AABE--Language Barrier Called Health Hazard in ER

When a Spanish-speaking hospital receptionist refused to interpret during her lunch hour, doctors at St. Vincent's Staten Island Hospital turned to a 7-year-old child to tell their patient, an injured construction worker, that he needed an emergency amputation.

With no one to bridge the language gap for another patient, a newly pregnant immigrant from Mexico with life-threatening complications, doctors pressed her to sign a consent form in English for emergency surgery. Understanding that the surgery was needed "to save the baby," the young married woman awoke to learn that the operation had instead left her childless and sterile.

Those cases were among dozens detailed in a civil rights complaint contending that the lack of basic translation services at St. Vincent's and three other New York City hospitals endangers their immigrant patients and violates state and federal law.

The complaint, to be formally submitted today to the New York attorney general, Eliot Spitzer, was compiled by a coalition of advocates for immigrants who spent two years surveying patients, monitoring area hospitals and pressing for the translation services required by laws against discrimination on the basis of national origin.

Juanita Scarlett, a spokeswoman for Mr. Spitzer, said the attorney general's office was already conducting an inquiry into language barriers at the four hospitals, which besides St. Vincent's include the Flushing and Jamaica Hospital Medical Centers in Queens and Brookdale University Hospital and Medical Center in Brooklyn.

"We're greatly concerned that the health care needs of patients with limited English proficiency are not being met," Ms. Scarlett said.

Citing privacy rules, Michael Fagan, a spokesman for St. Vincent's, would say nothing about individual cases. But he said that because of meetings with immigrant advocacy groups, the hospital had made hiring bilingual employees a priority, and that last year, 17 obtained interpreter credentials.

Adam Gurvitch, director of health advocacy for the New York Immigration Coalition, which coordinated the efforts to document language barriers, called the civil rights complaint a last resort. "We feel like we've hit a wall," he said.

Other hospitals approached about the translation problem were far more responsive than the four private hospitals named in the complaint, he added, and some, like the city-run Elmhurst Hospital Center, have become models of health care access for immigrants, in part by training their multilingual employees to serve as interpreters.

Though more than 150 tongues are now spoken in New York, nearly all the problems highlighted in the complaint concern Spanish and Korean. A survey conducted at Flushing Hospital by Korean Community Services of Metropolitan New York, for example, showed that 40 percent of patients with limited English reported that they had received no interpreter services, and 47 percent reported that the language assistance provided was inadequate. A follow-up late last year found no improvement, the complaint said.

The Queens and Brooklyn hospitals are part of the MediSys network. Margaret M. Johnson, vice president and general counsel of MediSys, insisted that its hospitals were in full compliance with federal and state law and offered access to telephone translation for languages unknown to staff members.

"We're very sensitive to these issues," she said, citing a letter she sent to immigrant organizations last September that listed 73 Korean-speaking nurses, prayer services by Buddhist monks and free health screenings at centers for the elderly as examples of "commitment to multicultural awareness."

But the immigrant organizations said their surveys found pervasive problems. Typical were cases like that of a woman who had to rely on her English-speaking Korean cabdriver to translate a doctor's directions for treating her 11-year-old son, or the woman who minimized her symptoms of depression because the person translating was her 13-year-old son.

Among the cases cited was that of a Korean woman taken by ambulance to Flushing Hospital Medical Center last year after being beaten in the head with a brick in a street robbery. Doctors used 30 stitches for her head wound, but when the woman, a 45-year-old manicurist, returned for follow-up care a few days later, she was handed a piece of paper stating in English that to be seen by a doctor she had to pay $95 and bring a photo ID. The robbery had left her with neither.

"I felt helpless," said the woman, who works in a nail salon in Great Neck, on Long Island, speaking by telephone through a translator on the condition that she be identified only as Ms. N. "I was crying at home." Seongho Kim, then a social worker with Korean Community Services, returned with her to the hospital, where he pointed out that Ms. N.'s care would be covered by the New York State Crime Victims Fund. Only then did an employee agree to let her be seen by a Korean-speaking doctor, Mr. Kim said. "People are dying because of their language."

The woman who was left sterile, who identified herself only as Nayeli, said two emergency operations were performed without adequate translation.

In her first visit to St. Vincent's, only her brother was available to translate, which made her "ashamed," she said, to discuss her treatment with doctors. They apparently removed one Fallopian tube after finding that an embryo was growing inside it, a dangerous condition known as an ectopic pregnancy.

Nayeli, who cleans houses, said she was assured after that operation that she and her husband would have no trouble conceiving in the future. But seven months later a new pregnancy, also apparently ectopic, put her back in the operating room, where her second Fallopian tube was removed, leaving her sterile. "Never at any time did I know they were going to remove my tubes," she said.

In some cases, the monitors themselves witnessed the medical consequences of communication failures. Ana Maria Archila, executive director of the Latin American Integration Center, an immigrant rights and social service agency, said she and two others overheard doctors at St. Vincent's telling a construction worker, through his 7-year-old cousin, that the worker needed an amputation.

"The child said, 'I'm not sure if they said foot or said toe,' " Ms. Archila recalled. "This worker, he was about to cry."

The monitors later learned that it was the man's third trip to the emergency room after a construction accident that had crushed his toe weeks earlier. Unable to explain his symptoms in English, he reported, he had been handled dismissively until he returned with his big toe blackened by gangrene.

Later, after the toe was amputated, Ms. Archila added, he had to rely on a patient in the next bed to translate the doctors' instructions for postoperative care.