Consumer info fact sheets translated into WA’s threshold written languages
(Chinese, Lao, Khmer ( Cambodian), Korean, Russian, Somali, Spanish, and Vietnamese) were posted on Dec. 16, just one week before the deadline to start an application for coverage to be effective Jan. 1, 2014. In an unrelated development, HBE decided on this brief extension
for completing applications due to various problems people have had in being able to use the online forms and or access phone customer services. Regarding the translated fact sheets, it’s taken almost 6 months for their publication to replace the original problematic versions
that were taken down from the site.
However, the new fact sheets are not easy to find as they are not posted on the consumer website, but located exclusively on the HBE corporate website
. The corporate site features a line at top right-hand side of homepage entitled “Information in Other Languages” which links to the fact sheets page, plus also links out to the consumer website. In contrast, the consumer Healthplanfinder site
(which is in both English and Spanish) does not offer any such subject line, nor does it display a link to corporate site. The Healthplanfinder site likewise does not contain any readily visible clear statement of consumer language access or disability access rights, except for a message in tiny font on bottom of the homepage that says [sic] : If you need additional language or disability accomodations, you may call 1-855-WAFINDER (1-855-923-4633).
On the Spanish version of the website, this statement illustrates yet another example of faulty translation, as the term “disability accomodation
” is twice translated, and very ungrammatically, as “discapacidad alojamiento
” which means disability lodging. Sure enough, a quick check on Google Translate English > Spanish reveals “lodging” as the first translation for “accommodation.” Since 2012 advocates had been recommending the inclusion of multilingual tag lines and/or translated summaries sections for the website.
Information on some metrics for the Healthplanfinder call center became available last week with the release of the November Healthplanfinder Data Repor
t. On the language access side of things (p.10 of the report) the numbers are not encouraging: the call center received almost 12,000 calls in Spanish, but handled only some 1600 of them. The call center in Spokane has bilingual Spanish-English staff (reported as 6 out of 80 employees
at start-up) on site and routes calls in other languages to a telephonic interpreter service. For calls in all languages besides Spanish combined, 1045 were actually handled (answered)out of 3621 calls attempted. The report does not state if the multilingual calls are included in the totals for approximately 35,000 calls handled in November or the almost 158,000 calls throttled (deflected from the system, i.e. not put into the queue to await a response). While the HBE is said to be increasing staffing for the call center
, any increases planned for its language capacity are as yet unknown. Given the demand, it would seem that Spanish-speaking callers too could benefit from immediate access to interpreter services.
Posted in Advocacy, Assistance, Discrimination, Ethics, Global Health, Health Care Marketing, Health Care Reform, Health Disparities, Health Insurance, Health Literacy, Healthcare Inequalities, Hispanic/Latino, Immigrants, Language Access, Language Services, Limited English Proficiency, Medicaid, Promotions, State of Washington, Translation | Leave a Comment »
The irony was not lost for me that while writing on the positive results of the FDA’s use of translation services, that here in my state, once known as a national leader in language services, we are still struggling to get quality translations for our Health Benefits Exchange (HBE). The efforts to achieve this goal have been a major focus for the Washington State Coalition for Language Access, and its been a year now since we co-authored with Northwest Health Law Advocates the report Language Access in Washington under the Patient Protection & Affordable Care Act expressly for the HBE efforts. Now with 175,000 enrollees, Washington State deserves the praise it’s getting for the record-breaking enrollment figures in the new health insurance marketplace Washington Healthplanfinder, especially compared to the situation in neighboring Oregon and to the federal Healthcare.gov platform. But the picture is much less rosy regarding providing equal access for Washingtonians with limited English proficiency (LEP), who now number some 8% of state population or half-million residents, representing an increase of 210 % in the past decade . Demographic data on enrollees is said not to be available.
We are now less than 2 weeks away from the enrollment deadline for coverage to start Jan. 1, 2014, and the consumer fact sheets that were intended to inform the public of the options under the ACA have not yet been made available to Washington’s LEP population. Even though work began in July to replace the problematic original translations – errors brought to HBE’s attention by advocates- there are still no consumer fact sheets available in Washington’s threshold languages ( in written form these are: Chinese, Lao, Khmer, Korean, Russian, Spanish, Somali, and Vietnamese).
