12520: Medical field resists U.S. rule requiring free interpreters (fwd)

[Bob Corbett <corbetre@webster.edu>]

From: leonie hermantin <lhermantin@hotmail.com>

Medical field resists U.S. rule requiring free interpreters

By Bob LaMendola
Health Writer
Posted July 7 2002


The gynecologist needed to talk with a young Haitian mother in Delray Beach
to diagnose and treat a cyst in her uterus. But he and his staff spoke
English; she spoke only Creole.

The woman was forced to use her 10-year-old son as an interpreter. With her
feet in the stirrups, she told her symptoms to the boy, who relayed them to
the doctor and then passed back the doctor's questions and treatment
options.

"Can you imagine that little boy having to hear that? And put yourself in
that mother's position," said Robert Arrieux, executive director of the
Haitian Center for Family Services, who works with the family. "Do you think
she told that boy every detail? I wouldn't if I were her.

"This just shows how much we need to have medical interpreters in doctor's
offices."

Today, although few in medicine know it, practitioners are being ordered to
use trained interpreters -- and pay for them.

Federal guidelines issued two weeks ago say that hospitals, pharmacies and
many doctors must offer free interpreters -- in person or by phone -- and
translated written materials to every non-English-speaking patient. Not
doing so could be a civil rights violation.

The cost would be minimal, federal officials said, citing a White House
Office of Management and Budget estimate that the rules would add one-half
of 1 percent to the average cost of a medical visit.

But physician groups say the cost of interpreters would be noticeable and
are strongly opposed to paying.

The American Medical Association is negotiating with federal officials to
relax the rules.

Fatal mistakes

Advocates for non-English speakers call the rules long overdue, saying
language barriers in medical settings cause misdiagnoses, medication errors
and complications leading to needless illness, hospitalizations and deaths.

Creole speaker Marie Pierre of Homestead died of a fatal drug interaction
three years ago after she misunderstood instructions from her
English-speaking doctor, said a family friend, Mona Cherestant of Fort
Lauderdale.

Stricken with asthma, diabetes, high blood pressure and stomach problems,
Pierre thought she was supposed to take all her different pills at once,
Cherestant said.

A national study of 4,000 uninsured people released in April by the Access
Project at Brandeis University found that 25 percent of those who did not
have an interpreter were confused about how to take medications, compared to
2 percent of those who had one.

Several national studies have shown that patient-doctor language barriers
contribute to health gaps among minorities in cancer, heart disease and
other illnesses.

Florida will be a key testing ground for the new guidelines. More than 10
percent of the population -- 1.5 million people -- do not speak English
well, according to the 2000 census. That includes 173,325 in Broward County,
103,824 in Palm Beach County and 731,814 in Miami-Dade County (one-third of
the population).

President Clinton set off the issue in August 2000 by decreeing that the
1964 civil rights law banning discrimination on the basis of national origin
applied to people with "limited English proficiency," or LEP.

The U.S. Department of Justice two weeks ago issued guidelines interpreting
the law. By year's end, the Department of Health and Human Services will put
out a version applying to all hospitals and pharmacies, and to doctors who
accept payments from Medicaid, the state-federal program for low-income
people.

Based on early drafts, the LEP guidelines will require health providers to
offer interpreting through either a staff interpreter, trained bilingual
employees, private contractors, community volunteers or phone services.

"In general, they have to have some way to communicate," said Robin Sue
Frohboese, acting civil rights director at HHS. "This is no new right we're
bestowing. This is a 40-year-old obligation."

Doctors with many non-English speakers in their communities and their
practices would have to offer more extensive interpreting services; those
with few could offer less. They would be judged case by case.

The federal guidelines do not allow practitioners to use family members or
untrained bilingual staffers, who currently do most of the interpreting,
because they don't have medical expertise and may make harmful mistakes,
Frohboese said. Also, speaking through a relative may inhibit the patient
from revealing embarrassing details, such as sexual history or drug use.

Patients, however, may waive the rules and choose to let relatives do the
translating.

Doctors balk at cost

Most hospitals already have interpreting services. Physicians, however, said
they are being unfairly smacked in the wallet. They will have to pay for
interpreters but will get no more money from Medicaid or insurers to help
cover the cost.

Private interpreters in South Florida charge $50 to $75 for a one-hour
visit, and phone services charge about $132 an hour, usually billed by the
minute. A family doctor typically collects $50 or less for a Medicaid or HMO
visit.

"It would cost you more than you get to see the patient," said Dr. Brent
Schillinger, a dermatologist in Boca Raton and Delray Beach.

Bringing in strangers as interpreters may alienate patients and interfere
with doctor-patient rapport, said AMA President Yank Coble, a Jacksonville
physician.

"People and their doctors worked things out. This is taking away the right
for people to work things out," Coble said. "This is a solution that does
not solve the problem. Many people will not speak openly to someone who is
not a family member."

Doctors said the rule could wind up hurting patients. Hurried physicians may
ask fewer questions or be less thorough because using an interpreter takes
longer. Many won't see Medicaid patients rather than pay for interpreters.

Optimally, patients would go to physicians who speak their language. It's
possible in South Florida to find Spanish- or Creole-speaking doctors.
What's much harder is finding a bilingual specialist.

Elia Cintra, 73, a Davie retiree born in Cuba, said she was needlessly weak
and sick for a year because she refused a gynecologist's suggestion that she
take hormones.

"I only heard the word hormones, and I didn't think I wanted to take them,"
Cintra said through an interpreter at Hispanic Unity in Hollywood. "I
couldn't understand what he was saying about the benefits."

A year later, she found a Spanish-speaking gynecologist who explained how
hormones would help. "I feel like a new person," Cintra said.

Some doctors turn away patients who don't speak English. Hispanic Unity has
had women rejected for mammograms because they did not bring interpreters,
health program manager Malena Castillo said.

That's the attitude the new guidelines should attack, said Ariela Rodriguez,
health and human services director at Little Havana Activities & Nutrition
Centers in Miami.

"People in the mainstream do not think they have to go out of their way to
take care of people who don't speak English," Rodriguez said.

The big question is how strictly the government will enforce the new
guidelines.

HHS has two people in its Atlanta office to handle language complaints from
eight Southern states.

Officials said they will stress voluntary compliance rather than court
action. Creative ideas will be encouraged, such as having community groups
supply interpreters or having doctors share hospital interpreters.

For example, in April the Palm Health Care Foundation in West Palm Beach
gave $75,000 to the Haitian Center for Family Services and the
Guatemalan-Maya Center in Lake Worth to hire interpreters who would
accompany patients to doctor and hospital visits.

Bob LaMendola can be reached at blamendola@sun-sentinel.com or 954-356-4526.





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