Lacking English, Patients At Risk

Crisis In Health Care Over Language Barrier

October 25, 2006
By HILARY WALDMAN, Courant Staff Writer

Justa Ramos speaks little English, so she relies on her 9-year-old daughter to translate for her when she seeks care at the St. Mary's Hospital clinic in Waterbury.

But when Ramos goes to the gynecologist, there are things she just cannot say in front of her fourth-grader, Starlette. There's one problem she's wanted to discuss with her doctor for a year now, but has remained silent, rather than sharing it with her daughter.

That sort of reluctance, or an inability to speak for oneself, can jeopardize patient safety and result in life-threatening mistakes or delayed treatment, advocates of better medical translation say.

But while a federal law directing hospitals to provide qualified language interpreters is 40 years old, grade-school children and janitors still are often on the front line of efforts to bridge the language barrier between patients and professionals across Connecticut.

"I don't think the English-speaking community understands what is going on," said Carol Burkhart-Lyons, director of the Naugatuck Valley Project, a community organizing group.

The biggest obstacle to providing language interpreters has long been money. But without a firm price tag, it has been difficult for advocates and sympathetic lawmakers to get any state money to provide them.

"The question has always been if you want Medicaid to pay for face-to-face interpretation services, what's it going to cost us," said Pat Baker, president and CEO of the Connecticut Health Foundation, a group dedicated to increasing access and eliminating disparities in health care.

To answer that question, the foundation is releasing a report today documenting, for the first time, the cost: $4.7 million a year. Because that could be financed through Medicaid, the government health insurance for the poor, half the sum could be reimbursed by the federal government.

The report, commissioned by the health foundation and compiled by Mathematica Policy Research Inc., said that because health care is delivered in so many diverse settings, it makes most sense to allow providers to bill Medicaid directly, instead of hiring staff interpreters at hospitals.

Without the ability to bill, hospitals now spend hundreds of thousands of dollars a year for part-time interpreters and on telephone language lines that cost $2 to $3 a minute and often fail to help doctors and patients communicate well. Just as often, a volunteer orderly or maintenance worker is called into action.

In clinics and doctors offices, patients who don't speak English commonly bring friends or family members to help them.

But that does not guarantee good care and, frequently, untrained interpreters inadvertently muddle communication, rather than clear things up, said Dr. Jorge Otero, an emergency room physician at Windham Hospital in Willimantic. Otero is a native of Colombia, speaks Spanish fluently and has found that when he talks directly to patients the story can change.

"Sometimes the interpreter says the patient has chest pain when he has abdominal pain," Otero said.

Dr. Alberto Perez, another Windham Hospital emergency physician, recalled trying to get a medical history from a non-English-speaking Asian patient. He asked a question and the patient went on for two minutes in her native language.

The translator then turned to Perez and said, "She said no."

"You're left in a dark hole wondering what am I missing," Perez said.

At a different hospital, a woman was in obvious distress when she arrived at the hospital maternity unit. She was crying and unable to speak English so the nurses brought in the only available translator that day - a janitor - to help them figure out what was wrong.

In active labor herself in a neighboring room, Aide Lorduy heard the woman screaming "no! no!" through the wall. Then, a nurse appeared in Lorduy's room and asked if she spoke Spanish.

When the nurse pushed the crying woman's wheelchair into Lorduy's hospital room, she first apologized in Spanish for disturbing Lorduy's delivery. The woman, who was about halfway through her pregnancy, told Lorduy she felt like she might be going into premature labor.

Lorduy suggested that the woman explain the problem to the Spanish interpreter.

"She said there wasn't an interpreter, he was the janitor," Lorduy said. The woman felt exposed, her feet in gynecological stirrups, when the male janitor was brought in to interpret. "That's why she was yelling," said Lorduy, a mother of four from Ansonia who requested the hospital in question not be named because the incident occurred nine years ago and she didn't want to cause any embarrassment.

State Sen. Toni N. Harp, chairwoman of the legislature's appropriations committee, which controls state spending, called paying for interpreters through Medicaid "an excellent idea." Because the cost of Medicaid is shared 50-50 between the state and federal governments, the $4.7 million cost could be offset with federal funds, bringing the cost to $2.35 million a year for Connecticut taxpayers.

But before that can be done, Connecticut must establish criteria by which to train and license interpreters. Harp secured money in this year's state budget to allow the state Department of Public Health to draw up licensing standards for medical interpreters. Once those standards are in place, the legislature can consider adding language interpretation to its already long list of services covered under Medicaid.

Maine, Massachusetts and New Hampshire now pay for interpreters through Medicaid, although each state uses a different formula. The average interpreter is paid $50 an hour.