Putting ideology and bad policy first, the Senate is currently considering an amendment that could literally mean the difference between life and death for medical patients with limited English. Senator Tom Coburn (R-OK) has proposed an amendment to immigration reform legislation that would repeal Executive Order 13166, Improving Access to Services for Persons with Limited English Proficiency (LEP), a provision that has helped to eliminate language barriers to attaining quality health care services. The Senate should reject this amendment.
The executive order requires federal agencies to ensure that people with limited English skills can access their services and programs, and also requires federal agencies to develop language access guidelines for other federally funded programs that are not directly managed by the federal government. This order is consistent with Title VI of the Civil Rights Act, which protects individuals against discrimination based on national origin.
In the health care sector, physicians, hospitals and other medical providers who receive Medicare and Medicaid reimbursement must provide interpretation and translation services in their patients’ primary languages, thus ensuring that patients with limited English proficiency can have access to health care services equal to that of English speakers. Although language barriers persist, these policies have made needed health care services more attainable for individuals struggling to communicate in health care settings.
At a time when the U.S. is more linguistically diverse than at any other point in our nation’s history, decreasing language barriers to health care should be a priority. Recent immigration trends have significantly increased the number of people who speak a language other than English at home. This segment of the population (PDF) grew by 38% in the 1980s and by 47% in the 1990s. By 2000, 47 million persons over the age of five spoke a language other than English at home.
For native English speakers, understanding and processing diagnosis and treatment information can be challenging. But for those who have difficulty reading, writing or understanding English — it can be nearly impossible. And language barriers are not just an inconvenience: They can compromise quality of care and increase the risk of adverse health outcomes among affected patients.
A survey in the Archives of Pediatrics and Adolescent Medicine revealed that language issues are the single greatest barrier to health care access for Latino children. One-fourth of parents identified language as an access barrier, especially when an interpreter or provider does not speak Spanish. Another 6% of parents reported not bringing their child in for needed care because of language barriers.
Another case in point: Chinese-speaking immigrants have less knowledge of how to manage their diabetes — and generally tend to have poor blood glucose control — compared with Asian American immigrants who speak English. These barriers make it difficult to manage chronic conditions. Language barriers can lead to inefficient care because clinicians are unable to elicit these patients’ symptoms and, thus, use more diagnostic resources or invasive procedures.
The story of Letticia Herrera is a tragic example of how language barriers can have life-or-death consequences. Herrera entered a Savannah, Georgia, emergency room last May in significant pain. Because of her limited English, the mother of two was misdiagnosed with a stomach infection and sent home. Her condition worsened, and less than a week later she was brought back to the same hospital, where she later died.
Instead of working to ensure that this kind of tragedy isn’t repeated, the Senate’s two doctors, Sen. Coburn and Senate Majority Leader Bill Frist (R-TN), have exhibited a distressing disregard for the doctor-patient relationship. Sen. Coburn, by promoting this amendment, will undermine meaningful communication between doctors and patients — thus relegating those who do not speak English to a lower rung of our health care system. And Majority Leader Frist last year allowed political considerations to take precedence over standard medical practice when he diagnosed Terry Schiavo’s physical and mental state without examining her in person.
Letticia Herrera and other limited-English speakers deserve far more from these two doctors and the members of the Senate. If the Senate were to repeal Executive Order 13166, it would undermine recent improvements in language access and appropriate health care for 47 million people. The Coburn amendment would strike a devastating blow both to access to quality health care and to civil rights protections.