Gotham Gazette

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Language Barriers at the Drugstore

When Catalina Martinez of Ridgewood walks into a pharmacy to get a prescription, the task may not be as easy as it seems.

Beyond the long lines and their physician's unintelligible handwriting, Martinez, like thousands of other New Yorkers, faces a seemingly insurmountable wall at their local drugstore: a language barrier.

"When I go to the pharmacy, I see that the bottles are in English and I want to know what it says on the bottles," said Martinez, who was interviewed through a translator. "So many times I leave the pharmacy without knowing what it is saying. That's scary for me."

According to immigrant and health care advocates, the majority of pharmacies, particularly in the outer boroughs, do not provide translation services to their customers. This leaves thousands of New Yorkers with limited proficiency in English to fend for themselves. Labels remain untranslated, so crucial instructions from the pharmacist may be incomprehensible.

Unlike hospitals, which, under state regulations, must provide translators, pharmacies are under no such requirement. That, some city leaders say, may soon change.

Where Regulations Stand

For the hundreds of thousands of New Yorkers who do not know English, the local pharmacy and its rows of bottles with labels reading Zoloft or Ambien can be baffling. With Americans increasingly reliant upon prescriptions, advocates say an inaccurate translation -- or none at all -- can pose a significant danger.

The 2000 Census showed that nearly half of New York City households speak a language other than English, and one out of four New Yorkers do not speak English at all. That leaves 25 percent of the city's population scrounging for health care in their own language or care at a facility offering translation services.

While the state approved regulations in 2006 that set out language requirements for hospitals, pharmacies were overlooked, said some advocates. According to a recent report by the New York Academy of Medicine, two thirds of city pharmacies do not translate prescription labels, despite the fact that 88 percent said they served limited English proficiency patients daily.

A report released late last year by the advocacy groups New York Lawyers for the Public Interest and Make the Road by Walking details nearly a dozen anecdotes from Brooklyn and Queens residents who do not speak English.

Catalina Martinez is one of them. She suffers from gastritis and has a 14-year-old son prone to allergies, forcing her to visit the pharmacy often. A native of Mexico who has lived in Ridgewood for a decade, Martinez sometimes stops strangers on the street, hoping to get her prescriptions translated since the pharmacies she frequents do not provide language assistance. Sometimes, she said, she will not give her son medication for fear of administering it incorrectly.

"Maybe I have to give him this much medicine, sometimes I have to give less," said the 49-year-old. "Sometimes I won't even give it to my son because I won't know how to do it."

Martinez's apprehension is shared by many immigrants, said Nisha Agarwal, a staff attorney with New York Lawyers for the Public Interest. To address this, the lawyers group, along with City Councilmember Eric Gioia and Public Advocate Betsy Gotbaum, is drafting legislation that would require translation services be provided at all city pharmacies.

"Giving New Yorkers access to the information they need starts with simple, common sense steps, like providing translation services and extra medical instruction for those with limited English proficiency who are filling prescriptions," said Gotbaum in a prepared statement. "Our proposed legislation will help break down the barriers many currently face when seeking health care and ensure that no New Yorker is left guessing when it comes to questions about their medication."

Other council members have also expressed support for the measure. "Although I appreciate the efforts already taken by a number of pharmacies to help their customers read their prescription label in a more familiar language, these businesses still have more work to do," said Councilmember Joel Rivera, chair of the Health Committee, in an e-mailed statement. "People should not have to guess how to administer their medicine just because they can't read the directions. Clearly the consequences can be devastating. The translate of drug labels by pharmacies is not only a good idea, it is the right thing to do."

What Advocates Want

Advocates, like Agarwal, believe the city's existing human rights law, which prohibits discrimination based on race or ethnicity in public places, requires pharmacies to translate. So far, though, pharmacists do not interpret the law that way.

Both New York Lawyers for Public Interest and Make the Road by Walking filed a formal complaint with the state attorney general's office, claiming 16 pharmacies in Queens and Brooklyn routinely failed to translate drug labels or provide instruction to non-English speakers, thus violating their statutory duty. That complaint is pending, said Agarwal.

They hope the legislation currently being drafted will replicate what the state required from hospitals in 2006, making language access a requirement of quality health care. Agarwal said the legislation should be introduced in the coming weeks.

The specific standards for pharmacies would strengthen the current requirements under the human rights law, said Theo Oshiro, the director of health advocacy at Make the Road by Walking.

Oshiro said his group has already seen some success. Pharmacies in Bushwick, for example, stepped up their language education campaigns with signs announcing translation services behind some counters.

"I guess there has been spotty results; there has not been a whole chain setting out clear guidelines," said Oshiro. "We're still looking for that kind of sweeping solution, not only in Bushwick and in Woodside."

City officials spearheading the legislation say the proposal would simply turn an assumed right into an explicit one. Business leaders, however, disagree.

Business Barriers

James Detura owns his own pharmacy in the South Bronx where the population is predominantly Spanish speaking. Detura, who is president of the New York City Pharmacists Society, said a translation mandate would be catastrophic. It is already difficult to find any pharmacist -- due to a nationwide shortage of pharmacists -- let alone a bilingual ones, he said.

For communities that do not have one or two dominant languages, but three, four or even five, it could be next to impossible to meet strict language access guidelines. "What about a pharmacy that is in certain area of New York City when you've got Spanish and Russian?" asked Detura. "What do you do in a case like that? Are you going to have a separate pharmacist for each one?" There are enough pharmacies in the city, especially locally owned businesses that cater to certain communities, that customers who cannot find the services they need at one pharmacy can always find another one a block or two away, he said.

Detura also fears inaccurate translations. He said it may be easy to translate "one pill a day," but more complicated instructions may not be as readily interpreted -- especially if there are no services available for a local pharmacist to double-check a phoned-in translation.

But advocates said there are plenty of accurate resources for a local pharmacist, such as subscriber hotlines that can translate at the click of a dial. Oshiro also said they were not looking to require bilingual pharmacists.

Like Detura, others question whether the legislation would put an unreasonable burden on small, independent pharmacists. In response, Oshiro said the smaller pharmacies already do a better job accommodating immigrant populations' needs.

Instead, advocates argue that it is larger chains, such as Duane Reade and Rite Aid that fail to translate. Even if the big chains have the ability to provide the service (some have telephone translation networks or bilingual staff), they often do not advertise it to their customers.

A Bilingual Call

While many of the details must still be worked out, immigrant and health care advocates said they are keeping both business and health interests in mind. The idea is to save people's lives, or at the very least prevent confusion and sickness.

Convinced she became ill after incorrectly taking medication with a label she couldn't understand, Martinez said she cannot, nor can she give her son, medication with an easy mind.

If pharmacies cannot provide bilingual or trilingual employees, they should at least provide labels in other languages, Martinez said. That way, she added, she and thousands of other New Yorkers can take their medication with confidence.

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