In addition, the Spanish versions of the paper application for Healthplanfinder, while continuing to be publicly available, have contained horrific translation errors. In the section which inquires about the applicant’s citizenship status, the phrase ” Non-citizen legally present in the US” was translated into Spanish to mean just the opposite, i.e., the translation says “ non-citizen not legally present….” , complete with the I-word in Spanish in version #1. After the mistake was identified on Oct. 15 , again by advocates, staff said they took immediate action to have the vendor correct it. The screenshots included here show the sections containing the mistranslations.
Spanish version #1
And yet, advocates identified that the new translation contained the same error, just written with different wording. Here is Spanish version #2, as it appeared on Nov. 14:
This one particular error may now have been recently corrected for a 3rd iteration, through volunteer efforts of local language access advocates trying to beat the clock to help consumers. However, we hear anecdotally that more translation concerns persist and can’t be confident that there are not similar errors in the translations in the other languages.
What remains a mystery is how this sorry state of affairs has come about, and if there were ever robust quality assurance measures in the procurement chain for the translations. It is beyond comprehension how such blatant errors could be made given that the work was done by vendors holding official State contracts who must affirm that they use qualified translators and proper translation procedures. And if this is happening in Spanish, the 2nd most used language in both our State and nationally, and thus one for which there is an ample number of nationally-certified translators available to do the work, there is a real reason to fear that similar egregious errors may exist in other language translations.
Shortly before Thanksgiving, HBE staffers announced at a meeting of its Health Equity Technical Advisory Committee, that work halted back in June to create a Language Access Plan (LAP) for the HBE requested by the TAC , will resume in the new year. LAPs are meant to serve as blueprints to guide the work of agencies and programs to comply with the laws requiring they provide language services, and to help prevent the kind of problems that we’ve being seeing here in the other Washington. I’ll continue to report on the work in progress.
Posted in Advocacy, Discrimination, Global Health, Health Care Marketing, Health Care Reform, Health Disparities, Health Insurance, Health Literacy, Healthcare Inequalities, Hispanic/Latino, Immigrants, Language Access, Language Services, Limited English Proficiency, Medicaid, State of Washington, Translation | Tagged language translations, quality translations, translations, Washington Healthplanfinder, Washington State | Leave a Comment »
Two recent news stories about honey, illustrate yet again the vital importance of communications to health. In these completely unrelated cases, it was all about translations, the rendering of messages from one written language to another. The fraudsters seemed to have assumed they could get away with selling their products to unsuspecting consumers due to a lack of language skills on the part of regulatory authorities.
In September, Bloomberg Businessweek broke the story on a honey scandal at the global level with an article entitled The Honey Launderers: Uncovering the Largest Food Fraud in U.S. History , describing a convoluted plot by German company ALW to sell millions of pounds of Chinese honey in the US, by disguising its origins. Over the course of several years, ALW arranged with the Chinese brokers to channel their product through other countries, where it was filtered, doused with additives to disguise its unpleasant flavor, and re-labeled to make it seem to have come from nations authorized to export honey to the US. Some of the adulterated honey was also found to contain residues of the antibiotic chloramphenicol, long banned in the US. The impetus for the fraud was purely financial , as honey fetches top dollar in this country, the major world consumer. Over a decade ago when domestic beekeepers complained that honey imports from China were seriously undercutting their business, the US imposed such stiff tariffs on Chinese honey imports that little enters the country legally any more. But the super-cheap price of honey in China has remained a lure for international exporters. Some Chinese producers seize this opportunity to increase their own profits by artificially increasing the quantity of honey available to be sold. According to the FDA investigation of this case, a number of techniques like harvesting the honey early and not letting the bees complete the process naturally were routinely used in China, along with machine-drying the honey to speed things along. ALW abetted the process and instructed its 2nd-country middlemen to add sweeteners to disguise the sour taste caused by the premature harvesting.
In order to keep the doings secret, ALW officials exhorted the young German employees sent to run the firm’s US operations to use the phone, not emails, to discuss business and to conduct all communications in their native language. While the staff did restrict their discussions to the German language, they continued to use emails for correspondence. Their missives were later translated into English during the course of the FDA investigation. The federal prosecutor who worked on the case commented:
“They were extremely sophisticated and intelligent in some ways, but so sloppy in other ways. What do they think—no one can translate German?”
