December 31, 2001

Brenda Aguilar
Office of Information and Regulatory Affairs
Office of Management and Budget
Washington, D.C. 20503

Re: Request for Information: Assessment of Costs and Benefits Associated with the Implementation of Executive Order 13166. Federal Register, November 30, 2001.

Dear Ms. Aguilar:

The National Immigration Law Center (NILC) submits these comments on behalf of NILC and the undersigned organizations in response to the request for comments on the costs and benefits of implementing Executive Order 13166 issued by the Office of Management and Budget (OMB) and published in the Federal Register on November 30, 2001. NILC is a nonprofit legal services organization that works on behalf of low- income immigrants and their families.

The Executive Order enunciates the principle that persons with limited English proficiency (LEP) must not be denied meaningful access to programs and services funded with federal dollars, and clarifies that federal agencies, as well as other recipients of federal funding, must take reasonable steps to ensure such access. We strongly support the Executive Order and the subsequent guidance issued by the Department of Justice, the Department of Health and Human Services Office for Civil Rights, and other Departments.

The principle that language barriers should not be used to deny individuals' access to federally funded services is firmly rooted in Title VI of the Civil Rights Act of 1964. The Executive Order does not impose any new obligations on federal fund recipients. Costs incurred by recipients in providing LEP persons access to federally funded programs and services should therefore not be viewed as costs of implementing the Executive Order. With respect to federal agencies, the Executive Order clarifies agencies' obligations under basic principles of civil rights law in effect for over 30 years. Any costs associated with fulfilling these obligations must be weighed against the benefits of providing access and the consequences of denying services, as well as the value of protecting individual civil rights.

While difficult to quantify, the failure to provide language assistance has real costs. Denying LEP individuals meaningful access to federally funded programs and services harms the public. Among other consequences, it undermines law enforcement efforts, threatens worker health and safety, slows disaster recovery efforts and frustrates public health campaigns.

Below we respond directly to questions and issues raised in the OMB's request for information.

· Determining how best to quantify the numbers of LEP individuals and which languages they speak.

The U.S. Census asks whether respondents speak a language other than English at home, which language is spoken, and how well the respondent speaks English. This data is available by state and region, and provides a uniform data source on LEP individuals available throughout the country. The Census Bureau's Supplementary Survey and American Community Survey provide additional information. However, legitimate concerns about the Census' recognized undercount of LEP households should be taken into consideration, and this data adjusted by demographers or other experts to correct for undercounting.

While universally available, Census data should be supplemented by reliable data which more clearly reflects the LEP population within a particular community. The Food Stamp Program regulations provide one model for the development of such local data. The regulations require state Food Stamp agencies to develop local estimates of the number of low-income LEP households by using census data (including the Census Bureau's Current Population Report: Population Estimates and Projections, Series P-25, No. 627) and their knowledge of the local communities. The regulations specify that Local Bureau of Census offices, Community Services Administration offices, community action agencies, planning agencies, migrant service organizations, and school officials may be important sources of information in developing these estimates. If the recommended information sources do not provide sufficient information for the State agency to determine whether there is a need for bilingual staff or interpreters, state eligibility offices are required to record their contacts with LEP households. 42 C.F.R. § 242.4(b)(6).

Proposed federal regulations also require states to develop a methodology for identifying the languages spoken by Medicaid managed care program enrollees and potential enrollees throughout the state. Proposed 42 C.F.R. § 4388.10(c), 66 Fed. Reg. 43613 (Aug 20, 2001). The process of developing these methodologies should prove useful in measuring the states' LEP populations.

· Understanding the number of different languages spoken by LEP individuals, and their geographic distribution.

See the response to the preceding question.

· Characterizing the interactions of LEP individuals with both federal and federally funded entities. For example, how frequently do LEP individuals interact with government at all levels? What types of government services do LEP individuals typically access? Are there types of services that LEP individuals access more or less frequently than non-LEP individuals?

LEP individuals interact with many federal agencies and recipients of federal funding, but the lack of data collection by agencies and recipients precludes an accurate assessment of those interactions.

