Suffolk County Language Access Executive Order Signed!

by Lindsey Hennawi, Program Assistant

Great news! On November 14^th, 2012, Suffolk County Executive Steve Ballone signed an executive order requiring county government agencies to translate vital public documents into the top six languages spoken by limited English proficient (LEP) residents of Suffolk County and to provide interpretation services for all LEP residents as well.

Twenty percent of Suffolk County’s 1.5 million residents are LEP. Now, residents whose primary languages are Italian, Mandarin, Spanish, Polish, French Creole, and Portuguese will be able to access local government offices and communicate with officials. This means victims of domestic violence and hate crimes can access police protection. Residents affected by Superstorm Sandy can receive much needed information about recovery efforts. Support services such as unemployment insurance and public benefits are now also accessible to LEP residents. Thanks to this executive order, an individual’s language will no longer be a barrier to participation in government services or access to important resources.

The order is descended from similar legislation, including President Clinton’s 2000 executive order that mandated all agencies receiving federal funding develop language access plans in order to comply with the 1964 Civil Rights Act’s prohibition of discrimination based on national origin; Mayor Bloomberg’s Executive Order 120, signed in 2008, that bans city agencies from discriminating against residents based on their primary language or national origin; and Governor Cuomo’s 2011 Executive Order 26 that does the same for executive state agencies.

One of the first of its kind in a suburban county in the United States, Mr. Ballone’s executive order comes on the heels of the previous Suffolk County executive, Steve Levy, who in his tenure utilized county police as immigration agents, criminalized Latino day laborers, and marginalized Latino-majority neighborhoods, earning the county a reputation for anti-immigrant resentment and violence.

Suffolk County’s executive order is a result of the advocacy of the organizations with which NYLPI partnered on this campaign, including the Long Island Civic Engagement Table, the Long Island Language Advocates Coalition, Make the Road New York, the Center for Popular Democracy, and other groups that have tirelessly promoted immigrants’ rights in Suffolk County for years. Since 2009, NYLPI has advocated for language access orders on the city, state, and county level, and is currently working to develop materials to help other advocates replicate these efforts.

We are thrilled Suffolk County has taken this critical step toward advancing the civil rights of LEP individuals and making New York a more inclusive home for all its diverse residents. Congratulations to all of the advocates involved and thank you, Steve Ballone, for your work toward equality and justice on behalf of LEP residents! May yours be one of many county orders to come.

The Battle Isn’t Over: What’s Next for the SafeRx Campaign

Knowing how to take prescription medications safely is incredibly important—especially for people who are limited English proficient (LEP) or have other difficulties understanding prescription medication labels.  New York recently passed landmark SafeRx legislation that will greatly increase many New Yorkers’ access to prescription medication. Under SafeRx, prescription pads will have to reflect a patient’s language preference and medication labels will become more patient-friendly. Pharmacies will be required to provide translation and interpretation services to LEP consumers. But while the passage of SafeRx represents a huge victory, we still have more work to do.

The law will go into full effect in late March of 2013. The New York State Board of Pharmacy (SBOP) is currently in the process of drafting recommendations for the implementation of the legislation. Unfortunately, the SBOP has failed to include stakeholders—advocates and LEP consumers—in the process. The SBOP has yet to schedule even one formal public hearing at which advocates and consumers can provide input on how to best implement the new law. Only one informal meeting has been mentioned, but not scheduled—and it’s in Buffalo. Not exactly an easy trip to make for many people around the state.

In response to the limited opportunities for stakeholder engagement, members of the SafeRx Coalition have published a report which discusses several key recommendations for the implementation of SafeRx legislation. (You can also read the accompanying cover letter to the SBOP here.) Through our recommendations, we hope to balance the interests of consumers and the pharmacy industry alike, while still meeting the health needs of New Yorkers.

Here’s a quick rundown of our recommendations:

Determine Pharmacy Primary Languages Fairly
Rather than selecting languages based on whether or not 1% of the general population speaks a given language, SBOP should require translation services in the top seven languages spoken throughout the state. This approach ensures that a uniform standard is applied statewide.

Standardize Prescription Labels
Prescription labels should be patient-centered. Labels should have clear directions, written in simple and large fonts.

Notify Patients of Their Rights
A Patient Bill of Rights should be translated into the selected languages and shared with consumers on pharmacy websites, in stores, and through other outreach.

