An audit released today by State Comptroller Thomas P. DiNapoli found that the New York City Department of Health and Mental Hygiene (DOHMH) does not consistently provide or track required language services across its public health clinics and other public-facing programs for patients and clients who have limited English proficiency, creating barriers to accessing vital services.
“It’s not acceptable that the city’s Department of Health cannot tell whether it’s consistently delivering the language services people need,” DiNapoli said. “Language barriers can delay care and lead to worse outcomes. The department needs to strengthen its oversight and implement our recommendations to ensure better, more accessible health care for all, and I’m pleased to see they have begun making the changes needed.”
More than 1.7 million New York City residents have limited English proficiency according to 2023 U.S. Census data. By law, DOHMH must provide free language assistance, including interpretation, translated documents and multilingual information on how to provide feedback or file complaints if necessary.
The audit covered January 2019 through December 2024. Auditors conducted site visits to 10 DOHMH public health clinics and other facilities across Manhattan, the Bronx, Brooklyn and Queens, including Tuberculosis Chest Clinics, Sexual Health Clinics, the Fort Greene Immunization Clinic and the Office of Vital Records.
Significant Documentation Discrepancies at Clinics
The audit found that the number of patients documented as receiving language access services was significantly lower than the recorded number of patients with limited English proficiency. For example, at DOHMH’s Tuberculosis Chest Clinics in 2023, 62.9% (4,341) of all patients were identified as having limited English proficiency, yet only 12.2% (840) were documented as receiving language services. Similar discrepancies were found at DOHMH Sexual Health Clinics.
It is unclear whether services were underreported or if language access services were not provided.
No Centralized Tracking of Language Services
The audit found that DOHMH does not use a centralized system to track language services across its clinics and other public-facing programs. Documentation practices vary by location, with some sites not systematically recording services.
Auditors also found that DOHMH does not track unsuccessful attempts to connect people with interpreters at health clinics. As a result, it cannot ensure that language assistance is consistently provided or measure how effectively services are working across facilities.
Without coordinated tracking, DOHMH cannot identify patterns or monitor performance across its operations.
Staff Certification and Equipment Issues
During site visits, auditors found bilingual staff providing services without completing required fluency assessments, delays installing phone equipment used to connect patients with interpreters, connectivity issues affecting video interpretation, limited availability of interpretation equipment at some high-volume locations and multilingual signage and complaint information that was not consistently visible.
Issue Extends Beyond Clinics
The audit also found similar weaknesses in other DOHMH public-facing activities, including food safety inspections. Of 50 food establishments surveyed, 31 had staff with limited English proficiency. Nearly half of those establishments said they didn’t know DOHMH language assistance services were available.
Auditors made unannounced calls in 12 languages and dialects to DOHMH public-facing clinics and public service phone lines to assess language access to language assistance. They encountered barriers on 25 of 38 calls (66%), including automated systems that were difficult to navigate, disconnected calls and difficulty reaching interpretation services. Reviews of DOHMH public-facing websites also found limited information available in multiple languages.
Recommendations
The audit makes several recommendations, including developing a centralized system to track language access services, improving documentation of language services, ensuring bilingual staff complete required fluency assessments and expanding multilingual access. DOHMH generally agreed with the recommendations.
Audit
New York City Department of Health and Mental Hygiene Oversight of Language Access Services
Related Work
New York City Health + Hospitals Corporation Oversight of Language Access Services
Department of Motor Vehicles Language Access Services
Language Access Services (Follow-Up)
State Education Department English Language Learners Programs