Critical Connection

Language isn't the only thing getting lost in the translation as Hispanic patients struggle to communicate with English-speaking ER doctors

"We've got to get the boca abreeed," yells the short, energetic ER radiologist in seventh-grade Spanish, butchering the phrase for "open his mouth." She chews her gum furiously and adjusts her pale blue shower cap. "You know, I speak French. It doesn't seem to help me in the ER."

Ten o'clock on Friday night and the Good Samaritan Emergency Room in Central Phoenix is hopping. A trauma team of 17 crowds around Rojilio, a 40-year-old man who has just been in a car accident and has a head injury. A thin stream of blood trickles from Rojilio's temple, and the smell of alcohol clings to the air around him. He struggles against the neck and chest restraints and flails his arms about wildly, making the X-ray tech's job impossible. Several members of the trauma team yell at him in the few words of Spanglish they can muster.

"No movee, buddy," one doctor says.

No amount of medical training can change the fact that no one here can ask this man his name, where he is having pain, what has happened to him or what medications he is allergic to. No one can explain that the X-rays won't work unless he holds still. No one can explain that they must do a rectal examination to check for internal injuries. Veterinarians and baby doctors treat their patients all the time without the benefit of language. Still, a rectal probe is not the kind of thing you like to spring on a grown man.

Enter 19-year-old Maria Burruel. She is not a doctor or a nurse, yet she possesses a skill that is essential in Phoenix emergency rooms: Maria speaks Spanish. She is a trained, paid, full-time medical interpreter, and it is hard to imagine how this place muddled through before this job existed. She rushes into the hectic room and stands at the head of the trauma team. The doctors filter their questions and instructions for Rojilio through her.

Until 1999, Good Samaritan ER doctors often had to accommodate non-English-speaking patients by pulling a janitor to translate or hoping patients showed up with a bilingual family member.

There are other hospitals in the Valley that still do business that way, even those with emergency rooms that see twice as many Latino patients as Good Samaritan does.

But now Good Samaritan has a staff of 12 paid interpreters -- seven full-time, two part-time and three on-call. All are trained in medical terminology, anatomy, physiology and cultural sensitivity. During the program's first year, the interpreter staff translated for 33,500 people. The program is spreading gradually among the five Valley hospitals operated by Banner Health, the parent company created when Mesa Lutheran and Valley Lutheran bought Good Samaritan, Desert Samaritan and Thunderbird Samaritan hospitals in September 1999.

Translators started at Desert Samaritan in March and will start at Mesa Lutheran in July. Thunderbird will follow in the winter.

Perla Flores, director of Hispanic customer service and marketing for Banner Health, is coordinating the program, which costs $200,000 to $300,000 a year. She says the need was obvious.

"The most basic aspect of providing health care is communication," Flores says. "We can't know what's wrong with you if we can't communicate with you."

There's another good reason for hospitals to have interpreters like Maria: federal law.

The Civil Rights Act of 1964 prohibits discrimination against people from different countries. This extends to providing "linguistic accessibility" so that non-English-speakers get an equal shot at medical care. The U.S. Office of Civil Rights says this means all hospitals that receive federal funding -- and most do because of Medicaid and Medicare patients -- are required to offer qualified interpreters.


Ask local hospitals whether they offer interpreting services to Latino patients, and the question invariably comes up: "Is this about that Zamora girl?"

Almost everyone in the Valley health-care community seems to remember Gricelda Zamora, a 13-year-old Latina who died of appendicitis in the Good Samaritan ER after being airlifted from Mesa Lutheran in the spring of 1999.

According to the malpractice lawsuit filed by the girl's family, Gricelda's parents took her to Mesa Lutheran ER on March 16, 1999, with stomach pains. Hospital staff didn't speak Spanish, and Gricelda, who spoke English, was too ill to deal with them. She was given a pregnancy test and an X-ray, diagnosed with gastritis and sent home with instructions to schedule a doctor's appointment within three days. The Zamoras didn't have a family doctor, but her condition worsened, so they took her on March 18 to the Mesa doctor recommended by the hospital.

For disputed reasons, Dr. Stuart Agren's office did not treat the girl. The family claims she was turned down because the doctor's office could not confirm that the family had insurance. The Zamoras had to use a 14-year-old bilingual family friend to explain Gricelda's condition and the family's insurance policy to Agren's office. Agren claims that his office offered to treat her, and the Board of Medical Examiners has cleared him of wrongdoing. He could not be reached for comment.

Regardless, the Zamora family returned to Mesa Lutheran ER that same day. Eventually, Gricelda was diagnosed with a ruptured appendix and was flown by helicopter to Good Samaritan. She died there a few hours later.

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