Include Mail Order Pharmacies
Those count, too! Resources should be dedicated to assessing the language access needs of consumers who use mail order pharmacies and the services that these pharmacies currently provide. In fact, many mail order pharmacies actually have already begun providing language services.

Eliminate the Waiver Option
As the legislation stands now, pharmacies have the ability to opt-out of the requirement to provide language assistance services. But the whole point of the SafeRx campaign is that pharmacies have a federal obligation to do so. Pharmacies shouldn’t be given the ability to dodge their legal responsibilities.

Promote Liability & Accountability
SBOP should implement a plan to monitor and assess pharmacies’ compliance with the law.

Modify Prescription Pads
The NYS prescription pad should be revised to reflect if a patient is LEP and, if so, what the primary language spoken is.

If implemented correctly, SafeRx could improve business for pharmacies by improving customer service and consumer loyalty. For the healthcare system as a whole, SafeRx could dramatically reduce the 700,000 emergency room visits and 100,000 hospitalizations that occur every year when patients misunderstand how to take prescription meds [i]—saving the healthcare system over 3 billion dollars per year overall. [ii]  

With millions of New Yorkers who stand to benefit and millions of dollars to be saved, there’s no reason for the SBOP not to get on board with our recommendations.  And with the clock ticking toward when the legislation will take effect, the time to do so is now.

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[i] Daniel Budnitz, et al., National Surveillance of Emergency Department Visits for Outpatient Adverse Drug Events, Journal of the American Medical Association (JAMA), 2006; 296 (15):1858-1866.

[ii] William Shrank, et al., Educating Patients About Their Medications: The Potential and Limitations of Written Drug Information, Health Affairs, 2007; 26 (3):731-40.

Advocacy Tools – An Example from the SafeRx Campaign

by Jennifer Swayne, Staff Attorney

We are excited to share with you a significant victory for New York, where Governor Andrew Cuomo included a plan known as SafeRx in his Executive Budget released January 17, 2012!   As many of our readers know, SafeRx is a plan that NYLPI, Make the Road New York and other organizations have been working to implement statewide over the past several years to make sure that patients understand their prescriptions.

SafeRx has been an important campaign for us because it recognizes the rights of immigrants, people of color, seniors, those who are disabled, and others to understand how to take their medications.  SafeRx requires that chain and mail-order pharmacies throughout New York state provide language access services for those who are limited English proficient (LEP), and requires that prescription labels be standardized so that they are easier to understand for patients such as the elderly who have trouble reading and understanding labels.  SafeRx also requires modification of prescription pads to allow prescribers to indicate if a patient is LEP.

Our work on SafeRx included the pursuit of passing New York state legislation, where SafeRx had been introduced as a bill.  However, given the politicized and slow nature of passing legislation, we jumped on the opportunity to be involved in another process known as the Medicaid Redesign Team (MRT) process.  The MRT members were appointed by Governor Cuomo and convened to tackle various cuts to Medicaid in New York and to help determine what might go into the Governor’s Executive Budget.  While we continued to pursue legislation, we saw the MRT process as an additional opportunity to continue our advocacy, and as an alternative to the legislative bill enactment process.

NYLPI’s Health Justice Director, Nisha Agarwal, and Make the Road’s Director of Health Advocacy, Theo Oshiro both sat on the MRT Health Disparities Work Group, one of the many groups whose members were selected by the MRT to help assess various factors impacting Medicaid.  Through the Health Disparities Work Group, the full MRT had access to experts, documents, and presentations providing very important information about the ways that New York was actually losing money by not incorporating prescription safety for patients in pharmacies. After a series of meetings, the Health Disparities Work Group selected some of the most pressing issues—including SafeRx—as part of its recommendations to the MRT.  Even with the prospect of cuts, the MRT recognized the importance of patient safety in pharmacies and passed these recommendations to the Governor to be included in the budget.

Fortunately, this strategy was successful!  We were able to get SafeRx included in the Executive Budget.  Now, unless the legislature decides to take out the provisions regarding accessible prescription labels, the original legislation will essentially pass as part of an omnibus budget bill.

This serves as an example of one of the many advocacy tools that can be used to bring about positive changes for those lacking access to healthcare and other rights.  Legislation is but one means, and looking for other opportunities within the policy process is critical for us to be able to continue our work on behalf of those underserved in healthcare.  In addition to coalition building and continually voicing our concern over how patients are treated in pharmacies, participating in discussion and action items surrounding budget cuts, and inserting our work into the executive process proved to be a great strategy that prevented us from being bogged down by the legislative process.

