-  Civil Rights for Providers of Health Care and Human Services      -  Provider Obligations 
  -  Civil Rights Clearance for Medicare Provider Applicants 
  -  Compliance & Enforcement        -  Resolution Agreements 
    -  Enforcement Examples 
  -  Training 
  -  Civil Rights Laws, Regulations & Guidance        -  Regulatory Initiatives 
    -  Regulations Enforced by OCR 
  -  Civil Rights and COVID 

                      -   
                      -   
                      -   
                      -   
                      -   

# Enforcement Success Stories Involving Persons with Limited English Proficiency

## Summary of Selected OCR Compliance Reviews and Complaint Investigations

                          -  **Mee Memorial Hospital of California** agrees to expand and improve accessibility for persons with limited English proficiency (LEP).  MMH consists of a main hospital and five clinics serving approximately 50,000 people throughout 2,500 square miles in rural California. (8/21/14) Read the HHS Bulletin | Read the Resolution Agreement 
                          -  **Mississippi Department of Human Services, Division of Family and Children's Services** (MDHS-DFCS) - OCR and (MDHS-DFCS), have signed a voluntary resolution agreement to expand language assistance services for persons with Limited English Proficiency (LEP). Under the agreement with OCR, MDHS-DFCS will take a comprehensive approach to ensure persons with LEP have meaningful and timely access to a variety of critical services, activities and programs. (04/15/14) Read the Voluntary Resolution Agreement | Read the Bulletin 
                          -  **Memorial Health System (MHS) in Colorado Springs (CO)** - OCR and MHS have signed a voluntary resolution agreement to ensure effective communication with and improve the quality of services for persons who are deaf, hard of hearing, or limited English proficient. This voluntary resolution agreement demonstrates OCR’s commitment to enforcing federal laws that prohibit discrimination by health care and human service providers.(Date: 11/07/12) Read the Voluntary Resolution Agreement | Read the Bulletin 
                          -  **Shenandoah Memorial Hospital (SMH) in Woodstock, (VA)** - OCR and SMH have signed a voluntary resolution agreement to expand language assistance services for limited English proficient (LEP) persons. Language assistance services are essential to meaningful access to quality health care. If providers and patients do not understand each other clearly and cannot communicate effectively, quality of care is compromised, sometimes even jeopardized. This voluntary resolution agreement demonstrates the benefits of hospitals working cooperatively with OCR to ensure Title VI compliance. (Date: 8/28/12) Read the Voluntary Resolution Agreement | Read the Bulletin 
                          -  **Resurrection Healthcare (IL)** - OCR Region V resolved a complaint alleging that Resurrection Healthcare Hospitals, a group of six Chicago hospitals totaling over 2000 beds, had violated Title VI of the Civil Rights Act of 1964 by failing to provide language assistance services. To resolve the complaint, Resurrection Healthcare agreed to appoint a language assistance coordinator, train 37 employees as interpreters, contract with an interpreter agency to provide back-up services, and establish a comprehensive employee training program on its revised language assistance policies and procedures. 
                          -  **Alameda County Medical Center, Highland Campus (CA)** – Pursuant to Title VI of the Civil Rights Act of 1964, OCR Region IX resolved a complaint against the Alameda County Medical Center, Highland Campus, a 236 bed facility in Oakland. To resolve the complaint, the Medical Center agreed to improve its language assistance services by: (1) training its staff in Title VI compliance and oral/written communication needs assessments for LEP patients; (2) issuing medical cards to indicate a patient’s primary language; (3) updating its registration area signage to include the five most commonly used languages in its service area; (4) posting signage indicating that interpreter services are available free of charge; and (5) contracting with video and telephone interpreter services who can serve Karen-speaking immigrants from Burma. 
                          -  **Maryvale Hospital (AZ)** - OCR Region X resolved a complaint alleging that Maryvale Hospital had violated Title VI of the Civil Rights Act of 1964, by failing to provide language assistance services to limited English proficient (LEP) patients in its Emergency Department. In response to OCR’s investigation and provision of technical assistance, the Hospital took corrective action to improve its language services program, including: (1) revising its LEP policy to notify consumers that in-person, telephone and video interpretation services are available free of charge; (2) publishing the revised LEP policy on its website and in patient materials; (3) training staff on the revised LEP policy; (4) contracting with new interpretation service providers offering American Sign Language and sixty spoken languages; and (5) posting language interpretation information in the main lobby, admissions area, and Emergency Department. 
