one-third of hospitals in low-need areas, her team reported in Health Affairs.

Using census data from 2009 to 2013, the researchers calculated regional needs for translation services. Then, they examined the availability of these services at 4,514 U.S. hospitals as reported in the American Hospital Association’s 2013 annual hospital survey.

The data revealed holes in language-service coverage in multiple regions, such as in central Tennessee around Nashville and central Nebraska around Lexington. Other regions, like the New York-New Jersey area and Florida’s Tampa-St. Petersburg area, had uneven results, with some hospitals offering services and others not, the study found.

Private, not-for-profit hospitals were far more likely to offer translation services than private for-profit and government hospitals, the study found.

Dr. Alicia Fernandez of the University of California, San Francisco School of Medicine, who studies language barriers in healthcare but wasn’t involved in Schiaffino’s research, said the new study raises more questions than it answers.

It remains unclear if the hospitals that reported not offering language services failed to provide them in any capacity anywhere in the hospital, or if, for example, some of their healthcare professionals might have been bilingual, Fernandez said in a telephone interview.

“This would be a big, big problem if they’re really not offering any services,” Fernandez said. “We can’t tell the extent of the problem.”

She and Schiaffino both called for more research to further identify gaps in hospital language services.

Prior studies have shown that patients in the U.S. with limited English proficiency are more likely to remain hospitalized longer, to be misdiagnosed and to be subjected to medical errors. The use of professional interpreters reduces the disparities and improves clinical outcomes, Fernandez reported in a 2014 study (

“You can imagine how difficult it is to get a cancer diagnosis when you’re not really understanding. When family members act as interpreters, they make many mistakes and they carry the anxiety of making a mistake,” Fernandez said.

The 1964 Civil Rights Act requires hospitals receiving federal funds - and that includes all hospitals - to provide language services to patients with limited English proficiency. Services could mean telephone translators, bilingual staff, professional on-site translators or video translators, Fernandez said.

Because commercial vendors provide telephone translators to hospitals, the service could be made available in any hospital at any time, she said.

“The law is really clear here,” she said. “There’s no excuse.”

Fernandez said she was especially troubled that the study found holes in translation services at hospitals in areas with new and expanding immigrant communities, like New Orleans, as well as in areas with long-established immigrant communities, like parts of Southern California.

Language barriers complicate doctor-patient communication, making healthcare not only inequitable but more expensive and dangerous, Schiaffino said.

“If you don’t know how to speak the language, you don’t know how to ask where it hurts,” she said.

As a bilingual employee of a medical clinic, Schiaffino said she saw how a medical bill for an unnecessary ultrasound devastated a family.

“These are the things we take for granted through language, and we shouldn’t,” she said. “At the end of the day, it’s a federal mandate. It’s a great policy.”

Hospital administrators may think of immigrants as lacking health insurance, but many immigrants are insured. “They have their papers, and they have insurance,” she said. “It’s a great opportunity for hospitals.”

SOURCE: Health Affairs, online August 1, 2016.