There is certainly more work to do—for example, making sure the final enacted budget accurately reflects all provisions of SafeRx—but right now we can breathe just a little easier knowing that the Governor’s budget reflects the understanding that patient safety has to be a part of any discussion about the budget.  We know that such an understanding will help reduce health disparities and improve access to care for people of color, immigrants, seniors, people with disabilities and many others as well—the ideals that we work so hard to make others recognize.  For more information on SafeRx, please click here!

Bridging Theory and Practice for Language Rights

Check out a newly published article in the Journal of Health Care for the Poor and Underserved, co-authored by Health Justice Director, Nisha Agarwal, on the importance of language access in the pharmacy setting. This is an area where the evidence about the importance of providing language concordant services for patients who are limited English proficient (LEP) keeps growing and, despite all the discussion in medical circles about “evidence-based” policymaking, we continue to face resistance at state agencies charged with protecting and advancing public health. Instead of collaborative discussions about how to improve access to prescription medications for immigrant communities and reducing health disparities, we hear complaints about how language assistance services might put huge chain pharmacies out of business – immigrant scape-goating at its worst.

We’re taking our fight to the pages of research journals, as well as to the corridors of power in Albany and to the streets until we win. Join us in this effort! Send us an email and let us know that you’d like to join the coalition to ensure Safe Access for Everyone to prescription medications (SafeRx): healthjustice[at]nylpi.org.

A Community Mobilizes to End Medical Apartheid

Hello readers, we are pleased to announce that the peer-reviewed journal, Progress in Community Health Partnerships, has published a piece about our campaign with Bronx Health REACH to end segregation in the delivery of health care services by teaching hospitals in New York. You can download a copy of the piece here. Feedback welcome! We are using every avenue at our disposal to get the word out about this urgent issue, including the very types of publications that health care providers and policy decision-makers are likely to peruse.

New York Needs Safety Net Hospitals

Here is our op-ed on the Medicaid Redesign Team that ran in today’s Albany Times Union. Comments most welcome!

By Nisha Agarwal and Shena Elrington

Gov. Andrew Cuomo‘s Medicaid Redesign Team was handpicked by him and elected by no one. Though touted as a collection of health care “experts,” the majority of the team’s members have strong ties to special interests in the health care industry.

Not surprisingly, its proposals for cuts reflect the vested interests of its members.

Proposal 67 calls for the closing or downsizing of safety net hospitals that provide health care services in medically under-served areas. We need more health services in these communities, not less, particularly since these communities have been ravaged by hospital closures in recent years.

Central Brooklyn, with its extremely low-income and 90 percent black and Latino population, has lost two hospitals, OB-GYN and prenatal services at two other local hospitals, 13 outpatient clinics, a federally funded health center and at least two women, infants and children program centers that provide nutrition education and assistance in recent years, despite having some of the worst health outcomes in the city.

The infant mortality rate in the Brownsville section of central Brooklyn is nearly five times that of Manhattan’s Upper East Side.

Do we really need more hospitals in areas like central Brooklyn to close?

When safety net hospitals close, people are forced to travel farther to see care at the few institutions that remain open — usually elite private academic teaching centers. These are the very same institutions to which many of the Medicaid team’s members have strong connections, raising questions about the appropriateness of using the regulatory process to funnel business to special-interest groups.

What is more, proposals that would actually support safety net institutions and use public dollars in an accountable and transparent way never made it into the final Medicaid reform package.

Proposal 66, for example, would have recalibrated charity care and Medicaid dollars so that the distribution of that funding would be based on the actual Medicaid and uninsured losses. Hospitals in New York now receive “indigent care” funding regardless of the volume of care they actually provide to Medicaid and uninsured patients. So, hospitals that provide very little care to low-income New Yorkers often get more money from the indigent care pool than they deserve, while safety net institutions, which provide a lot of care to Medicaid and uninsured patients, do not get their fair share.

Recalibrating the way this funding is distributed would not only make sense and bolster the financial stability of critical safety net institutions. It also is required under federal health reform and was very favorably ranked through the Medicaid Redesign Team’s own scoring process. Yet, the proposal never made it into the team’s final recommendations.

