Advocacy

Our advocacy component was created not by choice but by need. Historically recognized as a program that offers no-cost medical interpretation services, PALS for Health in actuality can only conduct as many no-cost interpretations as our funding allows. Beginning in 1998, due in part to program outreach and word of mouth, requests for interpretation services from health care providers and limited English proficient (LEP) patients began to exceed the number we were able to pay for. Hand in hand with the submission of more proposals to various funding sources, we began to investigate in-house language capabilities of various health care facilities.

Sadly, we learned that many health care facilities operating in our diverse region did not make many provisions for interpretation or translation services. Each time we telephoned a health care facility the individual who answered our call would not know where to direct it. It wasn’t uncommon for our calls to be transferred from department to department while someone tried to establish who within the facility was in charge of language services. Our calls would sometimes end at Human Resources, Business Development, Patient Services or Public Relations but again, no one really knew what hospital policies were in place. Various letters were sent to hospital administrators but they were all unanswered. We also spoke directly to many direct service providers who were currently utilizing our services and asked them to compensate PALS for Health for the services of our interpreters. Although many replied that our program was vital, they were unwilling or unable to pay for interpretation services. Some cited that they would use bilingual staff although no proficiency tests or training had been offered to these individuals.

Every month after we had accepted the maximum number of appointments we were funded to complete we faced the challenging task of informing patients and providers that we were not able to assist them further. We also referred callers to local ethnic specific community based organizations but learned that although many had bilingual staff they were unable to leave their responsibilities to travel to, and interpret at various health care facilities. Patients were asked to locate their own interpreters and often enlisted the assistance of minor children or adult family members who were not fluent in English and untrained in medical interpretation techniques. Those who were unable to bring their own interpreters faced gross delays in the receipt of health care, sometimes for months. Although, PALS for Health staff collected anecdotal information from limited English proficient (LEP) patients about their difficulties, there was little that we could do.

In 1999, we were invited to attend a symposium conducted by the Region IX Department of Health and Human Services’ Office for Civil Rights. As we listened to OCR’s National Director, Thomas Perez speak, we realized that we might after all have an ally in our advocacy efforts. We learned one key fact – under Title VI of the 1964 Civil Rights Act recipients of federal funding (most health care facilities receive some form of federal funding) are required to offer language assistance to limited English proficient (LEP) persons to ensure meaningful access to programs and services! To read the Office for Civil Rights LEP Guidance law, you can download the Adobe Acrobat .PDf file here, but you must have Acrobat Reader to view it: LEP Guidance.

It wasn’t long before our program’s challenges caught the attention of Ira Pollack, Regional Manager for the Region IX OCR office. We agreed to a face-to-face meeting at the PALS for Health program on Friday, October 8, 1999. We shared client anecdotal information as well as letters that we had sent to hospital administrators. After reviewing several cases Mr. Pollack thought that we had a strong basis for an OCR complaint against one hospital – Rancho Los Amigos Medical Center, a county operated health facility. Although not admitting to any wrong doing Rancho Los Amigos Medical Center agreed to a Resolution Agreement (you need Acrobat Reader to view) which had several provisions to improve their cultural and linguistic capabilities. The entire process from investigation to negotiation lasted 12 months.

In the Fall of 1999 we also began partnering with the National Health Law Program (NHeLP) and the Asian Pacific American Legal Center to learn more about in-house language capabilities of health care facilities such as Los Angeles County USC Medical Center, Harbor UCLA Medical Center, Olive View Medical Center, Good Samaritan Hospital, California Hospital Medical Center, etc. which were frequented by PALS for Health clients. Our meetings did not yield any expected results and limited English proficient (LEP) patients continued to struggle with the understanding of their health care treatment. We also came to the realization that time did not permit us to meet and follow-up with more than a handful of health care facilities so we decided to focus on Los Angeles county operated health facilities, as their patient population is generally impacted by socio-economic, linguistic and cultural factors that impede access to quality care.

Our meetings with Los Angeles County Department of Health Services have yielded minor successes but there is still much to do. Our current team of advocates which now include Armenian Relief Society and Coalition for Community Health are appreciative of the department’s willingness to increase linguistic access but intense effort still need to be invested by the department in appropriate staff training, interpreter training, proficiency assessment, monitoring, data collection, development of updated policies,  and more.

There is also much to do to educate our diverse communities about language rights, as many limited-English proficient persons (LEP) do not know that they can ask for interpretation services during medical appointments. (Please refer to “I Speak” Cards page). PALS for Health and our partner agencies occasionally facilitate language access training sessions for community member and health care providers. For information about upcoming workshops, please refer to the “Events” page or call us at (213) 553-1876. Last but not least, we invite you to join in our local advocacy efforts to improve health care access for limited English proficient men, women and children residing in Los Angeles and Orange Counties. There are many health care facilities operating in our diverse counties that need to be monitored for language appropriateness. Your participation can strengthen our small group as we work together to advocate for much needed changes in how limited-English proficient (LEP) patients receive health care. If you reside outside of our service area and would like to share your advocacy efforts or anecdotal information, please do not hesitate to reach us as well. 

Currently, advocates are seeking community participation to help evaluate the effectiveness of the Los Angeles County Department of Health Services’ Language Identification Poster and Point-To Card. We need to learn if patients using the signage actually do receive interpretation services. Are they made to wait longer periods? Are their appointments rescheduled if no bilingual staff or interpreters are available? What is the quality of interpretation services received? If you are interested in helping in anyway, please call any of the 4 listed contacts.

If you have any comments or questions about this component, please call Anita Le at (213) 553-1876 or e-mail anital@palsforhealth.org.