Many government agencies and recipients of federal financial assistance currently fail to collect primary language data of individuals utilizing federal and federally-funded services. If collected, this data would provide concrete evidence of the types of services LEP individuals typically access, whether some services are used more or less frequently and what types of linguistic and cultural competency services should be implemented to assist in this access. For example, as suggested in the Office of Minority Health's National Standards on Culturally and Linguistically Appropriate Services (CLAS) in Health Care,⁽¹⁾ health care organizations should include a patient's race, ethnicity and spoken and written language in health records and the organization's management information systems. The routine collection of this data would provide accurate information for evaluations like those being undertaken here by OMB. However, it must be noted that language barriers prevent LEP individuals from accessing services. No amount of improvement in utilization data will capture information on LEP individuals who should benefit from a given program or service but never even try to do so because of an agency's or recipient's perceived or actual inability to communicate with them.

· Determining the costs and benefits of improving English language proficiency among LEP individuals.

While not directly related to the implementation of the Executive Order, increasing English language proficiency among LEP individuals would decrease their need for interpreter and translation services. Developing English skills also increases LEP individuals' productivity and economic status. A study by MassINC found that employed immigrants in Massachusetts who are fluent in English earn 33 percent more than immigrants with limited English speaking skills.⁽²⁾ A similar study in Los Angeles by the Economic Roundtable found that former welfare recipients who were English proficient earned a higher wage than former welfare recipients who did not speak English or who were LEP.⁽³⁾

LEP individuals recognize the benefits of learning English. Enrollment in adult English as a Second Language (ESL) classes has grown rapidly, and consistently exceeds the availability of such classes. In many communities, waiting lists for ESL classes extend to months or years.

· Understanding and quantifying the level of services provided by the government or government funded organizations to address the special needs of LEP individuals prior to Executive Order 13166 and to what extent changes will be necessary to achieve full compliance with Executive Order 13166 and related agency guidance.

As noted previously, Title VI has required recipients of federal funds to provide access to LEP individuals since Congress adopted it in 1964. The Executive Order and accompanying guidance restated and clarified recipients' pre-existing obligations rather than imposing new duties. This clarification may highlight the fact that some recipients need to provide additional language assistance services to comply with their Title VI obligations. However, the cost of such services should not be regarded as costs associated with the Executive Order.

In addition to Title VI, various laws and regulations in existence prior to the Executive Order require federal fund recipients to provide access to LEP persons. These include:

1. The Voting Rights Act, which bans English-only elections and prescribes other remedial devices to ensure nondiscrimination against language minorities, 42 U.S.C. §1973b(f)(1);

2. The Food Stamp Act of 1977, which requires states to provide written and oral language assistance to LEP persons under certain circumstances, 7 U.S.C. § 2020(e)(1) and (2)(A);

3. Judicial procedure laws that require the use of certified or otherwise qualified interpreters for LEP parties and witnesses, at the government's expense, in certain proceedings, 28 U.S.C. §1827(d)(1)(A);

4. The Older Americans Act, which requires state planning agencies to use outreach workers who are fluent in the languages of older LEP persons, where there is a substantial number of such persons in a planning area, 42 U.S.C. §3027(a)(20)(A);

5. The Substance Abuse and Mental Health Administration Reorganization Act, which requires services provided with funds under the statute to be bilingual if appropriate, 42 U.S.C. §290aa(d)(14);

6. The Disadvantaged Minority Health Improvement Act, which requires the Office of Minority Health (OMH) to enter into contracts to increase the access of LEP persons to health care by developing programs to provide bilingual or interpreter services, 42 U.S.C. §300u-6(b)(7);

7. The Equal Educational Opportunities Act of 1974, which requires educational agencies to take appropriate action to accommodate the language differences that impede equal participation by students in instructional programs, 20 U.S.C. §1703(f); and

8. Regulations issued by the Centers for Medicare & Medicaid Services (CMMS) which require that evaluations for the mentally ill and mentally retarded be adapted to the cultural background, language, ethnic origin and means of communication of the person being evaluated, 42 CFR 483.128(b).

A number of states and communities also have laws and ordinances that require language assistance. For example, California's Dymally-Alatorre Bilingual Services Act requires bi-lingual staffing and services at all state agencies when 5 percent or more of their customers speak a language other than English. The Act notes that "the effective maintenance and development of a free and democratic society depends on the right and ability of its citizens to communicate with their government and the right and ability of the government to communicate with them." Cal. Government Code § 7291. San Francisco and Oakland, California have enacted local ordinances that require key city departments to hire bilingual staff in public contact positions and to translate vital documents into the major languages spoken by LEP residents. Chapter 89, San Francisco Administrative Code; Chapter 2.30, Oakland Municipal Code.

