A new audit from State Comptroller Thomas P. DiNapoli reveals that New York City Health + Hospitals is not fully meeting its obligation to provide interpretation services to patients who need language assistance, a basic right under state regulations.
H+H operates the largest municipal health care system in the country, serving patients across 11 acute care hospitals, five post-acute and long-term care centers and 30 community health centers.
“The Health and Hospitals Corporation has a tall order given the diversity of languages spoken in New York City, but it needs to do better,” DiNapoli said.
In Fiscal Year 2024, it reported more than 2.6 million requests for interpretation services, double the amount from five years ago, resulting in 35.6 million minutes of language assistance across 255 languages and dialects. Despite those numbers, the audit found major gaps between reported service levels and actual accessibility.
Phone Calls Expose Barriers
Auditors placed 55 calls in Spanish, Chinese, Russian, Hindi, Haitian Creole and Tagalog to six H+H facilities. Only 12 calls successfully reached an interpreter. In 43 cases, callers encountered barriers, including 16 failed attempts to connect to an interpreter. Some staff hung up on the auditors and even when interpreters were reached, staff interrupted the conversation or refused to share basic information.
The automated call system also posed challenges: 16 calls were difficult to navigate and 11 were disconnected. The general line loops through nine language options with an “other” category that auditors found unusable and without any voicemail option.
H+H requested documentation of the calls but declined to address the issues, saying it could not verify them without the names of specific staff members.
Interpretation Services Lacking in the Field
When staff cannot identify a patient’s language, they are expected to call an interpretation vendor’s help line for a live operator. A test call made alongside H+H officials failed to connect.
Mobile health vans also fared poorly. At the Lower East Side mobile unit, signage listed Chinese as available, but only English and Spanish were offered. On a separate visit, staff attempted to communicate using Google Translate in Tagalog, which led to inaccuracies. The Bedford-Stuyvesant location had no bilingual staff and none of the mobile units had access to phone or video interpretation services.
Missing Assessments and Incomplete Training Records
The audit found that H+H failed to conduct required annual assessments of language needs from 2019 through 2024. Those assessments are intended to help determine the demographics and language demands of surrounding communities.
H+H policy requires annual staff training on language services, yet records for Harlem and Woodhull hospitals were not provided. Bellevue reported over 4,000 training sessions but roughly 13% were incomplete.
In-House Interpreter Lists Not Maintained
H+H employs bilingual staff who can interpret for patients, but auditors found that Bellevue and Woodhull hospitals had no accurate count or list of trained interpreters. Harlem Hospital reported keeping an updated list twice a year but did not provide a copy. In cases where bilingual staff did interpret, those services were not recorded, contributing to broader issues around record keeping.
Vendor Data Errors and $215K in Overpayments
Vendors contracted to provide interpretation services must submit monthly reports, yet auditors found errors, missing data, and discrepancies in the reports they sampled. In several cases, H+H could not explain the gaps. One major vendor, responsible for 73% of phone-based language assistance in the first half of 2024, reported zero service failures over nearly three years, which auditors found implausible.
Weak data oversight resulted in H+H overpaying vendors by $215,879, according to the audit.
Recommendations
The comptroller’s office issued nine recommendations, including the need to:
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Record and review all language service requests with full accuracy.
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Conduct annual assessments of language needs and ensure all staff complete required trainings.
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Maintain updated lists of bilingual and interpreter-qualified staff across all facilities.
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Improve access and navigation for language service phone lines and mobile health units.
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Ensure all facilities develop or update language access policies to meet H+H standards.
H+H generally disagreed with the audit findings.
“Language access is an essential component of NYC Health + Hospitals’ mission to deliver high quality health care services to all patients," a spokesperson for the hospital system said in a statement. "While we disagree with the comptrollers findings, we remain committed to advancing health equity through a robust language access infrastructure to support New York City’s diverse populations.”
