Alexis Wills had a job she loved. In January, the recent UW-Madison graduate started working for Family Service Madison, a respected, century-old nonprofit that provides behavioral health therapy services and assists other nonprofit organizations.
In the role of bilingual service coordinator for an early intervention program, Wills helped Spanish-speaking families whose children have developmental delays access therapy and other services.
“I loved going to work, and I went above and beyond in my job,” Wills says.
But she believes going above and beyond got her fired.
On May 20, Wills received a termination letter stating that her conduct had damaged Family Service Madison’s “professional business image in the community” and led to the “unanimous decision” to let her go.
In April, the Spanish-speaking mother of a child on Wills’ caseload told her she needed help making an appointment for her older child at Madison Orthodontic Centers, one of the only Medicaid providers in the area.
Wills contacted the orthodontist’s office and explained the family would need an interpreter.
According to an email from the orthodontist, Dr. Thomas Kuhn, “Alex told my receptionist it was mandatory to provide a translator and unlawful not to do so. My receptionist kept passing the information to me. I was not concerned. I speak a little Spanish. Also, translation can be provided quite easily on the internet. Plus, other Spanish-speaking people are usually available in our office.”
But after phone calls from Wills insisting that a trained interpreter, familiar with medical terminology, be there became “more frequent” and “increasingly hostile,” in Kuhn’s words, the orthodontist sent an email complaint to Russell King, president and CEO of Family Service Madison.
Two days later, Wills was fired.
She says it was the first and last complaint she received in her five months on the job.
After coaxing from mentors, Wills sought out the Workers’ Rights Center in the hopes that they could help her get her job back. But attempts to resolve the matter informally deteriorated after King canceled a June 16 meeting with Wills and a third-party mediator, Salvador Carranza, a member of Voces de la Frontera.
Carranza says the broader issue is the difficulty Latinos often face in accessing services to which they’re entitled.
Title VI of the 1964 Civil Rights Act prohibits providers who receive federal funding like Medicaid from discriminating on the basis of national origin, which has been interpreted to include limiting “meaningful access” to services for those with limited English proficiency (LEP). An executive order signed by President Bill Clinton in 2000 clarified the law and mandated that federal agencies develop additional LEP guidelines for funding recipients.
Those guidelines allow hospitals, doctors and dentists some flexibility in exactly how they make interpretation services available — whether by video-stream or in person, for example — and in whether they must translate written documents. But in Carranza’s view, relying on the internet for translation or asking untrained staff to interpret falls short of the “meaningful access” standard.
“Interpretation is totally different than translation,” Carranza says. “Health is a very complex language that needs to be interpreted properly. That’s why you need an interpreter that has the expertise in health terminology. That’s the bottom line.”
Latinos aren’t the only, or even the largest, demographic in Madison to whom federal LEP requirements apply. According to the U.S. Census Bureau’s American Community Survey for 2010 to 2014, nearly 6% of the city’s total population — more than 13,000 people — have limited proficiency in English.
LEP households, defined as those in which no one over age 14 speaks English “very well,” account for 3.5% of all households.
In Madison, 24% of LEP households are Spanish-speaking, while 32% speak Asian and Pacific Island languages, with Chinese and Hmong accounting for the largest subgroups.
“We have a lot of Hmong speakers who need interpretation services, and we have more and more families coming from other countries to the area,” Carranza says. “This issue is not going away.”
A former civil rights compliance officer for a state agency in Wisconsin, who asked not to be identified, explains that the obligation to provide certain language services, such as translation of vital documents, depends on the concentration of LEP individuals within a service delivery area and on how critical the service is.
“One thing is a must: a doctor [who accepts federal funding] cannot refuse to hook up an interpreter to determine exactly what the need is. That provider needs to be able to assess what is the need and be able to provide access to the services.”
Although undocumented immigrants are covered by federal LEP requirements, many are reluctant to come forward with formal complaints in an era of increased deportations.
In such cases, they often end up “passing on the responsibility to nonprofits that are trying to help LEP individuals,” the former compliance officer says.
On June 26, following a public campaign by the Workers Rights Center to reinstate Wills, Family Service Madison’s CEO circulated a statement clarifying the reasons for dismissing her. Wills’ engagement with the orthodontist was simply outside her professional purview as well as the scope of the organization, King wrote.
“This child involved is not, nor ever has been, a client of Family Service Madison,” he wrote of the sibling needing orthodontic services.
“Ms. Wills was conducting private, personal advocacy for a non-client while working in a program paid for by federal funds specifically allocated to children living with disabilities,” the statement reads. “No matter how laudable the activity, the federal government does not allow these funds to be misdirected to advocacy activities or expended on non-clients.” King declined to comment further on the case.
Kaleem Caire, a Family Service Madison board member, says King has kept the board informed of the situation, and that he has its full support.
For his part, Carranza hopes a positive outcome for all — particularly the family — is still possible.
“Obviously, Family Service is providing very needed services to the community,” he says.
“The initial effort was to try to get some positive outcome for the young woman that was fired and for the family that was not...provided the services they’re entitled to. I’m still hopeful that a positive solution is possible.”
