NYC’s Language Access Service Needs Callout

Interactive Map: NYC’s Language Access Service Needs (2023-N-11)

Objective

To determine if New York City Health + Hospitals Corporation is adequately serving the needs of individuals with Limited English Proficiency, complying with State regulations and local laws, and providing sufficient oversight of Language Access Services. The audit covered the period from January 2019 through December 2024.

About the Program

The New York City Health and Hospitals Corporation (H+H), a public benefit corporation created by the New York City (NYC) Health and Hospitals Corporation Act of 1969, is the nation’s largest municipal public health care system. H+H includes 11 acute care hospitals, five post-acute/long-term care centers, and 30 community health centers (Gotham Health) located across NYC’s five boroughs. H+H also provides medical services through programs such as ExpressCare, Correctional Health Services, Community Care, and Street Health Outreach & Wellness (SHOW) mobile units. H+H’s mission is to provide high-quality, compassionate, respectful, and dignified health care services to all New Yorkers regardless of income, gender identity, where they come from, what languages they speak or understand, or their immigration status. H+H provides comprehensive health care services to approximately 1 million New Yorkers annually.

Title 10, Section 405.7 of the New York Codes, Rules and Regulations (NYCRR) requires hospitals to develop a language assistance program to ensure meaningful access to the hospitals’ services as well as reasonable accommodation for all patients who require language assistance or who exhibit Limited English Proficiency (LEP). Individuals are classified as having LEP if English is not their primary or preferred language and they encounter difficulties in communicating in English. For instance, hospitals must designate a language assistance coordinator, referred to as a language access coordinator, who reports to hospital administration and manages the provision of language assistance services—also referred to as Language Access Services (LAS). Hospitals must also post signage in public areas listing the availability of free LAS. The 2023 American Community Survey conducted by the U.S. Census Bureau estimates over 1.7 million NYC residents have LEP, speaking hundreds of languages.

H+H provides LAS in multiple languages and dialects through Telephonic or Over-the-Phone Interpretation (OPI), Video Remote Interpretation (VRI), Spoken/Sign Proximal or Face-to-Face Interpretation, and Translated signs and essential documents. In fiscal year 2024, in response to 2.6 million requests for LAS, H+H provided 35.6 million minutes of interpretation services in 255 languages and dialects at a cost of $24.1 million.

Key Findings

We identified numerous weaknesses in H+H’s administration and operation of its LAS that led to non-compliance with relevant standards and regulations and other LAS issues.

• H+H did not provide adequate oversight of LAS data:
  ▪ LAS data had discrepancies, including missing or mislabeled information such as facility name and cost.
  ▪ H+H could not confirm that interpretation services for rarer languages were provided.
  ▪ H+H did not reconcile LAS data with billed invoices, and there are no standard review procedures for invoices.
• H+H has not fully adhered to the requirements of 10 NYCRR 405.7, which mandates an annual needs assessment to identify limited-English speaking groups and requires in-service training:
  ▪ H+H failed to perform required annual LEP needs assessments for years 2019–2023, limiting H+H’s insight into current demographic needs and trends of its LEP population.
  ▪ Between 2019 and 2023, workers at Bellevue Hospital did not complete a total of 4,061 annually required LAS training sessions. H+H failed to provide training records for Woodhull and Harlem hospitals.
• H+H lacks a centralized list of qualified in-house interpreters and bilingual staff. At the facility or program level, facilities acknowledged they had no such listing, or they stated a list exists but either they failed to provide it or the available lists were outdated. Further, interpretation services by some bilingual staff were not reported in LAS data.
• H+H requires its facilities/programs to develop LAS policies for their staff. We found 29 facilities/programs had no LAS policies. For the 21 facilities/programs with policies, we found discrepancies between the H+H LAS guidelines, facility policies, and actual practice.
• We have no assurance that H+H manages and tracks translations of patient medical records, after-visit summaries, and discharge papers into different languages to ensure the accuracy of information in these documents for patients. Also, H+H could not confirm that patient calls lasting 2 hours were reviewed to determine reasons for the lengthy calls and if LAS services were properly provided.
• Bilingual and multilingual OSC auditors conducted an anonymous unannounced survey of H+H facilities and programs to test the availability of LAS, and encountered several barriers:
  ▪ Instances where H+H staff did not attempt to connect callers to an interpreter or to provide information.
  ▪ Difficulty in navigating H+H’s automated call systems and voicemails, particularly for LEP patients.
  ▪ Inability to access LAS through SHOW mobile units.
• H+H did not sufficiently manage contract payments:
  ▪ From January 2022 to June 2024, H+H made $215,879 in overpayments to vendors for LAS. For example, some OPI services were billed at VRI rates, which are higher, and some services for Spanish were billed at higher “Other Languages” rates. One vendor was also paid at the higher rates from an earlier contract, instead of the new, lower contract rates.
  ▪ H+H would have saved a total of $8,247,840 for fiscal years 2023 and 2024 had it negotiated or used vendors with lower per-minute contract rates.

Key Recommendations

• Develop procedures to ensure information for all LAS requests is reported. Conduct periodic reviews to ensure that the LAS data is complete and accurate and that services are rendered.
• Adhere to the requirements of 10 NYCRR 405.7, including ensuring that annual assessments of LEP needs are conducted and that staff complete all annual LAS trainings.
• Prepare and maintain centralized and facility listings of in-house interpreters and bilingual staff.
• Ensure all facilities/programs develop LAS policies and/or update established policies to align with H+H LAS guidelines.
• Ensure information in patient records is accurately translated into various languages.
• Review and maintain documentation for patient calls lasting over 2 hours.
• Establish procedures to improve patients’ experience in accessing and navigating LAS call lines and LAS access in mobile van units (e.g., bilingual staff, OPI/VRI).
• Review records and recoup outstanding overpayments made to vendors, as appropriate.
• Establish procedures to ensure the most cost-effective LAS vendors are selected, based on negotiation or using vendors with lower per-minute contract rates.