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Speaking the LanguageInterpreting for California:

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Medical InterpretersIntroduction:

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Californians are at a historic crossroads when it comes to health care. Our state is on track to be the largest beneficiary of health care reform, yet more than a third of those who are about to gain access to the system will have no way to communicate with their new doctors and nurses. We are the most diverse state in the country with the stron-gest laws requiring interpretation in medical settings. Yet we are standing at this crossroads without a clear plan for how Californians with Limited English Proficiency (LEP) will access healthcare in a language they understand. We need to take action to implement reform in a way that saves lives and money.

The people of California need to be understood.

This report represents the testimony of patients from around the state who opened their homes and workplaces to Interpreting for California from December 2012 to June 2013 to share their stories of hardship and resilience when seeking healthcare as a LEP patient. Patients and family members described tragic, life-threatening events that resulted from a lack of interpretation, as well as the everyday struggle of trying to communicate in healthcare settings through friends, children, telephone relay lines, waiting room strangers and medical staff such as administrators and janitors who have never taken a class in medical terminology. Many of them have suffered the preventable death of a child or parent because they did not have access to interpreters. Many more stories document routine hardships demonstrating a broken system of healthcare delivery for LEP patients, including:

•Denialofconsentformedicalprocedures •Failuretoexplainatreatmentplan,includingdosages of medication •Exclusionfromdiagnosisandtreatment •Childrenforcedtointerpretforimportantand sensitive medical decisions •Ongoingdiscriminationbasedonlanguage

It’s Time to Speak the Language of Care.Californians who speak a language other than English make up almost half the patients in our state’s healthcare program. With national health care reform, millions of Californians will be soon be eligible for health care; of those enrolling in Medi-Calinthenextfiveyears,about3millionwillrequirelanguage assistance. We need to be prepared to meet the needs of these LEP patients who frequently report problems relatedtotheirexperienceofcare.Patientsgavetheseresponses to the state when asked about their healthcareexperiences:

•LEPenrolleesinthestate’ssevenlargesthealthplans were more likely than English-proficient enrollees to report problems understanding their physician (11.2% vs. 2.6%).

•Theyarealsomorelikelytobelievetheywouldhave received better care if they were of a different race or ethnicity (14% vs. 3.2%).

The human and financial costs of doing nothing are too great.

Lack of proper interpretation in a medical encounter has serious and sometimes tragic consequences. In one survey, almost half the physicians were familiar with incidents in which quality of care was compromised by language barriers. Also, Limited English Proficient patients in hospitals are at far greater risk of suffering unintended harm that is not a result of their disease or condition, up to and including permanent brain damage, paralysis, and death. This language barrier to healthcareleadstotheuseofmoreexpensiveemergencyservices, higher diagnostic and testing costs, and increased liability for providers. In this fiscal climate, our state cannot afford the costs of poor communication.

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California Has the Opportunity: A Plan to Enable Doctors and Patients to Understand Each Other. California has the ability to draw down significant federal funding for interpreter services through Medi-Cal, receiving $270 million per year at full implementation of an interpreters’ program. The Obama administration has made interpretation a priority under the Affordable Care Act. California can receive up to75%ofthecostsofmedicalinterpretationforexistingMedi-Calpatients.FornewpatientscomingintotheMedi-Calprogram under the Affordable Care Act, the state can bill for 100% of the costs of interpretation. A California medical interpreters’ program will create a new statewide system allowing health care providers to access funded, professional medical interpretation. Overtenyears,approximately7000newjobswillbecreatedin the medical interpreting field.

The decision is up to us.

We can either allow the thousands of newly insured Californians who speak a language other than English to join Medi-Cal with-out access to critical interpretation services, or we can take full advantage of the available federal funds to create a program in Medi-Cal that will offer certified, professional interpreters to both providers and patients, so they may be understood. California can achieve quality of care for those who are not fully fluent in English. To do less is to invite human and financial disaster. Cali-fornia has a choice. Governor Brown can show the leadership our state needs. He can sign AB 1263 into law this year, accepting all available federal funds and creating an interpreters’ program in Medi-Cal .

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dition, he did not speak Spanish and no interpreter was pro-vided so that I could properly understand what he was saying. Legally, I had the right to press charges and fight this matter in court but I did not want to risk my ability to stay in this coun-try, or that of my family’s. I prayed to God and decided not to fight because I did not want to compromise my life in America. Losing my baby forced me into a deep depression. I could not bear looking or holding babies because the thought brought back painful emotions. It took years to move on but I will never forget the wrongdoing done to me. I am telling my story today because I want to make sure this never happens to anyone else ever again.

In March of 2008 I went to the Los Angeles General Hospital to seeifIwaspregnant.Forthreeyears,Ihadbeentryingtogetpregnant.Ihadbeenexperiencingsymptomsofpregnancyanddecided to see if I was pregnant by going to the hospital. The doctor checked me and I was indeed three months pregnant. I was so happy! The doctor spoke only English, and when he asked me asked me if I wanted to keep this baby. Without hesi-tation, I replied, “yes” to his question. Before leaving this hos-pital, the doctor prescribed me medication that I thought was prenatal care. I now realize I didn’t understand what he was asking me. That lack of communication between the doctor and I has changed my life forever.

On March 4th, I took the prescribed medication. On March 7th, Iwasexperiencingincreasinglyviolentpaininmyabdominalarea and began to notice blood. The following day, I started to bleed more profusely and went back to the hospital to see what the problem might be. Another doctor informed me that the bleeding was the result of a miscarriage. My baby was dead. The medication the initial doctor prescribed to me was not prenatal care but medication to induce an abortion.

The doctor I saw on March 4th would not listen to me when Itriedtospeaktohim.Whenconfronted,heexplainedthathe asked whether I wanted to have an induced abortion. He claims that I told him “yes” I wanted an abortion. However, I thought he was asking me if I wanted to have my baby and so I responded “yes” I want to have my baby. Not speaking any English, I was unable to understand his question to me. In ad-

“I want to make sure this never happens to anyone else.”Maria Guevara • Los Angeles

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explaintheliabilityformsthattheyhadtosign.Aftermypar-ents signed the liability forms, the interpreter left and never returned. This was the only time that an interpreter was offered to us. Sometimes the nurses would try to communicate important information to my mother at 2 a.m., and I had to interpret for her.

The procedure was scheduled at noon. During the procedure, our mom went into the room and saw Aldo bleeding from his mouth as the doctors were placing tubes down his throat. She was immediately told to leave the gruesome scene. After the procedure, Aldo was left unconscious and on a respirator. Then, he underwent dialysis. After that, Aldo had a series of surgeries, opening up on his neck, then his lungs, and then his thigh. He was poked constantly with needles by nurses-in-training. I confronted the doctors, and asked them why they were using Aldo to teach the nurses—the doctors said, Long Beach Memorial was a teaching institution in addition to being a hospital, and that they had to teach the Cal State Long Beach students how to perform procedures. We felt Aldo was not treated with dignity and respect. Aldo never regained consciousness after the sample was removed from his spleen. My baby brother, Aldo Mauricio, was pronounced dead shortly after midnight on April 14, 2008.

The day before Aldo died, we had a meeting with the five doctors that were responsible for treating him. Only then,were we told that there was a one in five chance that he would

My name is Julio Cesar Perez. I’m a student at California State University,Fullerton.ThestoryI’msharingwithyoutodayisabout my baby brother Aldo Mauricio, born on April 3, 2003 at SaintFrancisMedicalCenterintheCityofLynwood.OnFriday,March28,2008,myAldoandIweresickandhadgoneto a clinic in South Gate, where injections were given to each of us. Our mom took us to this clinic because the doctor spoke Spanish. After the visit to the clinic, Aldo did not get better. The nextday,ourmomtookhimbacktotheclinic,butthedoctortold her that he was dehydrated and could not do anything else for him. She was asked to sign a liability form by the doctor in case anything happened to my brother. Then, our mom, took himtoSaintFrancisMedicalCenter,hopingthattheywouldbeable to cure my brother. When we arrived there, we were told that they did not have the necessary equipment to treat him, so he was transferred to Long Beach Memorial. Long Beach Memorial Hospital did not have any doctors or nurses that spoke fluent Spanish, so I had to be the interpreter.

The doctors at Long Beach Memorial told us that Aldo had bacteria in his bloodstream, so they were going to begin treatment right away. His fifth birthday was spent watching cartoons from the hospital bed, while telling us that he wantedtogohome.Thenextday,thedoctorstoldmyparentsthat they were going to have to remove a sample from my brother’sspleentofindoutexactlywhatwasinfectinghisimmune system. Since the doctors knew that my parents did not speak fluent English, they brought an interpreter to

“My baby brother’s death was an InJUsTICe.”Julio Cesar Perez • Norwalk • How Aldo Died

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survive. We questioned why they didn’t tell us sooner. They told us matter-of-factly that the end result would have been the same.

I feel that my baby brother’s death was an injustice. We wanted to file a lawsuit against Long Beach Memorial Hospital, but we were afraid that we would have been deported if we filed a lawsuit. I feel that an injustice was done to my family. If we had proper interpreting services, my baby brother, Aldo, would be alive and our family would be celebrating his 10th birthday tomorrow.

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Left to Right (Julio Perez, Patient Rally at Alameda County Medical Center, Patient Rally at UC San Diego Medical Center) 2013

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More StoriesSpeaking Out:

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OvervIew:

SAN FrANCiSCo AreA

Len Situ Age 56 San Francisco General Hospital Ruptured Appendix

Wenlan Rong Age 52 Rheumatoid arthritis

Un Un Che Age 44 UCSF Broken Arm – Age 8 Daughter

Hai Ping Li Domestic Abuse

Chin Hong Lou UCSF Stroke / 911 call

Saihuan Liang Age 51 Northeast Medical Services Tooth Removal

Muoi To Huynh Hospital ER Cut Finger

Ruben Vargas Age 49 Doctor Medical Center Kidney Failure

ALAMeDA CouNty

Adrian Perez Munoz Alta Bates Summit Medical Ctr Stroke-like symptoms

Gloria Estela Ortiz Age 55 Eastmont Women’s Clinic Liver medication complications

SANtA CLArA CouNty

Rocio Longoria Santa Clara Valley Medical Ctr Pregnant / Bleeding

Mariana Ayala Santa Clara Valley Medical Ctr Pregnant / Gall Stones

Graciela Santillanes Santa Clara Valley Medical Ctr High blood pressure / ER visit

Maria Trinidad Escobar Regional Medical Center Pregnant / Hit by car

Esperanza Ybarr Age 72 Santa Clara Valley Medical Ctr Arthritis misdiagnosis

Camille Fontanilla Santa Clara Valley Medical Ctr Gout misdiagnosis/ lung cancer

Erika Borja Santa Clara Valley Medical Ctr Son ENT issues

Maricela Garcia Santa Clara Valley Medical Ctr Pregnancy / daughter interpreted

Nabor Mora Mendez O’Connor Hospital Colon Cancer

Rocio Ramos Kaiser, San Jose Son / pneumonia

Mauricio Gallardo Burgos Regional Medical Ctr Car accident

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SAN MAteo CouNty

Ana Ester Romero Ponce Ravenswood Family Health Ctr Gestational diabetes

Feng Xiao Mei Age 58 San Mateo Medical Center Hypertension Prescriptions

Evelia Salinas Bermudez Stanford Hospital Pregnant / ER visit

FreSNo AreA

Otilia Ortigoza St. Agnes Hospital Birth / bleeding & fever

Shen Yang Fresno Community Hospital Chest pains / short breath

Lou Vang Fresno Community Hospital Seizure episodes

Pang Thao Fresno Community Hospital Blood clots

Jer Xiong St. Agnes Hospital Pneumonia

Thao Yao Pao Dignity Hospital Diabetic / xray problems

LoS ANGeLeS AreA

Malin Ouk Memorial Clinic Prescription confusion

Pouelinna Po Memorial Clinic Diabetes / brain tumor

Amanda Em Pacific Hospital Prescription confusion

Maria Alvarado Hospital ER Miscarriage in ER

Flor Florez Kaiser Long Beach Son / Diabetes

Maribel Nava Long Beach Comm Hospital Pregnant with complications

Indira Rodriguez Kern Medical Center Pneumonia

Ruth Seve St Mary’s Hospital Prescriptions

Taigogo Misa Pacific Hospital Stroke

Elizabeth Faapito Lakewood Regional Med Ctr Rash

Mutarau Faapito Lakewood Regional Med Ctr Back pain / Rash

Martha Leyva Chino Community Hospital 2 week hospital stay

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Maria Ulloa USC General Hospital Long waits

