HEALTH ACCESS UPDATE
Friday, February 24th, 2006
LANGUAGE ACCESS RULES AT STAKE IN DMHC PROCEEDING
- Comments Due at March 3rd on New Cultural and Linguistic Access Standards
- Hearings Highlight Need for New Rules at Department of Managed Health Care
- Emotional Testimony About Errors, Lack of Care Because of Language Barriers
- Health Access VMI Projects Show Solutions Possible, If Policies in Place
Patients who speak little English, gave eloquent and emotional testimony at Department of Managed Health Care hearings in Los Angeles and Oakland last week in an effort to influence proposed regulations that would require health plans to provide sufficient interpreters for patients.
COMMENTS DUE MARCH 3RD: Advocates for health care and communities of color will have until March 3 to submit written comments to follow up on the Cultural and Linguistic competency regulations. Written comments can actually be submitted online, at the DMHC website, at:
HEARINGS ON LANGUAGE ACCESS PROCEEDINGS: These hearings were held to assist DMHC who is charged with developing regulations to implement SB 853, the 2004 legislation by Sen. Martha Escutia. This law essentially says all patients – regardless of their primary language — have the right to competent medical interpreters. The responsibility of providing interpreters falls on health plans and the providers that they contract with. A full copy of the regulations (entitled “2004-0115: Language Assistance Programs”) are available at the DMHC website, at:
Language access to health services is a central issue, especially in California , where 40 percent speak a language other than English at home. According to the California HealthCare Foundation, “the most recent California Experience Survey (PEP-C) found 49% of patients reported not being able to receive interpretive services when needed.”
Advocates are also calling on plans to compile a demographic profile of enrollees, including race, ethnicity and primary language—a requirement that is not yet reflected in the regulations.
LOS ANGELES HEARING: In the Los Angeles hearing, over 70 beneficiaries, interpreters, advocates, providers, association representatives, and academics gave testimony in the all-day hearing, including California Pan-Ethnic Health Network (CPEHN), a sponsor of the SB853, as well as Health Access California, National Health Law Program (NHeLP), Asian Pacific American Legal Center (APALC), Pacific Asian Language Services (PALS for Health), and many others.
The theme of the testimony emphasized that insufficient attention to language, race, ethnicity, and culture lead to limits to access to providers and poor quality of care. This, in turn, results in health care disparities and poor, even tragic health outcomes. The testimony was dominated by beneficiaries, many of whom spoke through interpreters.
- One Korean speaker told of taking his wife to the hospital emergency room because she was bleeding. They waited from 8:00 a.m. to after 11:00 pm because no one spoke Korean. She ultimately had to undergo risky treatment due to the significant loss of blood.
- One woman spoke tearfully of the aftermath of her diagnosis of breast cancer. Her doctor sent her for a biopsy of the lump, but the technicians did the biopsy on the wrong breast. She tried to tell them of their mistake, but she couldn’t communicate with them and they did not speak Spanish. She tried to enlist the help of her young daughter and her brother to translate for her, but her daughter’s vocabulary was insufficient and her brother was embarrassed to talk about her condition. Due to her fear about her health and the frustration of making herself understood, she abandoned getting any further treatment. Ultimately, she had to suffer through more radical and painful surgery and treatments because of the delay in diagnosis and treatment.
- One woman spoke of her trip to the hospital emergency room after the collapse of her infant daughter. She took her 13-year-old along to interpret. When she returned to the hospital she was not able to bring her teenage son, so the hospital brought in an aide from another department. The aide did translate for part of the visit but literally stopped in mid-sentence when the doctor began to explain that her infant daughter had a terminal disease.
- A frail Asian woman told of her involvement in a clinical trial where she was called upon to sign several complicated release forms without understanding a single word.
- Another man described going for emergency treatment, but because his English was so poor, he could not be understood. The hospital went out into the parking lot and pulled a construction worker off a hospital renovation project to interpret for him. Although the construction worker could speak Spanish, he had no knowledge of the patient’s medical condition, treatments, and no particular skill in interpreting in a sensitive situation.
OAKLAND HEARING: The hearing in Oakland featured more testimony from providers and advocates, such as Latino Issues Forum, California Immigrant Welfare Collaborative, Asian Pacific Islander American Health Forum, Asian Health Services, Health Rights Hotline, Latino Coalition for a Healthy Coalition, and Bay Area Legal Aid.
For example, Dr. John Pescetti, of La Clinica de La Raza in Oakland , emphasized the moral and financial costs of miscommunication with a limited-English proficient patient. He said that knowing a patient’s medical history is 70 percent of a doctor’s diagnosis, but when a doctor can’t understand the patient, bad advice will be dispensed. This, in turn, could result in increased malpractice lawsuits and costs.
While Director Cindy Ehnes sympathized with testimony from all sides, she questioned how interpretation could be implemented in a cost-efficient way. Providers also spoke up, emphasizing how they felt the regulations were burdensome and potentially costly. Keith Pugliesse, representing the physician groups, suggested patients should “be allowed to use their families and friends – anyone they feel comfortable with.’’ Leanne Gassaway from the California Association of Health Plans said patients can already look in “provider directories’’ to find physicians that speak their language.
Advocates responded that friends and family don’t have the training to do medical interpretation, and that patients who do rely on children or family do so largely because they have no choice. While Ehnes did empathize with providers, she did seem open to looking at evidence of health care discrimination and looking for concrete ways that interpreter programs can work.
VIDEO MEDICAL INTERPRETATION: At these hearings, Health Access Foundation provided information about its Video Medical Interpretation (VMI) projects, which work to implement videoconferencing technology to cost-effectively provide trained language interpretation services in Bay Area public hospitals. Health Access is incubating these pilot projects to show that the language access problem is solvable, with the appropriate policies in place.
Janice Chin of Alameda County Medical Center spoke about their hospital’s commitment to interpretation services, and their use of VMI, in partnership with San Francisco General Hospital , to serve their diverse patient population, to reduce wait times and provide a greater range of languages. More information about this project which is coordinated by Health Access, is available at:
Another Health Access project is laying the groundwork of a Health Care Interpreter Network (HCIN), where using either mobile video conferencing units or ordinary telephone equipment, participating healthcare providers will be able to access the Video/Voice Over IP Call Center interpreter services throughout the multi-hospital system. More information about this project, which has started at San Joaquin General Hospital , is available at:
NOTE: If you had problems getting the text from the last Health Access Update about the hospital financing waiver, it is archived, along with all Health Access Updates, at the Health Access website, at:
FYI, the Stakeholders Meetings for the hospital waiver “coverage initiative” will be held on Monday, February 27th in Sacramento, and on Friday, March 10th in Los Angeles.