Y.K. Lo, a 70-year-old San Jose resident who immigrated to the United States from Hong Kong in 1998, visits his homeland at least once a year for a health check-up. Although he can speak enough English to request an interpreter in a U.S. hospital, he says the process is irritating. Lo also could bring his son with him to the hospital to translate, but he chooses not to.
“It’s bothersome when my son has to take a day off to come with me to the hospital,’’ Lo said. “It’s easier that I do my check-ups in Hong Kong where I can speak Cantonese with them.”
Language is still a barrier for many seeking health care in California. Late last year, a Korean woman in Los Angeles died while receiving treatment for stomach cancer because of the lack of medical interpreters. According to Korea Times, she made several unsuccessful attempts to request an interpreter, and she was discharged in 2005 without being aware she signed a form to terminate her chemotherapy treatments.
A 2006 study of Alameda County hospitals showed that 44 percent of the people calling for emergency care in a language other than English failed to reach a person speaking the caller’s language. Specifically, 63 percent of the calls in Cantonese and 62 percent of the calls in Vietnamese failed to connect to a proper interpreter.
“We had a suspicion that there was a problem going on, but the extent of the number of people being hung up on was a surprise because we didn’t expect it to be so high,” said Jessica Borja, research associate of the Discrimination Research Center, a nonprofit organization that researches, advocates and provides public education on discrimination in various settings.
While some estimate that more than 200 languages are spoken in California, the state Department of Education reports 56 languages spoken by English learners in public schools.
With the Kopp Act of 1983, a California state law, hospitals became bound to provide a translator for languages spoken by at least 5 percent of patients being served. But some health-care advocacy groups believe the need is not being met.
For example, the California Primary Care Association, a professional association for more than 600 community clinics and health-care centers, is advocating that all health-care professionals have cultural training as part of their certification.
“A lot of problems occur when people with limited English receive health care, especially with their prescriptions and how to communicate with doctors,” said Jamila Edwards, the group’s associate director of special programs. “Our No. 1 goal is to have doctors and nurses receive training about being sensitive to cultures. Cultural and linguistic competency is not emphasized enough.”
Some people opt to have a family member accompany and translate for them instead of requesting for an interpreter at the hospital.
“My son has to take time off of work to drive me to the hospital,” said Peter Chang, a senior citizen at Iola Williams Senior Center in San Jose.
Others who do not want to burden their children prefer to go to health clinics tailored to their ethnicity. The Asian Americans for Community Involvement (AACI), a non-profit service organization located in San Jose, provides education and health programs for Asian Pacific Americans in Santa Clara County.
“Most [of our clients] cannot speak English and they don’t have education here. Their primary language is their mother language,’’ said Jennifer Tseng, compliance and quality improvement manager of AACI. “They want to be entitled to know about their medical condition, so this place is their first choice.’’
Some patients who don’t speak English rely on community members for help.
“I go to the [health] clinic, and I see people who don’t even understand when their name is called. Because I can speak multiple dialects of Chinese, I am able to help translate for them,” said Katherine Chen, a retired banker and occasional interpreter for those she sees in need.
While some patients such as Lo prefer traveling to their homeland for medical treatment, South Bay resident Yuk-Mei Tang says she needs to go to San Francisco to feel comfortable getting medical care.
After Tang immigrated to the Bay Area from Hong Kong 10 years ago, her first encounter with the U.S. health care system was intimidating. She felt uncomfortable talking to an English-speaking hospital clerk, who was trying to determine the language she spoke. After what seemed like hours of waiting, the clerk finally reached a Cantonese interpreter.
Since then, Tang travels an hour to San Francisco to receive health care at Chinese Hospital, where most employees speak either Cantonese or Mandarin and most medical services are provided in one location.
“The hospitals are a lot better now with interpreters, but my husband and I still prefer going to a hospital where I don’t need to try speaking English,” Tang said.
Some hospitals have tried addressing the need for language interpreters. Since 1997, the Santa Clara Valley Medical Center has used the Automatic Call Distributor system, hoping to address all language interpretation needs through a phone call. Calls are routed to one central location with 27 interpreters. Instead of focusing on face-to-face interpreters, the hospital has relied on what it considers a more efficient approach to the language access problem.
“Our model allows efficiency that is not otherwise available with face-to-face. If you are in a call center, you could help three or four people in the time it would take you to walk over to help one,” said Jerry Wallerstein, director of language services at Santa Clara Valley Medical Center. “Last month, we answered 17,000 calls and had an average waiting time of 65 seconds.”
Kaiser Permanente Hospitals in Oakland and Fremont connected non-English speaking callers to the Emergency Room almost 100 percent of the time, according to the Discrimination Research Center study.
“The Kaiser Permanente Fremont Medical Center was recognized as one the best among 12 Alameda County hospitals surveyed for its language assistance over the phone with emergency services,” said Calvin Wheeler, physician-in-chief of the Fremont and Hayward Kaiser Permanente Medical Centers. “In Northern California, Kaiser Permanente has professional interpreters available in our medical centers or by phone who can assist in 140 languages, including American Sign Language.”
At El Camino Hospital in Mountain View, staff members carry Vocera Badges -- lightweight wireless devices that allow instance voice communication -- which enables them to use the language line in any given moment. The hospital, paying for AT&T Translating Services with medically certified interpreters, receives calls in about 40 to 50 languages a month.
“I’ve never had an instance where I haven’t reached someone...the language line is extremely reliable,” said Chris Tarver, interim director of inpatient and emergency services at El Camino.
While many hospitals and organizations have tried to fix the language barrier over the years, there is still more work to be done.
"Access to trained health care interpreters is essential to improving the health outcomes of limited-English proficient health care consumers,’’ said Jeff Okey, senior media relations associate for the California Endowment, a group advocating for an increase in access to health care. “Though many providers do ensure access to these services, we still have a long way to go to make sure that individual needs are being met."