                          -  **Rhode Island Department of Human Services (RIDHS)** - OCR Region I entered into a voluntary resolution agreement with RIDHS that helps ensure that clients with limited English proficiency - those who have a limited ability to read, write, speak, or understand English - will have improved access to RIDHS programs and services, including access to Medicaid and other social services programs. Under the agreement, RIDHS will also ensure that current and new staff will receive comprehensive training on a provider’s duties under Title VI of the Civil Rights Act of 1964. The resolution agreement resolves a complaint filed with OCR by the Rhode Island Chapter of the American Civil Liberties Union and a concurrent review conducted by OCR to determine whether RIDHS was in compliance with an open agreement it had with OCR to improve language access services for RIDHS’ LEP clients. HHS/OCR, Resolution Agreement, Montgomery Department of Social Services, October 2009  Read the Resolution Agreement  **Maryvale Hospital (AZ) -** OCR Region X resolved a complaint alleging that Maryvale Hospital had violated Title VI of the Civil Rights Act of 1964, by failing to provide language assistance services to limited English proficient (LEP) patients in its Emergency Department.  In response to OCR’s investigation and provision of technical assistance, the Hospital took corrective action to improve its language services program, including:  (1) revising its LEP policy to notify consumers that in-person, telephone and video interpretation services are available free of charge; (2) publishing the revised LEP policy on its website and in patient materials; (3) training staff on the revised LEP policy; (4) contracting with new interpretation service providers offering American Sign Language and sixty spoken languages; and (5) posting language interpretation information in the main lobby, admissions area, and Emergency Department. 
                          -  **Rhode Island Department of Human Services (RIDHS) -** OCR Region I entered into a voluntary resolution agreement with RIDHS that helps ensure that clients with limited English proficiency - those who have a limited ability to read, write, speak, or understand English - will have improved access to RIDHS programs and services, including access to Medicaid and other social services programs. Under the agreement, RIDHS will also ensure that current and new staff will receive comprehensive training on a provider’s duties under Title VI of the Civil Rights Act of 1964.  The resolution agreement resolves a complaint filed with OCR by the Rhode Island Chapter of the American Civil Liberties Union and a concurrent review conducted by OCR to determine whether RIDHS was in compliance with an open agreement it had with OCR to improve language access services for RIDHS’ LEP clients. Read the Voluntary Resolution Agreement 
                          -  **Montgomery County Department of Social Services (NY)** - OCR Region II secured a Voluntary Resolution Agreement with the Montgomery County Department of Social Services (MCDSS) in New York to ensure that people with limited English proficiency (LEP)  – those who do not speak English as their primary language and who have a limited ability to read, write, speak, or understand English – will have improved access to Medicaid and other social services programs. The MCDSS provides or administers a wide range of publicly funded social services and cash assistance programs, including Temporary Assistance for Needy Families, Supplemental Nutrition Assistance Program (formerly known as the Food Stamp Program), Medicaid, emergency assistance, general relief, adult protective services, and personal care services.  Its programs reach approximately 28,000 people. Under the agreement, MCDSS voluntarily committed to take steps to ensure that the language access needs of its LEP clients are properly assessed and that competent language access services are provided to clients for the full range of services, including home visits and evaluations.  MCDSS agreed to provide timely language assistance services to ensure effective communication during home visits and evaluations; to notify LEP clients of the availability of free language assistance; to use family or friends as interpreters only when specifically requested by the client after the client has been notified of the option for free language assistance; to translate vital program documents; and to establish mandatory staff training on their obligations under Title VI. (08/10/2009)Read the Resolution Agreement | Lea el communicado de HHS prensa en Español(Read the HHS Press Release in Spanish) 
                          -  **Medco Health Solutions, Inc. (CA)** - OCR Region II secured corrective action that resolves an LEP complaint against Medco Health Solutions (Medco), a pharmacy benefit management company that is also the nation’s largest mail-order pharmacy operation.  The complaint alleged that Medco failed to provide LEP members with meaningful access to mail-order pharmacy services and other pharmacy benefit management services.  Medco agreed to address the issues in the complaint and provided OCR with written assurance that it will implement a number of measures to strengthen its provision of language assistance services to LEP members with whom Medco directly communicates. (06/15/2009) Medco Commitment Letter | OCR Closure Letter | Lea el communicado de HHS prensa en Español  (Read the HHS Press Release in Spanish) 
