Lost in Translation: Audit Finds Language Barriers at City Health Facilities & During Restaurant Inspections

The audit discovered “numerous deficiencies” in how the Health Department provided interpretation services to New Yorkers with limited English proficiency at its facilities, and when staff conducted health inspections at restaurants.

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In 2024, a group of 18 bilingual auditors contacted the New York City Department of Health and Mental Hygiene (DOHMH) to experience firsthand the challenges that people with limited English proficiency face when trying to access information or services in their own language.

The results, published in a New York State Comptroller audit released Wednesday, are not very reassuring: in 66 percent of their attempts to reach the agency, auditors faced hurdles, like not being connected to an interpreter or their calls getting dropped after selecting the Spanish-language option.

“Health care that people can understand—in their own language—is fundamental and life-saving. For immigrant New Yorkers facing aggressive federal enforcement and budget cuts to the healthcare they need, this right has never been more urgent,” said Vlad Tlali, senior policy strategist at the New York Immigration Coalition, in response to the findings.

The audit discovered “numerous deficiencies” in how DOHMH provided interpretation services to New Yorkers with limited English proficiency when they visited the agency’s facilities, or when health inspectors visited businesses in the city between 2019 and 2024. 

The department must comply with federal, state, and local laws to ensure meaningful access for individuals with limited English proficiency (LEP). One of the most comprehensive mandates, Local Law 30 of 2017, requires the translation of key documents into the top 10 designated city-wide languages. In addition, city agencies are required under Local Law 73 to provide free telephonic interpretation, multilingual signage, and document translation.

The audit identified several key concerns, including the absence of a centralized system for tracking language services requests and discrepancies between the number of LEP patients recorded and the number of patients receiving language services at the Health Department’s tuberculosis chest centers and sexual health clinics. 

DOHMH was also “unaware” of how often calls for interpreters are dropped or instances “where an interpreter cannot be found for over-the-phone interpretation or video-remote interpretation,” the report says.

When it comes to Health Department inspections of restaurants, the auditors found that 40 percent of the business owners their office surveyed didn’t know they had the right to ask for an interpreter during the process.

“The Comptroller’s audit confirms what our communities have experienced for years: significant gaps at clinics between language needs and services offered, lack of services tracking, limited availability of certified multilingual staff, and programs that completely lack language access services,” said Tlali. 

When asked about the audit, a Health Department spokesperson said the agency has already made a number of changes and is “always looking for opportunities for improvement.”

The audit examined language access services from 2019 to 2024, which includes the COVID-19 pandemic, when many city services faced disruption and setbacks, officials said. The period also saw hundreds of thousands of new immigrants who arrived in the city starting in the spring of 2022, many of whom sought out city shelters and other programs.

“While we largely agree with the audit’s findings, it is not a reflection of the department’s delivery of language access services as they stand today,” a DOHMH spokesperson said in a statement. 

Of the seven recommendations made by the comptroller, “nearly half are complete and the remainder are underway,” the spokesperson added. That includes a new electronic medical record system currently in the works, which is expected to run at all DOHMH public health clinics by the end of the year.The new system is already in place at the city’s tuberculosis chest centers.

The Health Department has implemented weekly reports on language preferences and requests to address issues promptly, officials said. And by the end of this year, its sexual health clinics will be required to collect language preference information from patients who seek out language services. In addition, multilingual posters were displayed at DOHMH clinics to explain how patients can provide feedback, as well as how to file a complaint.

“The Health Department’s goal is to provide meaningful and equitable access to important services and resources that keep New Yorkers healthy, including New Yorkers with limited English proficiency. We continue to strive to meet that goal every single day,” a spokesperson added.

The City Council, meanwhile, funds a citywide initiative called “Access Health NYC” that funds community-based organizations to provide healthcare education, outreach, and assistance to immigrants and LEP residents.

Those organizations include the Coalition for Asian American Children and Families, based in lower Manhattan, which is calling for a $4.5 million increase for the program in this year’s budget deal. 

“New York City’s nonprofit sector sees firsthand how our [community-based organizations] are the first place immigrant and LEP New Yorkers turn to when they need help assessing healthcare services—including translation and interpretation,” Anita Gundanna and Vanessa Leung, CACF’s co-executive directors, said in a joint statement. “Language access is not a privilege or a perk—it is the key to a truly equitable public health system.”

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