New York: Non-English Speakers Charge Bias in Prescription Labeling

[Harold F. Schiffman]

October 31, 2007

Non-English Speakers Charge Bias in Prescription Labeling

By ANNE BARNARD

Pharmacies across the city routinely fail to help non-English speakers
understand their prescriptions, raising the chances that customers could
harm themselves by taking medicines incorrectly, immigrant advocacy groups
charge in a discrimination complaint that they plan to file today with the
New York attorney generals office. The complaint names 16 pharmacies in
Brooklyn, Queens and Long Island, most of them operated by chains. It
argues that federal civil rights law and state health regulations require
pharmacies to provide linguistic help to guarantee that people who speak
little or no English receive equal access to health care. That assistance
should include interpreters at pharmacies and written translations of
medication instructions, the advocates say.

Nisha Agarwal, a lawyer for one of the groups filing the complaint, said
the attorney generals office had already issued subpoenas to several
pharmacies listed in an earlier version of the complaint filed in July.
The new version names more pharmacies, and an accompanying report includes
more examples of comprehension problems non-English speakers have had.

The idea is that people should not be placed in danger by not
understanding their medication regimen, said Andrew Friedman, an executive
director of Make the Road New York, one of the groups filing the
complaint, along with New York Lawyers for the Public Interest and the New
York Immigration Coalition.

Jeffrey Lerner, a spokesman for the attorney generals office, said only,
We have an ongoing investigation.

The pharmacies named include six operated by Rite Aid, three CVS stores,
three Duane Reade stores, a Walgreens and a Wal-Mart. CVS said it was
cooperating with the attorney general. The other companies declined to
comment on the pending legal matter, but said they were trying to provide
good service for diverse populations.

Tiffani Bruce, a spokeswoman for Walgreens, said the chain provided
medication labels in 14 languages and kept a nationwide database of its
pharmacists who speak other languages, enabling a pharmacist to call a
colleague who can talk to a customer.

CVS said it provided telephone interpreters in 150 languages, and Rite Aid
said it tried to hire bilingual pharmacists and provided labels in 12
languages.

In a survey of pharmacists at 200 New York drugstores to be published next
month in the Journal of Urban Health, 88 percent said they saw
non-English-speaking customers daily, and 80 percent said they had the
ability to translate labels, according to Linda Weiss, a senior research
associate at the New York Academy of Medicine, who conducted the study.
But only 34 percent said they translated labels daily, and 26 percent said
they never did.

Many states require hospitals to provide translation and interpretation
services in emergency rooms. Last year, New York States Department of
Health tightened regulations to require that all hospital departments
provide interpreters to non-English speakers within 20 minutes.

Health advocates have increasingly used federal civil rights law to push
hospitals, nursing homes and clinics to provide language services.
Language barriers to health services constitute discrimination based on
national origin, they argue, a violation of federal civil rights law,
which applies to hospitals because they receive federal funds through
Medicare and other programs.

The latest effort aims to expand similar requirements to pharmacies. The
complaints also cite the New York Education Law, which requires that
medications be labeled in a way that ordinary people can understand. That
is meaningless if they are in a language the patient does not comprehend,
Mr. Friedman said.

This month, California enacted a law requiring the states pharmacy board
to implement new requirements for clear prescription labeling by 2011, and
to consider the needs of non-English speakers.

The advocacy groups provided The New York Times with a copy of the
complaint and the accompanying report.

The report chronicles the stories of more than a dozen New Yorkers who
said they struggled to understand their prescriptions at local pharmacies.
Reyita Rivera, 47, for example, who speaks and reads only Spanish, said
she could not understand the printed instructions that came with her
antidepressant medication, and ended up taking too much. She said she had
to be admitted to a Queens hospital after the medication caused a racing
heartbeat.

That experience scared me a lot. I felt very bad  I thought I was just
going crazy, Mrs. Rivera, a Dominican immigrant, said in an interview,
speaking through an interpreter.

She said she could not communicate with the staff at her pharmacy in
Ridgewood, Queens, and received no printed explanation of the medication
in Spanish.

Jos Cadavid, 63, of Woodside, Queens, said he usually could not get his
pharmacists to explain his medication in Spanish. Whenever I go to the
pharmacy I see a lot of people struggling to communicate, said Mr.
Cadavid, who immigrated from Colombia. Theres no one helping them. It
affects a lot of people.

http://www.nytimes.com/2007/10/31/nyregion/31pharmacies.html

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