Like the costs of complying with Title VI, the costs of providing language access under other state, federal and local laws should not be considered as costs of implementing the Executive Order.

· Quantifying and describing the costs to the Federal Government or recipients of federal funds of providing oral and written translation services.

As noted previously, the costs of providing oral and written translation services required to comply with Title VI are not costs associated with the implementation of the Executive Order. In developing its report to Congress, OMB should focus specifically on the costs directly related to the implementation of the Executive Order - the costs incurred by federal agencies in developing and implementing plans for LEP assistance.

Nonetheless, we cite several examples of cost-effective methods of providing interpretation and translation services. The costs of language access can be reduced by training bilingual staff to act as interpreters and translators, standardizing documents to reduce translation needs, and centralizing interpreter/translation services to achieve economies of scale.

The California Department of Motor Vehicles (DMV) has implemented a cost-effective approach to serving a large number of LEP persons. Approximately 17 percent of the persons served by the DMV are LEP. Yet the DMV spends less than .8 percent of its budget for translation and interpretation services. This efficiency is accomplished by using bilingual staff to translate documents and to serve LEP customers speaking the most common languages. Staff are supplemented by interpreters and translators as required. During its 1999-2000 fiscal year, DMV spent only $350,000 on interpreters and $126,000 for translation services. Bilingual staff served 8.5 million LEP customers and translated 93 documents into Spanish. Outside vendors provided interpretation for 5,792 customers and translated the 101 page California Drivers' Handbook into Chinese, Korean, Tagalog and Vietnamese. The Driver's License Examination was translated into 30 languages in addition to Spanish.

DMV's experience, as well as that of other California government entities, shows that the use of in-house translators can improve the efficiency, quality and consistency of written translation. Over 30 percent of the persons served by the California Department of Social Services (DSS) are LEP. DSS translates documents into four languages (Spanish, Chinese, Vietnamese and Russian) using in-house translation staff, and into 25 additional languages using contract translators on an as-needed basis. Translated documents include forms, regulations, hearing requests, hearing decisions and letters, and are used by a range of programs, including child abuse prevention, TANF, child support, foster care and legal proceedings. DSS currently provides approximately 29700 pages of translated documents. New documents are created and existing documents are revised by staff on an on-going basis. Johnny Oh, Chief of Language Services at DSS, reports that using in-house staff makes translation significantly more efficient by reducing the time required to complete a translation and provides consistency through the use of standardized terminology and forms.

Using in-house staff for language services is also cost effective. SEIU representatives report that their members frequently act as interpreters at minimal cost to their agencies. The California civil service system has a "Translator" classification with a base salary range of $32,568 to $39,800. Some agencies classify translators as "Staff Services Analysts," with a higher base salary of $30,000 to $46,800. In-house translators also perform additional duties. DSS translators spend 10 percent of their time performing duties such as certifying bilingual employees and interpreting on telephone calls. DMV translators have also performed work for other agencies.

· Quantifying and describing the benefits to LEP individuals and society as a result of having oral and written translation services available, in accordance with Executive Order 13166.

Oral and written translation services benefit LEP individuals and society by helping LEP persons access the government services that their taxes support. They also help the Internal Revenue Service collect those taxes.

Language assistance helps LEP individuals maximize their contributions to the economy by participating in job training programs and vocational education and receiving services, like childcare, that support employment. Providing translation and interpretation services helps agencies that serve LEP persons to operate efficiently, without the increased administrative costs that result from failed communication.

Interpretation and translation services enable LEP individuals to participate in workplace health and safety inspections, ensuring the safety of their workplace and the food and other products that they produce. Services speed disaster recovery efforts and make it possible to communicate severe weather warnings, evacuation and recall orders, and public health information. They also promote the public order by enabling LEP individuals to report crimes to law enforcement and to participate in investigations and trials.

In the health care context, language assistance results in better outcomes and has been shown to reduce costs. A study by the Boston Medical Center found that the use of trained medical interpreters actually reduced the cost of providing emergency room services to LEP patients. As compared to LEP patients who did not have translator assistance, LEP individuals assisted by trained medical interpreters at the emergency room (ER) were more likely to keep follow-up appointments at medical clinics and less likely to return to the ER within 30 days after their initial visit, resulting in lower treatment costs over the 30 day period.⁽⁴⁾

One of the most significant benefits is avoiding the cost of failing to provide access for LEP individuals. This cost, like that of other civil rights violations, is difficult to quantify but significant.

