Systemic Barriers to Spanish-English Medical Interpretation in Georgia Hospitals: Impacts on Equity, Safety, and Quality of Care

Language access to health care is legally mandated and essential for equitable, high-quality, safe care. With more than 25 million people in the U.S. considered Limited English Proficient (LEP)—two-thirds of whom are Spanish speakers—interpretation services are crucial (Haldar, Pillai, & Artiga, 2023; MACPAC, 2024). Yet hospitals often prioritize less expensive virtual options over in-person services (Jacobs, Shepard, Suaya, & Stone, 2004). This research examines how system-level decisions influence Spanish-English interpretation in hospitals. Based on surveys of 20 interpreters, five providers, and interviews with four Georgia hospital systems (referred to as Health Systems 1–4), it reports staffing shortages, a lack of cultural competency training, and workflow integration problems. Interpreters are frequently excluded from urgent care due to budget and scheduling barriers. Overreliance on virtual platforms negatively affects communication, particularly in high-stakes situations. Without stronger enforcement, investment, and policy change, Spanish-speaking patients will continue to face care gaps. Hospitals must prioritize interpretation at every step of care, not treat it as a checkbox.