When Anaheim resident Gabriela Ortiz checked into the emergency room at Anaheim Hospital, none of her doctors could tell her about the condition of her unborn child.
Ortiz only speaks Spanish, and at the time there was no interpreter on hand to help her communicate with hospital staff. Unable to understand her doctors, Ortiz would not consent to an emergency caesarian section without a family member on hand to translate.
During the hour that she waited for the family member to arrive, Ortiz began hemorrhaging. Her child was born healthy but now has a learning disability, which Ortiz attributes to her condition during the birth.
Ortiz's ordeal, which she recounted during a recent press conference at Latino Health Access, shows how for non-English speaking patients, access to an interpreter can be the difference between life and death.
A new bill on the floor of the state Senate could ensure Medi-Cal patients with limited English receive proper language assistance by creating a coordinated program for medical interpreter services.
Proposed by Assemblyman John Pérez (D-53), AB 2325 would establish a new agency called CommuniCal that would certify and oversee trained interpreters for low-income residents with limited English. It would also reimburse Medi-Cal providers for the cost of interpreter services.
The bill, which is awaiting a vote in the Senate before their August 30 recess, would also expand existing law by providing more interpreters in emergency situations and remote telephone or video translation for patients speaking uncommon languages.
An Acute Need
One in five Californians has limited English and nearly half of all beneficiaries of Medi-Cal, the state’s health insurance program for the low-income residents, speak a language other than English. Spanish is the most common at 35.7 percent, followed by Vietnamese, Cantonese, Cambodian/Hmong, Armenian and Russian.
Under current state law, medical providers are required to provide interpreters to their patients, free of charge, either in-person or over phone or video conference.
But studies have shown that the language assistance services are uncoordinated and often provided by untrained staff or family members.
A 2013 study in the journal Pediatrics found that 57 percent of U.S. pediatricians still report using family members to communicate with limited English patients.
But even when they are available, interpreter services are often underutilized.
Many medical residents forgo professional interpreting services because of their own time constraints, choosing instead to “get by” with their own language skills or interpretation by a family member or untrained staff member.
A survey of Chinese- and Spanish- speaking patients in the San Francisco Bay area found that, even though hospitals had interpreters on-site during weekdays and 24-hour phone interpreters available, only 17 percent reported the use of a professional interpreter with physicians and just 4 percent when interacting with nurses.
More than a third of patients said they managed without an interpreter or were barely spoken to at all by nursing staff.
In states that offer reimbursement to providers for language services, pediatricians were more than twice as likely to utilize services, according to the 2013 Pediatrics study.
If CommuniCal were to become law, California would join a dozen states and the District of Columbia that reimburse doctors, hospitals and other health providers for providing language services to Medicaid patients.
Dr. Mai-Phuong Nguyen works with many elderly, non-English speaking Medi-Cal patients at the Asian Health Center in Westminster, where staff speak Vietnamese, English and Spanish.
“The difficulty is when we send [patients] to a specialist. If they don’t have a specialist who speaks Vietnamese in their network, then they’re lost," said Dr. Mai-Phoung Nguyen, who works with many elderly, non-English speaking Medi-Cal patients at the Asian Health Center in Westminster
"And they come back and have no idea what happened to them, we don’t get notes from the doctor -- it’s very uncoordinated care.”
Staff at the Asian Health Center speak Vietnamese, English and Spanish. Yet Nguyen, who was born in Vietnam but raised in the United States, says even with her language skills she is still learning new words on the job every day.
“Sometimes patients don’t understand what I’m saying and I feel like I’m speaking the best Vietnamese I possibly can - because I’m not saying it in the right way,” Nguyen said.
Nguyen says lawmakers can’t depend on immigrant doctors to bridge the language gap.
“We're having a hard time getting younger physicians to stay in the community - and we still have a continuous influx of immigrants. Our patients are elderly and recently immigrated - they don’t speak English,” she said.
“Now we're getting second generation physicians training, and their Vietnamese isn't that fluent. So it only takes a generation [before the Vietnamese community] is going to need interpreters as well.”
CalOptima, the county’s health provider for Medi-Cal patients and other low-income residents, does provide face-to-face and phone translation services. In 2013, the agency received 554 requests for face-to-face interpreters and provided 5,681 translations over the phone.
While the agency does not require its interpreters to be certified, contractors and bilingual staff are tested for language skills, said CalOpltima spokesman Michael Downer.
If the CommuniCal bill is passed, CalOptima would also be reimbursed by the program and gain access to state certified translators.
A Second Chance
It is identical to a bill introduced last year, AB 1263, which was passed handily by both chambers but vetoed by Governor Jerry Brown. Brown's argument was that it was too much to ask given January's expansion of the Medi-Cal program as part of the implementation of the Affordable Care Act.
“I don’t believe it would be wise to introduce yet another complex element,” Brown said in a statement.
If passed by the Senate before their August 30 recess, the bill would be before Gov. Brown for approval by September.
Under the proposal, the state would spend $200,000 and be eligible to receive up to $270 million in federal funds for interpreter services under the Affordable Care Act.
The bill is opposed by the Virginia-based National Right to Work Committee, which argues that the bill, which allows interpreters to unionize and ensures a minimum $60 per hour rate, will give “union bosses monopoly bargaining powers over virtually all interpreters operating under the program.”
Nguyen believes that without the bill, medical providers won’t make language access a priority.
“This is an unfunded mandate. There's no money for it. You have the right to have someone speak to you in your language, but they don't provide. So how does it happen? It doesn't,” Nguyen said.
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