Health Law Will Bring Help To More Patients Who Don’t Speak English

May 16--WASHINGTON -- President Barack Obama's health care law was meant to change the face of Americans with health insurance, and now the industry has to adapt.

As many as 2.5 million Americans who speak limited English have joined the ranks of the insured, by some projections. Now a Florida company is among those stepping in to try to bridge the language gap.

When patients and their providers can't communicate in their native language, the outcome can be bad for everyone, said David Fetterolf, president of Stratus Video, a Clearwater-based interpretation services company.

"Number one it's bad for the patient. Number two, it increases our overall health care costs in the United States," said Fetterolf, who provides hospitals, clinics and doctor's offices with medical interpretation services offered via video.

Patients with language barriers are more likely to misunderstand home care instructions or how to take their medication and end up returning to the hospital in greater numbers than English speakers.

"You can die," Fetterolf said.

A 2010 study by the University of California at Berkeley School of Public Health analyzed claims made against a malpractice insurance carrier that operates in four states.

It found 35 claims in which language barriers had a direct effect on the patients' outcome. In 32 of those claims there was no appropriate interpreter used. In one case, a sick child was used as the interpreter before suffering respiratory arrest and dying.

The carrier paid out more than $2.3 million to settle the claims and another $2.8 million in legal fees.

Two children and three adults died and others suffered irreparable harm. The language barrier claims made up a quarter of its malpractice claims.

Advocates for minority groups had pushed to get funding included in the Affordable Care Act to cover translation services, but the money never made it into the law, said Manuela McDonough, associate director of the Institute for Hispanic Health at the National Council of La Raza.

Health care facilities that receive federal funding are required to provide translation services.

"The reality is sometimes health care providers aren't aware of this responsibility; it's not a priority. They don't have the funding for it, and no one is holding them accountable," McDonough said. "We're fearful that's going to continue with Affordable Care Act implementation."

Hospitals routinely use janitors and receptionists -- even children -- to translate complicated medical terminology to their patients.

Alice Chen, executive director of Doctors for America talks about her own experience trying to communicate with patients by shouting out random symptoms like headache and nausea in her less-than-fluent Spanish. She might get a head shaking no or a blank look.

Then when the patient talked through a translator, Chen would hear: " 'Oh I had a terrible night. I couldn't even sleep. Everything hurt. I couldn't breathe.'

"The difference between having a translator and trying to muddle through is really quite stark."

Her organization has put out a translation app for its doctors to help deal with the dramatically changing demographics brought on by immigration and the health care law.

No firm figures are yet available to show how many enrollees are not native English speakers. Such questions were optional for enrollees.

The Department of Health and Human Services announced that its hot line conducted 1.2 million calls in Spanish and more than 114,000 calls in other languages.

Prior to the enrollment period, officials estimated that about 9 million of the 30 million Americans eligible for a health law plan had limited English skills. Eight million Americans signed up for plans, federal officials. If non-native speakers enrolled in proportion, that would mean about 2.4 million signed up.

Translation services are not only important for those who don't speak proficient English. Health care costs are driven up for everyone when patients who did not understand their discharge instructions end up returning to the hospital for unnecessary treatment.

A 2012 study found that patients with limited English ability who did not have an interpreter are more likely to experience "adverse medical events" and to have problems following their treatment plans.

"Research has shown that the use of untrained, ad hoc interpreters or family members can result in disastrous mistakes," said the report in the Journal of General Internal Medicine.

Patients without interpreters remain in the hospital between one and four days longer than an English-speaking patient with a similar condition. Patients without interpreters are also more likely to be readmitted within 30 days of discharge from their original hospital stay.

"It's essential that you serve them in their language of comfort because, when you're conveying medical health terms that are so high stakes, the nuances are important," said CB Wohl, assistant clinical director at Caridad Center, a Boynton Beach clinic that serves the uninsured. About 80 percent of the clinic's clientele is Spanish-speaking. Another 14 percent speak Creole.

Stratus Video Interpreting brings a certified health care interpreter into the treatment room through an iPad so that patients can use their native language to describe their symptoms and to learn how to properly take their medication. Its interpreters are not only trained in the language but in medical jargon. They must pass written and oral tests of national standards.

"Can you imagine if you went over to a foreign country and you're with your spouse and your spouse becomes really sick?" Fetterolf asks.

Imagine questions coming at you in Mandarin, such as are you allergic to anything? Did you eat anything?

"Think about the panic," Fetterolf said. "You put yourself in a situation in another country and that's a pretty scary thing. That happens in the U.S. every single day."

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