Worker Safety. Worker safety suffers when LEP individuals are unable to communicate with workplace health and safety inspectors. An investigation of the California Occupational Health and Safety Administration found that investigators often failed to interview LEP witnesses to workplace accidents because of language barriers. In many cases fines against employers were reduced or reversed because of the agency's poor investigative work. The same study found that employers of LEP workers were routinely violating their obligation to provide safety equipment and provided safety manuals and warning signs in English only.⁽⁵⁾

Law Enforcement. Law enforcement's inability to communicate with LEP victims and witnesses also has an adverse effect on safety and the public order. A three-year study by Ayuda, a Washington, D.C. based legal services organization, found that Spanish speaking domestic violence victims frequently had difficulty communicating with police officers. Two-thirds of respondents reported that police officers who arrived in response to complaints never attempted to communicate with them in Spanish, directly or through an interpreter, and over 30 percent of the respondents reported that the responding officers never spoke to them.⁽⁶⁾ San Francisco domestic violence victims testified before the city Board of Supervisors that language barriers frequently prevent crime victims from reporting crimes to the police. One Cantonese-speaking woman ran to the police station after her husband pointed a gun to her head. Because no translator was available, she was forced to repeat her story many times. The police took this to mean that she must have been lying. In Long Beach, California, a father witnessed his son's shooting by gang members in front of his home. The police arrived after a neighbor called 911, and arrested the father. The father was later released after bystanders explained the situation to the police. The adverse effect of such encounters colors LEP communities' overall view of law enforcement, undermining law enforcement's ability to control crime and protect public safety.

Language barriers do not only impede effective police work in direct contact settings. Crime investigation and prevention efforts are also hindered. The FBI's investigation of the September 11th attacks was delayed because the agency did not have enough agents fluent in Arabic, Farsi and Pashto. Emergency response systems are also compromised. A 1992 study by the United States Commission on Civil Rights included the story of a LEP rape victim who attempted to report her attack to the police by calling 911. Because of language barriers between the victim and the 911 operators, the operators hung up on the victim three times before she was able to report the crime.⁽⁷⁾

Health Care. In the health care context, communication barriers interfere with providers' ability to obtain information about symptoms, treatment and medical history, and make it more difficult for patients to understand treatment instructions. These barriers lead to increased diagnostic testing costs and other burdens on the health care system, as well as poorer outcomes for patients. In cases of communicable disease, such barriers are also public health threats. Community-wide public health efforts ranging from messages about HIV prevention to recalls of contaminated meats are also frustrated when they are not conducted in their audiences languages.

Patients' right to provide informed consent before undergoing medical procedures is undermined by a lack of language assistance. In a hearing before the California Personnel Board, a witness testified that a LEP woman from Guatemala had seen a doctor who gave her injections with no explanation. She abandoned her attempt to seek treatment. Another witness at the same hearing testified about a woman who was forced to wait 15 hours to be treated for a fractured leg at a hospital with no interpreter.

Social Services. The failure to provide language assistance can increase agency administrative costs. For example, communication problems can cause LEP individuals to lose public benefits to which they are entitled, requiring agencies to reinstate benefits, to process duplicative applications and to participate in avoidable appeals. Greater Boston Legal Services (GBLS) has represented numerous clients who experienced denials of language access by public benefit programs that were costly for the programs as well as harmful to the clients. One LEP client had her TANF and food stamp benefits terminated because she failed to respond to a notice requesting verification of wages from former employers. The client had attempted to ask her caseworker about the notice, but could not communicate with the English-speaking worker. With GBLS' assistance, the client's benefits were reinstated retroactively. Another LEP client had to reapply for TANF and food stamps after she failed to respond to an English notice requesting verification of information, requiring the agency to do a new eligibility determination. In some cases clients need to exercise their appeal rights in order to be reinstated. Pennsylvania advocates report the case of a man who had to appeal a claim for unemployment insurance benefits after he missed a deadline to submit evidence when he couldn't read an English notice.