New York is in the midst of an epic budget crisis. Medicaid is seen as the linchpin to solving that crisis. But its redesign should not be done in such a way as to threaten the very institutions that serve as a safety net for our state’s most vulnerable residents. The erosion of our health care safety net threatens the stability of the system for all of us.

Action Alert: Email the MRT

In response to the hurried and flawed process used to develop proposals for New York Medicaid redesign, the Save Our Safety Net-Campaign asks allies to send emails to members of the Medicaid Redesign Team (MRT) expressing our distaste with their decision making process.

Sample text and email addresses of MRT members are below.

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Subject: Disappointed with Medicaid Redesign Process

Sample text:

“Medicaid Redesign Team -

We are saddened and angered by the “rush to judgment” on February 24th in the vote of the Medicaid Redesign Team to approve a package of recommendations that you had in your hands for less than 24 hours.  There had been major changes in what recommendations you were being asked to vote on, yet you voted.  The information was just made available on the web site the same day as the vote.  The aborting of the time frame by five days meant the public had no opportunity to review, digest, and comment on this package – much of which will have a dramatic impact on people’s lives.

The process had so many flaws that it would be difficult to name all of them.  But while trying to appear as this was a public transparent process, in the end it was anything but open and public.  To cite just one “mistake”, Mr. Introne acknowledged publicly at the meeting on February 24^th that people who had been listed in support of proposal #67, had actually spoke in opposition to this proposal.  #67, or Berger 2, would make money available to close, consolidate or merge hospitals, nursing homes, and clinics and was actively supported by Ken Raske (GNYHA) and Stephen Berger.”

Email addresses of MRT members:

Ann Monroe<amonroe@chfwcny.org>;Arlene Gonzalez-Sanchez<arlenesanchez@oasas.state.ny.us>;Joe Giglio (Assembly)<giglioj@assembly.state.ny.us>; Assemblyman Richard N. Gottfried<gottfried@assembly.state.ny.us>; Carol Raphael<craphael@vnsny.org>; DanSisto<dsisto@hanys.org>; Dennis Rivera<drseiu@aol.com>; Dr. JeffreySachs<jsachs@sachsmessage.com>; Nirav Shah<nrs02@health.state.ny.us>; Dr. William Streck<william.streck@bassett.org>; Ed Matthews<ematthews@ucpnyc.org>; Eli Feldman<efeldman@mjhs.org>; Elizabeth Swain<eswain@chcanys.org>; Frank Branchini<fbranchini@emblemhealth.com>; GeorgeGresham<georgeg@1199.org>; James Introne<James.Introne@exec.ny.gov>; Jason Helgerson<jah23@health.state.ny.us>; Karen Ballard<kballard@nyc.rr.com>; Ken Raske<raske@gnyha.org>; Lara Kassel<lkassel@cdrnys.org>; Linda Gibbs<lgibbs@cityhall.nyc.gov>; Lisa Ullman<Lisa.Ullman@exec.ny.gov>; Max Chmura<max.e.chmura@omr.state.ny.us>; MikeDowling<mdowling@nshs.edu>; Mike Hogan<cocomfh@omh.state.ny.us>; RobertMegna<Robert.Megna@budget.state.ny.us>; Kemp Hannon (Senate)<hannon@nysenate.gov>; Thomas Duane (Senate)<duane@nysenate.gov>; SteveAcquario<sacquario@nysac.org>; Steve Berger<sberger@odysseyinvestment.com>

Let’s Go Wisconsin On Them

We are back in New York City after a productive weekend at the black, Latino and Asian legislators caucus in Albany, where we presented on a panel about the Governor’s Medicaid Redesign Team with Judy Wessler from the Commission on the Public’s Health System and Laray Brown from the NYC Health and Hospitals Corporation, among others. Our collective message was clear. In not so many words: the MRT process sucks. The proposals it is considering also, by and large, suck. And the hurt will be felt most acutely by black and brown and immigrant communities across New York State. (Here’s a link to our PowerPoint presentation. Judy presented an overview of the MRT and all its problems, which you can download here, and Laray discussed the impact of the MRT on the city’s public hospitals in particular – click here for her presentation.)

