2610 Notice who is to blame here

that foreigners and immigrants, many illegals, don't speak enough English to receive proper health care (at tax payers expense). The story at Medscape.com starts out with the anecdotal, obligatory story of "monolingual" [i.e. Spanish speaking only] parents bringing a 10 mo. old to the clinic, getting a perscription and then misreading the English instructions given at the pharmacy, and making the child really ill. The limited Spanish of the clinic's staff was apparently better than the "limited Enlish proficiency" (LEP) of the parents, but it is the people who are in the helping role who are to blame for not knowing this family's primary language. And even if the pharmacy staff had spoken fluent Spanish, the parents could still have misread the instructions--quite possibly their Spanish would be a bit more colloquial than someone who learned it in college.

"Almost 50 million Americans speak a primary language other than English at home, and 22.3 million have limited English proficiency (LEP), defined as a self-rated English-speaking ability of less than "very well."(1) The last decade witnessed a 47% increase in the number of Americans speaking a non-English language at home and a 53% increase in the number of LEP Americans.(2,3) Between 1980 and 2000, both of these populations more than doubled, whereas the overall US population increased only 25%.(2) Unfortunately, nearly half of LEP patients needing medical interpreters do not get them (4), and only 23% of hospitals provide training for staff on working with interpreters.(5) Americans' foreign language skills are dismal: less than half of US high school students are enrolled in foreign language courses.(6)

In the case description, we are told that neither bilingual staff nor interpreters were available for this clinic visit. Having access to trained medical interpreters or bilingual providers facilitates optimal communication, patient satisfaction, and outcomes and reduces interpretation errors for LEP patients and their families.(7) In addition, a Title VI guidance memorandum issued by the Department of Health and Human Services (DHHS) Office of Civil Rights states that the denial or delay of medical care for LEP patients due to language barriers constitutes a form of discrimination and requires recipients of Medicaid or Medicare to provide adequate language assistance to LEP patients.(8) This case underscores the importance of having appropriate language services available for LEP patients and their families, particularly in settings with high volumes of LEP patients."

Is Medscape by citing Title VI suggesting that hospitals, pharmacies, clinics and ER staff know Creole and French and Swahili and Portuguese, or just Spanish? Or is it OK to "discriminate" against a Brazilian or a Haitian? "Bilingual" means two. Just which two?

When does the immigrant take some responsibility? One year? Five years? About 15 years ago I invited a Cuban family for dinner--the parents who had lived in Florida for over 20 years were visiting in Columbus and spoke not even rudimentary English. They spoke through their son-in-law, who had learned English as an adult and was a Lutheran Pastor. Outside of Miami, they really weren't safe unless with a relative.

Another example: as part of "diversity training" the library staff in the 90s attended a workshop at the university taught by a Puerto Rican who was on the staff and living in Columbus, Ohio (yes, they are U.S. citizens by birth). His English was so poor I was embarrassed for him. His part of the event was a total waste of our time nor did his personal example win any friends for the cause of diversity.