When Translation is Law

“The single biggest problem in communication is the illusion that it has taken place.”George Bernard Shaw.

As a follow up to Intro to Translation, I would like to review exactly what types of documents physicians are required by law to translate for their practices.

If a physician has a practice which provides care to a substantial number of non-English speaking, or LEP (limited English proficiency) patients, then providing these patients with translated documents has a number of benefits. The United States federal government defines LEP as a patient’s own self-assessment of his or her ability to speak and understand English as less than very well.

Patient satisfaction surveys have consistently shown that LEP patients have 36% lower satisfaction rates than English speaking patients and 47% --almost HALF of them – are more likely not to return for future care as a result. Although there are 6 types of medical documents that must be translated in order to remain compliant with federal law, it may be worthwhile to consider including other practice materials, such as patient education materials or patient survey forms, in an effort to improve the LEP patient experience.

Under the Civil Rights Act of 1964, Title IV, patients cannot be discriminated against because of national origin by any institution that receives federal funding. When documentation is not provided in a language the patient can understand, this too is considered discriminatory under this act. The specific requirements for translation were further elucidated upon in 1997 by the Critical Access Hospital Program which focused on hospitals in areas of the U.S. that have a higher percentage of LEP patients. The six types of documents that must be translated are:

1 – notices of free language assistance

2  - eligibility for services of language assistance

3 – patient intake forms

4 – informed consents

5 – patient complaint forms

6 – discharge instructions

The Office of Civil Rights (which is part of the Department of Health and Human Services) requires that these documents be translated when “the LEP language group constitutes 5% or 1000 persons – whichever is less – of the population served.”

State government interpretations of this law may be more strict, as in the case of New York State, where the requirement given by the Office of Civil Rights has been expanded to “1% of the hospital service area.”

It is further important to note that the Affordable Care Act (ACA) has shifted incentives for doctors and hospitals to offer better quality, not quantity, of care. In essence, there are financial repercussions to providing care that does not result in patient satisfaction. Medicare provides higher rates of reimbursement with more readmissions. Doctors receive bonuses or penalties if they receive high or, conversely, low scores on patient satisfaction surveys.

Therefore, it is in the doctor’s best interest, aside from satisfying the legal translation requirements for providing care to LEP patients, to try to overall improve the LEP patient’s entire office experience by offering as much patient material as possible in the language the LEP patient can understand. These include as mentioned earlier in this blog entry: patient education pamphlets, surveys, and marketing materials.

The consent forms I have been referring to in this article apply to procedural consents provided to patients. In my office, they would include cataract surgery, laser iridotomy, chalazion/eyelid lesion excision, selective laser trabeculoplasty and YAG capsulotomy consent forms- to name a few. However, it is important to note that research-related consent forms are also included in this category.

The Institutional Review Board (IRB) requires that consents for research must be written in the language in which the patient interview is conducted. Further, according to information provided on the Language Scientific website regarding IRB-specific consent forms, there are 4 specific scenarios to consider when deciding if consent forms have to be translated from English:

1 – If the patient/participant has the ability to read and understand sixth-grade level English, then no translation is necessary. Forms may be provided in English.

2 – If the patient/participant cannot read but understands spoken English, then it is possible to have someone read the consent form to them with a witness present. Understanding by the patient must be documented and the patient, witness and reader of the consent must all supply signatures at completion.

3 – If the patient/participant cannot read or understand spoken English, but is fully literate in another language, then the consent and all related materials may be translated into the language the patient understands.

4 – If the patient/participant cannot read or understand spoken English, nor is literate in another language but can understand another language when spoken, then the consent must be translated into the other language and another person must read the translated consent to the patient with a witness present, documenting that the patient understands all that is being said. In the end, the patient, the reader of the consent and the witness will provide their signatures to this effect.

Further, the IRB “.. must review and approve all translated versions of an informed consent form before the form is used in a study.” If the study itself is complicated or carries with it significant clinical risk, then an added safety measure for quality assurance of a proper translation must be provided to the IRB via a back translation. A back translation is one where the translated document is translated back into the original English by a separate translator, to ensure that everything written in the language correctly reflects that which was written in the original English.

References

duMont-Perez, Suzy .“The 6 Medical Documents You Must Translate to Remain Compliant.” LanguageLine Solutions. http://blog.languageline.com/6-medical-documents-must-translate-to-remain-compliant (Accessed July 22, 2016).

Markert, Cory. “Medical Translation: Is Translation of Vital Documents Enough?” LanguageLine Solutions. http://blog.languageline.com/medical-translation-is-translation-of-vital-documents-enough (Accessed July 22, 2016).

“Office Guide to Communicating with Limited English Proficiency Patients.” American Medical Association. https://www.google.com/webhp?sourceid=chrome-instant&ion=1&espv=2&ie=UTF-8#q=what+is+the+definition+of+an+LEP+patient (Accessed July 23, 2016).

“6 Things to Know About Translating Informed Consent Forms.” Language Scientific. http://www.languagescientific.com/6-things-to-know-about-translating-informed-consent-forms-2/ (Accessed July 24, 2016).

Dubrovnik, Croatia. Courtesy: D. Hromin