California HMOs to provide interpreters
OAKLAND, Calif. — California has taken the first step toward giving non-English speaking patients equal access to health care.
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 OAKLAND, Calif. — California has taken the first step toward giving non-English speaking patients equal access to health care. At a news conference last week at Asian Health Services in this city’s Chinatown, community groups lauded the release of the first draft of regulations by the state’s Department of Managed Health Care, requiring all HMO plans in California to provide health care in the patients’ primary language. This brings private health plans up to the standards that are already in place in public programs, MediCal and the state’s Healthy Family Program. Uninsured Californians still have no guarantee that they will be able to access interpretive services. The regulations come out of a law (Senate Bill 853) authored by Sen. Martha Escutia of Los Angeles and passed by California voters in 2003. Following input from community groups and the public, members of the department will compile a final draft later this year. For Nghi Ph?m, who came to the United States 10 years ago as a refugee from Vi?t Nam, access to an interpreter means the difference between receiving adequate care and going home without understanding the doctor’s treatment plan — or not seeing the doctor at all. “I tried to learn English but at my age, English is still a big barrier for me, especially in health care,” said Ph?m, speaking with the help of a translator. “We had to wait for hours and hours (to see a doctor) before being sent home, without understanding why we were sent home.” According to a study released last week by the Discrimination Research Center, non-English speaking patients don’t have enough access to interpreters, limiting their access to health care in Alameda County, where more 30 percent of the population speaks a language other than English. At Asian Health Services, where Ph?m now sees a Vietnamese-speaking doctor, 18,000 patients have been treated in the last year in eight different languages, according to medical director George Lee. “This isn’t just about quality of care. It’s about human dignity,” said DMHC director Cindy Ehnes. “We heard people talk about not just that there was a barrier to care, but that they were humiliated. They were treated as less than human.” Some 96 health-care plans must have the program approved and implemented by July 1, 2007. By Oct. 1, 2007, they must have appropriate materials translated into certain languages and interpretive services available to its members. But the law doesn’t tackle larger issues such as the lack of interpreters in California hospitals and clinics, or the lack of diversity among the state’s medical staff. These questions, said Ehnes, represent the second part of their job: to provide leadership that goes beyond the regulations’ set of minimum expectations for everyone. But across the street, at a public hearing at the Oakland Asian Cultural Center, community leaders and physicians wondered who would foot the bill for the new requirements, how they would be standardized, whether they would really lead to more interpreters and how they would impact dentists and other small health practices. The draft’s vague language and lack of one uniform standard are going to lead to problems, said Edmond Carolyn of the California Dental Association. “For a dentist participating in six plans, he’s going to have to implement six different language access requirements. Many dentists may opt out entirely if it becomes too expensive and burdensome to provide care,” he noted. On the other hand, Ehnes said, the DMHC doesn’t want to create one standard that is overly restrictive. The regulations also don’t distinguish between trained, qualified face-to-face interpreters and less effective telephone interpreters, said Cary Sanders of the California Immigrant Welfare Collaborative. The use of untrained interpreters, such as children or family members, she said, should not be allowed except in emergencies. Dr. John Pescetti of Oakland’s La Clínica de la Raza highlighted the need for interpreters to accurately convey patients’ stories to their doctors. “I went to John Hopkins Medical School and the number one lesson is that the patient’s history makes up 70 percent of the diagnosis,” he said. “That history is carried in words.” But when children interpret for their parents, he added, the diagnosis can suffer. Pescetti recalled a patient who had pancreatitis (which can be a symptom of alcoholism), but when his 10-year-old daughter translated for him, the patient denied using alcohol. One speaker who started interpreting for his parents when he was 10 years old described the experience as “difficult, embarrassing and stressful.” Another speaker, who was 7 when her family came to the U.S. from Korea, noted that “no one ever questioned the inappropriateness of a 12-year-old girl interpreting for her father.” “It was agonizing to think that there was something wrong with my parents. It seemed their health was in my hands,” she said, along with the “expectations of trying to do this one thing right: speak English.”
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