In central Pa., a new wall?: How a Trump rule could come between immigrants and their doctors | Friday Morning Coffee

Good Friday Morning, Fellow Seekers.

File this one under: Watch what the Trump administration does — not what it says.

As our friends at Stateline.org report, the White House wants to relax an Obama-era rule “requiring that medical providers let patients know about their right to language interpretation services — and for people with disabilities, communication assistance such as qualified sign language interpreters or written information in alternative formats for the visually impaired. The administration insists that the current requirements are onerous and costly for providers.”

To underline the real-world implications of this change, consider a scenario that unfolded in a physician’s office about hour away from the state Capitol in Harrisburg.

Once again, from our friends at Stateline:

Ed Zuroweste, a family practitioner in south central Pennsylvania, got a call a couple of years ago from a nearby hospital in Chambersburg. A restaurant worker, newly arrived from Guatemala, had staggered into the emergency room a few days before with severe shortness of breath and coughing up blood.

Using as a translator the man’s co-worker, a Mexican national with limited English himself, the staff took a medical history. They ruled out tuberculosis because the Guatemalan said he had not had contact with anyone with the infection. They treated him for pneumonia and released him a couple of days later.

Then the results came back from the specimen they had cultured. The Guatemalan had tuberculosis after all.Zuroweste received the call because he is a tuberculosis expert who consults with the state health department on the infectious disease. Fluent in Spanish, Zuroweste ended up contacting the Guatemalan and successfully treating him.

The man told Zuroweste that back home he had been exposed to a friend and a brother who each had the disease. He hadn’t wanted to admit that in front of his co-worker, whom he barely knew, because of the stigma associated with tuberculosis. “I hope I don’t die of TB,” he told Zuroweste. He didn’t.

To the doctor, the incident points to the need for professional medical translation services for patients with limited English proficiency, which is guaranteed in federal law but often ignored, immigrant advocates say. Without translation services, Zuroweste said, there are likely to be misunderstandings that result in medical mishaps, mistreatment and avoidable health care costs

And now, that Trump rule could make things even worse, public health experts warned Stateline, with far-reaching implications. That’s because more than 27 million U.S. residents speak English less than “very well” or not at all, Stateline reported, citing Census data.

More from Stateline:

Under the proposed rule, patients would still have a right to language services, they simply might not know they do or how to go about getting those services.

Under the current rules, health care providers must have in-house plans on how they’ll provide language services, and they must post in their offices that patients have a right to language services and steps they can take to get them.

Providers also must include in “significant communications” with patients taglines in 15 languages that explain that patients have a right to language services and how to go about receiving them. Those notifications apply to assistance for non-English speakers and to those with impaired hearing or vision.

The rules also specify that non-English speakers have a right to qualified, professional interpreters, a signal that family members, and particularly minor children, are not sufficient to serve as translators.

“I think it’s a very dangerous step,” Harvard Medical School associate professor Alexander Green told Stateline. “It’s starting a process of eroding people’s rights to high-quality health services at a time when we are on a trajectory to remove disparities in health care. This is a motion to turn back the clock and cause more disparities in health care.”

While the administration says the move would save money, the public health cost, according to Stateline, is still dear:

Studies have shown that inadequate language services can result in consequential medical mistakes, including death. Patients may be unable to describe their symptoms for doctors or complete medical histories. They may not understand medication regimens or discharge instructions.

A 2010 study by the University of California Berkeley School of Public Health, published by the National Health Law Program, of a medical malpractice carrier operating in four states found that 2.5% of the carrier’s claims, resulting in nearly $2.3 million in damages or settlements, could be attributed to a provider’s failure to provide adequate interpretive services.

Even without the changes sought by the Trump administration, compliance with the current language requirements is lagging, advocates say. “Right now, with the regs we have, we hear these stories of people with limited English proficiency not getting adequate access to interpretive services,” said Kathy Ko Chin, CEO of the Asian & Pacific Islander American Health Forum, an immigrant health advocacy organization based in Oakland, California.

People who do not speak English very well come back from their medical providers, she said, “and really don’t know what happened to them. They don’t know what their medication regimen is, what it’s for, and how to use it.”

Walls, we cannot help but conclude, come in many different shapes and sizes.

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