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New York City Comptroller William C. Thompson, Jr. today issued a report finding that New Yorkers whose primary language is not English encounter significant barriers navigating the city’s complicated health care system, with nearly 75 percent of hospitals surveyed failing to provide Spanish-language services to callers to one or more departments.

At a news conference held in conjunction with the New York Immigration Coalition, Thompson discussed his report, Getting in the Door: Language Barriers to Health Services at New York City’s Hospitals. The report assessed the ability of New Yorkers with limited English proficiency to access services provided by their local public and private hospitals and affiliated clinics. Thompson found that one of every 10 hospitals surveyed performed poorly in three or more of the departments tested.

“In this day, not a single New Yorker should have to fear for her health or the health her children simply because she does not speak English,” Thompson said. “And yet, sadly, appallingly, my office has discovered in the course of a careful investigation of New York City’s hospitals that men and women with little or no English proficiency are often discouraged from seeking treatment and are even the victims of small-minded bigotry at the point of contact with the city’s health care system. This cannot and must not continue.”

Margie McHugh, Executive Director of the New York Immigration Coalition, a policy and advocacy network of more than 150 organizations, said the study points to larger problems within the health care system.

“This study shows that many hospitals make it difficult or impossible for Spanish-speakers to access hospital clinics,” she said. “Hospitals are preventing many New Yorkers from making appointments, due to communication barriers and poor service.  

It's worth noting that private hospitals performed much worse - how can someone hope to get medical care when the hospital hangs-up, insults her, or leaves her on hold forever?  These practices unfortunately end up costing much more for the patient and for taxpayers.”

Beatrice Carrasco, a member of Make the Road by Walking, which is based in Brooklyn, said she has encountered difficulties scheduling appointments because of a lack of interpretation services. “I face terrible discrimination almost every time I need to schedule a medical appointment,” she said. “Being sick is scary, but it’s much scarier for those of us who are still learning English.”

The 2000 Census shows that more than 3.5 million New Yorkers speak another language at home. Of these people, 915,000, or more than 12 percent of the city’s population age five and older, report they speak English “not well” or “not at all.”

“Language barriers make it difficult to get information about medical services, to make appointments, to understand payment terms, to obtain publicly subsidized medical insurance and otherwise to go through the steps necessary to access health care services,” Thompson said. “This is a major problem for patients and is costly for the entire health care system because poor communication deters people from receiving timely treatment and results in increased costs and inefficiencies overall.”

In the study, the Comptroller had testers call 51 hospitals at four important access points: the general information telephone number, a clinical appointment number, a health insurance/billing office, and an emergency department. Spanish-language services were tested because of the large number of New Yorkers – 23.9 percent - whose first language is Spanish.

“Hospitals should be able to accommodate the Spanish-speaking people living in their service area and unquestionably could be evaluated based on their ability to do so,” Thompson said. “Unfortunately, not all of the hospitals that were part of the study lived up to this standard.”

Among the Comptroller’s findings:

• Spanish-speaking callers were not able to get information from more than a third of the hospitals’ general information numbers.

The majority, 31 (60%), of hospitals had a Spanish-speaking attendant at the general information numbers or were able to transfer a tester to a Spanish-speaker within five minutes. However, 19 (37%) of the hospitals never provided testers with assistance in Spanish and testers were forced to call back in English to obtain information.

• A lack of language access prevented Spanish speaking callers from scheduling appointments with a third of hospital clinics tested.

Thirty (60%) of hospital clinics were able to provide an attendant who spoke Spanish immediately or within five minutes. Yet, 16 clinics, or nearly a third, were unable to provide anyone who could communicate with the testers in Spanish.

• More than 40 percent of the time, calls in Spanish to hospital billing offices ended in frustration.

Thirty (almost 60%) hospitals provided a Spanish-speaking attendant or were able to transfer the caller to one. But a substantial portion, 21 (41.2%) of these calls ended in frustration because testers were unable to reach an attendant who spoke Spanish. In some cases, nobody ever picked up the phone, or a call went to an English-only recording.

• Overall, hospital emergency departments reported that they had better Spanish language access services than other departments.

The majority, 35 (68.6%) indicated that a Spanish-speaking doctor or other professional staff would be available or that someone else would be available to translate. Only three hospitals reported that they did not provide any interpretation service.

The Comptroller said that, while many hospitals did provide appropriate Spanish-language services in the tested departments, the findings point to broader weaknesses.

“There can be little doubt that the 400,000 New Yorkers who speak languages other than Spanish face even greater barriers to obtaining hospital care than those identified in this study,” he said. “There clearly is need for improvement among our city’s hospitals to ensure equitable access to quality care for all New Yorkers.”

The Comptroller offered several recommendations.

• The New York State Department of Health should amend its “Patients’ Rights” regulations to explicitly require hospitals to provide language access services in all departments that routinely interact with the public, including information and appointment telephone lines.

• Hospitals must strengthen their corporate commitment to providing services to individuals with limited English proficiency. Each hospital should designate a person or department responsible for overseeing and coordinating translation services system-wide to avoid the kind of inconsistency in service we observed in our survey.

• Hospitals should increase their commitment to hiring bilingual staff for all positions that regularly interact with the public, including telephone attendants. They should also make available and inform all employees of the option to use commercial language lines, which allow English-speaking staff to communicate in more than 100 languages.

• The New York City Department of Health and Mental Hygiene should regularly monitor language access performance at all hospitals located within the City. The results of this monitoring project for individual hospitals should be made public, similar to the way in which restaurant violations are published.

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