Are U.S. Hospitals in Compliance with Federal Regulations on Language Access Services?

1Palo Alto Medical Foundation Research Institute, Palo Alto, CA
2The Joint Commission, Oakbrook Terrace, IL
3Rush University Medical Center, Chicago, IL

Meeting: Hospital Medicine 2010, April 8-11, Washington, D.C.

Abstract number: 46


Federal regulations require health care organizations to provide language services for limited English proficiency (LEP) patients. The National Standards on Culturally and Linguistically Appropriate Services (CLAS standards) in Health Care include 4 that outline what it means to provide adequate linguistic access services to LEP patients as prescribed in Title VI of the Civil Rights Act. It is not known how U.S. hospitals have incorporated the CLAS standards into practice.


We sampled 239 hospitals and received survey responses from 135 of 221 (61%). We used standard frequency analyses to describe study sample responses. We conducted bivariate analyses using the X2 or Fishers exact test to assess differences between responders and nonresponders and between the directed and national sample subgroups.


Most hospitals (78%) were able to provide interpreters for their most common language within 15 minutes dunng business hours, but only 48% could provide them in that time frame for their third most common language. Hospitals had difficulty informing patients of their right to linguistically accessible services. Many did so using Patients' Bill of Rights posters in English (44%), forms or brochures in English (29%), or multilingual posters (32%); verbally in other languages (33%); and through interpreter services outreach (4%) or media campaigns (2%). Most did not meet the standard regarding use of competent interpreters either: Sixty‐two percent reported that family members or friends of patients were used as interpreters, even though 70% of these hospitals also reported having a policy prohibiting this practice. Most hospitals required that staff (79%) and contract (63%) interpreters undergo interpreter training, but ad hoc interpreters, (e.g., volunteers and bilingual staff) usually did not. Finally, hospitals made the following translated documents available in their most commonly requested language: advance directives (65%). patients' rights (61%), discharge instructions (58%), informed consent (57%), and hospital signage (51%). Less than a third of hospitals had these written documents available in 2 or more non‐English languages. Very few hospitals could provide all of these forms in their most common language (17%).


Many hospitals are not providing language access services as required by federal law, even those that are held up as example institutions. Enforcement of Title VI is difficult and infrequent and the threat of enforcement is not a big enough concern to motivate hospitals. Hospitals will likely be moved into greater compliance because of efforts by accrediting organizations (e.g., the Joint Commission, NQF, and NCQA), all of which are using the CLAS standards to develop standards for linguistically accessible care. Our study reinforces the importance of these efforts and helps target interventions to improve the delivery and safety of care to LEP patients.

Author Disclosure:

L. Diamond, none; A. Wilson‐Stronks, none; E. Jacobs, none.

To cite this abstract:

Diamond L, Wilson‐Stronks A, Jacobs E. Are U.S. Hospitals in Compliance with Federal Regulations on Language Access Services?. Abstract published at Hospital Medicine 2010, April 8-11, Washington, D.C. Abstract 46. Journal of Hospital Medicine. 2010; 5 (suppl 1). Accessed March 31, 2020.

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