Dr. Hoda Bastani (from left), 1-year-old Katy, Katy's mother, Myrna Mejia, and hospital translator Barbara Perez.
Dr. Hoda Bastani (from left), 1-year-old Katy, Katy's mother, Myrna Mejia, and hospital translator Barbara Perez. Jennifer Ludden/NPR
At a Northern Virginia pediatric clinic, 1-year-old Katy is getting a checkup.
As Dr. Hoda Bastani peers into her throat and eyes, Katy's mother, Myrna Mejia, looks on. Standing just behind her is Barbara Perez, one of 16 full-time medical interpreters for Inova Hospital, which runs this clinic.
Under civil rights laws, health care providers who accept federal money must provide interpretation for patients who can't speak English. But the law doesn't compel the government or insurers to pay for that. As Congress debates a health care overhaul, medical providers are hoping that will change.
Inova also has a contract with a company that offers phone interpretation in 176 languages. And it has trained hundreds of its own bilingual staff to help out as needed. Inova spends more than $1 million a year on medical interpretation and is something of a model.
When You Have To Wait
But this is by no means standard. Mejia found that out a few years ago. Her older son had an asthma attack, and Mejia took him to another hospital late one night.
The hospital didn't have any interpreters on the overnight shift, she says. She had to wait four hours until someone who spoke Spanish showed up and could explain what was happening.
"Every day there are thousands of patients whose English is not very good who have a faltering ability to talk to their doctor or nurse," says Leighton Ku, who teaches health policy at George Washington University.
Ku says most insurance companies do not pay for medical interpreters, so many health care providers don't have them.
"There's no serious monitoring or enforcement of the law," he says. "Clearly it's the nature of the health care system that health care providers work in response to payment."
Often family members or friends are left to interpret. Ku says studies show that leads to confusion and medical error. Doctors order unnecessary tests, wasting money. Children can be scared when they have to interpret things like a parent's cancer diagnosis or the consent form for surgery. And then there is the list of horror stories kept by patient advocates like Mara Youdelman of the National Health Law Program.
"There's one case that came out of Florida where an 18-year-old young man collapsed into a coma, and unfortunately paramedics and personnel in the emergency department never got an interpreter to speak with the man's girlfriend or mother," she says.
They had told medical workers the man had been "intoxicado" — Spanish for nauseated. But emergency room staff took the word to mean "high on drugs." For 36 hours they treated him for suspected overdose.
"And it was only after the 36 hours when there was no recovery that they started to do a neurological examination," she says. "In the meantime the young man suffered a severe subdural hematoma and was left quadriplegic."
Response From The Federal Government
A $71 million malpractice settlement in that case among others has prompted a push for more interpreters. But progress has been slow. Some federal matching funds are available to pay for interpretation through Medicaid and the Children's Health Insurance Program. But states have to put up their own money first, and Youdelman says only 14 states and Washington, D.C., have done so. Starting this year, California became the only state to require private insurers to pay for interpretation.
One stumbling block may be that insurers often don't know who qualifies as a legitimate medical interpreter.
"We want to make it convenient and accessible for all the interpreters everywhere in the United States to be tested, and in essence allow for us to have one single certification process that will recognize individuals as a CMI — certified medical interpreter — designation," says Louis Provenzano, who heads Language Line, one of the country's largest interpretation providers.
The International Medical Interpreters Association estimates that right now, fewer than one-third of patients who need an interpreter get one. And with the country's changing demographics, that overwhelming demand is only expected to grow.