(Name-mce) ListServ Some current news articles re: LEP, Title VI & access to medical care

[bill@billhowe.org]

 Some current news articles re: LEP, Title VI & access to medical care 

 
  
   Language barriers plague hospitals 

 By Elizabeth Weise, USA TODAY 

Many hospital patients who have a limited ability to speak English and who
need a translator don't get one, which puts them at risk for poor and
sometimes life-threatening medical care, an analysis in today's New England
Journal of Medicine says.

>From 1990 to 2000, the number of residents with limited English proficiency
grew by 7 million, to 21 million, or 8.1% of the population, according to
U.S. Census figures. Yet, one study showed that no interpreter was used in
46% of emergency department cases involving such patients, says Glenn
Flores, an expert on language barriers in health care who based his
conclusions on his own studies and those done by other researchers.

Only 23% of teaching hospitals offer physicians training in how to work with
an interpreter, he says. "Lack of interpreters translates into impaired
health status, lower likelihood of being given a follow-up appointment,
greater risk of hospital admissions and more drug complications," says
Flores, a professor at the Medical College of Wisconsin-Milwaukee.

He cites the case of a 7-year-old girl with an ear infection whose mother
was told by a poorly trained interpreter to put the oral antibiotic in her
daughter's ears. In another case, a 2-year-old who fell off her tricycle was
taken from her mother by social workers because a doctor misinterpreted the
Spanish words "Se pegó" to mean "I hit her" rather than "She hit herself,"
Flores says. 

And in a case that cost a Florida hospital a $71 million malpractice
settlement, he says, an 18-year-old who said he was intoxicado, which can
mean nauseated, spent 36 hours being treated for a drug overdose before
doctors realized he had a brain aneurysm.

Under Title VI of the Civil Rights Act of 1964, the denial or delay of
medical care because of language barriers is discrimination. Any medical
facility that receives Medicaid or Medicare must provide language assistance
to patients with limited English proficiency.

The American Medical Association says making health care providers
responsible for the cost of an interpreter is unfair. An AMA survey found
that the cost of hiring an interpreter varied from $30 to $400 an hour
depending on language and skill level, significantly higher than the payment
for a Medicaid office visit, which in many states is from $30 to $50. 

California passed legislation in 2003 requiring health care providers to
make interpreters available to those who need them, says Cindy Ehnes of the
state's Department of Managed Health Care. Otherwise, she says, quality care
is clearly "difficult if not impossible."



Demand surges for translators at medical facilities 

By Elizabeth Weise, USA TODAY 

SAN FRANCISCO - Once upon a time, when a patient walked into the San
Francisco General Hospital emergency room speaking a language no one there
knew, the staff headed for the Yellow Pages.

"We used to call restaurants," says Alan Gelb, chief of the hospital's
emergency department. "If we had an Ethiopian patient, we'd look in the
Yellow Pages and find an Ethiopian restaurant and get them to interpret over
the phone."

Today, doctors at "the General" have access to interpreters who work in 31
languages, including nine Chinese dialects and five Filipino ones. And when
a patient shows up speaking yet another language, they call a telephone
language service that works 24 hours a day in 130 languages.

But while interpretation has gotten better, the need is growing even faster.
By 2004, the number of U.S. residents who speak a language other than
English at home grew to almost 50 million, 19% of U.S. residents. And there
were 22 million residents that year with limited English proficiency. 

Very few states even have interpreter-certification programs, says Maria
Michalczyk, former co-chairwoman of the National Council on Interpreting in
Health Care.

That's resulting in higher costs and worse medical care, says Glenn Flores,
a professor of pediatrics at the Medical College of Wisconsin-Milwaukee. His
analysis of language barriers to health care in the USA appears in today's
New England Journal of Medicine.

Making do with semi-fluent medical personnel can lead to trouble. Oncologist
Arturo Molina remembers one incident from his tenure at City of Hope cancer
center near Los Angeles.

A frantic colleague called Molina, who is fluent in Spanish and English, to
ask him to talk to a patient who was about to have a bone-marrow transplant.
The procedure makes the patient sterile, so the doctor had tried to explain
that she could freeze the patient's semen to preserve his fertility after
the cancer was cured.

But the physician's Spanish was limited. "What (the patient) heard was that
they were going to freeze his testicles," says Molina, who calmed the
patient down.


Having family members translate can be problematic. In California,
Assemblyman Leland Yee has proposed a bill to prohibit children under 15
from being required to translate for their parents

Yee, who grew up in San Francisco's Chinatown, was called upon to translate
for his mother at the doctor's office when he was 6 years old. "You were
never sure as to what you were translating was accurate. And the doctor
never knew. And my mother never knew, so it was all up to me," he says.

"It's probably one of the worst situations you can put a child in and one of
the worst situations you can create clinically in terms of getting good
treatment," Flores says. Children don't understand the terminology and don't
want to admit when they're scared or don't understand the question, he says.

Spanish speakers make up about two-thirds of the U.S. residents who speak
another language at home, Flores says. But less common languages can pop up
as international crises bring in new refugee groups or as older populations
shift.

In Washington, Oregon, California and Minnesota, large Hmong communities
exist. The Hmong are a hill tribe from Laos who came to the USA after the
Vietnam War ended.

In San Francisco, Geld says he has seen an influx of Mongolian speakers.
Berkeley, Calif., has a big Tibetan community. 

Michigan has a growing group of Somali refugees, who speak Bantu and Maay.
Lexington, Ky., has a small Arabic community, and in Oregon, a colony of Old
Believer Russians numbering in the thousands speak an archaic Russian
dialect, Michalczyk says. 

But the need for translators is hitting hardest in communities that have up
until now been entirely English-speaking. "A lot of rural communities have
never seen that kind of diversity. Tennessee and North Carolina - they're
seeing really high growth rates of Latino populations. That really brings
the issue to the fore," Flores says.

Federal rules require that any medical provider receiving Medicaid or
Medicare offer interpreters. But in general, the rules have not been
enforced, Flores says. Forty-three states have one or more laws about
language access in health care, up from 40 in 2003, according to a survey by
the National Health Law Program. But while some laws are detailed, others
say only that access is important. 

Some have suggested that people who come to the USA to live should simply
learn English, says Wilma Alvarado-Little, co-chairwoman of the National
Council on Interpreting in Health Care.

But foreign-born patients who otherwise do fine speaking English may need
help in an emergency room because they're too worried and lack the
vocabulary, she says.

Posted 7/19/2006 9:20 PM ET  






Bill Howe
 <http://www.billhowe.org> http://www.billhowe.org - Multicultural Educators
to South Africa 2006 - Join Me on this Exciting Trip

Past-President
National Association for Multicultural Education (NAME)
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