Edwin Agreda USC Medical Center Cancer

Rosa Calderon USC Medical Center Diabetes

Abraham Carrasco St Francis hospital Diabetes / Mother

Mana Amalia Romero Age 56 Huntington Hospital cut hand / bleeding heavy

Esvin Juarez Santa Monica Clinic UCLA Heart problems

Abukar Mohammed Alvarado Hospital

Ana Pacheco Long Beach Clinic Stomach Cancer

Ligia Anderson Queen of the Valley Hospital Child birth

Ester Santiago Age 38 Martin L. King Jr. Emergency Breast lump

Luxana Age 52 Women’s Breast Center Breast lump / bleeding

Phayao Age 57 Cancer Survivor

Sumalai Age 67 Breast Cancer Survivor

SAN DieGo AreA

Dolores Ortiz Age 42 Logan Clinic Thyroid condition

Dora Sanchez Age 17 Sharp Hospital No diagnosis/ IV

Joseph Kravets Age 87 Alvarado Hospital Heart problems

Zinaida Schezbakoda Age 67 West Coast Eye Care Eye problems

Bartola Andres de Arguelles Tri City Hospital Injured neck

Safi Illeeye Alvarado Hospital Mother / died of complications

Maria Gallardo Scripps Hospital Stroke

Jamie Tran (children) Sharp Children’s Hospital Hydrocephalous

Loi Nguyen Alvarado Hospital Short breath / High BP

Khai Trung Nguyen Age 71 Scripps Mercy Hospital Heart Attack

John Makuach Sharp Memorial Hospital Knee replacement

Minh Nguyen Sharp Memorial Hospital Kidney Stones

Hue Nguyen Mercy Hospital Sore throat/ lump in neck

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Ailian Zhang Mira Mesa Hospital Unknown

Alexander Shatov Scripps Mercy Hospital Torn meniscus

Dmitriy Glozman UCSD Hospital Chemo side effects

Dora Sanchez Sharp Hospital Accident injuries

Jeanette Showriz Mercy Hospital Heart problems

Kean Kao Dr.’s office / Sharp Hospital Stroke

Khai Trung Nguyen Scripps Mercy Hospital Heart surgery

Ko-Cheng Mak La Jolla Medical Center Cancer

orANGe CouNty AreA

Thuan Tran Age 79 Family doctor Specialist translations

Dung Nguyen Age 50 Stanton, CA Prescription confusion

Duc Nguyen Fountain Valley Hospital Disabled / constant pain

Sean Kim Age 68 UCI Hospital Knee replacement

Kimeng Sum Age 65 Community Coast Hospital Gall Bladder

David Ouk Age 65 Lake Forest Hospital Prescription confusion

Beatrice Lopez-Aguilar La Mesa area hospital Child birth

Salen Garden Grove Hospital Breast Cancer

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LeN SituSanFrancisco

In 2012, my sister Len went to the Emergency Room at San FranciscoGeneralHospitalwhenherappendixruptured.After waiting for three hours for an interpreter, the inter-preter helped my family fill outpaperworkforthenexthour and a half. Once the paperwork was complete, my sister was rushed into surgery. After surgery, the interpreter left, but the wound was not properly sewn, and internal bleeding ensued. Len was not unconscious, but she became very pale and was bloated. Although the doctor was pres-ent, he couldn’t communicate with us, and my family had to wait over an hour for an interpreter. My family was so worried that she was on her deathbed, and we couldn’t ask the doctor questions. Once the interpreter arrived, the doc-tor told us that if Len had to wait another ten minutes, she would have died.

WeNLAN roNGSanFrancisco

In 2007, due to progressively worsening, debilitating pain that spread from my wrist to my arms and legs, I could not take public transportation or go to work. After confirming with blood tests, that I had Rheumatoid arthritis, my Mandarin-speaking family doctor in Sacramento referred me to a specialist and pre-scribed a painkiller. Because the English-speaking spe-cialist denied my request for an interpreter, I brought my 17-year-old daughter, who did not have knowledge of com-plexmedicalterminology.Thespecialist prescribed a stron-ger painkiller, which initially worked very well, and I could even go back to work. After taking the stronger painkiller daily, I built up tolerance, and eventually, the debilitating pain returned. I mentioned the return of the pain to the Sacramento specialist, but there was no interpreter. I went back to China because I was still in pain and could not get adequate care in Sac-ramento. In China, I finally

discovered that my chronic condition had not been cured but rather the pain had been managed. My family of four moved from Sacramento to SanFranciscoinlate2008foraccessible healthcare. The specialist whom I now see at SFGHiscarefultoprescribeanon-tolerance forming dosage (0.2 mg) of the painkiller.

uN uN CHeSanFrancisco

On the third day of school in 2011, my eight-year-old daughter, Sara, broke her arm at the school playground. Immediately, her arm was swollen, bruised, and painful, and two bones were sticking up. I took Sara to Northeast Medical Services, whose staff directedmyfamilytoUCSF.After a two hour drive to UCSF,weweretoldtofillouta stack of English documents. We asked for help, but no one was present to help us fill out paperwork, so my ten-year-old daughter, Jenny, filled out the forms leaving what she didn’t understand blank. In addition, no interpreter was present,

so Jenny interpreted. At least three different people came into the room to check on Sara, but my family was un-sure who to ask our questions to.Thedoctorstookanx-rayand took my daughter away to reset Sara’s arm at 2:00 AM; a full 8 hours after we got there! The doctors told Jenny that my husband and I were not allowed to come into the room while Sara’s arm was reset. I was very worried because I could not ask why I could not be with my 7 year old daugh-ter.

When Sara returned, the doctors told me that Sara was asleep because of anesthe-sia and not to wake her up. Through the interpretation of my 10 year old daughter, Jenny, they told us that Sara could not get her cast wet. I had questions about how to prevent the cast from getting wet or what to do or who to contact if there was water contact, but couldn’t because Jenny was too tired to ask.Sara had the cast on for one month. At the follow up ap-pointment, although hospital staff knew that my husband

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and I could not speak En-glish,UCSFdidnotprovideanin-person interpreter. Instead, we spoke with an interpreter on the phone for a very short period of time; long enough for the interpreter to tell us that the arm looked good and that the doctors would take off the cast soon. No inter-preter was present when the cast was removed or gave followupexercisesforSara,who had limited mobility in the arm immediately after the cast came off, so I had Sara do as many “common sense” exercisesaspossible.

HAi PiNG LiSanFrancisco

Beginning twelve days after her first son was born, Li’s ex-husbandverballyandphysically abused her. When Li’s family immigrated to the United States in the mid-1990s, the abuse continued, and Li eventually divorced from her former husband fourteen years ago. As a re-sult of domestic violence, Li attempted to commit suicide threetimes.Finally,thehospi-

tal required that she seek the help of a psychiatrist, whom she saw until 2005 when she lost her job.

Li then found a new job, be-came Medi-Cal eligible, and sought treatment. Li was pre-scribedsixprescriptionmedi-cations for depression, neuro-logical disorder, and insomnia. The insomnia medication prevented her from waking up and going to work, so Li first drank coffee, but then she stopped taking the insomnia medication and turned to drinking. In addition, Li suf-fered from numerous other side effects, such as shaking arms and hands, dizziness, heavy appetite and subse-quent weight gain, and anal cysts that resulted in consti-pation.Furthermore,Lilostmental clarity, forgetting to rinse shampoo from her hair or frying food in dishwasher liquid instead of in oil. Li’s two sons ate Ramen noodles for two years because she could not cook. The side effects were so severe that Li stopped tak-ing her medications, causing terrible hallucinations that forced her to re-live her hus-

band’s abuse.

When Li tried to describe these side effects and her hallucinations to her doc-tor, Li knew from her limited proficiency in English that the interpreter did not convey her message to the doctor. Li’s friend, who speaks En-glish, told her to report the interpreter. When Li called the hospital, with the help of her friend, the hospital staff turned her over to the inter-preter, and she became very afraid. As a result, Li talked to her family doctor at Northeast Medical Services, who referred her to a new psychiatrist as well as a psychologist. Li says that if she had a quality inter-preter from the beginning, she would have more faith in the healthcare system and that her kids would not have suf-fered to the same degree.

CHiN HoNG LouSanFrancisco

One morning last year, Lou received a panicked call from

her mother, who said that her 87-year-old father had been dizzy for two days, he could not see, his face turned red, and his arms were shaking. Lou’s mother was afraid that he was suffering from an-other stroke, since he had a stroke ten years earlier. Be-cause Lou’s mother could not speak English, she asked Lou to come to her parents’ house and call 911. Lou did not want to leave her house because she takes care of her 23-year-old son, who has a mental dis-ability that requires 24-hour care. Lou asked her mother to call 911, and just say the word “Chinese” when she first talked to the operator, but her mother was so afraid. As a result, Lou made the difficult decision of leaving her son at home alone to attend to her father.

When Lou called 911, the op-erator only spoke English, and when Lou requested an inter-preter, the operator said that she should wait a few min-utes. Because Lou knew from her father’s previous stroke that even a few minutes could make a life-or-death differ-

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ence, she used her limited En-glish to describe her father’s symptoms, and an ambulance came to her parents’ house within fifteen minutes.

When Lou’s father arrived atUCSF,hedidnothavethestroke yet but was at high risk at any time. Lou’s brother, who speaks better English, ar-rived but was not allowed into all of her father’s treatment. Her father had a phone inter-preter at times, but because his hearing has deteriorated, he could not hear the inter-preter. Today, Lou’s father cannot balance as well as he could before the second stroke and walks with a cane. The family says that if the inter-preter had been present, they would have undergone less psychological stress.

SAiHuAN LiANGSanFranciscoI went to Northeast Medical ServicesinSanFranciscoinJune 2013 because I couldn’t stand the pain from my tooth anymore. The pain in my mouth got so unbearable that I could not eat, drink water,

or sleep properly. It was there that I was diagnosed as hav-ing a cracked tooth.

The dentist at Northeast gave me that a few options: I could pay $100 to patch the tooth, I could pay $1500 to clean the roots, or I could seek less expensivecareatPacificHos-pital. Northeast’s dentist also gave me painkillers for the pain. I went to Pacific Hospi-tal that day, where I was told that I needed to call to make anappointment.Thenexttwomonths would prove to be very frustrating and painful as I tried to make an appoint-ment. Repeatedly, through broken English, I asked if I could speak to someone that spoke Cantonese and I was repeatedly hung-up on. The pain became intolerable and I went to Pacific’s ER. No inter-preter was available at the Pacific Hospital, and the ER staff asked me to find my own interpreter. Because I have no adult relatives in the United States, no one was present to interpret for me. The staff at the ER told me to find any friend who could interpret.

As a result, I talked to my ten-year-old son’s teacher about pulling him out of school for one day to interpret. Accom-panied by my son, I received x-raysandwasgiventheoptionofextractingthetoothfree of charge. I learned that I needed a tooth implant or else my other teeth will be impacted. I asked my son to ask how much it would cost but no one could give me an exactprice.IfIhadbeenableto schedule an appointment right away and an interpreter had been present, then I could have avoided three months of pain.

Muoi to HuyNHSanFrancisco

Huynh is a cook at a restau-rant in Chinatown. While slicing a taro during the lunch hour, Huynh cut off a piece of her own flesh off of her hand. Huynh’s co-worker drove her to the Mills Peninsula Hospi-tal in Milbrae because they knew that the services in the nearby Chinese hospitals were limited. Because of the busy lunch hour, her co-worker re-

turned to work immediately.When Huynh arrived in the ER, the hospital staff asked her questions all in English. No interpreter was present, so she called her co-worker to interpret over the phone. Huynh was concerned that the quality of the interpre-tation was poor because her co-worker was busy working, and his English is not very good. Her co-worker then picked up Huynh’s 13-year-old daughter, Sammi, who tried to interpret, but the doctor knew that she could not understand the medical terminology and stopped her from continuing to interpret. Then, Huynh’s brother arrived to interpret, although his English is not good either. After heavy bleed-ing while waiting, Huynh receivedsixstitches,andherhand is now fine.

