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What If You Couldn't Understand Your Doctor? A New "Interpreter Bill" Would Save Lives Lost In Translation

One patient mistakenly aborted her baby due to language barriers—and her story is far from unique.

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Such problems are systemic and widespread. In a month-long investigation, Frying Pan News has reviewed 75 case studies from across California in which a qualified medical interpreter was not present. In all of the cases, the health professionals were fluent only in English; the patients spoke a variety of languages, including Spanish, Russian, Mandarin, Cantonese, Samoan, Vietnamese, Khmer and Hmong.

California is the most ethnically diverse state in the nation, and an estimated 40 percent of the population speaks a language other than English at home. The need for qualified medical interpreters, moreover, is expected to increase when millions of people who don’t speak English become eligible for health insurance under the Affordable Care Act. Experts stress that many of those newly enrolled won’t be able to communicate with their doctors and other health professionals unless interpreters are readily available.

“The Affordable Care Act will exacerbate this issue,” says Dr. George Flores, program manager for prevention at the California Endowment, a Los Angeles-based private statewide health foundation that works to expand quality health care for underserved individuals and communities in California. “A good portion of those eligible speak a language other than English. This will put more pressure on a system already bereft of language capability.”

State Assemblyman Philip Y. Ting (D-San Francisco), who held a forum on language access last week, agrees.

“This issue will become even more critical in the coming years,” says Ting, “as three million new patients who speak only limited English enter the health system .”

To address the problem, Assembly Speaker John A. Perez (D-Los Angeles) has authored a bill, AB 1263, that would significantly expand trained medical interpreters. The measure was passed by the Assembly in May and is expected to be voted on by the state Senate soon. If it passes the Senate, it would likely land on Governor Jerry Brown’s desk in September.

The bill would require the state Department of Health Care Services to seek federal matching funds to create a state-certified interpreter system. Under the bill, California would spend $200,000 to gain access to $270 million in federal funds authorized under the Affordable Care Act to fund interpreter services. It would create about 7,000 interpreter jobs over a 10-year period.

“For a relatively small investment of state dollars, we will be able to tap into federal dollars,” says Dr. Pan. “AB 1263 will ensure that all Californians are able to obtain quality care by ensuring good communication between patients and their health care professionals.”

Opposition to the bill is coming from the Virginia-based National Right to Work Committee, according to a legislative fact sheet distributed by Speaker Perez’s office. The National Right to Work Committee, a conservative nonprofit that fights trade unionism, did not respond to queries for this article.

In the absence of available interpreters, many people now use their children, other family members or friends to interpret for them. But physicians, government officials and other experts say this is almost always a bad idea.

“Children do not have the maturity to understand the importance and seriousness of medical discussions,” says Dr. Flores of the California Endowment. “There could be misunderstandings that could lead to very serious problems. Imagine a boy interpreting for a mother having menstrual problems. Parents might withhold information and think they were protecting the child, but this would hurt the medical encounter. It’s never appropriate to depend on a child to interpret.”

When things go wrong, the child interpreters are often left with lifelong scars. Poulinna Po was 15 when she was often pressed into service as an interpreter for her Cambodian father, who spoke Khmer. The elder Po had diabetes and could not understand how to take his medicine. He was reluctant to see doctors or go to the hospital because he felt there was no one who could help him. Poulinna Po could understand what the doctor was saying, but she did not know words in her native tongue to convey the medical information back to her father.