Late last year, the Senate Special Committee on Aging heard some very important testimony about how the drug industry needs to be better regulated in order to protect seniors and other consumers from medication labeling mistakes. But the testimony quickly turned to how to make information on drug labels clearer and more understandable to consumers, which is vital given the many risks inherent in prescription drugs.
Recently, I came down with a sudden illness while visiting friends in Central America. As an English speaker with little proficiency in Spanish, I realized that access to good information about the use and benefits of a drug is critical to making decisions about your own care. As I weighed the idea of going to a local doctor or “farmacia”, I realized that I would never be able to fully understand the treatment or drug they might recommend for me in a Spanish-speaking country. If the doctor was not bilingual, I would be forced to rely upon the friend I was visiting with, or her teen-aged kids, to translate. But despite being bilingual in most ways, my friends likely would not have the health and science vocabulary to fully explain the treatment’s risks and potential outcomes. I might not be able to fully understand or evaluate the risks or the warning signs.
I also realized this is the same situation patients and consumers with limited English proficiency face every time they go to a pharmacy in the U.S. Many such patients rely upon their children or grandchildren to translate for them at the pharmacy counter. But it doesn’t have to be so.
Late last year, a broad group of 35 senior, professional, and multicultural organizations wrote to the U.S. Senate Special Committee on Aging, asking the Committee and the Department of Health and Human Services (HHS) to address language barriers during a hearing on “Protecting Seniors from Medication Labeling Mistakes.” Given that approximately 4.1 million seniors who are Medicare beneficiaries are also limited English proficient (LEP), interpretation and translations services by pharmacists are vital to ensuring patient safety, and to empower patients to make meaningful decisions about their care.
The letter from this diverse coalition of concerned organizations asked that HHS work to address the language barriers to access in Medicare and Medicaid programs, while also noting that a number of common-sense solutions are available. For instance, HHS could consider using their rulemaking authority to:
- ensure drug labels and other drug information are translated into multiple languages, and that patients who are limited English proficient are informed how to ask the pharmacist for the information in an appropriate language;
- ensure that pharmacists identify the language needs of their patients; and
- establish policies that incentivize pharmacies to provide trained interpreter services, rather than rely on the ad hoc assistance of a patient’s own children or relatives, or upon untrained bilingual staff.
A few states, such as New York and California, have passed state laws addressing the safety concerns for patients with limited English proficiency, but neither law has been fully implemented. New York City has implemented rules requiring multilingual interpretation and translation services be provided by all pharmacy chains with four or more branches, thanks in part to a lawsuit by advocates filed back in 2009. (See page 19 here.)
The non-discrimination provision in the ACA (Section 1557) may actually help ensure that drug makers and pharmacists address the language barriers that could put patient safety and care at risk. The law grants Americans protection from discrimination based on race, national origin, age, etc., that could exclude the person from participation in, or deny them the benefits of “any health program or activity, any part of which is receiving Federal financial assistance, including credits, subsidies, or contracts of insurance” etc. This provision grants patients certain civil rights in their access to health care, especially with respect to Medicare and Medicaid, programs financed by the federal government. It expands upon the Civil Rights Act of 1964, which requires that agencies and service providers receiving federal funding must take “reasonable steps to ensure that limited English proficiency (LEP) individuals have meaningful access to their programs and services” (according to this NHeLP report, p.7).
This progress shows that legislators and regulators alike are recognizing that some small changes can go a long way to improve the quality and safety for patients who are more vulnerable due to their national origin. There are also many resources available to pharmacies that make it easy to add translation and interpretation services.
As millions of new patients gain access to care, Medicare and Medicaid programs need to ensure drug makers and pharmacies provide language-appropriate care that will grant these new consumers equal access to information and help them better understand and participate in decisions about their care.