Accuracy of Computer-Generated, Spanish-Language Medicine Labels

In August 2000, President Bill Clinton signed Executive Order 13166, Improving Access to Services for Persons with Limited English Proficiency (LEP), to enforce Title VI of the Civil Rights Act of 1964, which specifies that public funds cannot be used in ways that discriminate against persons according to racial or national origin. Executive Order 13166 specifies that agencies receiving federal funding (for example, Medicaid and Medicare) must strive to “develop and implement a system to provide services so that LEP persons can have meaningful access to them.”1 Several studies in the past few years have documented gaps in access to appropriate language services for individuals with LEP.2–5 In New York City, 38.6% of 200 randomly selected pharmacies that served clients with LEP on a daily basis translated prescription labels every day.2 In a study of 764 pharmacies in Colorado, Georgia, North Carolina, and Texas, 34.9% of pharmacies reported being unable to provide any translated instructions for medicines.4 One major mechanism that pharmacies use to provide translation of medicine labels is computerized translation software. In a 2004 survey of all pharmacies (99.4% participation) in the Bronx, New York, a county in which 44% of residents are Spanish-speaking, we documented that 69% of pharmacies could provide medicine labels in Spanish, most commonly (86%) by using computerized translation software.3 Anecdotal remarks made by pharmacists in that study raised questions about the quality of computer-translated medicine labels.3 In 2006, a survey led by the New York Academy of Medicine revealed that 75% of pharmacies in New York City reported that they could use computerized translation software to provide medicine labels in ≥1 language.2 When pharmacists were questioned regarding barriers to providing translated medicine labels, 5% reported concern about the accuracy of the translated information. No studies have evaluated systematically the accuracy of computer-generated, non-English medicine labels. New York City, where 47.6% of the population speaks a language other than English at home,6 is at the center of the struggles to meet Executive Order 13166. In 2007, a complaint was filed with the New York State Attorney General, charging pharmacies with bias for not providing adequate translation services to customers with LEP.7 After conducting its own investigations, the Office of the Attorney General secured agreements with major pharmacies in New York to provide counseling to customers with LEP in their own languages and to provide written translations of prescriptions in the predominant languages in New York.8,9 On September 3, 2009, Mayor Michael Bloomberg signed legislation requiring chain pharmacies in New York City to provide language assistance services to clients, including written translations of medicine labels for customers speaking 1 of the top 7 foreign languages in New York City (Spanish, Chinese/Cantonese/Mandarin, Russian, Korean, Italian, French Creole, and Bengali).10,11 In this article, we report on the availability of Spanish-language prescription labels in the Bronx, New York, during autumn 2007. We also report on the accuracy of computer-generated, Spanish medicine labels and discuss the findings in the context of current legal mandates.