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Patient and DoctorMaryland's population is showing a greater increase in its linguistic and cultural diversity than the total United States' population. In 2006, 41.7% of Maryland's population were racial and ethnic minorities, compared to 33.8% of the total United States' population. Racial and ethnic minorities accounted for the majority of Maryland's population increase of nearly 320,000 people from 2000-2006. The fastest growth rate was noted among Hispanics (47.6%) and Asians (31.0%), many of whom were new immigrants. More than 130,000 immigrants moved to Maryland in just six years. (Maryland Department of Planning, Planning Data Services from the Population Division, U.S. Census Bureau, May 17, 2007). Approximately 300,000 Maryland residents speak English less than very well (ACS, 2006). At the University of Maryland, the number of patients requesting interpreter services doubled over the past two years (2,255 to 4,000). The most frequently requested languages are Spanish, Korean, Russian and Amharic (an Ethiopian dialect).

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Need for Linguistic Competency

Limitations in spoken and written language comprehension hamper encounters between patients and health care providers, often leading to misunderstandings as to diagnosis and treatment, which in turn may result in poor patient compliance and unsatisfactory outcomes (Carter-Pokras et al 2004).
Barriers in communication affect health care providers as well. Some physicians who cannot fully understand their patients appear to compensate for the unaccustomed lack of information by altering their management to a more cautious, conservative style: when language barriers are present, more tests are ordered, more intravenous hydration is administered and hospital admissions are more frequent, a phenomenon termed a 'language-barrier premium' (Waxman and Levitt, 2000; Hampers and McNulty, 2002).

Not addressing language barriers during the informed consent process undermines the ethical obligation fundamental to the physician-patient relationship (Woloshin et al., 1995) and has potential legal ramifications as well. The risk of medical malpractice associated with language discordance between providers and patients is reduced when competent medical interpretation is provided. Although medical liability lawsuits are most commonly settled out of court, and the terms of the settlements are not revealed, there are a few published reports that detail the circumstances leading to a medical mishap related to language barriers (Harsham, 1984;Carbone et al., 2003).

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Benefits For Language Interpretation

Overcoming language discordance between patients and providers has been showInterpretern to lead to:
• Increased compliance with medications and appointments, fewer emergency department visits, better recall of information and more questions being asked
• Elimination of health-status disparities
• Increased delivery of health care services and satisfaction
• Reduced risk of medical errors due to language
• Decreases in the possibility of liability claims

 

Most medical interpretation schemes involve a triad of individuals including the patient, health care provider, and interpreter. This scheme relies on the interpreter taking the least invasive role as possible. The DiversityRx site, Choosing a Role outlines in more depth the duties of each individual.

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Legal Requirements

Federal Legislation
United States Department of Justice - Title VI of the Civil Rights Act of 1964 says
“No person in the United States shall, on the grounds of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance”
Office for Civil Rights guidelines define for providers what constitutes “meaningful access” for patients with limited English proficiency (August 2003).
Department of Health and Human Services regulations require all recipients of federal financial assistance from HHS to provide meaningful access to limited English proficient (LEP) persons, at no cost to the client.

State Legislation

Maryland Code Title 10, Subtitle 11 (2002) requires “each State department, agency, or program …  [to] take reasonable steps to provide equal access  to public services for individuals with limited English proficiency,” achieving that goal by “the provision of oral language services for individuals with limited English proficiency” and “the translation of vital documents ordinarily provided to the public into any language spoken by any limited English proficient population that constitutes 3% of the overall population within the geographic area served by a local office of a State program as measured by the United States Census” as well as “any additional methods or means necessary to achieve equal access to public services”.


Managed Care Organizations in Maryland (HealthChoice) are under contract to provide language interpretation for their LEP enrollees [Maryland COMAR, 10.09.66.01. B(1)(a)], as well as written materials “in the enrollee’s native tongue if the enrollee is a member of a substantial minority” (defined as “an ethnic or linguistic group that comprises 5% or more of the Medicaid population in the county to be served”)

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Maryland MCO's (Health Choice) -- Who to Call for Interpreters

Amerigroup

Ms. Susan Barry, Special Needs Coordinator
(800) 964-2112 ext. 4060 or (410) 981-4060

The Diamond Plan (Coventry)

Customer Service Representatives
877-703-3096
[Note: only telephonic interpreting available]

Helix Family Choice, Inc.

Customer Service
(800) 905 1722

JAI Medical Systems

Mr. Jerome Tyree, Outreach Coordinator
(410) 433-2200
FAX: (410) 433-8500

Maryland Physicians Care

Customer Service

1-800-953-8854
[Note: only telephonic interpreting available]

Priority Partners

Ms. Jennifer Mayer, Special Needs Coordinator
(410) 424-4906
FAX: (410) 424-4887

 

United Health Care –
Chesapeake Family First

Adam White, Special Needs Coordinator
(410) 379-3460
FAX: (410) 379-3474

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Medical Interpretation at the University of Maryland

How to obtain a telephone interpreter at UMMC (Inpatient): Contact the Inpatient Unit to determine where speaker phones are located. Speaker phones will allow for both the healthcare provider and the patient to speak to the interpreter and hear the interpreter. For telephone interpretation, call 1-866-271-7830. Enter the “organization number” 1270#, then enter the “pin number” 1364#. When prompted for reference number, enter ## then the language code if known. For assistance, or to be connected to a live operator, press “0” at any time. Over 250 languages can be interpreted.

 

How to obtain a telephone interpreter at UMMC (Outpatient): Contact your administrator to determine where speaker phones are located. Speaker phones will allow for both the healthcare provider and the patient to speak to the interpreter and hear the interpreter. To obtain a telephone interpreter, call 1-866-271-7830. Enter the “organization number” 1270#, then enter the “pin number” of your department. When prompted for reference number, enter ## then the language code if known. For assistance, or to be connected to a live operator, press “0” at any time. Over 250 languages can be interpreted.

 

How to obtain an in-person interpreter at UMMC (Inpatient and Outpatient): If a telephone interpreter cannot be utilized, contact the paging system at 410-328-2337 and enter code #8255 to request an in-person interpreter. A call back number is required.
For further information, please call Ms. Odetta James Harlee at 410-328-8777.

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