Understanding Drug Labels When You Don't Read or Speak English

Source:

EthnicNewz.org (formerly go-NEWz.com)

Writer:

M. Thang

Understanding Drug Labels When You Don't Read or Speak English

And What You, Your Doctor and the Law Can Do About It

by M. Thang

If you didn't speak or read English and needed prescription medication, could you count on the pharmacy to interpret or translate the drug instructions and precautions for you?

Probably not, according to a study led by Dr. Glenn Flores, professor of pediatrics and public health at the University of Texas (UT) Southwestern Medical Center.

In the study, published in the August issue of Pediatrics, 128 pharmacies - including Walgreens and CVS - responded to a survey that asked them what types of language services they provide to their limited-English-proficient (LEP) customers.

The 128 pharmacies were not in rural areas of the country. All of them were in Milwaukee County, Wis., where 73,355 people are foreign-born, and 129,357 residents speak a non-English language at home, according to the 2005 U.S. Census. [1]

The study - co-investigated by Michael Bradshaw and Sandra Tomany-Korman, both of Medical College of Wisconsin - revealed that "LEP customers [face] major barriers to receiving high-quality care in pharmacies," said Dr. Flores.

About 50% of the surveyed pharmacies never or only sometimes could provide translated drug labels or information packets. Of the pharmacies that could give translated information, most depended on computer software to do so - for prescription labels (88%) and information packets (95%).

When it came to spoken communication, bilingual interpretation was worse. Almost 65% of the surveyed pharmacies never or only sometimes could effectively speak to customers in foreign languages - using billing staff (67%), telephone interpreters (33%), and a family member or friend (11%).

SAFETY AND COMPREHENSION FIRST

"Every year, as many as 168 million prescriptions in the United States may be written in a language that patients can't fully understand, which poses potentially serious risks of medical errors and injury," said Dr. Flores.

Therefore, it is crucial that pharmacy customers fully comprehend the instructions, dosage and precautions of their prescription medications.

Dr. Flores cited one example of an infant who accidentally received a tenfold overdose of phenobarbital. The drug label of the phenobarbital was in English only, but the mother could not understand it - her primary language was Spanish.

The top-two pharmacy chains in New England – Walgreens and CVS – provide interpretation services for their LEP customers through bilingual employees and interpreters available by telephone at the pharmacies.

Walgreens uses a telephone service called "Dial A Pharmacist," which allows consultation in 14 languages, a media spokesperson said. (She did not know what the 14 languages were, and a request to know that and other information was not answered.)

According to the Walgreens Web site, the drugstore chain has 200 stores in New England, 123 of them in Massachusetts

At CVS - which has 562 pharmacies in New England, 330 of them in Massachusetts - pharmacies use the drugstore chain's "Language Line" telephone service for interpretation in any one of 150 languages, said a CVS spokesperson. CVS can also print bilingual prescription labels in Spanish and English.

HOW PHARMACIES CAN IMPROVE

As dismal as Dr. Flores' survey results were, they did not mean that pharmacists were satisfied with their foreign-language customer service.

On the contrary, almost 50% of the surveyed pharmacies were dissatisfied with their LEP-patient communication.

The pharmacies provided six main suggestions for improving patient communication:
• having employees receive continuing education
• producing a chain-wide list of resources
• hiring bilingual staff
• using telephone interpreters
• analyzing translation quality or accuracy of labels and information packets
• adding more languages to pharmacies' computer software.

Dr. Flores, who is also director of general pediatrics at UT Southwestern Medical Center and Children's Medical Center Dallas, agrees with these suggestions.

However, he warned about the "troublesome use" of untrained persons to act as interpreters.

"Using what we call 'ad hoc' interpreters - family members, friends, people pulled from the waiting room or the street, or it could be the custodian - it's disastrous because they don't necessarily have fluency in both languages [and] they don't necessarily have training in confidentiality or in medical terminology," he said.

Use of children to interpret is "especially dangerous," he added, since they haven't mastered either English or their other spoken languages. Moreover, they often do not deal with embarrassing subjects for them, such as bodily functions.

It's likely also that sensitive topics, such as domestic violence and sexual issues, may not be discussed in the presence of other family members - adult or child.

WHAT TO DO

If you have a friend who doesn't speak English and has prescription needs, Dr. Flores suggests that you ask your friend's doctor to tell the pharmacy that all your friend's prescription labels and accompanying information packets should be written in the patient's language.

At the pharmacy, make sure that all drug labels, package inserts, and written information are in that language. If not, request a written translation or ask to speak to a fully-bilingual pharmacy employee.

Also, you can ask the pharmacy for its telephone-interpreter service, such as CVS's Language Line.

If your friend still has trouble understanding the medication information, tell the pharmacy that you would appreciate its language services - written and oral - in the future. Your friend's doctor may be willing to make this request also.

Finally, if the pharmacy still is not helpful with foreign-language assistance, your friend can file a complaint against the pharmacy, with the Office for Civil Rights, says Mara Youdelman, a healthcare policy expert at the National Health Law Program (NHLP).

You can also file a complaint with the state attorney general or, if your state has one, its healthcare ombudsperson, she says.

THE LAW IS ON YOUR SIDE

Under Title VI of the federal Civil Rights Act of 1964, pharmacies that receive federal funds - as most pharmacies do by accepting Medicare and Medicaid payments - must provide foreign-language services to their LEP customers.

Though Title VI doesn't specifically apply to pharmacies, it does state that organizations that receive federal funds cannot discriminate on the basis of race, color or national origin.

"The Supreme Court and the federal agencies have interpreted the law to say that language can actually be a proxy for national origin. Therefore, [pharmacies] can't discriminate just because someone doesn't speak English very well," explained Youdelman, who is also director of the NHLP's National Language Access Advocacy Project.

To what extent - and how - pharmacies must provide language services is the unanswered question. However, the Office for Civil Rights of the federal Department of Health and Human Services (HHS) has issued guidance.

If a pharmacy did not adequately serve an LEP customer or told one to come back with an English-speaking person, the state's Office for Civil Rights - if it received a complaint - could possibly secure the pharmacy's compliance with Title VI.

Another important and separate issue coming from HHS, says Youdelman, is that staff serving as interpreters must be competent, not merely bilingual, so the interpreter must have knowledge in four areas:
• medical and pharmacy terminology
• confidentiality
• ethics
• the role of the interpreter.

Knowing one's role as interpreter is important in ensuring that personal advice or opinions are not part of the interpretation.

Besides concern for patient safety and non-discrimination, pharmacies would be wise to ensure that their customers understand their medications' instructions, dosage and precautions.

Providing good quality of care - which includes effective bilingual communication - can relieve pharmacies of legal liability for malpractice or negligence, says Youdelman, who is also an attorney.

source: go-NEWz.com