This post is by Rylee Sommers-Flanagan, a summer intern with the Health Justice Program and a student at Emory University in Atlanta, GA.
According to the US Census of 2000, ten years ago over 35% of the then 8 million residents of New York City were foreign born, and 47.6% spoke a language other than English at home. Since then, these numbers have only grown.
Given those demographics, it’s fitting for federal, state and local law to require pharmacies (as well as hospitals, other health care facilities, and all city agencies providing direct public services) to provide language assistance services to limited English proficient (LEP) customers or patients. Language assistance services entail translation (of written documents) and interpretation (of the spoken word). Because New York also requires that pharmacists counsel customers with regard to their prescriptions, both types of service are indispensable.
Even so, when activist organization Make the Road New York teamed up with us to file a civil rights complaint with the New York State Office of the Attorney General (OAG) in July of 2007, the results of the ensuing investigation were predictably disappointing. The OAG found seven chain pharmacies with names you’ll recognize – A&P, Costco, CVS, Duane Reade, Rite-Aid, Target, and Wal-Mart – in violation of the law and came away with seven settlement agreements, requiring newly specific and official translation and interpretation services.
In all cases, the deadline for implementing the required improvements was at latest May 15, 2010. They had plenty of time. We’re now trying to figure out whether pharmacies have used that time to get in line with their legal obligations.
Unfortunately, verifying compliance may not be so simple. On a recent visit to a CVS/Pharmacy and then a Rite-Aid, I asked which languages they could print on their labels and was promptly informed that no pharmacy employees could answer my questions unless I was a customer. The cold shoulder response makes monitoring pharmacies significantly more challenging, and it seems unlikely to be an accidental roadblock. We’ve heard through our contacts in the industry that many of the pharmacies are trying only to comply with the letter of existing laws and not their spirit. And we also know they’re resisting language access requirements in other states. Our allies in California report that pharmacy lobbyists–many from the same companies that signed settlement agreements in New York–are telling regulators on the left coast that it is not possible, difficult or too expensive to provide language assistance services.
This is troubling, to say the least, and patently untrue. Recently, for example, we spoke with representatives from a an international firm called RxTran that is well-equipped to create a database of translated warnings and instructions for easy use by pharmacists as an integrated part of their work routine. In fact, RxTran designed such an economically feasible and work convenient product—it typically costs less than $2 per day—that even some small, independent pharmacies have purchased database access.
It may be that the chain pharmacies are lazy or greedy and near-sighted (imagine trying to attract customers to whom you are incomprehensible). But for either possibility, we need to remember their pattern of negligence and, now call for the follow up.
Failing to provide accurate translation and interpretation has proven devastating on many occasions. Examples range from the children who vomit endlessly until they arrive in an emergency room (only to discover parents have been administering topical medications orally), to the little old ladies who take eleven times the amount of prescribed medicine (due to faulty translation of the word ‘once’). The United States, for better or worse, has not declared English a national language – can the illness and death ultimately associated with simple language errors really be declared an acceptable side effect of pharmacy arrogance?
Enforcing language access laws may be as difficult as passing them but we, who deserve to comprehend what makes us well or sick, must hold the Rite Aids, Duane Reades and CVSs accountable for that information, in all the languages we speak.