Luis Perez wanted to tell his doctor about his heart problem. His medication was making him feel worse, not better. Unfortunately, the doctor spoke just a little Spanish.
And Perez (pictured), who arrived in New Haven last year from Puerto Rico, knows just a little English, though, by necessity, he’s learning more.
“The doctor just told me to go see my cardiologist the next day,” Perez reported after his appointment the other day at New Haven’s Hill Health Center.
Perez is one of 22,000 Medicaid recipients in the state with limited English proficiency affected by a recent mid-year budget cut by Gov. M. Jodi Rell. Because of a suddent $300 million budget shortfall triggered by the Wall Street meltdown, Rell issues a series of cuts including eliminating $1.175 million in previously approved money for Medicaid medical interpreters services this year. Those on the front lines fear it will lead to increased disease and increased costs.
“The people that this helps the most are the growing number of poor who cannot access health care services because of limited English proficiency,” said Jeannette DeJesus, executive director of the Hartford-based Hispanic Health Council.
“Seventy-nine different languages are spoken in Connecticut,” she wrote in an email message. “The largest group is Spanish-speaking but [the problem] affects all LEP groups — this is why it has gotten such wide support across the state.”
DeJesus (pictured) wrote that the Hispanic Health Council brought together nearly 40 organizations that worked two years within communities across the state and with legislators to get the translators’ money approved.
She said the coalition will soon begin the work of getting the full amount restored. If they fail, she predicted “an increase in disease, and an increase in costs to our medical system” because those who cannot adequately speak English will not be able to access quality care and treatment. That can lead to medical errors that may require more treatment and medical intervention.
“Lack of understanding between doctor and patient may also lead to the patient not being able to follow instructions accurately,” she added. This results in increased time and treatment and therefore cost of care.
DSS spokesman David Dearborn called the medical interpretation program “one of several worthwhile programs or projects being delayed or deferred to help the state reduce the budget deficit.” Click here for the rescission document. (See page 15.)
New Haven State Sen. Toni Harp vowed to organize legislators to try to get the money restored. (Click here to read about that.)
One Center’s Efforts
One center with many Spanish-speaking Medicaid patients, New Haven’s Hill Health, has been trying to make do by enlisting other staffers. Sometimes that works. Sometimes it doesn’t. Luis Perez, for instance, is familiar with a nurse at Hill Health Center who speaks good Spanish and helps patients like him out on visits. But on the recent afternoon when he tried to tell his doctor about his heart, the nurse was not available.
Robert Kilpatrick, director of marketing and health education at Hill Health, said most patients have access to interpreters if they need them. But the interpreters are often employees pulled off their regular jobs to translate. He said the governor’s rescission “creates a situation in which we don’t have access to funds for people who have been trained specifically, and leaves us depending on existing staff and the telephone service we have called Language Line. That’s not the best way of doing it, but it’s seen as acceptable.”
Kilpatrick said one staffer has already taken a 40-hour medical interpretation course sponsored by the Eastern Area Health Education Center, and several more are planning to take it. Fluency in a second language besides English is a prerequisite for the course.
“I guess the hope is that if legislation ever gets implemented and money is put into it, these are the people who will be providing interpreting services.” He added that if people are not well trained, “You are opening yourself up to other problems, because there’s room for possible miscommunication.”
Other Staffers Step In
What about having a family member translate? One Republican candidate for State Senate this month, New Haven’s Melissa Papantones, argued that speakers of foreign languages should depend on relatives, not the state, to translate at the doctor’s office — the way her own grandparents did.
““We all have to make some sacrifices to get everything back on track” on the budget, she said. “It’s hard to have an army of people available to speak the languages we’re dealing with. It’s not just Spanish. It’s hard to find interpreters.”
“People can bring family members in, and they do,” Kilpatrick said. “But it’s not a legitimate way of doing it, because there could be times when the information is confidential and shouldn’t be shared with family members, and there are times when the family member might not understand medical terms,” especially if the interpreter is a child.
Luis Perez offered another reason not to bring one of his kids to translate for his appointments — even though they’re picking up English faster than he is. He doesn’t want to take any of them out of school.
“Our hope,” Kilpatrick continued, “is to get enough funding to have a full-time person doing medical interpretation. That would be in Spanish; about half our patients are Spanish-speaking, although not all of them need interpretation. We also have a lot of other languages. Language Line reports each month on the calls they get from us. It’s been Vietnamese, French, African languages, Eastern European.”