                          -  **University of New Mexico (UNM) Hospital(NM)** – OCR Region VI resolved a complaint which alleged that a 75-year old Spanish speaking individual was not provided with language assistance services during her medical appointment.  In response to OCR’s investigation and provision of technical assistance, the Hospital, a 431-bed facility, took corrective action to improve its language services program, including:  (1) revising its limited English proficiency (LEP) policy; (2) coordinating its interpreters and translations through a recently established Interpreter Language Service Department; (3) mandating a staff training program on language services; (4) implementing an interpreter qualification testing and training program; (5) posting signs informing the public of the availability of language assistance services; (6) translating over 900 forms and vital documents; and (7) conducting periodic reviews and monitoring to ensure the effectiveness of language services for LEP persons.  These corrective actions also were implemented at the Hospital’s off-site clinics, as well as the UNM Children’s Hospital, UNM Children’s Psychiatric Center, UNM Adult Psychiatric Center, the UNM Cancer Center, and the UNM Carrie Tingley Hospital.  Read the Letter of Finding 
                          -  **State of Hawaii Department of Human Services -** (serving a state population of more than 1.2 million) signed a statewide Settlement Agreement to ensure that limited English proficient persons receive equal access to its programs and services, including medical care for low-income persons.  Read the Resolution Agreement 
                          -  **Erie County Medical Center Psychiatric Department** (NY) - OCR's Region II resolved a complaint against Erie County Medical Center Psychiatric Department involving a 63-year-old homeless Spanish speaking person. The individual's language barrier limited medical staff from performing various psychological assessments. OCR's investigation found that the individual did not receive consistent interpretation services during his 150-day stay at the Center. As a result of OCR's intervention, the Center made systemic changes to its policies, procedures and practices for ensuring early identification of interpretation needs to ensure appropriate provision of service. The Center developed a "clinical alert" system to prompt an objective assessment of the timeliness and quality of service based on the patient's need. 
                          -  **New York City Human Resources Administration (NYC)** - OCR's Region II secured system-wide change for several thousand clients who are eligible to receive benefits and from the NYC HRA and an agency with which it contracts to conduct assessments for persons with mental and physical disabilities, Health Services Systems (HSS). HSS expanded its communication assistance to clients by utilizing the Language Line, a telephonic interpreter service to provide interpreter services for languages not spoken by HSS staff. As a result of OCR's intervention, approximately 124,230 clients, 42 percent of whom are LEP, will be notified of the opportunity to access translation and interpretation services. The revision of policy and training of HSS staff will assist them in better identifying and serving their clients who speak different languages. 
                          -  **PA Department of Public Welfare (PA DPW)** - OCR's Region III office resolved a complaint filed by Community Legal Services on behalf of the Refugee Communities Coalition of Philadelphia, alleging that the PA DPW discriminates against LEP persons on the basis of their national origin by failing to provide the language assistance necessary in the provision of employment and training services by the Bureau of Employment and Training Programs (BETP) and agencies under contract with DPW. As a result of OCR's investigation and subsequent technical assistance, DPW/BETP has taken the following primary actions: BETP expanded the standards in its Employment and Training Master Guidelines requiring that its various contractors be able to provide all services and activities to LEP individuals; BETP encourages its contractors to sub-contract with organizations prepared to provide linguistic and employment and training services to LEP persons; BETP has translated a variety of forms and general information into Spanish, with efforts being made to translate materials in other non-English languages; BETP developed monitoring tools to determine contractors' ability to identify language needs and to provide language assistance to LEP persons; BETP has agreed to add a standard to its Master Guidelines requiring that contractors provide LEP training to their sub-contractors and that sub-contractors provide the language assistance needed to ensure meaningful access to LEP persons; and BETP incorporated an LEP component to its training program that is provided to its contractors on an annual basis. BETP requested OCR's participation in the training and OCR provided LEP training sessions to BETP's contractors. The PA DPW, BETP will continue its efforts to address potential barriers and take appropriate steps to ensure that LEP TANF beneficiaries have meaningful access to employment and training programs and services. 
