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Improved Communications- Interpreters Mandatory

Interpreters a must for HMOs - State official: Quality of care, 'human dignity' behind edict

Saying non-English-speaking patients do not have equal access to medical care, state health officials announced Thursday that all health plans must provide care in the patient's primary language — the first such regulation in the country.
The California Department of Managed Health Care announced the draft rules at a hearing in Oakland's Chinatown.

The rules, stemming from a law enacted in 2003, will require health maintenance organizations to provide interpreter services at hospitals and doctors' offices that contract with them as well as offer written materials translated into patients' appropriate languages.

"It's not just about quality of care, though that is important," said Cindy Ehnes, director of the California Department of Managed Care. "It's about human dignity."

In Alameda County, more than half of patients with limited English skills who call any of 12 hospitals in the county for emergency services do not get adequate help, according to a report by the Berkeley-based Discrimination Research Center also releasedThursday.

The report authors enlisted bilingual volunteers to place more than 550 calls requesting emergency services at the 12 hospitals in five languages, including Spanish, Vietnamese and Cantonese.

Only Kaiser Permanente routinely routed the calls to appropriate medical personnel who could assist in the caller's language, according to the report.

In about two out of three test calls in Cantonese and Vietnamese, hospital personnel answering the emergency lines either hung up the phone, disconnected while transferring or put the caller on hold for more than 10 minutes. None of the test callers who spoke in English had these problems, according to the report.

"In Alameda County, more than 30 percent of the residents speak a language other than English," said Monique Morris, director of the Discrimination Research Center.

In one test call, a hospital employee laughed at a Cantonese-speaking tester. A Tagalog speaker was told to "get someone who speaks English to call." A Spanish-speaking caller was told, "No comprendo," and heard others laughing in the background, according to the report.

The hospitals surveyed included Washington Hospital in Fremont, Eden Medical Center in Castro Valley, San Leandro Hospital, St. Rose Hospital, Alta Bates Summit Medical Center, ValleyCare Health System in Pleasanton, Fremont Hospital and Highland Hospital Oakland.
Nearly 5 million Californians do not speak English at home, and 4.4 million Californians are unable to communicate well in English, according to a University of California, Los Angeles study to be released next month.

Of those enrolled in HMOs, 1.2 million enrollees age 18 to 64 speak limited English, according to the UCLA study.

Ellen Wu, executive director of the California Pan-Ethnic Health Network, said that requiring health plans to provide equal access to language services is a model for the rest of the country.

"Until this year, health plan members all paid their premiums, but they didn't get equal access to care," Wu said.

The health plans were not so sure they should be charged with the task of providing adequate medical language services.

"How does the health plan oversee this on a day-to-day basis?" asked Leanne Gassaway, vice president of legal and regulatory affairs for the California Association of Health Plans. "Health plans are not in the doctors' offices."

The association estimates the cost of providing interpreters and translating documents will be about $15 million to $20 million, Gassaway said. Hospitals are already required to provide interpreters, but the services are uneven.

Ehnes said the state will work with health plans and hospitals to raise the bar on language services. She pointed to innovative interpretation services such as video conferencing at the Alameda County Medical Center as models for others to follow.

By Rebecca Vesely, STAFF WRITER
Contact Rebecca Vesely at rvesely@angnewspapers.com.

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