FeNG XiAo MeiDaly City

In 2012, my hypertension prescriptions were delayed for three days, and I went to the ER at San Mateo Medi-

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cal Center because my heart was racing, and my head felt so tight that I thought I was going to pass out. My 21-year-old daughter interpreted for me during that visit. My sys-tolic blood pressure was up to 180. I received an EKG and was given the hypertension prescription medication right away. San Mateo General Hos-pital kept me until 6:00 AM.

GLoriA eSteLA ortiz rAMoSOakland

In 2006, Gloria Ortiz was pre-scribed a medication to reduce the fat content in her liver at Eastmont Medical Center. 7 months later she went back to the Eastmont Women’s Clinic and told the doctor that the medication was not helping her improve. She complained of nausea, vomiting, and pain inherstomach.Furthermore,Gloria would ask why she was still on the medication, whether there were any alter-natives and why her medical appointments were so spread out. The doctor would not

respond to her concerns, but rather would write her another prescription for the same med-ication and a set a follow-up appointment for her for 6-7 months later. The instruc-tions for the medication she was prescribed were always in English, despite her repeated requests for Spanish instruc-tions. She received a video interpreter during most of the appointments (sometimes over the phone). Gloria, unaware of any other resources, used her 10-11 year old son – who was still learning English himself – to understand how to take the medication properly. The young man could only render a basic translation. She took the liver medication for five years. Shenowexperiencesthrobbingpain all over her body, tingling in her hands, and pain in her right ring finger, issues she never had prior to taking the liver medication. In 2011, she started visiting a psychologist whoexpressedconcernthatthe patient was taking fourteen different medications. After doing some research, he told Gloria that she had been taking the liver medication for much too long of a period of time

and that taking that particu-lar drug for such a protracted period of time could result in damage to muscles and lig-aments and result in limited mobility. Had Gloria known the serious consequences of taking the medicine for such a protracted period of time, she would have objected more fervently.

rubeN VArGARichmond

Ruben, who suffers from kid-ney failure and HAS to un-dergo dialysis treatment, kept telling the doctors in Spanish that he did not feel well and that he needed to undergo this treatment before having heart surgery. The doctors thought that Ruben was just scared of undergoing surgery when he was trying to tell them that he needed dialy-sis. There were complications during the heart surgery and Ruben had to be rushed to the ICU. If they had a Span-ish Interpreter, they could have made sure that Ruben received dialysis before under-going the minor heart surgery.

roCio LoNGoriASanta Clara Valley Medical Center

InFebruaryof2011,Rociowas three months pregnant. Shehadexcessivevaginalbleeding and went into the emergency room. She waited several hours before being admitted and once admitted the physician attempted to use telephonic interpretation. They physician couldn’t get the telephonic interpretation to work and this led to the unraveling of a series of dra-matic events, the most serious being Rocio’s abortion of her fetus.

eVeLiA SALiNAS berMuDez

In May of 2008, Evelia was five months pregnant. She was working when she felt pain in her stomach and her co-worker rushed her to the emergency room. She was not offered an interpreter and Evelia stretched the truth about the familial relationship between her co-worker, who was bilingual in English and Spanish, and herself to allow

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him to enter the consultation room. Evelia underwent sev-eral surgeries--some of which Evelia feels were unneces-sary--that put her unborn child’s health in jeopardy.

GrACieLA SANtiLLANeS

In April of 2012, following the birth of her daughter, Graciela felt sick and went to the emer-gency room. She was admitted to the consultation room and waited several hours for an interpreter that never arrived. Her daughter, in the mean-time, was not allowed in the consultation room and was undergoing unnecessary hun-ger. Graciela decided to leave to a different hospital without having received care. At the other hospital, it was deter-mined that she was suffering high blood pressure due to postpartum hormone imbal-ance, which if untreated could have led to irreparable brain damage.

CAMiLLe FoNtANiLLA

In the fall of 1994, Camille’s uncle was misdiagnosed with gout when he actually had lung cancer. An interpreter could have made the differ-ence at the initial consultation because they physician would have learned that her uncle had been a heavy smoker for more than 20 years. He was properly diagnosed a couple of months later, but by that point, his lung cancer was irreversible causing him to die soon after the proper diagno-sis.

eSPerANzA ybArrASan Jose

Esperanza Ybarra’s misdiag-nosis caused her unneces-sary hardship and had she not taken steps to self-diag-nose herself, she could have suffered permanent nerve damage. In March of 2012, Esperanza felt immense pain throughout her right hip and leg and sought medical care at Santa Clara Valley Medical

Center. Esperanza is a Span-ish-speaker and her physician, Dr.ChristinaFernando,didnot speak Spanish. An inter-preter was not offered and Esperanza was left without as-sistance to effectively commu-nicate her pain. According to Dr.Fernando,Esperanza’spainwas caused by arthritis and she prescribed Esperanza with afivedaysupplyofNaproxen.Esperanza still felt pain after she consumed her supply of NaproxenandwentbacktoseeDr.Fernando,butwithoutan interpreter, she was not able to communicate that her pain was greater than arthritis pain.Dr.Fernandorequestedx-raysandstillmaintainedher original diagnosis. Espe-ranza was told that she could perhaps undergo surgery to alleviate the arthritis pain, but she would have to wait betweensixto24months.Atthis point, her pain had esca-lated so much that it limited her mobility. Esperanza de-cided to treat herself using an ointment she concocted out of pure alcohol and rosemary. This ointment provided some pain alleviation, but it also produced blisters throughout

the affected area. She toler-ated the blisters because she was desperate for pain allevia-tion. Esperanza could not bear the pain any longer and began to research her symptoms in a human anatomy book. She discovered that her pain emanated from her sciatic nerve region and consulted an alternative medicine book that detailed related issues and symptoms.

Esperanza made a follow up appointmentwithDr.Fer-nando to share her findings and took her bilingual grand-daughter, Carolina, to facili-tate communication. Carolina wasabletoeffectivelyexplainhow her grandmother’s pain was emanating from her sciatic nerve and that she neededamoredetailedex-amination. With this informa-tion,Dr.Fernandowasabletodetermine that Esperanza suf-fered from sciatica, which is pain caused from the pinching of the sciatic nerve by a lower backdisc.Dr.Fernandofinallyplaced Esperanza in corrective water therapies, which have helped her manage her sciat-ica.

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CAMiLLe FoNtANiLLA

In the fall of 1994, Camille’s uncle went into the emer-gency room at Santa Clara Valley Medical Center because hewasexperiencingshort-ness of breath and low energy. Her uncle spoke Ilocano and he was not provided with an interpreter. The physician noticed leg inflammation and diagnosed him with gout. He was given orders to avoid walking and to get plenty of rest. The physician, how-ever, failed to investigate her uncle’s lifestyle history. Her uncle was 43 years old at the time of the consultation and he had been a smoker since the age of 18. Her uncle re-turned to Santa Clara Valley Medical Center’s emergency room in March of 1995 be-causehewasexperiencingdifficulty breathing. Again the facility failed to provide him with an interpreter, but this time her uncle was diagnosed with lung cancer and the phy-sician told him he only had four months left to live; her uncle died three days after the diagnosis.

erikA borJA

In the summer of 2007 Erica had an appointment at Santa Clara Valley Medical Center with a specialist to have her son assessed for ear, nose and throat issues. Eric had a hoarse voice and had issues breathing and digesting food. Erika did not have an inter-preter present and the phy-sician spoke limited Spanish. The physician determined that Eric’s tonsils were too big and that corrective surgery was necessary. Erika wanted to communicate the issues of Eric’s problematic breathing through his nose as well as his hoarse voice. She strug-gled to convey the symptoms of Eric’s hoarse voice, to which the physician understood that Eric snored. In Spanish, “voz ronca”, which means hoarse voice, sounds very similar to “roncar”, which means to snore.(Erikaexpressedhowshe felt the physician was rushing to get through the appointment because of the understaffing and lack of re-sources at Santa Clara Valley Medical Center). Erika signed surgery waivers in English and

was uneasy because she did not understand what she was signing, but she signed any-way because she wanted Eric’s health to improve. The surgery was successful in treating Eric’s enlarged tonsils and issues with hearing. Ear tubes to assist with ear drainage were implanted. Eric’s voice was still hoarse. In December of 2009, Eric was rushed to East Valley Clinic’s emergency room because he lost his ability to hear. No interpreter was present and the physi-cian spoke very little Spanish. The physician said that Eric’s ear tube implants had been ejected and gave him ear drops to treat the irritation. In Februaryof2010,aphysicianat Santa Clara Valley Medical Center determined that, in fact, the ear tube implants were still in Eric’s ear canals. The issue was that Eric was buildingtoomuchearwaxand this was preventing him from properly hearing. In Au-gust of 2012, Eric underwent another surgery to replace his failing ear tube implants. At an appointment leading up to the surgery, Erika asked the physician if the many

surgeries and the repeated use of anesthesia would have an effect on Eric’s auditory nerves. The physician scoffed at Erika and made her feel like she had asked a stupid ques-tion. After that negative re-action by the physician, Erika did not feel the confidence to ask the necessary questions to give her piece of mind. In the meantime, Eric is falling behind at school because his issues with hearing, which span from 2007, have not been resolved. He has been in spe-cial education classes since 3rd grade. Eric still has issues breathing through his nose and he still has a hoarse voice.

MAriCeLA GArCiA

On March 25, 2008, Marice-la’s was feeling contractions and rushed to the emergency room. Because interpreters werenotavailable,hersixyear old daughter had to facilitate the interpretation. Herdaughterexplainedtothe nurses that her mom had peed herself to convey that her mother’s water had

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broken. Children were not allowed in the delivery room and Maricela was left alone without anyone to interpret for her.

NAbor MorA MeNDez

Nabor has been treating his colon cancer since October of 2012. Neither the special-ists he sees nor has O’Connor Hospital been able to provide him with an interpreter that can help him understand his condition.Forthatreason,hehas relied on his friend Rita Mora to interpret for him, despite the fact that this is not allowed due to a lack of familial relationship between the two. If it weren’t for Rita, Nabor would not have been able to understand his post-op care.

ANA eSter roMero PoNCe

In March of 2008, Ana sought care for her gestational dia-betes. She requested an in-terpreter, but was told that the doctor was bilingual. The

doctorhadahardtimeex-plaining the insulin regimen to Ana. Ana overdosed on insulin at home, which caused hertoexperiencehypoglyce-mia. The overdose aggravated Ana’s mental depression and has caused her to lose trust in her doctors.

roCio rAMoSSan Jose

In January of 2008, Rocio’s son was sick with pneumo-nia and immediately rushed to Kaiser’s emergency room. The family was not assisted by an interpreter. Rocio felt like she lacked clarity on her son’s health status and due to the stress of the situation, she suffered a miscarriage of her three month pregnancy in the public restroom.

ADriAN Perez MuNoz

In September of 2012, Adrian felt stoke-like symptoms and immediately drove to the emergencyroom.Heex-pressed his symptoms using

signs because he was not provided with an interpreter. The physician sent him home without care and Adrian’s stroke worsened, resulting in irreversible damage.

MAriA triNiDAD eSCobArSan Jose

On 12 May 2008, Maria Trini-dad Escobar was crossing an intersection when she was suddenly struck by a car. She was rushed to Regional Med-ical Center of San Jose and her mother, who has power of attorney over her, was im-mediately notified. Though Maria’s mother was present to make decisions over Maria’s well-being, Maria’s mother does not speak English and Regional Medical Center of San Jose could not provide her with a Spanish interpreter. Maria, despite being in critical condition, had to interpret for her mother. Maria was very adamant about not taking any pain killers because she was three months pregnant and did not want to put the development of her fetus in jeopardy. Despite Maria’s

wishes, Maria was adminis-tered morphine to subdue the pain. At this point Maria was heavily sedated, yet she had to continue interpreting for her mother. The medical staff administered another medi-cation, which Maria recalled amidst the confusion as being likely to cause her to abort her fetus. At this point Maria was deeply sedated and could not protest the administration of this drug. Maria spent one week hospitalized and it took her three months to recover fromherinjuries.Fortunately,the medications did not cause her to abort her fetus and today she is the mother of a young girl.

