(Getty Images)
Right now, drug labels appear only in English in California, yet 44 percent of Californians speak a language other than English at home. (Getty Images)

Every Saturday morning, a steady stream of Chinese and Vietnamese patients line up at the Paul Hom Asian Clinic in Sacramento. Most of them speak little to no English.

Patient assistance director Danny Tao says people come here to get free medical consultations and drug prescriptions. But, he says that when patients take those prescriptions to be filled, they don’t understand the instructions on the label.

“They go pick them up, and we don’t exactly know if they’re taking it or not — or if they know how to take it,” Tao said.

Tao says drug labels at most pharmacies in California are printed only in English. That puts patients in danger of taking of any number or errors — taking too much medication or not enough, taking it at the wrong time of day, and more. Such mistakes can cause serious harm or even death.

Tao says that for the drugs his clinic supplies directly, all have a bilingual label.

“It’s going to be English/Chinese or English/Vietnamese,” he said. “By the time they get home they know exactly how to take the medication, because it’s in their own language.”

This week California’s Board of Pharmacy will discuss new regulations that would require all pharmacies in California to provide translated labels on prescription drug bottles. Statewide, 44 percent of Californians speak a language other than English at home. New York approved a similar rule last year to make it easier for non-English speakers to take their medications properly and avoid costly mistakes.

But the board’s executive officer Virginia Herold says the move is very controversial. For starters, there is a concern that requiring translated labels would require larger bottles of pills to fit all the text. But she says patients don’t like larger bottles.

“They decant the drug out of the large container, put it in a baggie or someplace else,” Herold said. “There you’ve separated the drug from the container, now the instructions on how to take it have been separated.”

Pharmacists don’t like the proposal because they say it opens them to liability if there’s a mistake in the translation. Brian Warren is with the California Pharmacists Association.

“If the label is translated into Russian and there’s an error, and I’m a pharmacist that does not speak Russian, I cannot verify that that error exists,” Warren said.

At present, the state’s board of pharmacy includes on its website translations of basic instructions such as “take one pill at bedtime” in five languages: Chinese, Russian, Spanish, Korean, and Vietnamese.

Proponents of translating labels say that concerns about the change are outweighed by the problems patients who speak limited English face under the status quo.

“There’s a risk right now,” said Sarah de Guia, director of government affairs for the California Pan Ethnic Health Network, an advocacy group. “They can’t understand anything on their label because the label is not in their language.”

De Guia says the expansion of insurance under the Affordable Care Act places more urgency on the issue.

“You’re going to have 1.5 million more limited-English proficient individuals in the health care system now that the ACA has passed.

The discussions are in the earliest stages, and if new regulations go forward, many details need to be worked out, including how many languages press and who would have responsibility for translation.

Resistance to Translating Prescription Drug Labels 1 August,2014April Dembosky

  • If they’re getting free medicine in the United States of America, perhaps it’s not too much to suggest that they should learn English.

  • Jon Kelley

    Potential solutions:
    – Lean at least basic English. Not even total fluency, I believe 600-800 words will give you “functional literacy” and a basis for learning more (and, if you make the effort, I’m perfectly willing to help you learn. I enjoy accents and regionalisms – but I can’t stand people who move to a new country and can’t be arsed to learn the language.)

    – Bring your own translator (which you should be doing anyhow, I think.) Every time I get a document from the coverage carrier (I refuse to call it “insurance” – it ain’t) and I see that sheet that says “You have the right to have this translated, at no cost to you” I worry.
    — We have gotten to the point where everyone has a right, but no-one has a responsibility.
    — People aren’t assimilating, and we’re encouraging that behaviour through provision of interpreters, ESL classes as part of the mainstream, &c.
    — All this translation falls under “soft costs” – it’s not something you’ll see as a line item on a bill, but it’s part and parcel of EVERY line item, and it increases costs. Thanks…

    – Have the doctor write down instructions separately, on a note sheet, in whatever language. The patient pays the doctor (if applicable) for the service – instead of spreading it out onto everyone (including those of us who neither need nor want to pay for it, or those of us who are struggling already and just don’t need an extra cost.)

    The first option is the best. What happened to times 80-100 years ago, when people would come to the States and not only learn the language, but bust their brains getting rid of their ACCENT so as to “sound American”? We’ve gone from purging accents (which is a pity) to not even bothering to learn the language – and I have a BIG problem with that.

    I’ve been bloody everywhere, and I was fortunate in being able to pick up languages rapidly through immersion. But, as I said, learning 600-800 words is enough to be a good start, and gives you a basis for learning more. And, do that before you come here – it will make your life FAR easier.

    I do NOT support the idea of translating bloody everything, nor do I support the idea of providing translators /gratis/ when needed; simply because, as many have said before me, “Nothing’s free.” If YOU aren’t paying for it, *I* probably am.

    And I greatly resent that.


April Dembosky

April Dembosky is the health reporter for The California Report and KQED News. She covers health policy and public health, and has reported extensively on the economics of health care, the roll-out of the Affordable Care Act in California, mental health and end-of-life issues.

Her work is regularly rebroadcast on NPR and has been recognized with awards from the Society for Professional Journalists (for sports reporting), and the Association of Health Care Journalists (for a story about pediatric hospice). Her hour-long radio documentary about home funerals won the Best New Artist award from the Third Coast International Audio Festival in 2009.

April occasionally moonlights on the arts beat, covering music and dance. Her story about the first symphony orchestra at Burning Man won the award for Best Use of Sound from the Public Radio News Directors Inc.

Before joining KQED in 2013, April covered technology and Silicon Valley for The Financial Times, and freelanced for Marketplace and The New York Times. She is a graduate of the University of California at Berkeley Graduate School of Journalism and Smith College.

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