BILL ANALYSIS Ó
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 442
S
AUTHOR: Calderon
B
AMENDED: April 7, 2011
HEARING DATE: April 13, 2011
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CONSULTANT:
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Hansel
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SUBJECT
Hospitals: interpreters
SUMMARY
Requires general acute care hospital policies for the
provision of language assistance to patients with language
or communication barriers to include procedures for
discussing with the patient any cultural, religious, or
spiritual beliefs or practices that may influence care, and
to increase the ability of hospital staff to understand and
respond to the cultural needs of patients.
CHANGES TO EXISTING LAW
Existing law:
Existing federal laws, guidelines, and executive orders
prohibit public and private entities that receive federal
funds from discriminating based on race, color, or national
origin, and require these entities to provide limited
English proficiency individuals with language assistance,
to ensure they have equal access to programs and services.
Existing state law requires the Department of Managed
Health Care (DMHC) and Department of Insurance to adopt,
not later than January 1, 2006, regulations to ensure that
health plan enrollees have appropriate access to language
Continued---
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assistance services. Pursuant to regulations, health plans
must translate written materials into non-English languages
based on their number of enrollees and the number and
percent of limited English proficiency enrollees. Plans
must also assess and survey the language needs and
demographic profile of their enrollee population on a
regular basis, provide interpreters at points of contact
between enrollees and the plan, and inform enrollees of the
availability of language assistance services.
Existing state law specifically requires licensed general
acute care hospitals to meet several requirements related
to language assistance for persons with language or
communication barriers, including:
Adopt and review annually a policy for providing language
assistance services to patients with language or
communication barriers, defined as barriers faced by
individuals who are limited-English-speaking or
non-English-speaking who speak the same primary language
and who comprise at least five percent of the population
served by the hospital or the actual patient population
served;
Develop, and post in conspicuous locations, notices that
advise patients and their families of the availability of
interpreters;
Identify and record a patient's primary language and
dialect on the patient's medical chart, hospital
bracelet, bedside notice, or nursing card;
Notify employees of the hospital's commitment to provide
interpreters to all patients who request them; and
Prepare and maintain as needed a list of interpreters who
have been identified as proficient in sign language and
in the languages of the population of the geographical
area serviced who have the ability to translate the names
of body parts, injuries, and symptoms.
This bill:
Requires general acute care hospital policies for the
provision of language assistance to patients with language
or communication barriers to include procedures for
discussing with the patient any cultural, religious, or
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spiritual beliefs or practices that may influence care, and
to increase the ability of hospital staff to understand and
respond to the cultural needs of patients.
Requires hospitals to ensure that interpreters communicate
information about the unique needs of patients to their
hospital health care team.
FISCAL IMPACT
This bill has not been analyzed by a fiscal committee.
BACKGROUND AND DISCUSSION
According to the author, professionally trained medical
interpreters on-site at the hospital provide the most
protection, for both the patient and the provider, against
compromised services and poor health outcomes for ethnic
and underserved persons in a multi-ethnic population.
Hospitals are increasingly turning to the provision of
telephone interpreting services for reasons of convenience
and/or cost. This author-sponsored bill would make several
changes to enhance the provision of language assistance in
hospitals to persons who speak no English or have limited
proficiency in English. It requires the hospital's policy
to include procedures for discussing with patients any
cultural, religious or spiritual beliefs or practices that
influence care. It also requires the policy to be designed
to increase the ability of hospital staff to understand and
respond effectively to the cultural needs of patients, and
requires hospitals to ensure that interpreters communicate
information about unique patient needs to the hospital's
care team.
According to the author, the changes proposed by SB 442
will ensure that patients who require on-site medical
interpreters are provided the appropriate care, improve
satisfaction rates and potentially reduce the risk of
medical malpractice suits.
Need for language assistance in hospitals
According to US Census Bureau data, over 40 percent of
people in California speak a language other than English at
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home, and over 20 percent speak English less than "very
well." Seventy percent of health care providers in a
recent survey stated that language barriers compromise
patients' understanding of their disease and treatment
advice, increase the risk of complications, and make it
harder for patients to explain their symptoms. A recent
study by the Joint Commission, hospital accrediting body,
found that communication problems are the cause of a high
number of reported adverse events that occur in hospitals.
Language assistance requirements for hospitals
Hospitals are subject to both federal and state
requirements pertaining to language assistance. Federal
laws, orders, and guidelines require hospitals that receive
federal funding, e.g. through the Medicare or Medicaid
programs, to provide language assistance to limited English
proficient individuals whom they serve. The Office of
Civil Rights within the US Health and Human Services Agency
enforces compliance with these requirements. Hospitals
must provide language assistance services at no cost to
patients, at all points of contact, and in a timely manner
during all hours of operation.
State law SB 1840 (Kopp), Chapter 672, Statutes of 1990,
requires general acute care hospitals to adopt and review
annually a policy for providing language assistance
services to patients with language or communication
barriers. With respect to spoken language, state law
defines "language or communication barriers" as barriers
which are experienced by individuals who are
limited-English-speaking or non-English-speaking who speak
the same primary language, and who comprise at least five
percent of the population of the
geographical area served by the hospital, or of the actual
patient population of the hospital. Hospitals must also
notify patients and their families of the availability of
interpreters, identify and record each patient's primary
language and dialect, and prepare and maintain a list of
interpreters who have been identified as proficient in sign
language and in the languages of the population of the
geographical area serviced who have the ability to
translate the names of body parts, injuries, and symptoms.