MAriANA AyALASan Jose

In September of 2008, Mar-ianaAyalawassixmonthspregnant when she arrived at Santa Clara Valley Medi-cal Center’s emergency room because of pain in her gall-bladder. Mariana is a Span-ish-speaker and staff did not speak Spanish. The staff

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believed that the pain was due to her pregnancy, but Mariana tried to convey as best she could that the pain emanating from her gallbladder. Testing was administered, which in-cludedseveralbloodexamina-tions. Mariana tried to com-municate to the nurses—none of whom spoke Spanish—that her veins were thinner than the average person’s veins and that in the past nurses would use a smaller needle. The nurses poked Mariana several times before they were able to find a vein to draw blood from. It was finally determined that she had gallstones and that they had to be removed through surgery. The staff told her that her unborn child might die as a result of the surgery. Mariana decided to go through with the surgery and spentthenextweekhospital-ized waiting for medication to reduce the inflammation in her gallbladder. She had the surgery and fortunately her unborn child did not die. Mar-ianaspentthenext12hoursof recovery in agonizing pain before a nurse finally came to her aid. The nurse did not speak Spanish and demeaned

Mariana for not being able to speak English in a country like the United States. Mari-ana captured the attention of a bilingual passerby and this passerby was able to commu-nicate Mariana’s complaints of pain to the nurse. The nurse gave Mariana two injections, which left Mariana sedated to the point of complete paral-ysis for an entire day. Mari-ana did not know what was injected into her body and in fact wanted to avoid pain-killers altogether for fear of jeopardizing the health of her unborn child. Mariana was released four days later. On the morning of 27 Decem-ber of 2008, Mariana was due to give birth and she went to Santa Clara Valley Medical Center to receive care. The morning nurses did not speak Spanish, but Mariana tried to communicate to them as best she could that an abnormal bulge was emanating from her abdomen. The nurses gave Mariana instruction to walk for several hours, because according to them, walking would help with her cervical dilation. Mariana followed their instructions, but re-

turned to Santa Clara Valley Medical Center later in the day because the abnormal bulge had gotten bigger. The nurse this time around spoke Spanish and Mariana was able to effectively communicate her concern over the bulge in her abdomen. The nurse conducted an ultrasound and determined that the bulge emanating from her abdomen was, in fact, the unborn child’s head; the unborn child was in an unusual seated position and walking only intensified the upward movement of the unborn child, thus fur-ther pushing the child’s head towards Mariana’s abdomen. Fortunately,medicalstaffwere able to help get the un-born child back into a normal-ized position and Mariana was able to give a natural birth.

roCio LoNGoriASan Jose

Rocio Longoria was three monthspregnantinFebru-ary of 2011 when she sought emergency care at Santa Clara Valley Medical Center because

ofexcessivevaginalbleeding.Rocio is a Spanish-speaker and did her best to convey to emergency room staff that she needed immediate assis-tance because she was con-cerned for her pregnancy. The staff kept her in the waiting room for several hours. She was finally admitted to see a physician who did not speak Spanish. The physician at-tempted to get interpretation through a telephonic service, but this service was not ac-curately conveying Rocio’s urgent concern for her fetus. Rocio happened to overhear a passerby patient who was speaking Spanish and Rocio left the consultation room to request the passerby’s assis-tance. The passerby agreed and they both returned to the consultation room. Upon their return, however, the physi-cian told them that Rocio had forfeited her consultation by leaving the consultation room in the first place and released her without giving her care, all of which was translated by the passerby. Rocio spent the nextthreedaysathomewithexcessivebleedinganditwasnot until her body rejected a

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portion of her fetus that she sought help at a different health center. Rocio arrived at the Gardner Health Center withexcessivebleedingandwith parts of her fetus in her pants. She was met with a physician who did not speak Spanish and while trying to explainhersituationasbestshe could, Rocio fainted as a resultofhavingbledexces-sively for the past three days. Paramedics rushed Rocio back to Santa Clara Valley Medical Center where she was stabi-lized and where a different physician assisted with the removal of the remnants of her fetus.

MAuriCio GALLArDo burGoSSan Jose

On 7 August 2012, Mauricio, then 17 years old, got into a car accident and was imme-diately rushed to Regional Medical Center of San Jose. He was held for five hours and was treated for a broken arm before he was released. Though Mauricio speaks both English and Spanish well, the

hospital requested the assis-tance of a bilingual custodian to interpret for his mother who is a Spanish-speaker. The interpreter misrepresented the diagnosis of the physician. The interpreter told Mauricio’s mother that Mauricio’s hand was broken when in fact it was his arm that was broken; the interpreter told Mauricio’s mother that Mauricio needed medication every eight days when in fact he needed med-ication every eight hours. Mauricio left the hospital still feeling immense neck pain. On 9 August 2012, Mauricio went into Santa Clara Valley Medical Center’s emergency room because he no longer could tolerate the neck pain. At Santa Clara Valley Medical Center, Mauricio underwent a full cat scan and it was deter-mined that the pain resulted from two misaligned verte-brae. Mauricio was hospital-ized for an entire week, given treatment, and he eventually recovered.

tHAo yAo PAo

Yao Pao had an appointment foranx-raysetupatthehos-pital.  He arrived on time but was told to wait because they do not have an interpreter available.  Hours pass, an in-terpreter never shows, and he becomes increasingly hungry and fatigued; the only inter-action he has with the nurse is her motioning for him to “stay, wait.”  Being diabetic, he knows he needs to take his medication so after four hours he decides they must notbeexpectingtoseehimand he leaves.  He was dizzy and shaking by this time so he decides to walk home instead of drive.Thenextdayhereturnstothe hospital with his wife; the staff are upset with him for not waiting the day before but there is no way for him to communicate the situation.  They have him wait again for an interpreter for hours.  After thex-raytheyprescribemed-ication and direct him to take it.  There is still no interpreter but his wife guesses what they were trying to tell him; it looked like his blood pressure

was too high.  As soon as he took the pill, he doesn’t feel right. 

As the day wore on, he feels not only dizzy but also begins losing his eyesight.  Three hours after they had left they get a call from the hospital.  Again there is no interpreter but the nurse manages to convey that they must return immediately.  Ya Pao thinks he is going to die; he and his wife go by the soccer field so he can say goodbye to his son, who at this time Ya can-not even see.  When they get to the emergency room, they are handed a consent form but don’t understand what it says.  They asked the wife to sign, since she speaks broken English, and she asks to have an interpreter.  “No,” she is told, “if you want to, you have to wait 3-4 hours.” So they sign, without knowing what it is, and eventually he is stabi-lized.

A few weeks later, after again having to wait around for an interpreter who never comes, he is prescribed medication at 5:00 PM. A nurse mimes

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instructions to him on when to take the pills (e.g. one be-fore bed).  He is given three pills and takes the first one at the hospital.  When he gets home, he collapses and ap-pears paralyzed.  His wife said he passed out, and so they rush back to the emergency room. No interpreter is avail-able, but miraculously they find a Hmong security guard who accompanies them to the doctor.

By the time the doctor tells Mai (Yai’s wife) that her hus-band must’ve overdosed on the medication, he is laying down receiving an IV drip of some sort. 10-15 minutes later, he begins convulsing and falls to the floor.  He tries to grab her hand as he falls; all he can say is “I’m doing now, I’m dying now, help me.” Mai screams for nurses, but still she cannot understand what is going on.  He is even-tually stabilized, and Mai has to call her son from college as they don’t have anyone at the hospital; he is initially denied access to his parents.

otiLiA ortiGozA  

June 14th, 2009 Otilia gives birth to her second child at Community Regional Medical Center; no interpreter was provided.  A few days later she begins to have a fever, trouble urinating, and swelling; symp-toms build so she goes to the ER (Medical Community).  The first time they send her home and she’s told it’s normal swelling from the pregnancy.  The second trip to the ER is af-ter she begins having vaginal bleeding in addition to wors-ening pain.  Unlike the first trip, the only time she has an interpreter is at the beginning over the phone.

She’s frustrated because the interpreter on the other end doesn’t seem to understand many of the words she’s using and doesn’t appreciate how much pain she is in.  The pain isexcruciating;sheismadetowait for several more hours; she’s bleeding so much she has to change through several adult diapers.  By the time she is called, she’s lost so much blood she cannot stand on her own.  Two staff members

stop what they’re doing to assist her.  Otilia wakes up to the sight of gauze, which they just removed from her uterus.  She is prescribed medication for the pain but never gets an interpreter.  A week later the swelling and pain continue; she goes to the ER to find out what’s going on for a third time (now at St. Agnes).  In the meantime, her baby’s been sleeping much more than usual and is acting strangely. 

While at St. Agnes for Otil-ia’s condition, they find her baby has a fever and irregular heartbeat after they notice its eyes fluttering.  While Otilia is being kept at St. Agnes, they rush her baby to another hospital.  The baby is hospital-ized in intensive care for three days; its heartbeat is irregular because of the tremendous amount of pain medication the mother passed onto her through breast-feeding.  No oneexplainedatCommunitythat the medication could poi-son her child.  Otilia did not even know she had stitches for over a month after the sur-gery, which is why her body was still swelling. 

SHeNG yANG

InJanuary2010Shangex-perienced severe shortness of breath and chest pains so she called her daughter, who phoned an ambulance that took her to Community.  She had so much difficulty speaking that she did not seek anyone out or get up from the bed the two hours she waited; when a Hmong pastor came by, all she said was “pray for me.”  When they brought her into an-other room, no interpreter was provided.  They instead administered an injection.  Immediately Pang’s short-ness of breath worsened and her pulse began to race.  She knew she was going to have a heart attack but could not communicate it to the nurse.  She was fighting for her breath and only had the strength to whisper, but it did not matter because the nurse was turned the other way and Shang did not know how to communicate.

Two minutes after the in-jection was given Shang’s

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daughter came in and Shang mustered “I’m fighting for my breath.  I’m going to die, I’m suffocating.  Help.”  The daughter screamed to the nurse, “what did you give to my mother?  She is going to have a heart attack!”  The nurse turned and when she saw the machine and ran out into the hallway screaming forhelpaswell. Fourmenrushed into the room and told everyone to clear out.  They gave her another injection which again brought down her heart rate and eased the shortness of breath. 

Shang knows she would have asked “what are you injecting me with” had there been an interpreter.  She also would have told the nurse she was having problems.  Instead her daughter happened to come at the right time.  “If my daughter hadn’t come I would be dead.”  She was hospital-ized for a week total, during whichtimenooneexplainedwhy she had that reaction to the medication or what was causing her symptoms gener-ally.  Her daughter spent every night with her until she was

discharged.  To date she does not know if it was an allergy or mistake and it scares her to think it could happen again.   

Lou VANG

In 2007 Lou Vang began hav-ing seizure episodes.  During her first appointment she was briefly provided a Hmong interpreter over the phone, but did not get to ask any questions.  Instead, because she spoke a little Thai, Clovis Hospital assigned her a Thai doctor.  She could not describe her symptoms well or ask questions, was given medi-cation that did not work, and told to see her primary physi-cian if the episodes continued.  Her primary physician also used an over the phone inter-preter, and Lou had the same problem where she felt they were interpreting more for the doctor than for her.  She could not ask questions or inquire about what treatments were available. Overthenextthreeyears she was hospitalized three times for her seizures, which often involved sustain-

ing burns and other injuries from falling.  Nothing she was prescribed worked and she had an average of two epi-sodes a day.  After the third hospitalization she decided that it wasn’t worth it, she wasn’t going to go anymore because no one understood her. 

When hospitalized the first two times at Clovis Commu-nity in 2008 and 2009, she asked for an interpreter but instead received the Thai doctor.  In 2009 when she was hospitalizedatFresnoCom-munity, she did not receive any interpreter, even over the phone.  She became hopeless and thought she would live with this condition for the rest of her life.  Seeking treatment for depression, she found Cen-ter for New Americans.  They connected her with Healing Hope, which directed her to a specialist and provided an interpreter.  It took five visits, because at three there was no interpreter available and they could not communicate, but eventually she was prescribed medication that largely curbed the seizures.  She has

had much fewer episodes since 2010 and it’s changed her life.    

tHAo PANG

In2009Pangexperiencedse-vere stomach pains and went to Community Hospital.  No interpreter was made available at any point and Pang found theexperiencesofrustratingand traumatic that she swore off going to the hospital again even if the pain persisted.  She foundtheexperiencetrauma-tizing because of the complete lack of communication.

