Critical Connection

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

"At least I wouldn't have problems with communication there," Esmerelda says. "And I wouldn't have to worry so much about how to pay for it."

How to pay is one of the most confusing hurdles for uninsured, Spanish-speaking patients, says Frank Lopez, director of public information for Arizona Health Care Cost Containment System (AHCCCS). This is Arizona's Medicaid program and health-care plan for people who don't qualify for Medicaid. Without an advocate, navigating the logistics of AHCCCS coverage can bewilder patients.

"I don't think there are people at the border who instruct undocumented people what to apply for," says Lopez. "People don't know where to go, they don't have insurance and they've run into an illness and need care.

"There are a lot of misconceptions amongst citizens here about what we give undocumented people. They think they get all this free health care; they don't. They get emergency care to stabilize a life-threatening situation."

And there are many twists and turns to that care. Esmerelda's midwife, Anita Martinez, tries to help her patients understand the system. They must have their paperwork in order: proof of residence, which can be difficult for people who don't have driver's licenses; and proof of income, which is tricky for people who are paid in cash. They have to get a letter from their employer, who often doesn't want to admit to hiring undocumented workers. Martinez says rumor, fear and misinformation abound.

She sums up the situation for monolingual Spanish-speakers in the health-care system with two words.

"They're lost," she says.

Esmerelda is lucky to have Junker to help her understand the insurance she is eligible for and to help her get prenatal care, pay for her prescriptions and translate doctor's orders. But Junker says even as a fluent English- and Spanish-speaker, the health-care system confuses her.

"There's no attention given to customer service," she says. "It's like the DMV. Except we're talking about your health."


Phoenix Memorial isn't the only emergency room struggling when a patient comes through the door unable to speak English.

Among Valley ERs with the highest numbers of Latino patients, only Good Samaritan and Maricopa Medical Center have full-time, trained interpreters. Maricopa went full-time with its interpreters six months ago to accommodate the 60 percent Latino population in its ER -- twice as much as Good Sam's Latino demographic.

Four full-time translators float throughout the hospital, including the emergency room, during the day. There is one person at night, one on the third shift and two on weekends. Maricopa says it made the interpreters full-time due to the tremendous and growing need, but it has always tried to provide human interpreters instead of using a translation device. This is not the case in all Valley hospitals.

The ER at St. Luke's Medical Center, located on East Van Buren, is surrounded by Latino neighborhoods but can only offer its patients the language line telephone services, which a hospital spokesperson described as "self-explanatory." The hospital would not respond to requests for estimates of how many Latinos use its emergency room.

St. Joseph's Hospital and Medical Center, on East Thomas Road, has a 30 percent to 40 percent Latino population in its ER and also has only the language line, although it hopes to hire interpreters eventually.

Maryvale Hospital Medical Center, Phoenix Baptist, Mesa General and Chandler Regional ERs all rely on the CyraCom telephones, or try to pull bilingual staff away from other duties. None has a full-time interpreting staff, despite a Latino patient population of 30 percent to 40 percent.

Even if emergency room staffs use the translator phones, the phone service in and of itself doesn't meet the requirements of federal law, says Ira Pollack, regional director of the Office of Civil Rights. It's considered a supplemental tool. OCR guidelines also mention that telephone services may not always have readily available interpreters who are familiar with the terminology required for certain situations.

And family and friends should not be used as interpreters because that could represent a breach of patient confidentiality, Pollack said; interpreters should be competent, preferably certified.

"A lot of people aren't even aware of their right to an interpreter," he says. "Many hospitals just tell them to bring in their family members. We consider that a violation unless they are first informed that an interpreter will be provided at no cost."

Hospitals generally get around the requirements by claiming to have bilingual staff, even though they may be housekeeping employees who aren't trained in medical terminology and have other full-time duties, Pollack says.

But if no one complains, nothing is likely to happen, Pollack acknowledges. The Office of Civil Rights, with a staff of fewer than 20 people covering Arizona, California, Nevada and Hawaii, doesn't have the resources to search out violations or do compliance reviews. The office investigates case by case, based on complaints.

Nationally, the office has pursued complaints and forced changes in Seattle, Minneapolis, Boston and Chicago.

In California, where activist groups have filed the most complaints, bigger hospitals such as California Medical Center in Los Angeles and the University of California-Davis Medical Center have provided interpreters for years. The Contra Costa County Hospitals were required to make changes a year ago after complaints filed by five San Francisco-area civil rights organizations alleged that the county discriminated against their clients who didn't speak English.

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