Employment Supports. LEP individuals' ability to contribute to the economy by working is also diminished when they are denied language assistance in securing public services. The California Language Access Coalition has received reports of several cases where LEP individuals lost their drivers' licenses, and their jobs, because they were given driving tests in English. A Florida International University study found that Haitians in Dade County, Florida were underserved by job training and placement centers, in part because of a lack of case workers who spoke their language.⁽⁸⁾ Participants in focus groups conducted by San Francisco's Chinese for Affirmative Action cited the need for English skills as a major barrier to participation in vocation education, while participants in focus groups conducted by the Washington, D.C. based Southeast Asian Resource Action Center and Cambodian Association of Greater Philadelphia reported that individuals who have language assistance are able to participate in job training programs and find employment.

Special Education. LEP elementary school students in need of special education services are often denied services because their learning disabilities are perceived to be language barriers. In many cases, parents are aware that their children need special services, but language barriers prevent them from advocating with school officials. A Washington Post report states that there were more than 5,000 LEP students who had been waiting years for a special education placement when the current chief of the District of Columbia's special education program came into office.⁽⁹⁾

Language Brokering. Where trained interpreters are not provided, family members and others, including strangers, are often called upon to interpret for LEP individuals. This practice can seriously compromise the accuracy and confidentiality of the translation. One witness at a hearing before the California Personnel Board testified that a Cantonese man who had filed a wage claim against his employer was required to rely on his employer to translate during the hearing. A Mandarin speaking garment worker was also required to use her employer to translate her claim for unpaid wages and overtime.

Informal interpreters are often relied on in health care settings, where the accuracy of the translation can be impaired by the "interpreter's" unfamiliarity with specialized terminology and patients' reluctance to disclose sensitive information. Children are often called upon to translate for their parents. Parental reliance on children as translators disrupts family dynamics. In some cases, parents lose their authority and children lose respect for their parents.

Children who translate for LEP parents often feel pressured by the responsibility. Many miss school to translate for their parents, and may lack the required vocabulary. A Minneapolis 13-year old who struggled to interpret medical terminology for his mother when her newborn son died reports "My brother died and I don't know why. I feel bad. I feel frustrated because I don't know those words. I can't say them. I was disappointing her." A medical clinic serving the Hmong community found that patients were returning multiple times with conditions that should have been cured because their children were interpreting medical instructions incorrectly.⁽¹⁰⁾

Disaster Relief. Communication barriers hinder the effectiveness of disaster relief and recovery efforts. Following the September 11th attacks, the Federal Emergency Management Agency (FEMA) provided disaster relief information in English and Spanish only. This limitation slowed efforts to provide urgently needed relief to LEP individuals who spoke other languages, in particular many residents of New York's Chinatown, located near the World Trade Center site. The lack of multiple-language access also impairs officials' ability to prevent disaster through techniques such as severe weather warnings, evacuations, and public health campaigns.

· Identifying any existing studies of the costs and benefits of improving the quality of communications and interactions between LEP individuals and the federal government or federally funded services.

Language barriers often prevent LEP individuals from securing vital government services. A recent study surveyed California parents who requested an application for the state's Medicaid and SCHIP programs but did not complete it. LEP parents were more likely to find the application difficult to understand, not to complete the application, or to miss deadlines for submitting required documentation. Institute for Health Policy Studies, University of California, San Francisco, Barriers to Enrollment in Healthy Families and Medi-Cal: Differences by Language and Ethnicity, February 2001. As a result, their children were more likely to be uninsured and to experience the higher emergency services costs and poorer outcomes typical for uninsured children.

In many cases, the services being sought would support the LEP individual's economic self-sufficiency. A Florida State University study found that Spanish-speaking participants in WAGES, Florida's TANF program, had more difficulty obtaining subsidized child care prior to starting work than did English speakers. LEP participants also received less support in obtaining care - English speakers were twice as likely as LEP persons to have been offered a meeting with a child care counselor. Robert E. Crew, Jr. and Joe Eyerman, The Views of WAGES participants about Child Care in the WAGES Program, Florida State University (undated report based on surveys conducted during August-September 1998).

