Patient-interpreter bill aims to overcome language barriers Five years ago, Julio Perez's mother didn't understand what the doctors and nurses were saying. Her 4-year-old son, Perez's younger brother, was on a ventilator, his health worsening as bacteria in his blood began infecting his vital organs. But Perez said his mother didn't know what doctors were trying to tell her when they woke her up in the hospital, sometimes at 3 in the morning, with news about her young son. She speaks limited English, Perez said, and the hospital didn't have an interpreter available. So Perez, 19 at the time, did the interpreting for her and the doctors. "It was very distressing, because I didn't know if the information I was interpreting was correct," said the Norwalk resident. I feel like being placed in that situation added more confusion to the whole situation. He added that "it was very difficult, just the feeling that someone's life was depending on me." According to a 2012 study prepared for the federal Agency for Healthcare Research and Quality, pediatric patients with limited-English-proficient families who speak Spanish "have a much greater risk for serious medical events during hospitalizations than patients whose families are English-proficient." Perez's younger brother held on for months but eventually died in the hospital of a blood infection. That experience, Perez says, is the main reason he joined the advocacy group Interpreting for California, a coalition working with Assembly Speaker John A. Pérez (D-Los Angeles) to pass a bill that would make a statewide medical-interpretation program available to Medi-Cal patients. At a recent Los Angeles County Board of Supervisors meeting, Pérez and two other members of the group asked that they encourage Gov. Jerry Brown to sign the bill, AB 1263. It would require the state Department of Health Care Services to apply for federal money that would pay for a certified medical-interpreter program. Such a program is needed, supporters say, to prepare hospitals for the millions of limited-English speakers expected to use healthcare services over the next few years. Under the Affordable Care Act, about 500,000 people who speak limited English will be eligible to join Medi-Cal next year, according to a study by the California Pan-Ethnic Health Network, an advocacy organization in Oakland. But language barriers could affect the safety of those patients. People with limited English proficiency face a higher risk of being misdiagnosed or receiving unnecessary treatments that could hasten their deaths, according to the bill's supporters and health officials. Limited-English speakers also are more likely to avoid hospitals altogether, opting for community clinics where staffers might speak their language but are not always equipped to handle certain ailments. Michael Wilson, a spokesman for the county's Department of Health Services, said interpreter services are "particularly important in a place like L.A., where there's a diverse patient population who speaks many different languages and come from many different cultures." He said "there's guidance and information that patients and doctors need from each other." State laws require hospitals to have interpreters available either on site, by telephone or through video monitors, according to the state Department of Managed Health Care, which oversees hospital interpreter systems. The law states that interpreter services must be paid for by health plans and must be available around the clock. But Rudo Meda, an Interpreting for California organizer, says the system lacks oversight and uniformity and requires no formal credential, often leaving doctors to rely on a patient's family or friends or untrained staff to interpret. Meda gave an example of a Bengali-speaking woman whose daughter interpreted for her at the doctor's office. The woman later found out that the doctor, misunderstanding what she was suffering from, prescribed her medications for an illness she did not have. "Something dire could have happened to that lady," she said. Dr. Anish Mahajan, director of system planning at the Department of Health Services, said Los Angeles County hospitals follow a strict interpreter standard, under which the contractor either communicates with patients in real time through television screens brought into the hospital room or works with the patients and doctors via speakerphone. Other times the "diverse healthcare staff" at the hospital is used "on an ad-hoc basis," he said. Patients have to request the service, he said, and some are more upfront than others about needing an interpreter. When the Affordable Care Act opens the way for more people to enroll in Medi-Cal, Mahajan said, an existing agency has services that have already been handling the load. Healthy Way L.A., the county's free public healthcare program for underinsured and uninsured residents, already offers video, telephone and staff interpretation services to limited-English speakers who might switch over to Medi-Cal, he said. "But we're always looking to optimize those services for patients," he said. Jamie Ream, a legal analyst for Interpreting for California, said those interpretation methods are not "good enough. None of those options are as good as an in-person interpreter. Ream said that if the Pérez bill passes, California's healthcare interpreter program will most likely resemble the system operating in Washington state. There, when a patient with language-assistance needs schedules a doctor's appointment, his or her name appears in an online database. That database is searched by state-certified interpreters, who sign up online for the job and meet the patient at the appointment. The interpreter stays with the patient through the entire appointment. Other aspects of the interpreter system would change as well. The bill would create a certification process for contractors to complete before they're able to work as healthcare interpreters through the program. That would ensure that the contractor is able to communicate medical terminology in a specific language, Meda said. The certified interpreters would be independent contractors but would be given collective-bargaining rights, something most interpreters working as freelancers don't have. The cost of the program would be covered by the federal government, using money the Affordable Care Act has allocated for language services for the newly insured. Federal officials have agreed to pay the full interpretation costs for new Medi-Cal patients. Mahajan said he isn't sure how the bill's passage would affect the interpreter system used in county facilities. But "the idea that there is a push to do an even better job of interpretation is a good one," he said.