BILL ANALYSIS Ó
SB 442
Page 1
Date of Hearing: July 5, 2011
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
SB 442 (Calderon) - As Amended: April 26, 2011
SENATE VOTE : 21-14
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. Specifically, this bill :
1)Requires a hospital's policy for providing language assistance
services to patients with language or communication barriers
to ensure meaningful access to translation and interpreter
services by limited- or non-English-speaking individuals and
to include appropriate criteria for demonstrating the
proficiency of the translation and interpreter services.
2)Requires the hospital policy referenced in 1) above to include
procedures for discussing with the patient any cultural,
religious, or spiritual beliefs or practices of the patient
that may influence care. Requires the procedures to be
designed to increase hospital staff's ability to understand
and respond effectively to the cultural needs of patients.
Requires procedures to ensure that interpreters are accessible
by telephone or video medical interpretation, 24-hours per
day.
3)Requires hospitals to annually transmit to the Department of
Public Health (DPH) a copy of the updated policy in 1) above
which includes a description of its efforts to ensure
effective communication between patients with language or
communication barriers and staff.
4)Requires hospitals to review the standards of the health care
interpreting industry to incorporate improvements or standards
for health care interpreter certification, and standards for
testing to ensure quality, accuracy, and consistency in the
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provision of health care interpreter services.
5)Requires hospitals to take reasonable steps to assess whether
interpreters demonstrate proficiency in the ability to
communicate information accurately in both English and in the
other language, including, but not limited to, all of the
following:
a) Knowledge, in both languages, of health care terminology
and specialized terms or concepts unique to the hospital's
program or activity;
b) Ability to use the appropriate mode of interpreting,
including, but not limited to, consecutive, simultaneous,
summarization, or sight translation; and,
c) Possession of an understanding of, and ability to
follow, rules of conduct relating to confidentiality,
impartiality, and interpretation ethics.
6)Requires hospitals to notify employees of the hospital's
commitment to provide interpreters to all patients who request
them and that the interpreter communicate information about
the unique needs of the patient to the health care team.
EXISTING LAW :
1)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 (LEP) individuals with language assistance, to
ensure they have equal access to programs and services.
2)Requires the Department of Managed Health Care (DMHC) and the
California Department of Insurance (CDI) to adopt, not later
than January 1, 2006, regulations to ensure that health plan
enrollees have appropriate access to language 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 LEP
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
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availability of language assistance services.
3)Requires licensed general acute care hospitals to meet several
requirements related to language assistance for persons with
language or communication barriers, including:
a) 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- or non-English-speaking who
speak the same primary language and who comprise at least
5% of the population served by the hospital or the actual
patient population served;
b) Develop, and post in conspicuous locations, notices that
advise patients and their families of the availability of
interpreters;
c) Identify and record a patient's primary language and
dialect on the patient's medical chart, hospital bracelet,
bedside notice, or nursing card;
d) Notify employees of the hospital's commitment to provide
interpreters to all patients who request them; and,
e) 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.
FISCAL EFFECT : According to the Senate Appropriations
Committee, pursuant to Senate Rule 28.8, negligible state costs.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, professionally
trained medical interpreters and policies to increase the
ability of hospital staff to respond to unique cultural needs
will help to ensure that patients who require on-site medical
interpreters are provided the appropriate care. The author
argues that hospitals are increasingly turning to the
provision of telephone interpreting services for reasons of
convenience and/or cost to meet the requirements in existing
law to provide medical interpreters to patients. The author
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also asserts that 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. The author maintains that this bill
will result in high patient satisfaction rates and may reduce
the risk of medical malpractice suits.
2)BACKGROUND . According to US Census Bureau data, over 40% of
people in California speak a language other than English at
home, and over 20% 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, the hospital accrediting body, found that
communication problems are the cause of a high number of
reported adverse events that occur in hospitals.
Cultural competence in addition to linguistic competence has
increasingly become recognized as a fundamental aspect of
quality in health care and as an essential strategy for
reducing disparities by improving access, utilization, and
quality of care. According to the California Healthcare
Interpreters Association publication, Guidance on Interpreter
Roles and Interventions (CHIA publication), various barriers
to cross-cultural communication exist including language
differences, language complexity, and differences in cultural
norms, in addition to organizational or broader systemic
barriers. The CHIA publication further reports that culture
determines how people behave, make decisions, communicate and
interact with each other and that culture and language are
inseparable. Cultural beliefs about health and illness around
the world vary significantly from the biomedical perspective
and that many traditional health beliefs, practices, and
healers lack equivalent terms. According to the CHIA
publication healthcare interpreters have a fundamental role in
helping both parties understand each other's cultural
explanation on health and illness.
3)HOSPITAL 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.
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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.
DPH assesses whether hospitals are complying with state
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.
4)SUPPORT . The California Language Teachers Association (CLTA)
writes in support of this bill that effective communication is
a critical component in the diagnosis of a health issue, and
if the patient does not understand or cannot respond in
English to the questions being posed by the medical staff, it
can be a matter of life and death. CLTA maintains that this
bill would remediate this issue by having qualified
interpreters/translators who can ensure effective
communication between the patient and medical professionals.
The California Medical Association (CMA) writes in support
that this bill goes an important step further by encouraging
instruction of hospital staff in cultural competency. CMA
maintains that a health care transaction is often a
negotiation between different perspectives and immigrant
populations often bring with them a set of beliefs, attitudes
and practices that can affect a provider's understanding and
diagnosis, a patient's compliance with treatment orders,
satisfaction with care, the cost of care, and most
importantly, health outcomes. The California Hospital
Association (CHA) writes in support that California hospitals
are actively addressing the needs of the diverse LEP
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population and the deaf and hearing impaired by using a
variety of language services to ensure quality health care
services are provided to every patient. CHA states that to
determine which service is most appropriate, hospitals assess
the frequency with which they should have contact with LEP
individuals from different language groups, seeking
assistance. According to CHA, the more frequent the contact
with a particular language group. The more likely that
enhanced language services in that language are needed. CHA
asserts that hospitals will continue to take the necessary
steps to ensure the proficiency of interpreters and
translators.
5)PREVIOUS LEGISLATION .
a) SB 853 (Escutia), Chapter 713, Statutes of 2003,
requires DMHC and CDI to adopt regulations to ensure
enrollees have access to language assistance in obtaining
health care services.
b) AB 292 (Yee) of the 2003, 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. AB 292 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. AB 292 died on the suspense file in the Senate
Appropriations Committee.
c) 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- or
non-English-speaking who speak the same primary language
and who comprise at least 5% of the population served by
the hospital or the actual patient population served.
REGISTERED SUPPORT / OPPOSITION :
Support
American Federation of State, County and Municipal Employees,
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AFL-CIO
California Hospital Association
California Language Teachers Association
California Medical Association
National Association of Social Workers, California Chapter
Opposition
None on file.
Analysis Prepared by : Tanya Robinson-Taylor / HEALTH / (916)
319-2097