Earlier in the year in a less notorious case, the honey firm Nature Nate’s in Texas garnered FDA censure because it violated the instructions issued by the FDA following a 2012 audit, when the company was ordered to stop advertising its honey in ways that characterized it as a drug, i.e. by making various health claims for its products. While Nate’s had promised to stop the spurious marketing by Fall of 2012, an FDA follow-up in mid-2013 found that the firm continued to make these claims on its Spanish-language website, under the banner ” Remedios Caseros con Miel or Honey Home Remedies “, describing such benefits (in English translation) as:
• “Food Poisoning. Blend 1 Tablespoon Apple Cider Vinegar and 1 Tablespoon of North Dallas Honey dissolved in a glass of chilled water.”
• “‘[O]rganic honey’. A client of mine that is a doctor told me to try yours for allergy relief. It has COMPLETELY eliminated allergies for the entire household … it is our daily dose … “
A cached copy of the Spanish information on how to use Nate’s honey as an arthritis remedy said:
Para la artritis – 100% Pure Raw & Unfiltered Honey naturenates.com/espanol/para-la-artritis
“Receta 1. Tome una taza de agua caliente con dos cucharadas de miel y una cucharadita de canela en polvo por la mañana y la noche. …
FDA translation: “May Help with Arthritis. Recipe 1. Take 1 cup of hot water with two spoons of honey and one small teaspoon of cinnamon powder both morning and night. .. “
The FDA issued the new warning letter in June 2013, and Spanish version of Nature Nate’s website appears to have now been taken down.
And the phenomenon of the FDA using translation as an investigative tool is hopefully now a regular practice, as a evidenced by yet another recent case, this time involving the Sundial herbal supplement company which got an FDA Warning Letter based on claims made solely in Spanish which characterized its products as drugs. As a commentator for Regulatory Affairs so aptly explained
…just because a product’s unapproved claims aren’t in English, that doesn’t mean FDA isn’t paying attention.
Posted in Consumer Protection, Environmental Health, Ethics, FDA, Global Health, Health Care Marketing, Hispanic/Latino, Language Services, Paitent safety, Patient Safety, Promotions, Translation | 3 Comments »
The long-awaited verdict on the latest appeal by Novartis was issued April 1 , to the relief of health justice advocates and patients in India and around the world. For seven years now, Novartis has challenged India’s patent laws which apply to Glivec, their brand of the cancer drug imatinib mesylate ( which the company spells as “Gleevec” in North America, to uniformize pronunciation) , an action which portended grave global problems for access to costly drugs in general. India’s high court ruled that the form of Glivec which the company wished to patent was not a new drug which would merit such status. The ruling is important to assure that affordable generic forms of vital medicines can be manufactured, but advocacy efforts will continue to be needed for future drugs. With so much published on the case no need for me to repeat details here , among the excellent sources for those wishing to learn more is Knowledge Ecology International and its IP-Health listserv.
Posted in Health Care Marketing | Leave a Comment »
This blog has been on hold for a good while now as a result of life circumstances, despite best intentions. On the day of my last post, my very elderly father took a fall which caused a brain injury from which he ultimately succumbed. Although he had declined considerably in the preceding months, and had recently acknowledged that he might need to make a change in his living arrangements, he continued as his fiercely independent self and fell on his walk to the grocery store. The previous day I had attended the 2012 Northwest Patient Safety Conference , including the excellent workshop Safe Passage: Opportunities to Reduce Harm While Providing Care at the End of Life by Hope Wechkin, MD, Medical Director of Evergreen Hospice and Palliative Care. Although the topic has long been of both personal and professional interest to me, I had no idea then how very valuable her practical advice would be as I dealt with negotiating my dad’s “safe passage.” My only regret about his last weeks is the time that I had to spend dealing with bureaucracies instead of being at his side.
But despite all my background and almost a decade of experience as Dad’s point person & caregiver, I had to be extremely assertive to get him a palliative care referral and then a hospice referral. Never once did the medical staff ever mention these subjects, despite my father’s condition. Once on board, the palliative care team ,and later the hospice nurses, were excellent. It’s a sad commentary indeed on our broken system that these services are not offered routinely.
My plans for the blog this year are to continue to offer news and commentary on topics and issues that may not be getting so much attention in the general media.
Posted in Advocacy, End of Life, Paitent safety | Leave a Comment »