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Under civil rights laws, health-care providers who accept federal funds are supposed to provide interpreters for patients who can't speak English. But the law does not compel the government or insurers to pay for it. As Congress debates a health-care overhaul, medical providers are hoping that will change.
NPR's Jennifer Ludden reports.
JENNIFER LUDDEN: At a Northern Virginia pediatric clinic, 12-month-old Katy(ph) is getting her checkup.
Dr. HODA BASTANI (Pediatrician, Inova Fairfax Hospital): What a good girl.
LUDDEN: As Dr. Hoda Bastani peers into her throat and eyes, Katy's mother, Myrna Mejia(ph), looks on. And standing just behind her is Barbara Perez(ph). She's one of 16 full-time medical interpreters for Inova Hospital, which runs this clinic.
Dr. BASTANI: And are you doing whole milk?
Ms. BARBARA PEREZ (Medical Interpreter, Inova Fairfax Hospital): (Foreign language spoken)
Ms. MYRNA MEJIA: (Foreign language spoken)
Ms. PEREZ: What do you mean by whole? (Foreign language spoken)
Ms. MEJIA: Si.
Ms. PEREZ: Yes.
Dr. BASTANI: Okay, good. And how much does she...
LUDDEN: Inova also has a contract with a company that offers phone interpretation in 176 languages, and it's 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, but this is by no means standard. Baby Katy's mom found that out a few years ago. Her older son had an asthma attack, and Mejia took him to another hospital late one night.
Ms. MEJIA: (Foreign language spoken)
LUDDEN: They didn't have any interpreters on the overnight staff, she says. We had to wait four hours until someone who spoke Spanish showed up and we could tell them what was happening.
Professor LEIGHTON KU (Health Policy, The George Washington University): 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.
LUDDEN: Leighton Ku teaches health policy at George Washington University. He says most insurance companies do not pay for medical interpreters, so many health-care providers don't have them.
Prof. KU: There's no serious monitoring or enforcement of the law. Clearly, it's the nature of the health-care system that health-care providers work in response to payment.
LUDDEN: This often leaves family members or friends to interpret, and Ku says that leads to confusion and medical error. Doctors order unnecessary tests, wasting money. Children can be scarred when they have to interpret things like a parent's cancer diagnosis or the consent form for surgery. And then there's the list of horror stories kept by patient advocates like Mara Youdelman of the National Health Law Program.
Ms. MARA YOUDELMAN (Staff Attorney, National Health Law Program): There is one case that came out 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.
LUDDEN: They told medical workers the man had been intoxicado, which can mean feeling nauseous in Spanish. But emergency room staff understood the word to mean high on drugs. For 36 hours, they treated him for suspected overdose.
Ms. YOUDELMAN: And it was only after the 36 hours, when there was no recovery, that they started to do a neurological examination. In the meantime, the young man suffered a severe subdural hematoma and was left quadriplegic.
LUDDEN: 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 the District of Columbia 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.
Louis Provenzano heads Language Line, one of the country's largest interpretation providers.
Mr. LOUIS PROVENZANO (President and Chief Operating Officer, Language Line Services): 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.
LUDDEN: The International Medical Interpreters Association estimates that right now, fewer than a third of patients who need an interpreter get one. And with the country's changing demographics, that overwhelming demand is only expected to grow.
Jennifer Ludden, NPR News, Washington.
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