June 9, 2014 (San Diego) Imagine going to the doctor and not understanding what the doctor tells you? Imagine being in an Emergency Room and not getting it? It is not because you are not intelligent, but you simply do not speak English to the level that would allow you to be a partner in your medical care. AB 2325 will help to solve this problem by creating CommuniCal, which will help to create a core of medical translators to help patients and their families during both routine care and emergencies.
This is the third year that the Legislature attempts to get a version of this bill passed. From the bill website, here is the history as it stands right now.
AB 1263 (John A. Pérez) of 2013 was substantially similar to
this bill. AB 1263 was vetoed by Governor Brown who expressed
concern given the substantial growth in Medi-Cal as a result of
health care reform, he did not believe would be wise to start a
AB 2392 (John A. Pérez) of 2012 was substantially similar to
this bill with the exception of naming the State Personnel Board
as the certifying body for the CommuniCal program. AB 2392 was
held on the inactive file when the bill was in the Assembly for
SB 442 (Calderon) of 2011 would have required general acute care
hospital policies for the provision of language assistance to
patients with language or communication barriers to include
procedures for discussing with the patient any cultural,
religious, or spiritual beliefs or practices that may influence
care, and to increase the ability of hospital staff to
understand and respond to the cultural needs of patients. Would
have required hospitals’ policies on language assistance
services to include criteria on proficiency similar to those
that apply to health plans. SB 442 was vetoed by Governor Brown
who said these types of policies should be developed at the local level.
SB 1405 (Soto) of 2006 would have required DHCS to create the
Task Force on Reimbursement for Language Services, as specified,
to develop a mechanism for seeking federal matching funds from
CMS to pay for language assistance services, as specified. SB
1405 was placed on the inactive file.
AB 800 (Yee), Chapter 313, Statutes of 2005, requires all health
facilities (hospitals, skilled nursing facilities, intermediate
care facilities, correctional treatment centers) and all primary
care clinics to include a patient’s principal spoken language on
the patient’s health records.
SB 853 (Escutia), Chapter 713, Statutes of 2003, requires the
Department of Managed Health Care and the California Department
of Insurance to adopt regulations to ensure enrollees have
access to language assistance in obtaining health care services.
Double Referred: This bill has been double-referred to the
Assembly Health Committee where it was heard on April 8, 2014,
and passed out of the Committee on a vote of 13 to 6.
According to Martha Villanueva, a health promoter in the community, “to those of us who do not speak English, the interpreter is vital” She added, “I do not speak English and it is critical to have an interpreter when I seek medical care.” This is especially the case when one goes to the Hospital or the Emergency Room.
Villanueva was also quite emphatic that this was not just Spanish but all the other languages that are spoken in our medical system. I asked about UCSD, which tells us that there are translators in multiple languages. She pointed out that when one asks patients, they do not exist, and that if there is a law in the books, they will have to.
Her point was made very well by Council Member Marti Emerald. “in city heights, one of the neighborhoods I represent, there are approximately sixty languages and separate dialects spoken in our schools, in our stores, in our doctor’s offices.” Emerald emphasized that this was not just limited to San Diego, but was a state wide problem.
Activists told their stories, including a young Somali woman, her name is Maviva, who went to see her provider after feeling quite a bit of malaise. She was given a pill, and this pill led to an unwanted abortion and vaginal bleeds that lasted three months. She had no idea what she was taking. Nor did she speak Somali, but Kisigua May May, a dialect common in northern Somalia. This is a problem, even in her daily life when trying to find a way to talk to school teachers.
A Mexican American citizen pointed out that his mother, who was wheelchair bound, was not treated correctly by American medical personnel and he ended up seeking medical care in Tijuana.
On a personal level I have experienced this problem, as a child I had care at an American hospital and not speaking English proved to be a barrier. So this is not a new problem.
Where the money comes from?
We always have these questions. This is not a new program, and the dollars for it are available, at the Federal Level according to Amanda Ream, from the American Federation of State, County and Municipal Employees. The funds are there, but the legislation is needed for the State to be able to request the funds.
In her opinion, it is a cynical political decision that leads to this. Governor Jerry Brown does not want to seem to be creating a new bureaucracy. Yet, the current status quo is affecting millions of Californians, and it is costing the rest of us in lower health outcomes and more spending.