                          -  **Madison Early Childhood Center, Loveland (CO)** - As a result of OCR's investigation and intervention, a Head Start program stopped its practice of placing non-English speaking children in classes with an English-only speaking teacher. Now, bilingual aides are placed in the classes with the teacher so there is more effective communication between the teacher and students. This change will affect approximately 105 students each year. 
                          -  **Marin General Hospital (MGH), Greenbrae (CA)** - A community advocate on behalf of a Spanish-speaking LEP person filed this complaint against MGH. Marin County has a substantial LEP Latino population. The complaint alleged that MGH discriminated against an LEP individual on the basis of his national origin by failing to provide him with an interpreter during his hospital stay and when given discharge instructions, and that MGH's failure to provide language assistance to LEP persons denied them an equal opportunity to access MGH's services. OCR's investigation substantiated the allegations in the complaint and as a result of our investigation, MGH has taken substantial action steps to augment services to its LEP patients. In response to OCR's finding, MGH took the following actions: formed an Interpreter Task Force to enhance its services to LEP patients and visitors; revised its policy on providing language assistance to LEP persons; provided OCR with information on a new program offered by MGH's parent corporation that determines if willing MGH employees can provide basic and/or medical interpretation for LEP patients and visitors; contracted with a service to provide telephonic interpretation for LEP patients; appointed a translation services coordinator to oversee the facility's interpretation and translation services; and began monthly training of all new hospital employees on its translation services programs and MGH's LEP policies and procedures. Importantly, MGH now determines if a patient is LEP during the admitting process and regularly translates discharge instructions into Spanish for its Spanish-speaking patients. MGH also provided OCR with documentation of multilingual posters; interpreter services notices, and hospital signage available in Spanish. 
                          -  **Yale New Haven Hospital (YNHH) (CT)** - OCR secured a signed Resolution Agreement that resolves an LEP complaint against YNHH, an acute care provider in southern Connecticut and one of the Northeast's major referral centers and the primary teaching hospital for Yale University School of Medicine. In FY 2003, YNHH provided services for approximately 447,350 individuals as outpatients (outpatient visits) and 45,349 individuals as hospital patients (hospital discharges). OCR's Region I office investigated the complaint allegations and identified concerns about the implementation of YNHH's interpreter services policy. In the Resolution Agreement, YNHH agreed to implement its current interpreter services policy and take additional steps to ensure meaningful access to its services by LEP patients. 
                          -  **Catholic Charities Maine (CCME)** - OCR secured a signed Resolution Agreement that resolves a complaint filed against Catholic Charities Maine (CCME) alleging that CCME's Home and Family Program failed to provide interpreters for LEP clients speaking Somali, Vietnamese and Cambodian. CCME had a contract with Maine Department of Human Services (ME DHS) to provide home services to LEP families for child protective services, including parenting skills training to LEP individuals and refugee resettlement assistance. OCR's Region I office investigated these allegations and worked with CCME and ME DHS representatives to address OCR's concerns identified during the investigations. OCR and CCME resolved the issues through a Resolution Agreement, in which CCME agreed to implement a new Language Assistance Policy and to take additional steps to ensure that LEP persons are provided meaningful access to all of its more than 40 programs in over 15 locations throughout the state. The services include senior services; children and youth services; substance abuse and mental health services; refugee and immigrant services; and dental and pregnancy services. CCME also developed an interpreter services program to provide written and oral language services for hospitals and other service providers in Maine since the filing of this complaint. Their staff interpreters provide language services for over 25 different languages. The interpreters are recruited from the community they serve, have received appropriate training in interpreting techniques, ethics and protocol, and will provide useful linguistic and cultural clarification for both the client and the provider. 