She had questions about her illness she couldn’t commu-nicate to anyone.  They had her sign documents without understanding, strip naked andundergoanx-raywithoutbeing informed beforehand, and handed a prescription she was instructed to have her children get filled (through her husband, who speaks very lit-tle English).  Only weeks later did she learn she was suffer-ing from blood clots from her

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primary doctor. Since going to the ER Pang has faced three occasions where she felt she should go to the ER but was too afraid to go.  Each time the pain lasts about a week and she finds it diffi-cult to move.  Her doctor tells her every appointment that she needs admit herself to the hospital when severe pain arises, but she refuses.  When she asks the doctor what she should do about the lack of an interpreter, he says (like the doctors at Community) to take her children.  Each of the three times, however, her chil-dren have not been available to go.  She just takes more of her medication than pre-scribed, which is not what the doctor advised.  “Every time I go there are no interpreters.  What benefit will I receive if I go?”

Jer XioNG

Normally when Jer went to her family doctor one of the receptionists, who spoke Hmong, would interpret.  When she developed a se-

vere cough and headache in 2010, however, the staff member was not available.  All she could do was mime her symptoms to the doctor, who only spoke Vietnamese.  Doing her best to convey the intense pain she was in, she was prescribed cough syrup.  She believes her symptoms were more serious than that, but she had no way to com-municate her needs or symp-toms beyond hand gestures.

OverthenexttwodaysJer’scondition worsened consid-erably, and her son took her tothehospital. Shewasex-periencing coughing, short-ness of breath, chest pain, and fever and was so ill that that they hospitalize her for two weeks.  At no point dur-ing her stay does she receive an interpreter.  The doctor instead tries to communicate through her husband, who speaks very limited English.  They learn she had devel-oped pneumonia and her husband was told that with-out immediate treatment she may not have survived.  It took her an entire year to recover, and she relied on

herchildrentoexplainhowtotake her medications.  Upon checking out she learned that there was medication she could have taken earlier that could have prevented her from suffering so much.   

“It was very overwhelming without interpreters….I think I could’ve died.”  Jer vows to never go to the doctor again without an interpreter. 

MALiN ouk

Malin had been asked to translate for her mother and other family member when they go to the Memorial Clinic on Anaheim and Raymond in Long Beach. Her mother has been prescribed different medicines and Malin feels insecure because she says she has no idea what the doctor is saying. Her concern is that she is not sure of the dosage and how often the medicine should be taken.

PoueLiNNA Po

Poulinna’s father died recently of Diabetes.  Her father did not have medical insurance, so he was not able to get reg-ular treatment for his diabe-tes.  There was a language access issue when he was able to get medicine.  When he got the medicine, he did not understand how he was supposed to take it. Prior to his passing Poulinna’s father told her it was useless going to the hospital because there was no one there that could help him. Pouelinna was often asked to interpret and feels responsible for her father’s death. She could understand what the doctor was saying but did not know words in her native tongue to convey back to her day. Although he was diagnosed with Diabetes he ultimately died from a brain tumor and complications from a stroke. The family was treated at the Memorial medi-cal Clinic.

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AMANDA eM.

In spring of 2012 she was pulled out of school for an entire day to translate for her grandmother. Amanda was told that grandma was going to Pacific Hospital in Long Beachforx-rays.Amandawassenttheretoexplainwhatwas going on because in their previous visits the hospital did not provide any interpret-ers. Amanda’s grandmother did not know what was go-ing on according to Amanda. All grandma said was it was something to do with her heart and cholesterol. Amanda proceeded to ask the doctor what was going on, but felt lost. The doctor prescribed several medications without anyexplanationondosageorfrequency. The only thing that Amanda understood was that the medicine was for high blood pressure and cholesterol.

MAriA ALVArADo

She was pregnant went to hos-pital due to pain, was unable

to communicate with staff, was waiting to be seen and still had no interpreter to assistherwithexplainingsymptoms. She was finally seen and was informed that her child was dead (she had miscarried her child during her wait).

FLor FLorez

Her son became very ill at the age of eleven he was diagnosed with Diabetes. Ms. Florezwasneverprovidedinformation in her native language (Spanish) on how to provide on-going care and wellness for her child.

MAribeL NAVA

Maribelwassixmonthspregnantwhensheexpe-rienced complications ( major side pain). She was transferred to three differ-ent hospitals in one day, but didn’t have access to an interpretertoexplainwhatwas happening. She had an emergency surgery due to a

cist on her ovary while being sixmonthspregnant.Thiswasin 2005. The first hospital was St Mary’s in long Beach, which sent her to Long Beach Com-munity Hospital which then transferred her to another hospital in riverside the name Maribel could not recall.

SALeN

In 2011 Salen was diagnosed with Breast Cancer at Garden Grove Hospital. No interpreter wasprovidedtohertoex-plain her condition or treat-ment options. Evidently there was a tumor that had to be removed. Salen’s left breast was removed without anyone explainingtoherwhatwasgoing on. Prior to the removal of her breast she was given chemotherapy again with no instructionorexplanation.Be-cause of the mental strain she had contemplated suicide.

rutH SeVe

Ruth story involves her father who had a stroke in 2000 in Hawaii. Ruth went to Ha-

waii that same year to bring her father to California to care for him. Once here in Long Beach most of his treatment was at St Mary’s hospital. In all of their visits to the facil-ity there was never anyone to translate in the Samoan language. If Ruth’s father had to attend visits with his home health care provider there would not be anyone to translate for him. Ruth was not always available to go to the Dr’s appointments due to her work schedule. Because he was constantly going back and forth to the Doctor, Ruth eventually had to quit her job. They had challenges with prescriptions, dosages, and treatments.

tiAGoGo MiSALong Beach

In 2011 Tiagogo was rushed to Pacific hospital in Long Beach believing he had a stroke. His wife with her limited English tried to describe what hap-pened to the doctor. There were no interpreters of the Samoan language available at

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the facility. The doctor did an examinationandsentTi-agogo back home. Two hours laterMrMisiexperiencedanother attack at home. The ambulance was called and this time he was taken to Harbor UCLA Medical Center in Carson. Harbor UCLA di-agnosed Mr Misi as a stroke patient and began treatment. When told that he had been to Pacific Hospital just two hours earlier the doctor seemed baffled that he was nottreatedifhehadexhib-ited the same conditions. He was told had he been treated the second episode may not have occurred.

eLizAbetH FAAPitoLong Beach

Elizabeth’s husband was admitted to Lakewood Re-gional Medical Center in Lakewood Ca in 2010 for what appeared to be some form of rash. There was no interpretation services pro-vided for Samoan language. Elizabeth’s concern is that had she not been available to provide translation for her

husband he would have had a hard time communicating with the medical profession-als.MrFaapitospeakslimitedEnglish and even has trouble understanding it as well. He has several medical chal-lenges is constantly battling with proper diagnosis, and treatment plans.

MutArAu FAAPitoLong Beach

Mutarau has several health challenges. In 2010 and 2011 he has had to frequent Lake-wood Medical Center in Lakewood CA for a number of reasons. Most recently he had an incident with a rash and also he believes he hurt his back while at work. Both times he went to the hospital there was no interpretation service provided. During the incident with the rash his wife accompanied him and was able to tell the doctor what was wrong. In regards to the incident from work there was no one to relate what is prob-lem was. Mutarau was not able to relate what his symp-

toms were, so he didn’t get the treatment he needed.

MArtHA LeyVALong Beach

In 2012 at Chino Community Hospital Maratha’s mother was rushed to the emergency room. Once there she was ad-mitted with niece being used as interpreter. The mother did not understand English, and the niece (20) was confused by the medical terms being used. Mrs Leyva’s mother was in the hospital for a total of two weeks without anyone in the family ever being told what the actual ailment was. After the two week stay in Chino Community her mother was released. Within a month she needed to go back to the hospital, however that time the family made sure she did not go back to Chino Commu-nity due to the fact that no one communicated to them in their language.

MAriA uLLoALos Angeles

In 1990 at USC General Hos-pital Maria’s mother in law had to go to emergency. She waited nearly 13 hours before she was finally called into a room to see a doctor. When the nurse asked if she spoke English and she replied no, she then had to wait another two hours to be seen. After the two hours passed and the doctor had not seen her yet, she just decided to leave. Maria then had to miss a day from work to accompany her mother in law and act as her interpreter in order for her to be attended too.

eDWiN AGreDALos Angeles

In 2002 at USC Medical Cen-ter in Los Angeles Edwin’s sister went to the hospital with complaints of pain in her stomach. When she arrived she was asked if she spoke English. She feels because she didn’t speak English, she had to wait a couple of hours without being seen. After

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about three hours she left. A couple of days later she re-turned with the same symp-toms someone spoke to her in Spanish and she was diag-nosed with cancer.

roSA CALDeroNLos Angeles

Rosa’s issue is ongoing, started in 2010. Rosa’s moth-er-in-law regularly attend USC Medical Center in East L.A. for treatment to her foot. She has several medical challenges, in-cluding diabetes. Rosa’s sister has to almost always attend the medical appointments because the mother in law speaks no English and Rosa is not comfortable with hers. Rosa swears that her mother-in-law has never been spoken to by anyone on the hospital staff in her native language. She has many questions that the daughter cannot answer.  There has been problems with her medication as well as treatment options.

AbrAHAM CArrASCoLos Angeles

Abraham’s mother went to St FrancishospitalinLynwoodwith a broken foot. His mother is diabetic and has many complications because of her illness. Hospital staff had her sign a consent form without explainingtoherinSpanish.By the time her family arrived shewasinsurgery.Familymember were very concerned because she also has Heart condition. the mother upon recovery told her family she did not know what she was signing, or understand that she was giving permission for surgery.

DoLoreS ortiz

Since the beginning of 2003 to the last few months of 2005 Mrs. Ortiz had to go to Logan Clinic every three (3) months for checkup, and to remove the liquid from her throat as a result of her thy-roid and asthmatic condition. Logan Clinic did not provide Spanish interpretation and there was no one there that

couldexplainthingstoherin her native language. Her condition was not improving and she decided to transfer to San Vincent but unfortu-nately San Vincent also did not provide Spanish interpre-tation for her. On November 1st,2006,shefeltextremelytired, had trouble breathing and she couldn’t eat or swal-low. The ambulance took her to Sharp hospital where Mrs. Ortiz stayed overnight only to be transferred to Mercy hospital (at the time she didn’t understand why she was transferred) and it was at Mercy that she was told that she had cancer. She was in need of an immediate surgery because they needed to cut off the tumor on the right side of her neck. She refused to sign any documents because she didn’t understand the forms. FinallyshewasprovidedaSpanish speaking doctor who explainedthesituationandhaving understood the se-verity of her condition and the immediate attention it required Mrs. Ortiz proceeded to sign the surgery authoriza-tion forms. It has been three years since the last visit to the

clinic; she does not have the surgery results and does not have any understanding of her current condition which is making her feel very worried and concerned.

DorA SANCHez

On July 4, 2006 took her 17 year old daughter who fell and was unconscious to Sharp hospital in Chula Vista at 8:00PM. The hospital did not have a Spanish speaker who could translate at the time and as a result Mrs. Sanchez and her daughter waited for over twelve (12) hours to get anexplanationofwhathadhappened. Needless to say Mrs. Sanchez feels very frus-trated and wonders what happen to her daughter that day. The only treatment her daughter received was an I.V administered to her by a nurse and she was then released. Currently, her daughter occa-sionally passes out and they don’t understand why this is happening. They both feel that it is very important for hos-pitals and clinics to provide interpretation for those pa-

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tients that don’t speak English so they can understand their condition, procedures and treatment and medication instructions.

JoSePH krAVetS

Mr. Kravets arrived in San Diego in 1992 and he needed to consult a cardiologist. On the day of his visit to the hospital he was feeling very exhaustedandthedoctorproceeded to treat him with-out ever having a conversation with him, to find out how he was feeling or the reason he was there. His blood pressure was checked, he was given an injection and when his fever went down he was sent home.

