by Nisha Agarwal
Consider the experience of María Angela C., a Spanish-speaking woman from New York City who is in the process of learning English but hasn’t mastered it well enough to understand complicated health information. One day, her 5-year-old son broke out in hives due to an allergic reaction. She rushed him to the doctor, who wrote her a prescription but did not explain how to take the medication. When María Angela went to the pharmacy to fill the prescription, the pharmacist also failed to explain how to take the medication and handed her a bottle with instructions in English only. María Angela took the bottle home, opened it and saw a pink liquid that resembled “pepto,” so she surmised that the medication should be administered orally. After her son took a spoonful, however, he reacted with extreme disgust, and María Angela became nervous. She asked a neighbor to translate the label and learned that the medication actually had to be applied topically. María Angela was devastated. Her son risked another allergic reaction, or worse, due to the fact that the health care delivery system that she encountered operated in English only, and she did not (yet) have the English-speaking ability to navigate it safely.
María Angela and her son faced a barrier to equal health access, to a basic human need, that the rest of us take for granted. Though many Americans have felt powerless and overwhelmed in the U.S. health care system, most of us have probably not felt silenced – quite literally unable to ask for or receive help because of the language we speak. Fortunately, civil rights laws are in place to break this silence. Title VI of the Civil Rights Act of 1964 prohibits discrimination on the basis of national origin, which includes language. In the health care context, this means that hospitals and pharmacies must provide interpretation services and translated medication labels to ensure that individuals such as María Angela can access health services with the same hope as the rest of us: that it will improve well-being, not further compromise it. Unfortunately, the Supreme Court has, in recent years, begun to interpret the law in such a way that this right to equal access does not have an adequate remedy. In the 2001 decision of Alexander v. Sandoval, a case about an English-only amendment to the Alabama state constitution, the Court held that private individuals cannot sue in federal court for violations of Title VI unless they can show that they were the victims of intentional discrimination – that is, if they can point to something like a “Whites Only” sign on the front door of the pharmacy.
Sandoval put the kibosh on virtually all federal litigation under Title VI in the health care arena, among many others. Advocates have sometimes been able to work around the problem. For example, our Health Justice Program (HJP) represents Make the Road New York, a Latino community-based organization in New York City, and has successfully approached government agencies such as the state Attorney General’s office to compel investigations of and settlement agreements with national chain pharmacies that do not provide interpretation services and translated medication labels for their non-English speaking customers. We have also drafted and lobbied for the passage of language rights laws that would compensate for the erosion of civil rights protections at the federal level. In fact, this morning, New York City’s Mayor Bloomberg signed the Language Access in Pharmacies Act, which will ensure that, in the future, María Angela and her son can use pharmacies in the five boroughs and have their rights to language assistance services respected.
But what about people living in areas where government agencies are not as receptive to the claims of linguistic minorities, and where local elected representatives do not have the same numbers of immigrant constituents holding them accountable? What about people like Baltazar Cruz, who went to a hospital in Mississippi to give birth and ended up having her child taken away from her because she didn’t speak English? In these cases, re-opening the doors of the federal courthouse is crucial. Language rights are, fundamentally, civil rights, which should have a remedy in every part of our country. And leaving your health care provider with an understanding of how to care for your child, with that child still in your arms, is a basic right; it should not be a privilege.
Nisha Agarwal is the Director of the Health Justice Program at New York Lawyers for the Public Interest (NYLPI), a non-profit civil rights organization in New York City. You can learn more about the pharmacy language access campaign and download materials at: http://healthjustice.wordpress.com/resources/#Rx.