Language barriers create health problems for patients

By Timothy Pratt

Friday, May 17, 2002 | 9:35 a.m.

A woman arrived at the emergency room hemorrhaging, and doctors realized she needed a hysterectomy. But there was a problem -- she didn't speak English. Her teenage son did, but he was embarrassed to tell his mother what was wrong with her, and told her instead that she had a tumor in her stomach.

The miscommunication happened about three years ago at the University Medical Center's emergency room, and is a good example of why hospitals and clinics in the Las Vegas area need interpreters and other services for the area's growing immigrant population, Michelle Sotero, coordinator of the center's interpreters project, said.

"First, there was the language barrier -- the woman only spoke Spanish. Then, there was the cultural problem -- the son's shame at talking about his mother's body," Sotero said. "These are examples of the obstacles to obtaining quality health care for Hispanic immigrants in our area."

Millions of people face language and cultural barriers in their search for quality health care nationwide, according to two recently released studies.

In the emergency room case at UMC, a Spanish-speaking staff member was able to help the patient.

But hospitals and clinics in Nevada and elsewhere are finding that not having interpreters and other services can prove costly in terms of time and money and even dangerous to patients with limited English abilities, one report found.

According to "What a Difference an Interpreter Can Make," 27 percent of patients who needed but did not get an interpreter said they did not understand the instructions for taking their medications, compared with 2 percent of those who either got an interpreter or did not need one.

In Virginia a Hispanic man wound up in the emergency room after mistakenly assuming he should take three prescribed medicines at the same time, said Mark Rukavina, executive director of the Access Project, a Brandeis University-based program that advocates access to health care, which sponsored the report. The situation was resolved only after an interpreter was found and the patient explained what he had understood to be the doctor's instructions.

The report also said that language barriers have led to confusion about payment for health care. For example, more than half of those who needed but did not get an interpreter and who couldn't pay said they were not offered financial help, while only about one-third of needy patients who got an interpreter made the same comment.

Offering bilingual services is mandated by federal law, said the second study, "Providing Language Interpretation in Health Care Settings: Examples from the Field." The study was done by the National Health Law Program, a national public interest law firm that seeks to improve health care access for minorities and the poor.

At the same time, the law is not vigorously enforced, Mara Youdelman, co-author of the report, said.

An August 2000 executive order issued by President Clinton said that hospitals and clinics that receive federal funds must ensure access to patients who have limited English ability, the report said.

However, the order didn't identify sources of funding for such services, and federal officials are more focused on achieving compliance than punishing hospitals and clinics that don't offer the services, Youdelman said.

The report recommended doing more to fund, develop and research bilingual services for immigrant patients.

It looked at programs in 14 states and found that more programs are starting around the nation. Nevada was not one of the states studied.

Sotero since October 2000 has been leading what may be Southern Nevada's most comprehensive project to help patients with limited English -- hiring interpreters, translating documents and training staff in the nuances of Hispanic culture.

The project began in UMC's women's clinic, after it was found that nearly 60 percent of the obstetric patients were Hispanic -- about 10 percent to 20 percent of whom spoke little or no English, Sotero said.

By 2001, 77 percent of its 9,300 obstetric patients were Hispanic. Two interpreters currently work full time in the unit.

The project has extended to the family birth care and pediatric outpatient units as well.

The program cost $500,000 in 2001, all of which came out of the hospital's budget.

The Clark County Health District is also facing the issue and applied for a $1 million private grant for a pilot program that would train and place interpreters in eight health-care centers.

"We already have interpreters available by telephone in our clinics, but we know that's not the whole answer," Celia Martin, who helped write the grant for the county, said.

"What we need is more trained, qualified medical interpreters," she said.

Southern Nevada's Hispanic population is growing so fast that many such efforts are just beginning, she said.

"Like many other things in this county, with a 254 percent growth in Hispanics in the last decade, we're just getting off the ground as far as overcoming language barriers in our hospitals and clinics goes."