Limited English Proficiency (LEP) Patients: Frequently Asked Questions

Debra Kane Hill, MBA, RN, Senior Patient Safety Risk Manager, and Richard F. Cahill, JD, Vice President and Associate General Counsel, The Doctors Company

The Doctors Company frequently receives member inquiries about interpreter requirements for patients who are limited in their ability to speak or understand English, or “limited English proficiency (LEP)” patients. To help you understand LEP requirements, we have compiled a list of frequently asked questions with strategies to ensure compliance.


As defined by the United States government, LEP patients are individuals who do not speak English as their primary language and who have a limited ability to read, speak, write, or understand English. These individuals may be entitled to language assistance with respect to a particular type of service, benefit, or encounter. Federal laws applicable to LEP individuals include Title VI of the Civil Rights Act of 1964 and Executive Order 13166.

The U.S. Census Bureau recently reported that more than 350 languages are spoken in the United States, with 67.8 million people (nearly one in five of the current population) speaking a language other than English at home. After English, the most common languages are Spanish, Chinese, Tagalog (Filipino), Vietnamese, and Arabic.

The country’s increasing linguistic diversity presents communication challenges for healthcare practitioners who encounter LEP patients. With nearly 20 percent of the population communicating primarily in a language other than English, it is likely that practitioners will encounter patients speaking at least one foreign language. When patients are unable to interact productively with their practitioners, it affects access to care, limits compliance with treatment plans, and prevents optimum outcomes.

Frequently Asked Questions

Additional Compliance Strategies

It is important for all healthcare practitioners to be familiar with their obligations in managing LEP patients and how they can assist non-English-speaking patients in the office setting. Ensure that all staff members are trained in handling phone calls and inquiries with LEP patients. Failure to provide interpreter services can create access-to-care barriers. Healthcare practitioners can be held accountable for noncompliance and any resulting patient harm.

The following strategies can help to prepare your practice:

  • Develop policies and procedures for managing LEP patients. Periodically evaluate staff compliance and review policies and procedures to conform to HHS standards. Audit policies periodically, and amend the content as evolving circumstances may warrant. See HHS: Example of a Policy and Procedure for Providing Meaningful Communication with Persons with Limited English Proficiency.
  • Orient new employees to the practice’s LEP policy and procedure. Provide ongoing education to all staff as a periodic refresher.
  • Use a “mystery caller” approach to assess staff response to LEP patients.
  • Review patient documents, including questionnaires, educational materials, and other forms for ease of understanding. Make written documents available in the most common languages spoken by patients in the practice. Translated materials may be available from healthcare systems, professional societies, or specialty associations upon request.
  • Create a list of preferred certified medical interpreters available in your community or online. Your local hospital may assist with finding and recommending reliable resources. The General Services Administration’s List of Language Service Providers may be helpful.

For related content, see our article “Americans with Disabilities Act: Frequently Asked Questions.” For additional assistance, contact the Department of Patient Safety and Risk Management at (800) 421-2368 or by email


Agency for Healthcare Research and Quality, Improving Patient Safety Systems for Patients with Limited English Proficiency.

The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

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