Medical providers struggle to offer translation services
The Affordable Care Act is expected to change the face of the nation’s insured population. When the federal health care law is implemented, one in five insured patients will be non-native English speakers, up from one in eight.
Community clinics, doctors and medical facilities are already struggling to provide appropriate, culturally competent medical translation to diverse populations, and this shift could exacerbate the situation, Megan Burks, a KPBS reporter for the Speak City Heights project, recently reported on the radio and in the video below. Speak City Heights is an initiative of KPBS, Voice of San Diego, Media Arts Center San Diego and The AjA Project.
In her piece, Burks detailed the harrowing results of inadequate medical translation - including the story of Sahro Nor, a female refugee who had been circumcised back home in Somalia, and was trying to give birth in a Western delivery room.
“For a circumcised woman to give birth vaginally, the doctor would have to make incisions to re-establish the birth canal,” Burks explains in the piece. “Nor’s doctor had never seen a circumcised patient. Nor didn’t speak English at the time, so she tried to describe the procedure she needed by pantomiming through the pain and chaos of labor. It didn’t work. The baby came before the cuts were made, causing Nor a lot of pain and, eventually, permanent numbness.”
The state already requires medical providers to offer translation services, but Burks’ story shines a light on a wide hole in our medical system, and an opportunity to minimize health disparities. “The Affordable Care Act is going to increase the number of people who need translation - but it’s a problem, if doctors can’t already handle the need for translation,” Burks told me during a phone interview last week.
Burks explained to me that community clinics - especially in diverse areas like City Heights - make a concerted effort to hire culturally competent employees from the community. Still, clinics in the state can’t get reimbursed through Medi-Cal for translation services. In City Heights, Burks said, medical translation “is not a huge problem for the patients, but it is for the clinics.”
And when patients see a specialist, or visit a hospital, they might have access to a translator over the phone, or they might bring a relative to translate. Sometimes, in a pinch, local clinics will send over an employee to translate but, “the clinic can’t bill the hospital for that service,” Burks emphasized.
The Affordable Care Act could deal with these issues in a roundabout sort of way, Burks explained. The law will offer diversity grants, which are intended to bring more ethnic diversity into the health care industry. And hospitals could be fined if they have too many unresolved cases and repeat visits, which could occur, in part, due to inadequate medical translation.
But, as Burks explains in her story, refugee women in City Heights are seeking a more direct solution to this problem. They are asking residents to sign a petition to get insurance providers to cover face-to-face translation in doctor’s offices and hospitals. They plan to send the petition to the board overseeing California’s new insurance exchange.
Reporters across California, and the country, can report on the need for adequate medical translation in their communities. I asked Burks for advice for reporters interested in investigating this issue locally; as a starting point, she recommended speaking with community clinic representatives, and asking which services they are not reimbursed for. “One of them will be translation,” she said.
Photo credit: Megan Burks