LEP individuals who receive TANF often experience barriers to effective participation in welfare-to-work programs. In addition to burdening LEP recipients, these barriers frustrate the purposes of the programs. In Boston, for example, legal advocates have filed a complaint against the Massachusetts Department of Transitional Assistance based upon LEP client reports that they are being denied equal access. Complaints include the Department's failure to provide interpreters, multi-lingual telephone access, and information about interpreter services in client languages. Almost none of Massachusetts' welfare to work programs are able to accommodate persons who do not speak English fluently. Structured job search programs and one stop career programs are unable to accommodate non-English speakers, yet LEP persons are required to participate in such programs to obtain time limit extensions, and are penalized when language barriers prevent their full participation. Not surprisingly, the Department's own study found that 17.6 percent of persons whose TANF cases were closed because they had exhausted the program time limit were LEP. Massachusetts Department of Transitional Assistance, After Time Limits: A Study of Households Leaving Welfare Between December 1998 and April 1999 (November 2000).

Several other studies show that LEP persons are less likely to make successful transitions from cash assistance than English speakers. A study of Los Angeles County, California persons leaving AFDC found that LEP 'welfare leavers' have lower earnings and less stable employment. Mark Drayse, Daniel Fleming, and Peter Force, The Economic Roundtable, The Cage of Poverty, September 2000. In Washington state, adults who remained on TANF were more likely than TANF leavers to live in a home where English was not the primary language. Jean Du, Debra Fogarty, Devin Hopps, and James Hu, Washington Department of Social and Health Services, A Study of Washington State TANF Leavers and TANF Recipients: Final Report, March 2000.

LEP individuals have more difficulty interacting with the Internal Revenue Service. An Urban Institute study found that low-income Spanish-speaking Latinos are less likely to know about the Earned Income Tax Credit than other low-income parents, including English-speaking Latinos. Katherine Ross Phillips, Who Knows About the Earned Income Tax Credit, The Urban Institute, January 2001.

· Identifying "real-world" case studies that illustrate the costs and benefits of providing translation services to LEP individuals, as envisioned by Executive Order 13166, and related agency guidance; i.e. examples from multiple perspectives, including LEP individuals, federal agencies/recipients of federal funds, and the international context.

Our responses to the preceding questions include a number of "real-world" examples that illustrate the harm done to LEP individuals when language assistance is denied. Additional examples follow:

Law Enforcement. In Los Angeles, police officers picked up an elderly Korean man who was lost and could not explain where he lived. He was robbed and beaten after the police dropped him off far from home in the middle of the night. He died soon afterward.

In Washington, a police officer responding to a domestic violence call shot and killed an unarmed 24-year-old man when he reached into his waistband after being ordered in English to keep his hands up.

A female juvenile had to stay in a San Francisco Bay Area correctional facility after the charges against her were dropped because her Spanish-speaking mother did not understand the release papers.

Social Services. In Orange County, Calif., a Japanese single mother who speaks very little English was jailed for child abuse and neglect when neighbors called the police after hearing her child scream. Because she could not explain to the police that her 7-year-old child regularly has tantrums and that she chooses to ignore them until she calms down, the Child Protection Agency intervened without an interpreter, took the child away and had the mother jailed.

In Los Angeles, a Cantonese-speaking woman in her forties was admitted to a community health center for treatment for mental illness. The health center discovered that one year earlier, her five children were taken away from her by the county Department of Child and Family Services (DCFS). The DCFS had made no efforts to provide her with information in Cantonese, and she still did not understand why her children had been taken or where they had been placed.

Special Education. A Spanish-speaking mother in Virginia advocated for three years before obtaining a special education evaluation and placement for her son. An auditory and visual processing problem interfered with the boy's ability to read, but his difficulties were attributed to language barriers.

A Washington, D.C. girl was diagnosed with learning disabilities at age 11 but had not been placed in special education by the time she reached her high school graduation. A community organization that advocated on her behalf was told that the special education classes were full. Her Vietnamese-speaking parents were often not provided translators in meetings with school officials and did not understand the girl's situation.

Transportation. A Mandarin-speaking California woman was stopped by a police officer. The officer believed, incorrectly, that it was illegal for people with limited English skills to drive, and required the woman to re-take her driver's examination. The DMV assigned her to a non-Mandarin speaking tester and she failed the examination. Her license was revoked. The woman, who is her family's only wage-earner, was unable to get to her job on public transportation and was out of work for several months. She was re-assigned to a Mandarin-speaking tester after advocacy by a community organization, and passed the test.

Health. In Los Angeles, an elderly and depressed Spanish speaking man who refused to eat was improperly placed in a psychiatric ward until a hospital translator found him. His family had been searching for him along highways throughout the region.

