• Immigrant Healthcare Access

    Immigration status, language barriers, cultural differences, and financial circumstances can all combine to limit access to both the healthcare and the legal system. This article highlights these various obstacles that are often unique to immigrant patients, and also offers insight into legal solutions that can help calm fears and raise confidence for immigrant patients in need of assistance.

    Legal Protections for Immigrants

    As a result of a patient’s immigration status, they may not seek the healthcare they need after trauma, unless their situation is dire.If an immigrant patient is involved in a motor vehicle crash or a work-related injury, they should have at least basic knowledge of their rights. Even then, a patient may not risk contacting an attorney, who could help explain that these legal rights free of charge.

    In fact, Washington State has adopted legal standards that do offer protection to immigrant patients. For example, in 2018, the Washington State Supreme Court adopted Evidence Rule 413 (ER 413)[1].

    The rule strictly limits the use of someone’s immigration status as evidence in a legal case. This rule applies to attorneys and courts in both civil and criminal cases, and was the first of its kind in the United States. The rule generally does not allow any questions or evidence about a person’s immigration status as part of a case, because this information usually has nothing to do with the facts that led to a traumatic injury. For example, if a driver runs through a red light and injures the immigrant occupants of another vehicle, then the immigration status of the injured occupants is not legally relevant in any resulting civil or criminal case. The important evidence is that the negligent driver ran the traffic signal and injured others. If the issue of the injured person’s immigration status were to come up during a court case, that person’s attorney has the power and responsibility to limit, or outright eliminate the immigration issue from the case.

    Another legal protection for immigrants is a court rule having to do with the participation of jurors in trials. The Washington State Supreme Court adopted this rule in 2018, and it is called “General Rule 37”. This is how it works: if one attorney thinks an opposing attorney is trying to prevent a potential juror from serving on the jury because of that juror’s race or ethnicity, the judge in charge of the case gets to step in and ask more specific and probing questions than ever before about why the potential juror was struck. There are legitimate reasons why that juror might be excused. But, if the judge thinks that the juror was excused primarily because of their race or ethnicity, the judge can put the juror back with other potential jurors who may be picked to hear the case. This type of rule helps immigrant patients gain better access to the legal system because it helps ensure their cases are heard by jurors that have backgrounds more like the patients themselves.

    Overcoming Language Barriers

    There are many ways for patients and providers to communicate with one another despite speaking, reading, or writing in different languages. What is most critical is that patients, or those who support patients, ask for assistance in communicating. When it comes to something as important as exchanging healthcare information, it is critical that both the provider and the patient understand one another. In many instances, larger medical facilities have a formal procedure to assist with translation needs, and have dedicated resources on-site that have been vetted, such as interpreters. This is often true in a hospital setting, where using friends or family members to interpret can be discouraged because communications must be as accurate as possible in order for proper treatment to take place.

    The same standards hold true for patients and providers in non-hospital settings. However, smaller clinical settings may require other solutions. For healthcare providers with fewer staff members and more limited budgets, translation software on smart phones, tablets, and computers can provide relatively easy ways for providers and patients to understand one another. A provider or one of their staff may also be fluent in the immigrant patient’s native language. In other situations, the patient may have trusted friends or even co-workers that will volunteer to serve as an interpreter during healthcare visits.

    Courts in Washington State also have their own requirements when it comes to immigrants who are not comfortable using English as their preferred language. If someone is from a non-English-speaking cultural background, or if they have trouble understanding or communicating in English, then they will have access to a qualified interpreter in both civil and criminal cases.[2]

    Confidentiality When Talking to an Attorney

    Communications between an attorney and a client or even a potential client are protected as confidential, the same way that it applies in the doctor-patient relationship. This means that as soon as a patient speaks with an attorney about his/her legal situation, including immigration status, that attorney is legally and ethically responsible to keep all communications private and confidential. This allows for the open sharing of information and providing counsel on a person’s legal rights and remedies. It also places the patient’s attorney on alert to be watchful for immigration or language issues if they should come up.

    Financial Concerns: Insurance as Protection

    We regularly learn about situations in which immigrant patients cannot pay for healthcare after a traumatic injury, even if the injury was caused by someone else. The patient is then unable to work, or they must live and work with constant pain and discomfort. Often, the immigrant patient will prioritize earning a living over their own healthcare needs.

    Patients earning a modest wage will be unable to pay for health care costs out-of-pocket, as they may already be forced to be cost-conscious due to the cost of living. But, for $25-$50 per month, they can have multiple coverages rolled into one policy including liability, collision, uninsured, and Personal Injury Protection (PIP). PIP provides mandatory minimum protection of $10,000.00 in medical expenses for each person in the car at the time of a motor vehicle collision. These coverages are required of all vehicle owners in Washington state, regardless of immigration status.

    If the patient has neither PIP coverage nor health insurance, it will be challenging for the patient to receive needed treatment to recover from their injuries. Cash payments may not be possible beyond a very limited timeframe. Also, without receiving care, the patient will have a significantly diminished legal claim, if any at all. That is why it is so important that immigrant patients be informed about the insurance choices they can make to protect themselves. In our experience, many decide to invest in PIP insurance after learning how little it can cost and how much benefit it can provide.

    Final Word

    Washington State has effective ways to protect the rights of non-native-born patients/clients, and it is critical that patients are informed of their rights. Our office makes it a priority to share this information whenever possible so that immigrant patients can gain access to our legal and healthcare systems.

    If you or your staff ever have questions about how any of these topics impact a patient’s care or case, don’t hesitate to contact us. In the meantime, feel free to have a look at the answers to many frequently asked legal questions by our non-English-speaking clients here: https://bit.ly/clientFAQ. These answers are also available in Spanish here: https://bit.ly/AGPreguntas.


    [1] Microsoft Word – GA_ER_04_13_00.doc (wa.gov). Rules of evidence provide some of the guidelines and limits which attorneys must abide by in a court case.

    [2] RCW 2.43.010: Legislative intent. (wa.gov)


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