In California, a state where nearly seven million residents admit to speaking little or no English, having access to a professional interpreter can mean the difference between life and death in hospitals. With so many Californians at daily risk, a new bill would ensure that patients with limited English proficiency receive correct medical treatment. The law, however, will come too late for Guillermo Garcia Rodriguez. In 2011, the then-45-year-old, Oceanside father of three rushed his 42-year-old wife Elizabeth, who had suffered a massive stroke, to Tri-City Medical Center where she was intubated and put on life support.
Talking to Capital & Main through an interpreter, Garcia, who like his wife, speaks no English, describes a bewildering and frightening month-long ordeal in which he could get little information from the mostly non-Spanish-speaking nurses and hospital staff.
“I was visiting my wife every day,” he recalls, “but did not know that I was able to get an interpreter to tell me what was going on with my wife’s health. [So] I was using either my friend’s wife, who was visiting sometimes, to ask her to interpret for me. Or anytime I would see anybody with a Mexican face or a Hispanic face, I would ask them to interpret for me so I can help my wife and [find out] what was going on with her health.”
Because of the intubation, Garcia says, “she was not able to speak [easily], but she was able to speak very slow. But I’m sure she was able to understand what we were saying, and she was able to smile.” The most worrisome part, says Garcia, was being unable to convey his grave concerns over the life-support tubes, which were causing his wife to choke on her saliva and vomit.
“She would communicate by signs,” he remembers. “She would point to her mouth so people would come and help her. I would ask the nurses that were able to speak Spanish, ‘Okay, are you coming tomorrow to work? What’s your shift so I can talk to you about my wife’s care?’”
On July 13 the hospital called — Elizabeth had died. It wasn’t until the following day that Garcia finally spoke to a medical interpreter, who phoned to explain that “because of the vomiting, the vomit infected the blood, the infection reached the brain, and because of that there was brain damage, and that was the cause of death.”
What haunts Garcia is knowing that his wife died alone and helpless — that there was nobody there to alert the nurses to her vomiting, so they could apply suction before the vomit went to her lungs.
Last week in San Francisco, Mayor Ed Lee, Assembly Speaker John Perez (D-Los Angeles), and Assemblyman Phil Ting (D-San Francisco) gathered at Northeast Medical Services in Chinatown to support Perez’s Assembly Bill 2325. If enacted, AB 2325 would prevent the kind of nightmares that Garcia and other non-English speakers have experienced by creating CommuniCal, an agency that would expand, certify and oversee the trained interpreters available in emergency situations for low-income residents that speak foreign languages, especially uncommon ones. It would create about 7,000 interpreter jobs within 10 years by accessing $270 million in Affordable Care Act funds.
“We are enrolling over a million new people into Medi-Cal,” Ting announced. “This is just the first step.”
The bill is identical to last year’s Perez-authored AB 1263, which made it through both chambers only to be vetoed in October by Governor Jerry Brown, who cited the bad timing created by the “unprecedented expansion to add more than a million people to our Medi-Cal program.”
“The policy is essentially the same, but the timing is better,” Perez spokesman Will Shuck told Capital & Main. He added that if everything goes as expected, California’s non-English-speaking patients could see relief by September 30 — the last day for the governor to sign or veto bills passed by the legislature before its August 30 recess.
Stories such as Garcia’s come as no surprise to Ballav Poudyel, an employment counselor at Oakland’s Lao Family Community Development organization. Though Poudyel isn’t a medical interpreter, he says such misunderstandings are commonplace among the community of 500 Nepali-speaking Bhutanese that have been resettled in the Bay Area since 2007 because of ethnic strife in Bhutan.
As a speaker of both Nepali and Hindi, Poudyel often finds himself drafted as an informal translator to help with straightening out bills or dealing with correspondence from government social service agencies. It was while providing such help that Poudyel met Dumbari Magar, a Nepali-speaking mother, who with her husband and 12-year-old daughter, have lived in Oakland for three years.
“She came to me a month ago,” Poudyel recalls in a phone interview. “They were applying for Medi-Cal. The application required some family [medical history]. And then some questions: ‘Does a family member have a medical disorder?’ — or something like that. At that time she shared with me, ‘Oh, I have my daughter, the nose bleeds often.’ And at that time [I asked], ‘Did you take her to the doctor?’ ‘Yes [Magar said], one time there was a lot of bleeding, and [I] had to take [her] to hospital. But there was no interpreter — [no] Nepali-speaking people. So the doctor simply sent us back home. And it still is not cured . . . no follow-up, no diagnosis, no medications.’”
Complicating matters for refugees like the Magars is the fact that they often have little understanding that a diagnosis or follow-up visits are even expected. “They are lost in that navigation of the system,” says Poudyel.
“It’s the same old story,” he continues. “They feel they want to go to hospital for their medical checkup, but they don’t know how to say it. They feel [something’s wrong], but there is no way they can express it over the phone. ‘The pain is here,’ they say. They don’t know even in their own mother tongue [how] to say a medical part or name. But they can point [to] it — ‘I feel it, I see it.’ Those kinds of things. But they want to have [the help] to explain things.”
What they do have for now is the renewed hope offered by CommuniCal and AB 2325.
Gary Cohn is a Pulitzer Prize-winning journalist who has worked for the Los Angeles Times, Baltimore Sun and Philadelphia Inquirer, and writes currently for Capital & Main. This article was co-written by Bill Raden, a freelance Los Angeles writer who reports for Capital & Main.