In Ohio, a 72-year-old Chinese immigrant was rushed to a hospital emergency room after a truck struck him while he was riding his bicycle. He felt pain in his knee, but he could not describe his symptoms until his son-in-law arrived 30 minutes later. He compared his experience to being deaf and mute, while having no choice but to hope that the nurses and doctors were doing the right thing.

A 72-year-old Spanish-speaking woman endured pain throughout her two-week stay in a Maine hospital because she was unable to ask for medication in English. On one occasion, she called in Spanish for help going to the bathroom, but no one understood or assisted her. After 20 minutes passed, she attempted to get up and go by herself, but fell and lay on the floor for 20 additional minutes calling the nurses in Spanish.

A Spanish-speaking California house painter signed papers that he did not fully understand, making him liable for his father's $13,000 medical bills. He later discovered that his father had been eligible for state-funded health benefits.

Public Benefits. A 61-year-old Cantonese-speaking woman who worked at a bakery in Oakland, California developed adhesive capsulitis (frozen shoulder), a condition that limited her ability to work and made her eligible for state disability insurance (SDI). The woman initially qualified for SDI but the State subsequently ordered her to be evaluated by a state-contracted doctor. Because the woman speaks limited English and no one could accompany her to the appointment, her son wrote out her symptoms. The doctor, however, refused to conduct the evaluation. When a community agency contacted the state agency, it was told that claimants are responsible for bringing their own interpreters.

According to a survey of 724 public benefit recipients in Brooklyn and Queens, NY conducted by Make the Road by Walking, a Brooklyn-based non-profit organization, 65 percent of the Spanish-speaking respondents had problems communicating with their case workers.

· Identifying existing academic research and "real-world" case studies from the following sectors: health, social services/income maintenance, education, transportation, law enforcement and trade, as well as recommendations of additional sectors or perspectives from which to address this issue.

See the studies and examples cited above. These examples highlight only a few of obstacles that LEP individuals face in exercising their right to communicate with their government.

We hope that the above comments are helpful to OMB in preparing its report to Congress. Thank you for the opportunity to provide this input. We look forward to a continued and cooperative relationship with federal agencies as we work together to ensure equal rights for LEP persons.

Yours truly,

Susan Drake
Executive Director
National Immigration Law Center

Asian and Pacific Islander American Health Forum
Asian Pacific American Legal Center
Bay Area Legal Aid
Center for Battered Women's Legal Services at Sanctuary for Families
Chinese for Affirmative Action
Council of Senior Centers and Services of New York City, Inc.
Florida Legal Services
Food Research and Action Center
Illinois Coalition for Immigrant and Refugee Rights
Immigrant Workers Rights Project, New Jersey ACLU
Law Center for Families
Massachusetts Immigrant and Refugee Advocacy Coalition
National Center on Poverty Law
National Council of La Raza
National Health Law Program
National Senior Citizens Law Center
New Jersey Immigration Policy Network
New York Immigration Coalition
NOW Legal Defense and Education Fund
Service Employees International Union (SEIU) AFL-CIO
Services Immigrant Rights, and Education Network (SIREN)
Washington Alliance for Immigrant and Refugee Justice
Western Center on Law and Poverty

Notes

1. 65 Fed. Reg. 80,865, Standard 10.

2. MassINC, The Changing Workforce: Immigrants and the New Economy in Massachusetts (November 1999).

3. Mark Drayse, Daniel Flaming, and Peter Force, The Cage of Poverty, The Economic Roundtable (September 2000).

4. Josh Bernstein, et. al., The Use of Trained Medical Interpreters Affects Emergency Department Services, Reduces Charges and Improves Follow-Up, Boston Medical Center.

5. "Assemblyman Seeks Reform of Cal-OSHA Accident Probes," Orange County Register (October 23, 2001).

6. Unpublished manuscript available from the NOW Legal Defense and Education Fund.

7. Racial and Ethnic Tensions in American Communities: Poverty, Inequality, and Discrimination, 1 U.S. Comm'n on Civ. Rts. 41 (1993).

8. Relationship Between the Haitian-American Community and the Miami-Dade Welfare System, Florida International University (Sep. 2001), available at www.fla-spp.com/frresearch.htm.

9. "Missed Messages: Language Barrier Keeps Some from Getting Needed Special Ed," Washington Post (June 12, 2001).

10. "Immigrant Parents Depend on Children's Words," Minneapolis Star Tribune (Sept. 29, 2000).

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