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On March 19, Mexican immigrant Josefa Marín was one of over 30 people to sit in front of three assistant attorneys general and describe the plight of being a non-English speaker in a New York hospital. The story she told was of a day several years ago when her son Carlos fell out of his bed and bumped his head, and so, as she put it, "like any concerned Mother," she took him to the hospital. She arrived at Woodhull Hospital in Williamsburg around 11:45 a.m. with her four-year-old daughter in tow, and spent the next 12 hours waiting for someone to treat him, or at least talk to her in Spanish.
When midnight arrived and the nurses had done little more than take Carlos's temperature, she decided to go home. As she walked out, however, she was apprehended by security guards and escorted back into the hospital. Confused about why she was not allowed to leave, she finally found a janitor to help translate. The janitor spoke to the doctors, and then explained to her that the hospital was taking her son away because of suspected child abuse. "Imagine," said Marín, "being a worried mother trying to do the best for your child, and another person who doesn't even know you, doesn't even talk to you, accuses you of abusing your childall because you don't speak their language!"
It took almost three weeks for Marín to get her son back. When she finally spoke to a judge and, with the help of a court-appointed lawyer, explained her case, the judge immediately granted her custody.
Marín is a member of Make the Road by Walking, a Bushwick community organization that filed a civil rights complaint with the New York State Attorney General's Office against Wyckoff Heights Medical Center and Woodhull Hospital in Brooklyn for not providing adequate translation and interpretation services. Make the Road claims that their limited-English-speaking members have rarely been offered translation services, and often receive poor or inadequate treatment because of the language barrier. This kind of discrimination, the complaint asserts, violates Title VI of the Civil Rights Act, the New York State Patients' Bill of Rights, and state and city public health laws.
The civil rights department of the attorney general's office reviewed the complaint and has launched an inquiry into the matter. Though the office cannot comment on an ongoing investigation, a spokesperson said if the office determines the complaint is valid, it usually works with the accused party to solve the problem and try to avoid legal action. Andrew Friedman, co-director of Make the Road, believes the attorney general's investigation will back up the organization's claims.
"About 80 to 85 percent of our membership are Spanish-speaking immigrants, and they've been complaining about not getting good health care for years," he said. "We decided to look into it, so we went to the two hospitals and interviewed 145 non-English speakersthe results were horrifying. Eighty percent said they were unable to speak to their doctor or doctor's staff at all, 85 percent said they had never been informed of their right to receive free translation services at the hospital, and 65 percent said they were confused about their medical treatment."
Last Thursday, Brandeis University's Access Project released a similar study done on a national scale, in which over 4000 uninsured patients in 12 states were interviewed about their experience. One finding was that "27 percent of those who needed but did not get an interpreter said they did not understand the instructions for taking their medications, compared to only two percent of those who either got an interpreter or did not need one."
The administrations of Wyckoff and Woodhull hospitals have defended their translation services, pointing to several programs they already have in place. In a written statement, Woodhull's executive director, Lynda Curtis, claimed that Woodhull's staff is one of the most diverse in the country, speaking over 50 languages, and available to talk to patients at any time. They also have two telephone-translating services that translate at least 138 languages. Curtis said the hospital is considering hiring on-site translators in four languages.
Friedman said on-site translators would be a great step forward, because currently patients have to rely on a family member to translate or hope that the receptionist or a nurse will speak their language.
William Green, representative of Wyckoff, defended that hospital's translation services, also pointing to a diverse and bilingual staff and a phone translation system, in addition to free Spanish classes for all interested employees, and a Spanish-language health care workshop. However, Green said Wyckoff hasn't considered hiring translators because "it would be a total waste of resources. How often would a situation come up where the hospital would need eight hours of translating in a row?"
But Make the Road claims its members have rarely seen these current services in action. "I've interviewed all of our impacted members, and asked each of them if they've ever used the language line. They have all said no," said Rose Cuison-Villazor, an Equal Justice Works fellow of New York Lawyers for the Public Interest, who helped file the complaint. "I don't think the employees know the service exists, and if they don't offer it to the patients, what good is it? The law provides that an interpreter must be available within 10 to 20 minutes of a patient's need for an interpreter. Our members often wait for hours."
Make the Road's members complained of having to resort to using their young children to translate, or not understanding the correct dosage or side effects of their medicine. The complaint listed a number of other problems, including delayed treatment, improper diagnoses, and ineffective medical treatment.
The attorney general's inquiry comes on the heels of an Institute of Medicine report showing that people of color receive lower quality health care than whites, even when they have the same insurance and income. Friedman wasn't surprised by this report. "It's certainly resonant with the experience of people in our neighborhood," he said.
The inquiry is also concurrent with a lawsuit pressed against the Bush administration by ProEnglish, a Virginia organization working to make English the national language. They have sued to reverse Executive Order 13166, an order President Clinton signed in 2000, which outlined the protection of limited-English speakers under the Civil Rights Amendment, refusing federal funding to organizations who don't provide translation services to their clients.
"The executive order creates a huge additional expense for doctors and hospitals, what with the added costs of translators, and it opens up a whole new venue for medical malpractice suits," said K.C. McAlpin, executive director of ProEnglish. In reference to the complaints filed by Make the Road by Walking, he said, "It's this sort of lawsuit that will become an epidemic if we don't overturn Executive Order 13166."
Even if the White House were to overturn the executive order, hospitals may be held accountable for providing services by state or local laws. Queens councilmember John Liu has introduced the Equal Access to Health and Human Services Bill, which would require many city agencies and large agency contractors to provide free translation services. Liu said that over 20 councilmembers had agreed to co-sponsor the bill.
Friedman would like to see the bill passed. "As New York City demographics keep shifting and more and more New Yorkers don't feel comfortable communicating in English, enabling their ability to access health care should be a fundamental task for the administration," he said.