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The Department of Public Health (DPH) assesses whether
hospitals are complying with these requirements in response
to complaints and during initial and routine licensing
surveys.
The Joint Commission has issued language assistance
standards for hospitals, which will become requirements for
accreditation beginning in 2012. The standards emphasize
identifying patients' language needs, informing patients of
their right to receive language assistance services, and
ensuring the competence of individuals providing language
assistance services.
How hospitals meet requirements to provide language
assistance
Hospitals use a variety of methods of providing language
assistance to patients, including in-person interpreters,
bilingual staff, and telephone and videoconference-based
interpreter services. Many public, district, and UC
hospitals participate in a cooperative known as the Health
Care Interpreter Network (HCIN). Through HCIN, California
public hospitals share trained health care interpreters
through an automated video and voice call center.
Videoconferencing devices and telephones allow each
participating hospital to connect to interpreters, either
at their own hospital or another participating hospital.
More than 60 interpreters provide assistance in Spanish,
Cantonese, Mandarin, Vietnamese, Lao, Mien, Thai,
Cambodian, Hmong, Korean, Russian, Farsi, Armenian, Tongan,
and Hindi, and American Sign Language. When a language is
not available from an interpreter at one of the HCIN
hospitals, the system uses contracted telephonic language
providers.
Effectiveness of alternative means of providing
interpretation
Studies show that use of professionally trained
interpreters can improve health outcomes and patient and
provider satisfaction, vis-a-vis relying on family members
or friends (referred to as ad-hoc interpreters). According
to a review of studies published in 2008, Is the use of
interpreters in medical consultations justified? A critical
review of the literature, Partners for Applied Social
Sciences International, March, 2008, professionally trained
interpreters make fewer errors in translating medical
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information than ad-hoc interpreters, are better able to
obtain informed consent from patients, and better protect
the confidentiality of patients' medical information. The
same review found that use of professionally trained
interpreters is associated with improved utilization of
preventive services, more efficient use of medical tests,
and shorter lengths of hospital stay.
Prior legislation
SB 853 (Escutia), Chapter 713, Statutes of 2003, requires
DMHC and the Department of Insurance to adopt regulations
to ensure enrollees have access to language assistance in
obtaining health care services.
AB 292 (Yee) of the 2003-04 Session would have prohibited
public agencies, as well as organizations or programs that
receive state funding, from using children as interpreters
in their business, with exceptions. Would have required
such entities to have in place, available for inspection,
an established procedure for providing competent
interpretation services that does not involve the use of
children. Held under submission in Senate Appropriations
Committee.
SB 1840 (Kopp), Chapter 672, Statutes of 1990, requires
hospitals to adopt and review annually a policy for
providing language assistance services to patients with
language or communication barriers, defined as barriers
faced by individuals who are limited-English-speaking or
non-English-speaking who speak the same primary language
and who comprise at least five percent of the population
served by the hospital or the actual patient population
served.
Arguments in support
The American Federation of State, County, and Municipal
Employees (AFSCME) supports the bill's intent to ensure
that limited English proficiency patients are not deprived
of their health care rights. The California Language
Teachers' Association (CLTA) states that effective
communication is a critical component in the diagnosis of
health care needs.
Taking a support if amended position, Health Access
California (HAC) states that California law requiring
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hospitals to provide interpreters, dates back over 20 years
and fails to recognize video medical interpretation as a
means of providing interpreter services. HAC states that a
pilot project it started at public hospitals in Alameda and
San Francisco counties has found that video medical
interpretation is far preferable for both doctors and
patients to telephone interpretation, while not as
preferred as in-person interpretation. HAC is asking for
an amendment to add video medical interpretation as one of
the ways in which hospitals may provide interpreters. HAC
also notes that DPH checks for hospitals' compliance with
some hospital licensing requirements during the regular
surveys that it conducts, but compliance with language
assistance requirements is not one of them, and it has not
adopted regulations to provide for administrative penalties
for hospitals' violations of licensing requirements
pursuant to legislation that passed in 2006. HAC urges
further oversight to ensure that the provisions of SB 442
are effectively enforced.
COMMENTS
1. Proficiency and skills of interpreters. Existing law
requires health plans' policies on the provision of
language assistance services to meet criteria to ensure the
proficiency of translation or interpretation services,
including ensuring that interpreters have a fundamental
knowledge of health care terminology and concepts relevant
to health care delivery systems, and education and training
in ethics, conduct, and confidentiality. Existing studies
document that use of professionally trained interpreters
produces better outcomes for patients and providers. The
author may wish to consider amendments to require
hospitals' policies on language assistance services to
include criteria on proficiency similar to those that apply
to health plans.
POSITIONS
Support: American Federation of State, County and
Municipal Employees
California Language Teachers Association
Health Access California (if amended)
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Oppose: None received
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