Language gaps hinder doctor-patient relationships

Times Staff Writer

Shortly after being diagnosed with breast cancer, Enaida Cornejo had another problem: She and her oncologist could not understand each other.

Her primary doctor was bilingual, but this new doctor spoke English. Cornejo, a native of Peru, felt more comfortable speaking Spanish.

At their first few appointments, doctor and patient relied on Cornejo’s husband, her friend and even strangers in the waiting room to help them talk about her illness.


“It was already painful enough to deal with the cancer itself,” said Cornejo, 42, of Santa Ana. “Let alone not being able to understand my doctor and then having strangers come into my room.”

The state Legislature decided four years ago that the estimated 1.1 million patients in California who pay for private health insurance but speak little or no English should receive services such as language interpreters and translated materials from their insurance providers. Lawmakers set a deadline of mid-2008 for providers to submit a compliance plan to state regulators, with fines for noncompliance scheduled to begin in 2009.

The move, expected to cost tens of millions of dollars in private money, has generated little opposition. Proponents of English as the official language of the United States vary in their views of the new regulations.

K.C. McAlpin, executive director of Washington, D.C.-based ProEnglish, called California’s decision a “misguided approach.”

“Instead of spending money on doctors, nurses and medicine, private providers will have to use that for interpreters,” McAlpin said. “It’s going to drive up costs, encourage doctors to turn away limited-English patients because they’re too much trouble, and may even force doctors and providers out of business.”

Rob Toonkel, a spokesman for D.C.-based U.S. English, said basic healthcare services generally do not draw much ire.


“I don’t think anyone in their right mind would tell someone in a health emergency, ‘Sorry, you didn’t learn English, so too bad,’ ” he said. “If we English-speakers were in another country, you bet we’d hope there would be translators on hand to help us understand.”

Insurance providers are taking steps to meet the state requirements. Blue Cross of California, the state’s largest private insurer, expects to spend about $20 million to meet the new regulations.

Several other insurance providers declined to provide cost estimates or indicate whether premiums will increase.

State officials said each provider’s language assistance program will vary in cost and size, depending on their number of limited-English patients. But all plans must include a demographic profile of their membership, a list of what services they will offer to limited-English-speakers, and a system for training staffers on how to handle phone calls in different languages, officials said.

Under the new regulations, limited-English patients must receive vital medical documents, including bills and medication forms, in their native language. Nonvital materials, like promotional fliers, may be issued in English but must be translated within 21 days if the patient asks for such a service.

Most important, according to some officials, the new rules will require that private health plans provide an interpreter, either in person or by phone, for patients at appointments or for those calling customer service.


The new regulations focus on a group that usually gets lost as most attention goes to uninsured residents or those receiving public healthcare, said Ellen Wu, executive director of California Pan-Ethnic Health Network, a patients’ rights group.

“It helps cover a large portion of limited-English-speakers who have jobs and have insurance but don’t know their rights to better services,” Wu said.

Health officials said they could not provide examples of any fatalities tied directly to the existing conditions. The problems generally result in stressful, embarrassing, confusing moments that come at times when people already are at their least comfortable.

Marbella Sala, operations manager at UC Davis’ Center for Reducing Health Disparities in Sacramento, said she’s seen various mishaps over the years related to miscommunication.

In one case, Sala said, a Chinese-speaking patient was rushed to the hospital after she mistakenly placed hemorrhoid ointment in her eye.

In another case, a Spanish-speaking patient whose husband served as her interpreter during a medical visit believed she had contracted a venereal disease from a toilet seat. In another, a deaf patient canceled a minor surgical procedure after her 12-year-old daughter broke down while using sign language to explain the risks, which included death, Sala said. Those patients received proper treatment after interpreters arrived to help, she said.


“People need to understand that language services have to do with a patient’s quality of care,” Sala said. “I mean, just go ask your 8-year-old what an IV is, they won’t likely be able to describe it to you in any language.”

California’s hospitals and public healthcare plans, such as Medi-Cal, are already required to offer interpreting services and translated documents.

With the new regulations, private providers could face fines of $10,000 or more if they fail to comply, said Lynne Randolph, a spokeswoman for the Department of Managed Health Care, the state agency enforcing the new law for HMOs. PPOs are regulated by the state Department of Insurance.

Even with the fines, some health officials and politicians said the new rules do not go far enough because they do not ban the use of relatives as interpreters.

In the last three years, Sen. Leland Yee (D-San Francisco) has proposed two bills banning the use of children as interpreters in medical settings. Yee said he emigrated from China at age 3 and remembers interpreting for his mother.

“I remember how I was deathly afraid that if I didn’t do an accurate translation, she may get sicker and I would be the cause,” Yee said. “It’s a horrible feeling.”


Randolph said the regulations accommodate patients who prefer translations from loved ones over a stranger. “But it’s not the recommended route,” she said.

For Cornejo, the breast cancer patient, a solution came through a Los Angeles nonprofit organization, PALS for Health, which provides free interpreters for medical appointments.

Montebello-based physician Dr. Hector Flores said avoiding language problems with patients requires hiring bilingual staff. At his clinic, the 15-member staff speaks both English and Spanish. He still relies on interpreters for his Asian and deaf patients.

“We should encourage medical students to pick up a language in addition to the scalpel,” Flores said.

“One-on-one interpreting is much more intimate for both the patient and doctor,” he said.