Everyone we spoke to was hella angry about these Medicaid cuts and the means by which they are being made. As one panel attendee said, “we need to go Wisconsin on them!” And, indeed, we are plotting our next moves in advance of the MRT’s announcement of the cuts that it is recommending on March 1. We will keep you posted on this blog, or you can email the Save Our Safety Net Campaign to get up-to-the-minute updates (soscny@gmail.com). In the meantime, here are some important dates to keep in mind:

• February 24 & 25: Next meeting of the Medicaid Redesign Team (open to the public): 10:30 a.m. in Meeting Rooms 2-4, Concourse, Empire State Plaza, in Albany.
• February 28: Meeting of the Medicaid Redesign Team (open to the public): 10:30 a.m. in the Hart Theater of the Egg in Albany
• March 1: Medicaid Redesign Team announces its recommendations

Decisionmaking From on High

Tomorrow, Friday, February 18, is the deadline for members of Governor Cuomo’s Medicaid Redesign Team to submit their “scores” for 49 proposals given to them by the New York State Department of Health that are supposed to generate $2.85 billion–yes, billion–in cuts to the Medicaid program. These 49 were culled from the several thousands received via a severely flawed public hearing and online/written submission process that took place over the last several weeks in cities across the state. Not only were many proposals put forward by consumers and members of the public entirely excluded from the 49 that the Team will ultimately be deciding on, the few that did make it in were inaccurately captured in the bizarre spreadsheet format being used to capture major policy proposals to restructure the state and the country’s largest health insurance program for the poor. Oh, and did we mention that the proposals are going to be scored using Survey Monkey? That’s right, Survey Monkey.

In response, the Save Our Safety Net Campaign, of which we are a part, issued this open letter to the members of the Medicaid Redesign Team, instructing them how to vote on certain key proposals. This is not to say that we accept or buy into the ridiculous “process” that has been put in place by the MRT, but we also can’t remain silent on issues that will significantly impact the communities we care about. You can click here to download a copy of the letter.

Please let us know if you have any comments or concerns. There will still be other opportunities to weigh in on this process. On February 24th, the Medicaid Redesign Team will be meeting to discuss the scored proposals. The meeting will take place in Albany, and it’s important to have consumer voices out in full force. March 1 is when the final recommendations of the Team will be announced. We are planning activities in New York City around the announcement and will keep you posted about details. And, of course, state elected officials will have to weigh in on the recommendations too, and we are hoping that if you are  a New York resident that you will tell your representatives how you feel about the Medicaid program and why it is important to you and your community.

Critical decisions about the health care system in New York should not be made from on high, but from the ground up.

Community Input When a Hospital Closes

As we have written about before, the community of Southeast Queens has long experienced some of the worst health outcomes in New York City across a variety of measures.  No doubt, the shuttering last year of both Mary Immaculate Hospital in Jamaica and St. John’s Queens Hospital in Elmhurst has only placed additional strains on the already insufficient healthcare infrastructure in Queens, and on Southeast Queens in particular. These and other hospital closures occurred without any input from community members – the very people who utilized the services that these hospitals provided were left unable to make their voices heard on how the closure would affect them, and on what healthcare services they thought were critical for the community.

In order to ensure that communities affected by future hospital closures would have at least some voice in the process, Assembly Member Rory Lancman and State Senator Shirley Huntley introduced the Hospital Closure Planning Act. This original bill would have required the Commissioner of Health to hold a “public hearing” within 30 days of a proposed hospital closure in order to assess the impact a hospital closure would have on the area it serves.

Despite the overwhelming support in the legislature, as well as advocacy in support of the bill from Southeast Queens United in Support of Healthcare (SQUISH) among others, Governor Patterson vetoed that initial bill.  Now, after negotiating with DOH and the Governor–and, importantly, after the closure of St. Vincent’s in Manhattan, which, in contrast to the hospital closures in Queens garnered significant and vocal opposition from a notably wide range of politicians and stakeholders –the Governor signed a revised version of the bill.

As Assembly Member Lancman said last week, “The government has to, at least, make an effort to let communities affected by a hospital closure know how their healthcare needs will be addressed. We may not be able to stop a hospital from closing, but we ought to be able to measure the impact of that closing and come up with a plan for serving the residents who relied on that hospital for healthcare services.”

The revised bill requires the Commissioner to hold a “community forum” within 30 days after a hospital closure to hear from affected community members.  After the forum, the Commissioner must also release a written report on the anticipated impact of the closure to the community, as well as the Department of Health’s plans to mitigate the negative effects of the closure and to ensure continued access to healthcare.

To be sure, the Act is only a small first step in making sure that low-income communities of color most in need receive equal access to quality health care. Nevertheless, it is an important one in that it begins to recognize the community’s role in health planning.