Many Patients Suffer Language Gap

Despite state and federal laws requiring hospitals to provide interpreters and bilingual medical forms, many patients end up unable to talk with doctors and confused by documents written only in English, advocates and officials said.

The problem is especially acute in multilingual California, where a lack of language services has confounded not only speakers of such emergent tongues as Lao and Russian, but of Spanish as well, experts said.

“This is a nationwide problem,” said Tom Perez, director of the Office for Civil Rights at the U.S. Department of Health and Human Services. “I’ve been in all 10 of our offices and visited 200 advocacy groups, and this is a problem everywhere. By far, this is the most prevalent issue that has been raised.”

After heavy lobbying by advocacy groups, the California state auditor recently launched a wide-ranging investigation of publicly funded agencies, including county clinics and hospitals, state employment offices and the Department of Motor Vehicles. The audit will seek to determine if they are complying with a 1973 state law requiring them to provide interpreters and standardized forms in languages spoken by their clients.

A separate California law requires hospitals serving a population that is 5% or more bilingual to provide similar services.

A federal law, Title VI of the Civil Rights Act of 1964, is also applied to medical providers who use federal funding, such as Medicaid and Medicare, Perez said. The U.S. Supreme Court has ruled that people with limited English proficiency may not be discriminated against because of their language.

“These laws exist on paper, but not in practice,” said Jane Perkins, director of legal affairs for the National Health Law Program, a public interest law firm based in Los Angeles. “There are a surprising number of laws addressing it, but people just don’t know about them and they aren’t being enforced.”

Health care workers and legal advocates describe patients who have endured painful or inappropriate treatments, others who were turned away and told to return with an interpreter, and waiting room bystanders pressed into service as interpreters.

A San Fernando Valley house painter sued Mission Community Medical Center in May, charging that he was pressed to sign papers he did not fully understand, holding him liable for his 78-year-old father’s emergency medical treatment in April 1997.

Pedro Perez, 38, said the Panorama City hospital told him his father would not qualify for Medi-Cal coverage and that he needed to be transferred to another facility, according to the suit. A year after his father died, he was jolted by an unexpected $13,000 bill, only to learn later that his father had been eligible for the state-funded insurance after all.

A Spanish-speaking employee was present with the Perez family, hospital chief financial officer Bruce Donaldson said, but officials could not verify Perez’s assertion that the form had not been translated.

“It is not our intent, nor was it our intent, to cause him any hardship,” Donaldson said.

The lawsuit was filed by San Fernando Valley Neighborhood Legal Services and the Western Center on Law and Poverty on behalf of Perez, who supports his family of four on an annual salary of $23,000. An El Salvador native, he became a U.S. citizen several years ago.

“When I received the bill I didn’t understand what it was,” he said through a translator. “Where am I going to get this money from?”

Although advocacy groups say that the language access problem is persistent and widespread, few complaints have reached state licensing agencies and accreditation organizations.

The state Department of Health Services said it has not received a single such complaint in the last year from any hospital in Los Angeles, Orange or Ventura counties. One complaint was logged from a Kern County facility.

Experts say that few violations are reported, and even fewer cases reach lawyers because many victims are poor immigrants who are unfamiliar with their rights or fearful of the government.

“People don’t know to file complaints,” said Ira Pollack, regional manager for the Office of Civil Rights. “Most complaints are not filed by individuals; they are filed by community groups and advocacy groups.”

Hospitals often fall out of compliance because of staff turnover and cost-cutting measures, Perez said.

“That’s often the first thing that is cut: translator services,” he said.

Symptoms of language obstacles to health care are common, experts said:

* In Los Angeles County, an aging Korean man with psoriasis underwent painful treatments at a county facility for more than a year because he did not have an interpreter and the medical staff was unaware of the pain he endured, sometimes for days, said Heng Foong, program director for Pacific Asian Language Services in Los Angeles.

* A young boy in Los Angeles recently interpreted for his Spanish-speaking father who could not read a consent form. The son thought the form meant a nurse would make daily home visits to care for his mother. Instead, they learned the mother was sent to a nursing home, Foong said.

* In Maine, the National Health Law Program and the Maine Civil Liberties Union sued the Maine Medical Center in Portland, charging that two Spanish-speaking and two Farsi-speaking patients were not provided with interpreters or documents in their languages.

California is a daunting Tower of Babel for health care providers.

The state audit examining whether agencies are complying with the Dymally-Alatorre Bilingual Services Act of 1973 was approved by a legislative committee in April. Scheduled to be completed in October, it will be submitted to selected legislative committees for review.

The 1973 law requires state agencies to provide bilingual services and encourages local agencies to do the same, said California state Auditor Kurt Sjoberg.

“We want to look at how agencies are responding to changing demographics and changing linguistic needs,” Sjoberg said last week.

Pacific Asian Language Services in Los Angeles, a language bank specializing in health care interpreting, has forwarded 15 cases of alleged violations at county and private health care facilities to the state auditor.

“We think it will really shine a spotlight on some of these horrible problems that have been going on for years,” said Karin Wang, an attorney with the Asian Pacific American Legal Center in Los Angeles.

In many California communities where Spanish is well-established as the lingua franca, hospitals and service agencies provide adequate language services.

But the smaller the language community, the fewer the services and agencies to help them, Wang said, citing the isolation of some Laotian, Armenian and Russian immigrants.

Hospitals have an obligation to inform all patients of their rights, said Neal Dudovitz, executive director of San Fernando Valley Neighborhood Legal Services.

“The form that was thrown in front of Mr. Perez,” Dudovitz said, “he didn’t understand and felt he didn’t have a choice.”