Iowa Doctors Say Professional Interpreters Are Too Costly

Iowa physicians believe that "federal regulators are unfairly ordering them to provide free interpreters for immigrant patients," the Des Moines Register reports. The controversy was sparked by a federal memo released last year explaining a "longtime policy" that physicians must provide interpreter services for patients whose native language is not English (Leys, Des Moines Register, 2/26). Under Title VI of the Civil Rights Act of 1964, "No person in the United States shall on the ground 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." Using case law and existing regulations to support its case, HHS has interpreted this to mean that health care entities receiving federal dollars must provide limited English proficiency (LEP) persons "a meaningful opportunity to participate in their programs." The federal memo is policy guidance released on Aug. 30, 2000, in order to further inform providers of their obligations under the law (OCR Policy Guidance, 8/30/2000.) Under Title VI, the government can either stop federal payments to physicians who violate the law or take the doctors to court. "There's really nothing new here," Fred Laing, acting regional director for HHS' Office of Civil Rights, said. However, many medical professionals disagree. "It was news to us," Julie Barto, administrator of a gynecology practice in Sioux City, said, adding that her clinic would like to provide professional interpreters more frequently, but that at up to $100 per hour, the expense can be too burdensome. Echoing Barto's sentiments, the Iowa Medical Society has argued that many doctors, especially those in small towns, face "huge challenges" in finding and paying competent interpreters. The group said the government "should try to help instead of threatening to punish doctors struggling to comply." Laing defended the policy, saying the government wants doctors to make "reasonable attempts" to communicate with patients. Federal regulators added that patients "can be uncomfortable" speaking in front of bilingual family members and that "impromptu interpreters often are unable to explain complicated medical terms." In addition, Laing said that most cases are "settled peacefully" and that regulators would consider doctors' circumstances when investigating complaints (Leys, Des Moines Register, 2/26).

Easing the Burden
According to Tom Perez, director of the Office of Civil Rights at the time the policy was released, "OCR has a history of working cooperatively with health and social service providers to help them comply with the law and serve their limited English populations effectively without causing undue burden." HHS documents state that, depending on the need and circumstance of the individual facility, options for providing oral language assistance include hiring bilingual staff or hiring on-staff interpreters to contract for interpreter services as needed, engaging community volunteers, or contracting with a telephone interpreter service. By "need and circumstance" HHS means the size of the facility and the number of LEP persons served. OCR asserts that there is not a "one-size-fits-all" approach to compliance (HHS release, 8/30/2000). According to the Register, most of Iowa's interpretation needs involve Medicaid beneficiaries. However, Dennis Headlee, the state's top Medicaid administrator, said that the Medicaid payments doctors currently receive are expected to cover their business costs. He added that legislative approval would be required before the state could increase Medicaid funding "for special reimbursements," such as interpreter services (Leys, Des Moines Register, 2/26).