Language Barrier Handicaps Patients

Dealing with health insurers can be confusing, even when patients and providers speak the same language -- but it’s often significantly tougher for non-English speakers in California, according to a state study released Thursday.

The new study by the California Department of Managed Health Care surveyed the state’s largest HMOs and other health-care providers on language and cultural issues and identified areas where language is still a formidable hurdle for patients.

The survey found that translation services vary widely and are not always available in hospitals, where they can be critical.

Miscommunications can be harmful, health experts say. A patient, for example, who doesn’t understand instructions given by the medical staff, may take a suppository by mouth. Or bilingual children may be called upon by doctors or nurses to translate sensitive end-of-life or reproductive information to parents who don’t understand English.

The state managed care department will seek two key changes in language regulations, partly as a result of the survey, said state Cabinet Secretary Daniel Zingale, the former director of the managed care department.

“The failure to communicate should never get between a doctor and patient or between a doctor and a patient’s rights,” he said.

One rule would require that insurers report problems caused by inadequate interpretation to the state. Currently, HMOs must tell regulators about patients’ grievances on a quarterly basis, but complaints about language problems are not part of those reports.

The other change, Zingale said, would require insurers to test the competence of interpreters they use. Some insurers already test their phone interpreters, but hospital or clinic interpreters often aren’t held to such standards.

Zingale didn’t single out any particular HMO as being especially good or bad with language problems. He also said that he hopes HMOs will not fight these new standards. Otherwise, the department may have to seek legislation.

Patient advocates would welcome such changes, said Marjorie Swartz, an advocate with the Western Center on Law and Poverty in Sacramento. She complained that HMOs aren’t held responsible for ensuring that non-English speaking patients have interpreters, once they are hospitalized.

She cited the case of a Spanish-speaking man with pancreatitis who, because of inadequate translation, didn’t understand the plans for discharge and follow-up care at Fresno Community Hospital.

“He felt like he was being kicked out by the hospital,” said Swartz, and had to be admitted within two weeks when infections set in.

A recently completed investigation of the case by the federal Office of Civil Rights concluded that the Fresno hospital didn’t always follow its own policies for providing interpreters.

The hospital since has corrected the problems, the civil rights office found.

Insurers said that, although a lot of progress has been made in bridging the language barrier, they see room for improvement.