Check out how they actually scored each language based on data to arrive at the final selection:

Now, let's talk opposition.

From intention to the passing of the final bill, SB 698 was a collaborative effort between many stakeholders.

In order to maintain the integrity of the bill’s mission, the team had to fight for the intended impacts of the bill that were most essential to its success in expanding protections for the LEP population in Oregon.

Building on the work done in California and New York City, SB 698 (Oregon's bill) had a set of “intentions” that were identified as core to the bill’s efficacy.

Here, we’ll summarize the seven intentions, salient opposition points made by leaders in the pharmacy industry, and the results of our discussion leading to the final content of the bill:

Intention 1: All pharmacies will be required to comply, regardless of size or ownership.

OPPOSITION: It’s expensive and overly difficult for independent pharmacies to upgrade their software. New York City’s legislation only applies to chain pharmacies.

DISCUSSION: The team shared concern that including independent pharmacies might make the bill difficult to pass. However, after conversation with the Board of Pharmacy, they agreed that “If it is the right thing to do for one pharmacy, it is the right thing to do for all pharmacies”.

FINAL: All pharmacies except institutional drug outlets are required to comply.

Intention 2: Labels will be bilingual, with English and the patient’s primary language (“dual-language labels”).

OPPOSITION: California and New York City laws do not require dual-language label translation. There may be a need to update existing software to translate and print bilingual labels. Having dual labeling will take up more space on the container label and make it difficult to fit necessary instructions, further, it may impact the font size and the label’s readability.

DISCUSSION: Health providers, caregivers, and EMTs advocate for dual labels for safety. It may be necessary to read a patient’s medications to help with patient education or in an emergency situation where a care provider needs to know what medications a patient is taking. The technology for creating and printing dual-language labels already exists.

FINAL: Dual-language labels required (first in the nation to achieve this aim!).

Intention 3: Medication instructions need to be on the container label itself, not on supplemental inserts.

OPPOSITION: Translated supplemental inserts (separate printed pages with translated instructions given to the patient along with medications) will suffice and serve the same aim.

DISCUSSION: Relying on supplemental inserts is an unsafe practice for all patients and exceedingly unsafe for LEP patients. Many patients manage multiple medications and it’s all too easy to mismatch supplemental inserts and accidentally follow the wrong directions for a medication as a result. Label solutions such as pull-out tabs or bigger bottles exist already and can be utilized for longer instructions. The intention of this bill at its heart is that “if it can appear on the label in English, then it needs to appear on the bottle in the translated language.”

FINAL: Pharmacists must dispense medication bearing a container label with all instructions in both English and in the language requested and, if authorized by the board by rule, include an information insert in both English and the language requested.

Intention 4: Labels will be translated for anyone who is LEP, regardless of the language they speak.

OPPOSITION: It’s more expensive and complicated to allow for a greater number of languages to serve just a small percentage of the population. Independent pharmacies already operate with sensitive margins and this type of software update or subscription could impose undue financial burden significant enough to make them extinct.

DISCUSSION: The team intended to include all languages, but determined that this would be perceived to be prohibitive. We acknowledge that many pharmacies will have expenses in updating software and that there is significant heterogeneity in the practices of various pharmacies regarding translation and interpretation services. Currently, some pharmacies do not offer translated labels in any languages, while others have translation software but are challenged to provide dual-language labels. Reminder: this law will prevent medical errors and resulting hospitalizations, a huge cost savings. However, these cost savings are not passed on to pharmacies. This means that pharmacies must be reminded that this is an integral part of their professional Code of Ethics. Our research shows that the average cost of the software vendors is around $70/month. In order to pass the bill, a compromise to include a mandate of 14 languages was reached, so as to make the mandate less burdensome on pharmacies needing to upgrade or replace software. Rule-making involved bill sponsors in the Oregon legislature and language access experts at Oregon Health Authority (OHA). The selection of the 14 languages was based on analysis of three quality data sets, employing weights for both equality (i.e. the most common languages spoken in the state) and equity (i.e. languages spoken by those in the community with the greatest need, such as refugees). Find out more about the language selection process above on this page.

FINAL: Pharmacies must provide label translation into at least 14 languages other than English spoken in Oregon by LEP individuals. New York City’s law mandates at least seven languages and California’s five.

Intention 5: Pharmacist is required to identify and document patient’s preferred language if not done by prescriber already.

OPPOSITION: Pharmacists are neither trained to nor comfortable with identifying patients’ languages.

DISCUSSION: The burden of requesting a translated label should not rest on the patient. Further, pharmacy industry standards already require documentation of a patient’s primary language.

FINAL: A patient, prescriber, or patient representative can request dual-language labels. In keeping with federal law, visible signage must be posted notifying patients of the availability of translated labels and of interpretation services. The Board of Pharmacy will adopt rules to support pharmacy compliance with this requirement.

Intention 6: Liability for translation accuracy will lie with the third party translation service.

OPPOSITION: No direct opposition, but pharmacy representatives still expressed concern that there would be significant risk exposure for pharmacies to lawsuits over accuracy of translation. Further, concern regarding

DISCUSSION: We had suggested the word “certified” be added to the “third-party for the translation of the labels” but the legislative attorney felt this was unnecessary as any third-party supplier of translations would be certified.

FINAL: Pharmacies may contract with a third party for translation of labels and information inserts. Liability for translation accuracy will lie with the third party translation service, and a pharmacy, pharmacist, or pharmacy intern that dispenses a prescription drug in compliance with the requirements of the law may not be held liable for injuries resulting from the actions of a third party.

Intention 7: The bill will go into effect in 2020.

OPPOSITION: Pharmacies will not have enough time to implement these changes by 2020.

DISCUSSION: A compromise on timeline to implementation was achieved in interest of passing the bill.

FINAL: The law will go into effect in January 2021

Where did we get the content for the opposition statements?

They came from real letters of opposition! From the National Association of Chain Drug Stores and the Oregon Pharmacy Coalition.

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