Health Care Can Get Lost in the Translation

Spurred on by a growing number of immigrants who say they are unable to talk to their doctors, farm worker advocates have launched a statewide campaign to break down language barriers and boost the number of interpreters in hospitals and other health-care facilities.

The effort is aimed largely at people who are fluent in neither English nor Spanish, a population that includes recent arrivals from Southeast Asia and a rising number of Mexican immigrants who speak indigenous Indian languages.

Lawyers with the poverty law firm California Rural Legal Assistance contend that hospitals and medical clinics too often deny limited-English speakers equal access to health care by failing to provide adequate interpretive services, as required by state and federal laws.

The legal aid campaign includes efforts to inform immigrants of their rights to such services and to remind health-care providers of their language access obligations.

Lawyers also have flexed their legal muscle to force the issue, including a lawsuit filed this summer against a Fresno County hospital centering on language access and administrative complaints lodged last week accusing two Ventura County hospitals of failing to provide adequate language assistance to the region’s growing limited-English farm worker population.

“We are trying to make sure our clients’ rights aren’t existing just on paper,” said Jack Daniel, a director of litigation for California Rural Legal Assistance in Fresno. “I think it’s an issue that has been largely ignored by health-care providers and we ought to be doing something about it.”

Health-care providers dispute assertions that they are failing to do enough. Officials with the California Healthcare Assn., which represents 500 hospitals and medical facilities statewide, note that they held a series of seminars for providers earlier this year to review the legal requirements and discuss ways to meet language needs.

Association officials said they believe most health-care providers are doing all they can to provide language assistance, even in the face of tough economic times and a lack of reimbursement for those services.

“Hospitals do take this obligation very seriously,” said Jan Emerson, spokeswoman for the Sacramento-based association. “We are willing to do our part. We would love to have as many interpreters as any community needs, but it gets back to a question of who pays for it.”

The Ventura County complaints stem from the hospitalization earlier this year of Oxnard resident Celia Reyes, 18, a Mixtec Indian from the Mexican state of Guerrero. According to complaints filed with the California Department of Health Services, Reyes communicates almost exclusively in Mixteco Bajo, an indigenous language that bears little resemblance to Spanish.

Reyes was admitted to Ventura County Medical Center in early February and transferred to St. John’s Regional Medical Center in Oxnard in March, the complaints say. Both hospitals failed to provide adequate interpretation, according to the complaints. In fact, the complaints allege that Reyes’ live-in boyfriend, Gaudencio Diaz, was regularly called upon to provide translation, even though he too is a Mixtec Indian who speaks no English and limited Spanish.

Citing patient confidentiality, officials at St. John’s hospital and the county medical center refused to speak directly about the case. However, a county hospital official said he was unaware of any patient who had failed to receive proper care because of a language barrier. A letter from the owner of St. John’s, Catholic Healthcare West, to California Rural Legal Assistance said Reyes received ample language assistance.

At the couple’s Oxnard apartment, where medical complications have left Reyes paralyzed from the waist down, Diaz said he missed more than three weeks of work trying to help bridge the language gap. He also said he struggled to understand what doctors and nurses were saying, lacking fluency in Spanish and the technical expertise to grasp complex medical terms.

“I shouldn’t have to translate for my [girlfriend],” the 21-year-old fieldworker said through an interpreter. “Too many people are in the same position.”

Jeffrey T. Ponting, a California Rural Legal Assistance attorney in Oxnard who represents the couple, does not allege that a lack of interpretive services exacerbated Reyes’ condition.

But he argues that the hospitals had no business using a family member to interpret for her. And he maintains that both facilities need to do a better job of meeting the language needs of the region’s burgeoning Mixteco farm worker population, estimated at more than 10,000 at peak agricultural season.

Federal law requires physicians and other health-care providers receiving federal funds to provide free language assistance to limited-English speakers, Ponting said. And state law requires hospitals to provide interpretive services when at least 5% of the patient population -- or 5% of the population of the geographical area served -- speaks the same primary language.

