A new audit from State Comptroller Thomas P. DiNapoli found that the New York City Health and Hospitals Corporation (H+H) is not fully meeting patients’ right to interpretation services for those in need of language assistance.
“The Health and Hospitals Corporation has a tall order given the diversity of languages spoken in New York City, but it needs to do better,” DiNapoli said. “It is critical that those in need of medical care can communicate with health care providers. This audit found a number of shortcomings and offers recommendations that H+H can use to improve critical language services to its patients.”
H+H is the nation’s largest municipal health care system, overseeing 11 acute care hospitals, five post-acute/long-term care centers, and 30 community health centers. New York regulations require hospitals to have language assistance to ensure meaningful access to services. In the city’s fiscal year 2024, H+H reported providing 35.6 million minutes of interpretation services in person, over the phone, or by video in 255 languages and dialects in response to 2.6 million requests, more than double the number of requests five years earlier. Despite that level of interpretation service, DiNapoli’s auditors visited hospitals and found several issues, from a failure to connect to interpreters to a lack of adequate records when language services were provided.
Auditors made 55 phone calls to six H+H facilities in several languages including Spanish, Chinese, Russian, Hindi, Haitian Creole, and Tagalog. On 12 calls they were given an interpreter. On 43 calls they ran into barriers, including 16 calls that failed to connect to an interpreter or provide information. H+H staff hung up on several auditors. In some cases where an interpreter was provided, H+H staff interrupted them or refused to provide basic information that the auditor asked for.
H+H’s automated call system was hard to navigate on 16 calls and 11 others were abruptly disconnected. The automated message on its general line is a loop offering nine languages with an option for “other” that auditors found did not work and had no option to leave a voicemail.
Auditors provided documentation of the calls at H+H’s request, excluding the name of the employees they spoke with. H+H declined to address any of the issues auditors encountered, however, because they said they could not verify the calls took place without the names of the staff.
When staff cannot identify a patient’s language, they can call a hired vendor’s help line to get a live operator to assist. An auditor’s test call with H+H officials failed to connect to a live operator, however.
Visits to H+H mobile health vans also encountered problems. A sign at the Lower East Side mobile unit said services were available in Chinese, but auditors found only Spanish and English were available. At the same location on another date, staff used Google translate to communicate with an auditor in Tagalog, which led to misinterpretations. The Bedford-Stuyvesant location had no bilingual staff. Staff at mobile units did not have access to phone or video interpretation services provided by H+H’s vendors.
H+H is required to do an annual needs assessment to understand the demographics and language needs of the communities it serves. The audit found H+H did not assess language needs for 2019 through 2024. The audit provides a map of languages spoken in H+H service areas.
H+H’s policy is that all staff get annual training on providing language services, but it failed to provide auditors with training records for Harlem and Woodhull hospitals. The records that were provided for Bellevue found that over 4,000 training sessions, or about 13%, were not completed.
Besides outside vendors, H+H trains bilingual staff to interpret for patients. When auditors visited Bellevue and Woodhull hospitals, however, staff were not aware of how many qualified interpreters there were and had no list of who they were. In contrast, Harlem Hospital said it kept a list of staff trained to provide interpretation services that was updated twice a year, however it failed to provide a copy of that list.
In addition, when bilingual staff provided interpretation services it was not recorded, which is part of H+H’s larger problems with accurate records of the language services it provides to patients.
The vendors H+H hires to provide language access services for patients are supposed to submit monthly reports, but auditors found numerous errors, discrepancies, and missing information when they reviewed a sample of these reports. Given H+H’s inability to explain these issues, it was unclear if it adequately reviewed the data on how, when, and where interpretations were being provided. In one instance, H+H’s primary language access provider reported no instance of service failure over a nearly three-year period, which auditors found unlikely. H+H officials could not explain why service failure data was missing for the vendor and said it was insignificant, despite the fact that the vendor received 73% of over the phone language assistance requests through the first 6 months of 2024.
Inadequate record keeping and review of data led to H+H overpaying vendors $215,879, the audit found.
The audit made nine recommendations, including that H+H:
- Develop procedures to ensure information for all language access service requests is reported, and conduct reviews to ensure the data is complete and accurate and that services are rendered.
- Adhere to regulatory requirements including ensuring that annual assessments of limited English proficiency needs are conducted and that staff complete all annual language service trainings.
- Prepare and maintain centralized and facility listings of in-house interpreters and bilingual staff.
- Ensure all facilities/programs develop language access policies and/or update established policies to align with H+H guidelines.
- Establish procedures to improve patients’ experience in accessing and navigating language access service call lines and access in mobile van units.
H+H officials generally disagreed with the audit findings and recommendations. Their full response is available in the audit report.
Audit
New York City Health + Hospitals Corporation: Oversight of Language Access Services
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