Critical Connection

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

The lawsuit against the hospitals and eight doctors involved is painted with broad strokes, claiming that what constitutes medical malpractice in this case is a general delay in treatment, misdiagnosis and incompetence. It does not claim discrimination. But in the Latino community, Gricelda's death provoked protests and cries of racism. Community leaders accused the medical community of consistently offering second-rate health service to Hispanic patients.

The interpreter program had been in place for three months at Good Samaritan when Gricelda arrived there. Several months after her death, Banner Health announced it would expand the program to all its hospitals.

Flores, the marketing director, says Gricelda's death made the value of the interpreter program even more obvious.

Thirteen-year-old Gricelda Zamora died of a ruptured appendix.
Thirteen-year-old Gricelda Zamora died of a ruptured appendix.
Interpreter Cindy Arteaga translates for the mother of a newborn baby in an incubator at Good Samaritan. Arteaga floats through the hospital when she isn’t needed in the ER.
Paolo Vescia
Interpreter Cindy Arteaga translates for the mother of a newborn baby in an incubator at Good Samaritan. Arteaga floats through the hospital when she isn’t needed in the ER.

"We didn't point to the case or use it as a leverage -- it's too touchy," she says. "It wasn't the reason we moved forward with the program. It was just time. Look at the patient base that we're serving."

Good Samaritan spokesman Bill Byron says its ER did everything possible for Gricelda. A Spanish-speaking doctor treated her, but she was too far gone to save, Byron says.

Mesa Lutheran won't discuss the specifics of the lawsuit, but in reaction to the public outcry, the hospital retrained its staff to use the language line, a service that provides translators via telephone. It wasn't used in Gricelda's case.

"They had the language line at the time of this incident. Afterwards, it occurred to them to go back and make sure everybody knew how to use it," says Torie Jennings, the hospital media relations specialist.

Community leaders called a forum on Latino health care, and the Arizona Hospital and Healthcare Association set up a statewide task force on the issue.

The task force came to what seems like an obvious conclusion -- that doctors and nurses need to be able to communicate with patients.

"The most dramatic issue that we need to help hospitals and health-care systems with sooner than later is the language piece," says Fran Roberts, who sat on the task force.

In response, the hospital association formed a partnership with CyraCom, another telephone translation service, to try to encourage hospitals to use the devices. The service is similar to the language line but uses a two-way handset instead of a single handset that must be passed back and forth. Thirty hospitals across Arizona now have the service.

The task force members didn't review the translation services in place at local hospitals. If they had, they would have found ERs relying on rudimentary translation services and untrained interpreters who may or may not be available on the spot.

And if they looked today, they would find that not much has changed in most local emergency rooms for patients who speak Spanish.

It's hard to understand how hospitals can be sure they're ready for the Rojilios and Griceldas who arrive at their emergency rooms.

The Zamora family declined to talk about their case, but their lawyer, Ben Miranda, says the Zamoras could not read the specific discharge instructions for their daughter because they were written in English.

Jennifer Lopez, a 14-year-old family friend, made the doctor's office appointment for Gricelda, acted as a translator in explaining the family's insurance status and accompanied the Zamoras during their second ER visit.

Miranda says it's important to note that the hospital gave Gricelda a pregnancy exam during her first visit but not a test to determine blood-clot levels that may have been crucial to diagnosing her burst appendix.

"If you have a patient who is ill, and you have lack of a proficient interpreter in the room, and you have instructions being given to parents who only speak and perhaps write Spanish, that certainly to me seems to point out a problem," Miranda says.

And would pregnancy rather than appendicitis have been the first diagnostic guess for any 13-year-old girl?

"It's just speculation, but the question is, could it possibly be that this doctor, seeing a 13-year-old Hispanic woman with abdominal pain, immediately reached the conclusion that she was pregnant?" says Miranda. "That seems to be the likely explanation. Instead of looking for other explanations and answers, did he jump to this conclusion?"

Torie Jennings joined Mesa Lutheran three days before Gricelda's death. Suddenly, she had the nightmarish job of media relations for a hospital that was being publicly accused of racism and medical incompetence and was about to be named in a lawsuit. She says she learned from the experience that Mesa Lutheran isn't the only hospital in the area that needs to address its service to the Latino population.

"I think when we were in that community forum, there were people there that weren't talking about just that incident with Gricelda Zamora. They were there to address health care in general and what they perceived as secondary health care for the Hispanic community. Most of the people were giving testimonies about experiences they had at other hospitals. Everybody saw that we're not just talking about one hospital. We're talking about major issues," Jennings says.

Flores says she has not seen much beyond rhetoric since Gricelda died.

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