“Our belief is that both St. John’s and Ventura County Medical Center should be providing full-time interpretive services for this population,” Ponting said. “It’s important not just from the standpoint of how it benefits this [population], but there are public health issues here as well. It benefits everyone to be able to communicate with a population that is in our midst.”

Officials at both hospitals said they believe they already are doing plenty to meet the needs of limited-English speakers.

Ventura County Medical Center Director Michael Powers said the public hospital has 326 bilingual staff members who speak 14 languages and a phone system in place that provides ready access to interpretive services. The county also has a full-time Mixteco interpreter on staff at a south Oxnard health clinic who also is available to interpret at the county hospital.

“We don’t just comply with the technical legal requirements, we go well beyond them,” Powers said. “A core part of our mission is to make sure we are sensitive to non-English-speaking patients and that we treat them with respect and compassion.”

Likewise, St. John’s hospital officials said they have one staff member who speaks basic Mixteco, access to others in the community who know the language and a state-of-the-art phone system that provides interpretation in 144 languages, including Mixteco. The phone system has been in place for about two years and allows for a three-way conversation between doctor, patient and interpreter.

“We have found [the system] the most precise and helpful for medical translation, and we think we have enhanced the delivery of health care by using it,” said Christina Fernandez, a hospital vice president.

The issue is not limited to Ventura County or the health-care arena.

Across the state, schools, courts and police agencies are struggling with language access issues, especially in light of the waves of immigrants who enter the country speaking everything from Arabic to Swahili.

According to the nonprofit California Endowment, nearly 40% of California’s population speaks a language other than English at home and about half of those would benefit from language assistance when accessing health care and other services.

Earlier this year, Assemblyman Leland Yee (D-San Francisco) introduced legislation to address one of the most pressing concerns: use of children to bridge the language gap. Not only can those translations prove inaccurate, Yee said, but they can put youngsters in the difficult situation of relaying intimate or troubling news.

Yee’s bill would have banned the use of interpreters younger than 15 by any state or local agency or program that receives state funding.

The bill stalled in a Senate committee amid concerns that it would drive up medical costs and delay access to needed services. Yee said he plans to push the issue again when the Legislature reconvenes.

Still, cost remains a primary concern for health-care providers when it comes to providing or expanding interpretive services. Some providers note that federal matching funds are available to states that commit their own money for such services. However, California so far has declined to do so, citing budgetary problems. In the meantime, providers say the reality is that the state-administered program that provides health care to the poor reimburses a doctor less for an office visit than the doctor would have to pay an interpreter for that visit.

“Hospitals already have taken the first step by doing their best to ensure that proper interpreter services are available,” said Lois Richardson, a vice president and legal counsel for the California Healthcare Assn. “But providing reimbursement sure would go a long way.”

Some groups aren’t waiting for the money to rain down.

Later this month, Ventura County Public Health and the Mixteco-Indigena Community Organizing Project will present a daylong forum to explore language access issues. That will be followed in late October by an awards banquet at the Skirball Cultural Center in Los Angeles to spotlight the state’s limited-English-speaking farm worker community. Proceeds from the event will go toward California Rural Legal Assistance’s language access push.

Ponting said the initiative is important not only because it helps ensure that health-care providers do what is required to communicate with their patients but also because it seeks to avoid the tragic consequences that can happen when they don’t.

He noted a lawsuit filed by California Rural Legal Assistance this summer, alleging that a Fresno County hospital failed to provide adequate translation for a Hmong-speaking immigrant before amputating one of his feet. The man believed he was simply having his foot cleaned, the lawsuit said.

“Worst-case scenario, we’re talking about life and death stuff,” Ponting said. “Nobody is saying it’s easy, but it’s a question of desire; and if people want to do it; they’ll find a way to do it.”