                          -  **Los Angeles County Department of Public Social Services (LADPSS)**  - OCR entered into an agreement with the Los Angeles County Department of Public Social Services (LADPSS) to resolve a complaint of discrimination by the Asian Pacific American Legal Center, the Western Center on Law and Poverty, the Legal Aid Foundation of Los Angeles, and San Fernando Valley Neighborhood Legal Services. The complaint was filed on behalf of LEP participants, and low-income communities in Los Angeles County. LADPSS is the county agency responsible for administering public assistance programs, including CalWORKs (California's TANF program). OCR and LADPSS entered into a Voluntary Resolution Agreement that will result in enhanced efforts to provide meaningful access to individuals seeking LADPSS services who have LEP. The Agreement is significant because of the large and diverse population of Los Angeles County, the large size of LADPSS' caseload (more than 1.9 million individuals), and because more than 40 percent of the population served by LADPSS identifies a language other than English as their primary language. Under the terms of the Agreement, LADPSS will ensure the existence and implementation of comprehensive policies and procedures so that LEP persons have meaningful access to all LADPSS-administered and contracted programs and services. LADPSS agreed to undertake various specific actions to facilitate meaningful access, including: establishing an LADPSS office to ensure that appropriate language assistance is provided to LEP persons who apply and participate in CalWORKs and to monitor LADPSS compliance with Title VI and the Agreement; ensuring accurate identification of the primary language of program applicants and participants; actively recruiting and making a good faith effort to employ bilingual staff; ensuring that all interpreters are competent to interpret; and notifying LEP applicants and participants of the availability of free language assistance and providing training to LADPSS public contact staff and their managers on civil rights issues affecting LEP persons. 
                          -  **D.C. Income Maintenance Administration (IMA)** - OCR closed a compliance review of the D.C. Income Maintenance Administration's TANF program. The compliance review was focused on access to IMA for LEP persons. During the course of the review, OCR participated in IMA's annual diversity training, during which OCR presented an overview of the revised OCR guidance regarding Title VI prohibition against national origin discrimination affecting LEP persons. The training was attended by approximately 450 IMA caseworkers. In addition to the training, OCR worked with IMA to ensure the upgrading of IMA systems to identify and track the LEP individuals and the languages spoken in the IMA service area, and negotiated changes in policies and practices to address access for LEP persons seeking IMA services. As a result of the review, IMA will provide notices on informational and marketing materials about the availability of translation services when needed. IMA will also monitor the work of their vendors in serving LEP individuals. 
                          -  **Maryland Department of Health and Mental Hygiene** - After conducting a civil rights training for the Maryland Department of Health and Mental Hygiene in 2005, OCR conducted follow-up compliance reviews of three local health departments in both rural and urban settings of the state. As a result of the reviews, the county health departments have agreed to conduct periodic language needs assessments of their service areas and to incorporate a variety of data sources in the process. Also, they revised their policy and procedures to address critical components of an effective language assistance program; they formed a committee to identify, prioritize and develop protocol to translate written materials; they developed a uniform method for identifying and tracking LEP persons and for documenting the provision of language assistance services; they agreed to provide medical interpreting training to bilingual staff who provide language assistance and to assess their proficiency level in the second language; and they developed a comprehensive and uniform monitoring system to evaluate the language assistance services provided and to make changes when necessary. 
                          -  **Northwestern Medical Faculty Foundation (NMFF)** - Based on reports from advocacy groups, OCR conducted a review of NMFF to determine the extent to which NMFF was providing interpreter services to its patients who are limited in their English proficiency (LEP), and OCR also reviewed NMFF services to persons who are hearing-impaired. In June 2005, NMFF's president signed two agreements with OCR, one pertaining to NMFF's services to its hearing-impaired patients and the other pertaining to its services to its LEP patients. On the LEP issues, the covered entity agreed: to increase patient awareness of the availability of language assistance and increase staff awareness of procedures for providing language assistance; to make changes in its patient tracking system to ensure that if an LEP patient used an interpreter on one visit, the patient would be asked if he or she would require an interpreter on all subsequent visits; to make technological changes helpful in facilitating language assistance; to include the right to interpreter services in the NMFF "Patient Bill of Rights" and provide pamphlets about the availability of interpreter services in all of its doctors' offices; to train all staff, including its physicians, on their obligations under Section 504 and Title VI; and to publish pamphlets about the availability of interpreter services that will be prominently displayed in its physician members' offices. 

Content last reviewed July 26, 2013