Last year Mr. Kravets went to the hospital again to see his cardiologist. Mr. Kravets suffers from myocardial dys-trophy which causes him to get chest pains if he walks for long distances, in his case this means two (2) blocks and then he has to be given an injection to relieve his pain. His daugh-ter has to constantly translate for him because hospitals do

not provide any sort of trans-lation for him.

ziNAiDA SCHezbAkoDA

Mrs. Schezbakoda cannot communicate with Dr. Barny Katzman of West Coast Eye Care Medical because of the language barrier. She has been looking for a Russian Eye doc-tor that she can communicate with in her native language, but has not found one yet, so at this time she has to rely on her daughter in law or her son to translate in order for her to understand her eye condition. Ever since October, 2012 Mrs. Schezbakoda has been pa-tiently waiting for a referral to an eye specialist from Dr. Katzman. The doctor said he would contact her son to let them know about the arrange-mentsoftheirnextappoint-ment to a specialist, but they haven’t heard from him. Mrs. Schezbakoda has to cover her left eye so that she’s able to see from her right eye. She is feelingextremelyfrustratedbecause she cannot contact the doctor directly to find out

aboutthenextappointment.She feels that the only thing to do now is to wait for the doctor to call, and let them know about their appoint-ment with the eye specialist. She just wants to speak with adoctorthatcanexplainher condition in her native language so she can finally understand what is happen-ing to her.

bArtoLA ANDreS De ArGueLLeS

In October 2006, Bartola cleaned the house of a family in San Marcos, CA. While working in the fam-ily’s home, Bartola slipped and injured her neck. Her employer proceeded to take Bartola to the nearest bus stop and left her there. Bar-tola took the bus to Tri City Hospital. When she arrived at the hospital no one at the reception desk spoke Span-ish. She tried to motion that she thought her neck may have been broken. She was placed in a wheelchair and was taken to another intake area, where none of the

staff spoke Spanish. She was asked to write her name. She could not because she was in so much pain. When she was speaking with another staff person in the second intake area, the person did not understand her but was taking notes. The staff person recorded the incident that caused the injury, incorrectly. They recorded that Bartola had fallen in her house and not at work. Bartola received anx-ray.Shesaysthattheywanted her to pay for the ser-vices and she told them that she could not. Bartola was given the bill and told by staff to take the bill back to the home of where she had fallen.

On September 08, 2012, Bar-tolawasexperiencingkneeproblems. She said that her knee was very painful and felt like it had a significant amount of pressure on it. Bar-tola returned to Tri City Hospi-tal. She spent four days in the hospital. During her stay the only translator assistance she had was from her visitors who spoke both languages. Bartola said that she was given pain

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killers and that blood was taken. When she was released, she was not told the results of her blood tests and did not receive any follow up medica-tions. Her knee continued to bother her with its increasing pain and pressure. Bartola sought assistance from a hospitalinMexicowhereshetreated.

SAFi iLLeeye

Safi’s mother died after suf-fering complications from a procedure Safi says that her mother did not need. Her mother’s procedure was per-formed and recommended by Dr. Muhammad. Doctor Mu-hammad was Safi’s mother’s new doctor - he spoke Arabic and Persian. Her mother’s pre-vious gynecologist had retired. On her mother’s first visit, she went from seeing Dr. Mu-hammad to going to Alvarado Hospital for the procedure. After the procedure, Dr. Mu-hammad suggested that Safi’s mother be moved to a hos-pice. At this time, Safi reached out to all of her family to find someone who could trans-

late for her. Safi never asked for an interpreter because she assumed that the doc-tor knew what he was doing. When the procedure had been finished and Safi’s mother’s health worsened, Dr. Muham-mad told the hospital staff that Safi was a noncompliant and violent visitor. After the first procedure, Safi took her mother to another emergency room where her mother was treated for a bladder infection. Sharp Hospital worked well with Safi and her mother. She was recommended to take her mother to an after treatment facility, but Safi chose to take her Home to be treated by a provider. Safi’s mother’s cause of death was of the bladder infection and pneumonia.

MAriA GALLArDo AND Her DAuGHter, CArMeN CHAVez

Maria had a stroke in April. She spent three days in Scripps and was transferred to the Scripps Encinitas Reha-bilitation. At Scripps Encinitas no one at the facility could speak Spanish, but they made an effort. After Maria’s stroke

her cognitive and motor skills were in need or redevelop-ment. Maria was confused and forgetful. Her daughter, Carmen, had to train her to re-port the actions of people who cared for her when Carmen was away. Carmen had to be there to make sure that Maria was understood.

In June of 2012, Carmen se-lected Rio Vista as a skilled nursing facility. Carmen constantly photographed to document issues. There were only three staff members who speak Spanish. Spanish speaking patients were not considered with same respect as patients who could speak English. When Carmen would come to visit her mother, her mother would ask Carmen to translate requests made by the Spanish-speaking patients. There were many Spanish-speaking patients with a staff that did not speak Spanish. At the Rio Vista facility, English-speaking only patients were interviewed by the facility’s owner to inquire about their stay and level of care. None of the Spanish

speaking patients were ques-tioned.

Carmen felt that the facili-ty’s dismissive behavior to-wards its Spanish-speaking patients and their families was grounds enough to find another facility. Carmen movedhermothertoFriend-ship Manor that had a larger amount of staff that spoke Spanish. Maria’s confidence as she reported concerns to Carmen had increased. So much so that she would confront ill treatment given to her by staff when her daugh-ter visited. She talked about staff that tried to deny it, but Maria’s confidence that she could communicate her con-cerns to her daughter who would make sure her issues were addressed, empowered her. Maria says that when someone understands your language, you are treated dif-ferently.

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JAMie trAN AND Her CHiLDreN, CHArLie AND JiNNie trAN-MeDrANo

Jamie speaks Vietnamese. Charlie (14) & his sister Jinnie (10) were both born with hy-drocephalous. It is a condition that is diagnosed when there isanexcessoffluidinthebrain. Both children have had a procedure done that releases liquid from their brain. Jinnie has had to have two proce-dures because she is so active and the tube became unse-cure. Charlie’s caseworker speaks Vietnamese and would accompany them to doctor’s appointments to interpret for Jamie. The caseworker must come from an area that is more than 30 miles from Jamie. With the caseworker’s schedule it is hard to secure her for every appointment. When Charlie would get medication for his disability, Jamie would not be given the side effects. Charlie had been given medication to treat his hydrocephalous since being diagnosed with it when he was very young. When Charlie was two, Jamie notice that her son had not grown teeth. One

of the side effects of Charlie’s medication was that his teeth growth would be significantly delayed. Jamie was never told this. When Jamie secured an interpreter over the phone, she was then able to alert her doctor. When the caseworker is not there to interpret, her husband comes. When her husband is not available, she has to rely on the interpreter over the phone. When she was able to have a translator explainthemedicationthather son would take, she only remembered how often he was to take the medication, but not the side effects. When her children are brought to the hospital for an emergency, her children are treated, first. Then an interpreter is con-tactedanditisexplainedtoJamie what has been done. When she takes her children to their appointments with-out an interpreter she uses the two words that she knows in English, “fever” and “sei-zure”, and the doctor counts with his fingers the amount of times either have occurred and Charlie and Jinnie are medicated, accordingly. When she has to sign documents,

thetranslatorexplainswhatis on the document and she signs.

Loi NGuyeN

In October 2011, Loi stayed in the hospital for 10 days. Loi could not breathe and had high blood pressure. Loi speaks Vietnamese and knows a few English words. Loi called 911 and said “High Blood Pres-sure” and “No Breathe.” When he was admitted, he gave the staff person his driver’s li-cense and MediCal card and they filled the forms out for him. When he asked for an interpreter, they brought him an interpreter who only spoke Chinese. When the hospital did this, Loi had lost trust in the interpreter and hospital. He thought that the hospital really must be desperate for a Vietnamese interpreter if they just were going to use anyone, even someone who could not speak his language. On the third day of him being hospitalized, they recorded Loi’s allergies. Loi was very worried when his son was not there with him. He would

worry about needing them and because they could not understand him he would perish. The hospital staff did not speak to him. They would come into the room, check things and then leave. When it was time for him to leave the hospital, the staff told him where to sign and for him to go home. He was given his medication at a Vietnamese pharmacy,butnooneex-plained to him the side ef-fects. Loi thinks that it would be “super good,” if someone could speak Vietnamese in places where care and medi-cine are given.

kHAi truNG NGuyeN

On December 18th, he was ad-mitted to Scripps Mercy Hos-pital after suffering a heart attack. He originally wanted to be taken to Alvarado Hos-pital, but because of the lan-guage barrier, he was instead taken to Scripps-Mercy Hospi-tal. After being admitted, he was rushed to surgery, where a stent was placed was placed

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inside of one of his arteries to allow for better blood flow. The patient’s family requested a Vietnamese translator upon their arrival at the hospital at 8:00 p.m., but because the facility did not have immedi-ate access to one, the transla-tor did not arrive until 11:00 a.m.thenextday.Oncethepatient’s surgical procedure was completed, the nurse explainedthatheneededtoundergo a comprehensive cardiac rehabilitative program, which was only available in English. The patient’s wife strongly believes that acces-sible medical translation is neededbecauseshehasex-perienced frustration & worry over not knowing what is happening to her husband

JoHN MAkuACH

John came to the United States in 1994 and has lived in San Diego since 1997. John was hospitalized for three days when he had his knee cap replaced. While he was hospitalized, he could un-derstand English, but med-ical terminology was still

challenging. Even as John’s English has improved, trans-lating medical terminology is still very difficult. John shared that it is more difficult for Sudanese women. They are not encouraged to learn English. On one occasion he went to translate for a fe-male neighbor named Guang.Guang who had been in a car accident. He said when he arrived at the hospital, Guang was very grateful. John said that she commented on be-ing treated differently, when the doctor understood her. It took four hours to translate medical terminology and the woman’s symptoms between the doctor and Guang. Guang was hospitalized for two days. Each day she was hospital-ized, John would come to visit Guang and she would ask him to translate different things. John says that when transla-tors are not available, many times, the women would ask children to translate for them. John says that there are three dialects within Sudan; Nuer, Dinka, and Shillong. With Ara-bic being the official language.

MiNH NGuyeN

Minh’s doctor discovered kidney stones and determined that surgery would be needed. After the first surgery, there was a mistake and second, and third procedures followed. Minh and his wife, Hue were assisted by a Vietnamese translator after the second procedure had failed and Minh’s wife was asked to get a priest to give Minh his last rites. While Minh was rehabil-itating from each procedure, he stayed at Sharp’s nursing facility. No one at the facil-ity spoke Vietnamese. Minh would not eat the food at the facility and had to overcome physical obstacles that would come after each procedure, like painful constipation, with only the assistance of his wife, because no one in the facility understood or heard their concerns. After the first procedure had failed, the Viet-namese translator gave Minh and Hue her card to call her. When Minh and Hue returned to the hospital when a closed surgery opening had begun to leak yellow discharge, Hue called the translator with no

answer. Hue rushed to the receptionist yelling “Help.” The receptionist told Minh and his wife to call the translator, again. After an hour the trans-lator arrived and Minh was helped over five days later, when the specialist returned. Minh’s sore was not cleaned in the days that he waited for the specialist. Minh has returned to the specialist only once for a checkup. He returned to the office with a neighbor who is retired Navy. Minh says that the long wait and language issues have kept him from returning.

Hue NGuyeN

Hue had a sore throat since she arrived to the United States in 2001. She decided to get treatment in 2009. Her Vietnamese doctor sent her to a specialist at Mercy Hospital. Hue’s paperwork went in be-tween her doctor, her special-ist, and her doctor, again. Her doctor at Mercy Hospital did not speak Vietnamese. When she went to the specialist she underwent a series of tests.

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Her paperwork was sent to her primary doctor. She was then sent a letter telling her to go to another hospital. She did not go to the hospital because ofwhatshehadexperiencedat the office of her specialist. In 2011, Hue called Trang to help her get help after she coughed up blood. She was sent back to Mercy Hospital where she faced the same treatment amongst non-Vi-etnamese speakers. She was not talked to by the staff. After the visit, she was sent another letter suggesting that she go to another hospital, but Hue would not go. Hue says that she accepts the wait and lack of communication, but that both tire her. Today she has a lump on her neck, suffers back pains, and numbness on the right side of her body, but she will not go to the specialist. Hue’s healthcare process consists of having her healthcare issues addressed by waiting for her doctor to be available, communicating her issue to her Vietnamese doc-tor, and him communicating the emergency to a special-ist if needed or addressing it at the facility. Hue does not

worry about having an emer-gency, because there are for hiretranslators.Forafee(50-100, 15-20) she can have some-one she may or may not know come with her to the hospital, fill out her paper work for her, and communicate her medical condition to the doctor. But it is not guaranteed that these for hires will know how to fill out all of the forms. These assis-tants leave the parts blank that they are unable to fill out and the doctor knows to contact the Vietnamese doctor. Hue says that in her age and like many seniors who have come to this country in their older age, it is too late for her to learn and understand English. She thinks that health clinics, specialists, and hospitals would be better if there was someone there to speak her language. Until the option of having translators in these places, Hue seeks assis-tance for her mysterious neck lumps, back aches and numb-ness through Chinese herbal medicine, remedies, and saves doctor’s visits for emergencies.

