Case Study Outcome
[Because this physician accepts
federal money from the Medicare program, she is subject to Title VI of
the Civil rights act of 1964, which, other things, prohibits
discrimination based English proficiency.
Considering the four-factor
balancing test (including the number or proportion of LEP persons likely
to be encountered, the frequency of with which LEP individuals come into
contact with the program, the nature and importance of the services
provided, and the resources available to the provider) it appears as
though this physician will have great flexibility in the kinds of
language services he should provide to ensure the LEP patient access to
health care.
In this instance, the physician
is providing a low-risk, non-emergent service in a population with very
few non-English speaking people. Additionally, as a solo-practitioner,
she does not have the resources of larger practices, and thus, should
consider many lower-cost possibilities.
The Office of Civil Rights
(OCR) has issued guidance on a similar situation. It provides that in
non-emergent cases where two physicians are in the same field
with practice in the same geographic area and one of the physicians has
an employee fluent in a particular language, it may be appropriate for
the first doctor to refer LEP patients (who speak the same language as
the other physician’s employee) to the other doctor.
The physician may allow, but
not require, the LEP patient to use her son or another family member or
friend to act as an interpreter. The physician should consider the
special circumstances that may affect whether a family member or friend
should serve as an interpreter, such as concerns over competency,
confidentiality, privacy, or conflict of interest. The physician should
also consider resources such as commercial telephone interpreters
community volunteers.]
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