A bill that would require pharmacies across Washington to translate medical information, such as prescription bottle directions, passed out of committee this week and is awaiting a vote on the Senate floor.
The bill was crafted by medical students at the Washington State University Elson S. Floyd College of Medicine.
Aditha Vegaraju, Domeg Moore, Fatima Elwalid, Carmen Abbe, Bailey Hall and Aivi Tran spearheaded the research and writing of the bill. They are members of the Language Access Team from the regional chapter of Health Equity Circle, a student nonprofit with chapters in Spokane, Seattle, Portland, Denver and Laramie, Wyoming.
The goal of the bill is to “reduce harmful and costly medication errors” by requiring Washington pharmacies print prescription container labels in both English and “readable language for patients with limited English proficiency.”
In their proposed model, the vial will contain the standard information of the medicine’s name, directions of use and expiration dates.
After research and discussion with local organizations, the medical students drafted the bill in late August. Discussions with Atia Iqbal, an Afghan refugee and a coordinator at Refugee Connections Spokane, helped the team identify the cultural importance of passing the bill.
“She talked about how many women come to her, asking for help to translate prescriptions because they can’t ask the men in their family since it’s personally sensitive with medications,” Vegaraju said. “This is not only an issue for people who don’t speak English well but an issue based around gender equity.”
While it’s not uncommon for an interpreter to be on hand during a medical appointment to help a non-English-speaking patient communicate with a doctor, that help only goes so far.
“A patient may have an interpreter at the visit but once that visit ends the interpretation and understanding ends with them,” Elwalid said. “All their pharmacy interactions, their after-visit summaries, the medications they would take home, would all be in English, which would still be a big barrier for the continuity of care for our patients.”
According to the Institute of Medicine, over 90 million Americans misunderstand drug labels or have trouble following the directions. Medication errors are responsible for 1 of out 5 emergency room visits, with an average cost of $10,000. Pharmacoepidemiology & Drug Safety, a medical journal that examines the culture and methods of pharmacy practices, cites the total cost of the preventable visits at $1.2 million. For those with limited English proficiency, the rate of medication errors is twice as high.
Washington’s Office of Financial Management counts 541,000 Washingtonians – or 1 out of every 13 – with limited English proficiency.
Similar bills have been introduced around the country. New York’s bill mandated the use of translators in medical facilities such as hospitals and clinics. Oregon’s bill required the Oregon Health Authority to provide educational training for interpretation and translation service workers.
Other supporters of the bill include the Washington State Coalition for Language Access, Spokane Immigrant Rights Coalition and the Washington Immigrant Solidarity Network. The cost of implementing the multilingual prescription labels is estimated to be $70 per month for pharmacies.
Translations will be done through a technical device that has been implemented around the country where non-English speakers are more common.
Chuck Lee, a Korean immigrant, is one of the doctors affiliated with Meducation, a language translation system that delivers simplified medication instructions to all patients in different languages.
Since 2017, Lee has partnered with First Databank, one of the largest language translation database providers for patients and health care professionals. There are a couple ways pharmacies can receive the translated materials. One way is the company provides a spreadsheet with translations in a variety of languages, so the pharmacy can go to the appropriate column and pull that translation.
For the second method, Lee said: “Pharmacies ping our network with instructions and the language request, then we return that back to them in real time. All of our translations are done by humans, we’re just able to recognize those incoming requests.”
State Rep. My-Linh Thai and Sen. Karen Keiser are main sponsors of the bill.
“Prescription drugs don’t do anybody any good if they’re not taken at the correct dosages, times,” Kaiser said. “We really have to step up to make sure everyone understands their labels … on their prescriptions drug bottles.”
For Thai, the bill is more about patient empowerment. Translating medical information, she said, allows patients to actively participate in their own health care.
Even when immigrants do learn English, language proficiency can wane over time. This poses a problem for the elderly, who, Thai noted, can “easily lose agency” in health care. Thai supports the bill for giving the elderly a say and making them “partners in their own care and empowering to patients.”
Thai referred to the Vietnamese-American Pharmacists Association, which has independent pharmacies that are translating medical information from English to Vietnamese in communities where where needed.
“The software and technology is there, it’s the matter of expanding the service in the most equitable way to other communities,” Thai said.
After graduating from the University of Washington’s School of Pharmacy, Thai served as an Vietnamese interpreter at a refugee health clinic. She said she believes the translation bill gives cultural and technical understanding to patients.
“As I volunteered, I was learning how hard it was to get the cultural understanding through,” she said. “It was sometimes difficult to get some patients to understand depression or anxiety.”
Misunderstanding the use of medicine or forgetting to process doctors’ orders can even trigger fear among immigrants or refugees of being sent back to their home countries. Those anxieties, Thai said, can lead to worsening medical conditions. Thai spoke from personal experiences as well, highlighting the tuberculosis vaccination process her family underwent after arriving from Vietnam.
“We took these medication religiously because we were so fearful that if we don’t do what’s asked of us, we would be sent back,” Thai said. “I also understand the fear of, if I don’t do what’s asked of me by someone in authority, that I will be sent back to my country that I tried to escape. That fear is real, and patients don’t know that they have certain rights because they left from places where they had no rights.”
She noted the pace of the systems are not equipped to help individual refugees. The proposed translation bill and other policies that assess the overall situation of language proficiency would improve care.
“This bill will especially help patients who have that one-time procedure or surgery, or even being discharged from the emergency room and now they have a bunch of new medication for one time or the first time,” Thai said. “Even if it’s interpreted or read to you just one time, you’ll probably need to hear it again.”
As the nation looks for more equitable health care, Thai called proposed policies such as the translation bill “only the beginning.”
“That’s how we save and reduce the health care so that we can increase the rate of people that adhere to their medicines, but also builds trust between health care system and the people we’re taking care of. It’s bigger than simply wanting to take medicine,” Thai said.