MANA AMALiA roMero

Mana Amalia Romero was chipping at an ice block with a knife when her hand slipped, gauging through the muscles in her hand straight through her pointer finger. She went to the ER at 2 p.m. but by 1 a.m. had still not been attended to, even though she was bleeding profusely and has diabetes. No one at the hospital that she approached spoke Span-ish and she does not speak English, though she does understand a little of the lan-guage. By 2 a.m. she still had not been seen and decided to go home to sleep because she did not feel well enough to stay up any longer.

ThenextdayManawenttoalocal clinic where she knew the doctor spoke Spanish. After looking at it, he told her that because she has diabetes and was not treated on time the nerves in her finger are permanently damaged; she no longer has full sensation or complete range of motion in the afflicted finger, and it is permanently crooked. The doctor at the clinic told her

that had she been seen upon arriving at the hospital she would still have the full use of her finger.

eSViN JuArez

Esvin went to a Santa Mon-ica clinic because he had inflammation and swelling in his knee. The medication that they gave him caused his tongue to become numb and then a pain developed in his chest; when he went back to the clinic, they sent him to UCLA-Harbor Hospital’s ER. No one at the clinic or at Har-bor spoke Spanish; when he finally saw a doctor in the ER the first thing that he asked him was “Do you live in the United States?” to which he Esvin was able to answer yes. The doctor then brought in a nurse who could speak some Spanish but even with her present he interpreted Esvin’s problem as being related to illegaldrugs.Hetriedtoex-plain that his health problem wasn’t drug related, rather it was due to the medication he

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was on as a result of his knee being swollen. The doctor dis-charged him without provid-ing any sort of treatment plan and from there Esvin went to a second clinic with the as-sistance of his wife – who is illegal – and they discovered that the pain and swelling in his knee was due to cysts that had developed there. He is still waiting for surgery to have them removed.

AbukAr MoHAMMeD

Abukar speaks Somali. She was taken to Alvarado Hos-pital in 2010 because she had been vomiting for many hours the night before. Abukar had to bring her own interpreter because the hospital did not provide one. After securing her own interpreter she had to wait 3 hours for care. When she was seen she received an X-ray and they identified gastric activity. No mistakes happened in the hospital due to having an interpreter.

ANA PACHeCo

Ana started going to the hospital regularly, on a three month basis, complaining about a pain in her stom-ach. Each time she went the doctor would come into the room and proscribe her pain medication;shetriedtoex-plain the pain in her stom-ach but none of the doctors who saw her ever understood what she said. After the first or second time that she went in and realized she could not communicate with any of the providers there she started requesting for an interpreter but was repeatedly told that one could not be provided for her; she would have to bring one herself.

After a year the pain was increasing and the painkill-ers were no longer working. She brought in her ten year old son who did some of the basic interpreting for her. The doctor who treated her at this point decided to run some diagnostic tests on her; they found out that the pain was due to a tumor that ended up being cancerous.

LiGiA ANDerSoN

Translated from Ligia’s email:

When my daughter was born, I was scheduled for a cesarean. It was my fourth c-section and it occurred on April 29, 2002 at the Queen of the Valley Hospital in West Covina. I had all of the same routine procedures and examinationsforthispreg-nancy as the last three and was under the impression from the doctor that it would be a normal delivery. I was reluctant to undergo all of the tests they had scheduled for me; they indicated that they needed to do so many because in my country of origin, my doctor there never performed them on me.

When I went in to the hos-pital for my baby’s delivery nooneexplainedtomewhatthey were doing, or how much I was dilated, or where they were taking me. The OBondutyneverexplainedto me how I was to be as-signed a pediatrician after my baby girl was born. The

pediatrician assigned to me came to see us two or three times in the room where we both were staying in; when I asked the nurse what the doctor said about the con-dition of my baby girl she always said, “all is well with the child.” The nurses who helped me spoke English, my doctor spoke some Spanish, but they only ever came to see me when they needed to give me medication or to do an intravenous fluids check. The entire time they never really talked to me; they’d come in, do their job, and then leave.

After I left the hospital I was told to bring the baby into the doctor’s office in Glendora after a week or eight days for our first con-sultation. During that week my baby girl cried a lot and when I tried to feed her she could not latch onto either my breast or a bottle. Even though this is my fourth child, I thought I was doing something wrong. I called the doctor’s office to see if he could see us immediately, or at least earlier than a week,

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but the person on the other end of the phone that he/she didn’t speak English and that they couldn’t change our appointment – come in after eight days.

My neighbor did me a favor by telling me to call her pro-vider and to take my baby girl to the pediatrician where she took her children; it was near where we lived in Baldwin Park. The pediatrician who treated me spoke Spanish that said that my baby girl could not breathe while she fed; I went home and after some time I was able to breastfeed my baby a little bit better.

Something was still wrong with the way my baby girl was breathing while trying to eat so I went to WIC. The worker there told me that my baby girl was breathing while she was not feeding. The worker called a doctor to come in; after he attended to her he was able to tell me what was happening with her as she fed – her breathing passages were obstructed and it was due to something that should have been taken care of in the

hospital after she was born. He became very angry at me because he said that I should have realized that the girl was not breathing well, I already had three other children so had been through this before, and as a 41+ year old woman I should have known some-thing was wrong. This was nine days after the cesarean.

He made reference to the UCLA hospital and asked me if I had reliable transportation to get there. I took her to the hospital with my husband and at the hospital we physically explainedwhatwaswrongwith her. After running diag-nostic tests they were able to fixherairpassagesbutduetoprolongedoxygendeprivationshe now has learning disabili-ties and needs ongoing speech therapy because she does not have full use of her mouth.

eSter SANtiAGo

Ester went to the hospital be-cause she had noticed a lump in her breast. At the hospital they never told her what they were doing when she ended up undergoing minor surgery. They left something inside her breast during the surgery and after she had initially recov-ered from it she returned to the hospital because whatever was still inside was causing her significant pain. She de-scribed it as a burning sensa-tion that never goes away, ra-diating from her breast where the surgery was done out to the edge of her shoulder. The hospital had lost her file and could not tell her what had been done to her. She went to a different hospital but they turned her away because she couldn’t speak English and they do not speak Spanish. She still has no idea what is inside of her breast and she is still in constant pain; there is a large lump that one can see protruding from her breast

LuXANA

Shewasexperiencingherbreast as being really hot. She had problems for a few years before her actual diagnosis. Luxanaexperiencedmanymisunderstandings because no one spoke Thai. She also heard a lot of different rumors that were untrue, such as if she went to Hollywood Pres-byterian for treatment that she would receive a $10,000 bill. They told her to go to UCLA, 2 or 3 times, they didn’t do anything for her but refer to the Women’s Breast Center in Santa Monica. She went there for her biopsy. One day she was bleeding from her breast, there was blood and pus, there was so much blood that she needed a small trash can to catch it, and it filled half of a small trash can. Then she knew that she had to seek medical treatment. After all of these problems and misunderstandings, she finally contacted Nid, who helped her get treatment.

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PHAyAo

This woman is a breast can-cer survivor. She knows that she’s not doing well. She is undocumented and knew that she needed to get treatment, but she didn’t know how or where. She’s also very stub-born. She smoked and con-tinued to smoke. When Nid met her at the clinic, she was going to get the surgical treat-ment but did not want the chemotherapy. She refused chemo because she thought that she would lose her hair. Because of the language barrier, the doctor could not discuss the specifics about the pros and cons of chemother-apywithher.Finally,whenan interpreter was brought in (Nid), Nid was able to talk to her about chemo. Nid told her about other women who refused chemo and gave her support. She asked the doctor if she did not get chemo how long would she live, he said 5 years. She feels that if she had not had a person helping her interpret that she would have only lived 5 years after the surgical cancer treatment. Now she is living cancer free.

SuMALAi

Sumalai is a breast cancer survivor. Before her diagno-sis, she didn’t speak English at all and was homeless. She was by herself, with no family, but she belonged to and was active with a Catholic church. When Nid first met her, it was the church members who were helping her. Sumalai relayed to Nid the many bad experiencesshehadhadwithout an interpreter. In November of 1999, she went to the doctor for a biopsy and was diagnosed with breast cancer. She didn’t know what to do. In May of 2000, she started chemotherapy. She ended up having 10 cycles of chemo and some radiation, as well as taking 5 years of can-cer treatment medicine. Dur-ing her cycles of chemother-apy and radiation, Sumalai was homeless. She stayed at a Catholic, women’s homeless shelter. Her providers helped her contacting the drug com-pany to get the medicine for free. While her initial diagno-sis and treatment went well, Sumalaibegantoexperienceproblems when her treatment

planexpired.Sheattemptedto follow up without an interpreter and was trying to address her other health concerns such as diabetes. They didn’t follow up with her breast cancer screen-ing. Without an interpreter, Sumalai found it very diffi-cult to get follow-up care for her breast cancer as well as very difficult to get treatment and advice for her diabetes.

tHuAN trAN

Thuan was working for West View and he fell on the floor at work while he was doing maintenance. He drove his car home and then went to see his doctor, but the doctor did not have an interpreter. They did not understand each other. Thuan had to ask a relative to help with interpreting, and no one was available to help him. He went back to his family doc-tor who spoke Vietnamese and told him he couldn’t go back to the specialist that he was referred to. The doctor had to refer him. He thinks that translation is very im-

portant. He had to leave with no diagnosis. But he called his brother in law, who lives in San Diego. His brother in law drove to Orange County to help him with interpreting for the doctor. The treatment lasted 3 months and during the course of his treatment, he would sometimes be able to get an interpreter and sometimes his brother in law would come to help with interpreting. After his treat-ment, he decided to leave his job because he couldn’t physi-cally handle it any more.

DuNG NGuyeN

He is disabled; he is paralyzed from the legs down and is rel-egated to a wheelchair. Dung’s had arthritis since he was 12 years old and is used to being in pain. He can speak some English but cannot understand 100%. Because of his condition, he had to seek regular care from different specialists who couldn’t speak Vietnamese. He said that he understood less than 50% of

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what the doctors said, and the medications that he took from the prescriptions did help him much that he ended up taking it.He thinks that this provider never understood him very well. He needs help from his family.

DuC NGuyeN

Duc is disabled - a double leg amputee. He is relegated to a wheelchair. In the past, when they amputated his legs, they forgot to connect his nerves. The result is that he now has constant pain. One night when it was very pain-ful, he was rushed to Garden Grove Hospital. He requested aninterpreterandtheyex-plained that they did not have an interpreter at night. The doctor thought that Duc couldn’t urinate and that is how he proceeded with the di-agnosis.Ductriedtoexplainto the doctor that he tried to not drink anything in the afternoon so that at night he wouldn’t have to wake up his family members to help him urinate. So the doctor decided to insert a catheter to force

out the urine and pushed his stomach in very hard to en-courage the urine to come out. Ductriedtoexplainthatthisis not what he needed.

Another time he had pain in his legs and was taken to FountainValleyHospital.Heasked for an interpreter and there was none available. The doctor said immediately that he recognized the situation and gave him an injection. Duc felt much better and the pain was gone. He asked to go back home and the nurse consulted with the doctor. The nurse then proceeded to give him another shot. He refused, but the nurse did not understand him and gave him another shot. He was taken home and passed out/slept for three days. He only woke up to drink water.

SeAN kiM

She is a 68-year old woman from Cambodia. She came to this country about 25 years ago as a refugee. She has diabetes, high cholesterol and hypertension, arthritis, and is

losing her vision. She speaks very little English. At one visit to UCI Hospital, she tired her best to speak English but the doctor had trouble under-standing her. He called in the hospital receptionist, a young Cambodian woman, to inter-pret. This young woman was born in America. She speaks some Cambodian but she is not fluent, especially with the speech patterns of the older generation. Also, the recep-tionist has no professional training in medicine or medi-cal interpretation. The doctor had no way of determining the quality of the interpreta-tion. He may have suspected there was a problem with the receptionist’s language ability since he made the comment, “Why is it you both speak Cambodian but you sound dif-ferent?” After returning home, the woman complained that she did not feel the doctor understood her.

