A federal agency is monitoring Bay Harbor Hospital to make sure it abides by an agreement made to settle charges that the 150-bed hospital discriminated against patients who could not speak English.
Among other things, the hospital is required to develop programs to train and test volunteer medical interpreters, appoint a coordinator of bilingual services, review existing Spanish-language medical material and determine whether more should be made available, and ensure that the public knows that interpreter services are available. It also must clarify its policy on where English must be spoken in the hospital.
The agreement, in which the hospital does not acknowledge any wrongdoing, came after an investigation last year by the U.S. Department of Health and Human Services' Office of Civil Rights.
The agency concluded that only half of the hospital's 22 designated interpreters were "adequate" in interpreting patients' complaints and doctors' instructions. Investigators also said the hospital lacked a central authority for bilingual services and did not make it clear to patients that interpreters were available.
Virginia Apodaca, regional manager of the Office of Civil Rights, said that Title 6 of the Civil Rights Act of 1964 prohibits discrimination against patients in hospitals that receive public money in the form of grants or Medicare or Medi-Cal payments.
While the law does not specifically require bilingual services, hospitals must make sure that patients who do not speak English are able to communicate with doctors and that they understand medical procedures that affect them. "Patients cannot benefit if they do not understand," Apodaca said.
She said that most hospitals have some problems in complying, often because they do not understand the regulations, do not have trained interpreters or do not know what language skills their staff has. She said that every year in the region covered by her office--California, Arizona, Nevada, Hawaii and the Pacific Trust Territories--about 20 hospitals are put on programs, such as the one at Bay Harbor.
Apodaca said her office usually gets involved when there is a complaint, but it also tries to check on compliance through routine reviews of hospitals. "In 10 years, we hope to go to all of them," she said.
Results of the investigation at Bay Harbor, including the agreement concluded last Oct. 15, were disclosed in federal documents recently released by attorneys for Herlinda Rodriguez, a former Bay Harbor nursing secretary who filed a discrimination complaint against the hospital in October, 1985.
A San Pedro resident, Rodriguez claims she was forced to quit her job because of harassment stemming from her complaints about hospital procedures. Hospital officials, however, have described her as a disgruntled employee who quit.
A hospital spokeswoman said attorneys have advised hospital officials not to be interviewed because of a separate wrongful-termination suit that Rodriguez has brought against Bay Harbor, which is pending.
However, in a prepared statement, the hospital administration said that as part Bay Harbor's "commitment to serving the health needs of our community," staff members have provided voluntary interpreting and translating services for many years.
"In the normal course of events, we continually monitor and evaluate the services we provide in order to discover if they can be made even better and more responsive to the needs of our clients," the statement said. "As part of that ongoing process, we have examined our program of interpreting and translating services and made certain changes. We continue to evaluate these services and anticipate that even more improvements will be made in the near future."
Rodriguez asserted in her complaint that the hospital routinely uses Spanish-speaking housekeepers as interpreters, although they have no medical training; that patient information booklets are only in English; that Spanish-speakers "are not adequately informed" about medical procedures, and that Spanish-speakers generally are treated differently than English-speakers and may be asked to offer proof of legal residency when seeking treatment.
Rodriguez asserted that employees were sometimes pressured to act as interpreters when they didn't want to. She also charged that some employees were disciplined for speaking Spanish and other languages in the hospital, even among themselves.
Points in Agreement
The agreement forbids intimidation of employees for refusing to interpret, or for speaking languages other than English outside of "critical care areas" or where patient care is involved.
Investigators, according to the documents, tested the 22 people then serving as interpreters. They concluded that 11 were "adequate" interpreters, three were "borderline fluent" and eight "should not be on the interpreter list or utilized."
"Currently, there is no clear distinction between good and marginal, although the more proficient are generally used more often," they said, adding that there is inadequate interpreter coverage at night.
A list of interpreters provided by the hospital included housekeepers, maintenance workers, clerks, secretaries, the health educator and the director of education.
Investigators said Bay Harbor should train interpreters in vocabulary, especially in areas of physiology and bodily functions.
On the issue of general treatment of Spanish-speaking patients, investigators concluded that while there is "no pattern and practice of harassment of denial of treatment" there is a "perception" of differences, "usually due to inadequate or unavailable interpreter services."
Investigators also found that many hospital directional signs are not in Spanish, or are inaccurate or confusing. Main entrance bulletin board announcements are in English only, they said.
Rodriguez said the investigation proved her "complaints have merit." Her attorney, Jesse J. Banuelos, said that if the hospital lives by its agreement, "there will have been some accomplishment."
Although the agreement contains no admission of wrongdoing by Bay Harbor, Apodaca said her agency "did discover problems" that the agreement seeks to correct.
"The hospital recognizes them as problems and we do, too," she said. "Our aim is voluntary compliance. We want the problems rectified and the best way is a voluntary agreement."
She said that so far, the hospital is "meeting terms of the agreement" by submitting documents covering its progress. The hospital is required to submit regular reports and will be monitored for at least two years.
If the agreement is breached, Apodaca said, the investigation would be resumed and if Bay Harbor were found guilty of discrimination, it would lose the right to accept federal Medicare and state Medi-Cal patients.
"We got a good agreement," said Jonathan Botelho, the investigator in the Bay Harbor case. "It covers a lot of area, and implementation of that agreement is something every hospital in the country ought to do, because bilingual services are an issue."