On another occasion, when the Health Navigator was not available to accompany the patient, the patient asked her over the phone (speak-ing in Khmer) “How do you

say, ‘I have a sharp pain in my knee?’” Our staff person recited to her the words in En-glish. The woman, who is liter-ate in Khmer, transcribed the sounds in the Khmer script as best she could. Then she took the piece of paper on her doc-tor visit and recited the words, without understanding their meaning, to the doctor. After-wards, she was not sure if she communicated well.

In another incident, Sean fell and broke her kneecap. Her doctor told her she needed surgery. She did not under-stand clearly, but she said to go ahead. The surgeon re-moved the kneecap. When the patient woke up, she was surprised to find they had done that. Also, the surgeon had inserted a metal post in her knee. She did not know that this would be done. Days later she complained, “There is something wrong, I can’t bend my knee.” Only then was she informed about the metal post and its effect on her movement.

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kiMeNG SuM

This woman is 65 years old. She came to the U.S. in 2006 from Cambodia as an im-migrant, sponsored by her daughter. Since she came here, she has had many health problems. She feels sick all the time. Her symp-toms have included nausea, vomiting, dizziness, pains in her chest and stomach. Her daughter and grandson have taken her to the emergency room on several occasions. Sometimes she stays over-night and sometimes they send her home after a few hours. On each visit, the doctorwouldexplainabouther condition to her daughter and grandson, but they would havedifficultyexplainingwhat the doctor said to the patient. On one occasion, she was given prescription medi-cine and was told to take it “as needed.” She did not under-stand what this meant. She took it every day. After a week, she became very ill. She was taken to the emergency room at Community Coast Hospital. Her doctor took her off that medication. On another occa-

sion, the doctor said he would remove her gall bladder. But her grandson, acting as in-terpreter, told her that her bladder would be removed. She was very afraid. Later, after the operation, she was informed that her gall blad-der had been removed. The doctor told her this was not a serious matter, but in Cambo-dian culture the gall bladder is considered an important part of the body. She felt that her feelings were not respected. In many ways, this patient’s lack of access to language interpre-tation has hurt her ability to access quality health care.

DAViD ouk 

This man is 65 years old. He came from Cambodia 10 years agoandlivedinLakeForest.He had high blood pressure. He also suffered from head-aches and dizziness. He did not know how to apply for health insurance. No one informed him that he was eligible to receive MSI. On bad days he would “coin” himself (scrape his body with the edge of a coin) and use home reme-

dies. Eventually he had angina attacks. He went to the emer-gency room and received open heart surgery. He spoke some English but he didn’t under-stand what mediations were being prescribed for him nor did he understand the proper dosage.AtLakeForestHospi-tal, no one speaks Khmer and nooneexplainedtohimwhathis condition was. Two days after returning home he went backtoER.Finally,thecorrectdosagewasexplainedtohimand he is now in recovery.

beAtriCe LoPez-AGuiLAr

Imagine it’s one of the happi-est days of your life - you’re a new mother and your child, born the night before, is ly-ing peacefully in your arms while you’re asleep in your hospital bed. All of a sudden, your baby begins to choke; you don’t know why but she can’t breathe and her whole body begins to go stiff in your arms. You cry out, “Help, help, my baby can’t breathe!” but no one comes to your aide; you run through the halls of the

hospital, barely clothed, in the hopes that you can find some-one to save your baby. After what seems like an eternity you finally find a nurse, but there’s a problem: she can’t understand you – none of the available providers in the hos-pital can.

This is Dora Beatrice Lopez-Aguilar’s birth story. Aguilar is a 34-year-old legal immi-grantbywayofMexicowhosefamily lives and works in San Diego. The day this happened at a hospital in the La Mesa area, she was recovering from the birth of her third child. “Iwasextremelyscaredbe-cause no one was coming to help me,” says Aguilar. “If the cleaning lady had not stopped by my room when she heard me screaming for help and then gone to get a nurse, I don’t know what would have happened to my baby.”

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iNDirA roDriGuez

Indira Rodriguez’s one year old daughter and two year old son had suspected pneumo-nia and were referred to Kern Med. ER by a primary care doctor from the Clinic in Lost Hills. The ER nurses did not speak Spanish, and asked a bi-lingual patient (stranger) from the waiting room to translate their symptom collecting questions. Nurses adminis-tered fever reducing medi-cation and sent the family back to the main waiting area where a misunderstanding, possibly related to mispronun-ciation of names, led to the children waiting for 13 hours without care, nurses assum-ing the family had left and destroying the original intake paperwork. The intake pro-cess had to be repeated with a second stranger from the waiting room being brought in to translate. The doctor ran tests, and the lone Spanish speaking nurse who’d helped the patient’s mother case a few years ago delivered the confirmed pneumonia diagno-sis. The children stayed in E.R. for three days with nothing

communicated to the family, so on the third day, a family friend from Lost Hills came to Bakersfield to interpret. The doctor told the family to get a certified medical interpreter to help them understand the paperwork they had signed, and did not offer an inter-preter on the hospital’s behalf. Ultimately, a nurse at the local Lost Hills clinic translated the discharge instructions, med-ical dosage, and how to use the pumps the children had been given. She also informed the family that the paperwork instructed them to return to the hospital one month later, to get results of scans the children had had during the hospitalization. Given that the experienceatKernMedicalhad been so difficult, the fam-ily asked the Spanish speak-ing doctor at their local clinic (Lost Hills) to treat the chil-dren there during the recov-ery period instead of having them return to Kern Med. The children were only cleared after two rounds of scans one month apart.

AiLiAN zHANG

Ailian Zhang speaks Chinese. Mrs.Zhangsonalwaysex-plains to her how to take her medication. Mrs. Zhang has been diagnosed with insom-nia. Her doctor prescribed her sleeping pills. Two years ago, she took too many and had to be taken to Mira Mesa hospi-tal by her son.

In that same year, Mrs. Zhang experienceddifficultystand-ing after sitting to use the bathroom. Her husband called 911. They did not contact their son once they arrived. Her husband became very angry with the staff because Mrs. Zhang was not being helped. After five hours and two ver-bal altercations with hospital staff, their son was contacted and the staff took Mrs. Zhang togetanx-ray.Whentheyfed Mrs. Zhang, it had been so long since she had eaten, she vomited. Nothing was foundinthex-rayandpainmedication was prescribed. Mrs. Zhang said that the pain medicine did not work as the pain stayed. Her pain sub-sided after getting a patch

from a Chinese herbalist, but the pain returns in very cold weather.

ALeXANDer SHAtoV

AlexShatovspeaksRus-sian. He had a sudden severe pain in the knee and could not walk or even stand. He called an ambulance and was brought to Scripps Mercy Hospital ER. He spoke no En-glish and, for some reason, an interpreter could not be ob-tained, even over the phone. ER personnel couldn’t un-derstand his symptoms and x-raysandotherteststheymay have done did not show soft tissue damage (a me-niscus tear, as was revealed later). As a result, he spent all day in the ER, in pain, and without any relief. Instead, he was given a general physical checkup, even an ear, nose, andthroatexam,andproba-bly many other unnecessary procedures, even though he had a focused complaint.Lateron,Alexcalledanac-quaintance physician in Rus-

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sia, who diagnosed torn me-niscus over the phone by his symptoms, and recommended a proper remedy (a simple cast),uponwhichAlexmadehis own splint, having lost all confidence in “American medicine”. Indeed this was a spectacular failure to resolve a relatively simple injury after generating all kinds of unnec-essary costs. Apparently the ER staff did not order an even more costly MRI of the knee, which could have shown the tear that could have otherwise been diagnosed with careful attention to patient’s symp-toms. Proper interpretation would have saved all those unnecessary costs. 

DMitriy GLozMAN

Dmitriy cares for both of his elderly, disabled and Russian speaking parents. He recalled an instance when his mother had to be taken to the Emer-gency Room without him. His motherhadexperiencedsideeffects after receiving a che-motherapy treatment. Dmitriy was not there to interpret for

his mother so she was placed in a waiting room with conta-gious patients by the hospital staff who could not under-stand her. With his mother’s weakened immune system due to her chemotherapy treatment, this type of envi-ronment could worsen her health.

When Dmitriy arrived, 20 minuteslater,heexplainedtothe hospital staff his mother’s condition and their reason for being there and she was moved to a separate waiting room. After his mother was admitted, she was diagnosed with a bowel obstruction and recommended to stay hospi-talized for a few days to see if her condition improved. When Dmitriy was home, he received a call at 5 in the morning from his mother. She told him that she had been seen by the doctors and they would do surgery on her. The only thing she picked up from the interpreter less consulta-tion was that after the surgery she would have a bag outside of her belly. When he arrived at the hospital his mother was still very upset and he

demanded to speak with the doctorformoreexplanation.Thedoctorcameandex-plained varied options that they had and how to proceed withtreatment.Heexplainedthis to his mother and she was calmer.

DorA SANCHez

Dora speaks Spanish. On July 4, 2006 Dora Sanchez took her 17 year old daughter who fell and was unconscious to Sharp hospital in Chula Vista at 8:00PM. The hospital did not have a Spanish speaker who could interpret at the time and as a result Mrs. Sanchez and her daughter waited for over twelve (12) hours to get anexplanationofwhathadhappened. Mrs. Sanchez and her daughter were never given anexplanation.Needlesstosay Mrs. Sanchez feels very frustrated and wonders what happen to her daughter that day. The only treatment her daughter received was an I.V administered to her by a nurse and she was then re-leased. Currently, her daugh-

ter occasionally passes out and they don’t understand why this is happening. They both feel that it is very impor-tant for hospitals and clin-ics to provide interpretation for those patients that don’t speak English so they can understand their condition, procedures and treatment and medication instructions.

JeANette SHoWriz

Jeanette has to use several types of medications for her blood pressure and heart conditions. Her son teaches her how to use her medicine. Jeanette speaks Arabic. Her son, Saad, must go with her all of the time to her doc-tor’s appointment. Some of the medical terminology and expressionsaredifficulttointerpret.

InFebruary2012Jeanettewashospitalized for being burned on her side when she was at home. Saad and his brother took turns, making sure that they were at the hospital in order to communicate on be-

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half of their mother. Jeanette was not eating the food that the hospital and Saad would bring food to the hospital. Sometimes Jeanette would find out that a member of the hospital staff could speak Ar-abic and she said that it was much better. It made her feel betterbeingabletoexplainher pain. She believes that having a receptionist and peo-ple who work in the hospital that can speak the language of the patient is very important.

keAN kAo

Kean had a stroke in 2000 and was hospitalized for three days. He thought he would die because when he would lie down on his back, he could not breathe. When he was being transported to Sharp, he was strapped down and thought he would die and tried to communicate to the paramedics, but could not speak English. If someone in ambulance could com-municate he could have said something. He felt hopeless. He could only communicates with his son as an interpret-

ert. When his son arrived, he wasinthex-rayroomandin great need of interpreta-tion in order to communicate the amount of discomfort hewasexperiencing.Forthree days, no one spoke Mr Kao, just used body language. They wanted him to attend rehabilitation sessions. He rehabilitated on his own. Un-monitored by a physician, he walked daily.

When he thinks about hav-ing a life threatening episode, without his son being present to help me he becomes wor-ried and uncomfortable.

kHAi truNG NGuyeN

The patient is a 71-year-old man who speaks Vietnamese. On December 18th, he was ad-mitted to Scripps Mercy Hos-pital after suffering a heart attack. He originally wanted to be taken to Alvarado Hos-pital, but because of the lan-guage barrier, he was instead taken to Scripps-Mercy Hospi-tal. After being admitted, he was rushed to surgery, where a stent was placed was placed

inside of one of his arteries to allow for better blood flow. The patient’s family requested a Vietnamese interpreter upon their arrival at the hospital at 8:00 p.m., but because the fa-cility did not have immediate access to one, the interpreter did not arrive until 11:00 a.m.thenextday.Oncethepatient’s surgical procedure was completed, the nurse explainedthatheneededtoundergo a comprehensive cardiac rehabilitative program, which was only available in English. The patient’s wife strongly believes that acces-sible medical interpretation is needed because she has experiencedfrustration&worry over not knowing what is happening to her husband

ko-CHeNG MAk

I have a primary care physi-cian who speaks Chinese. In 2011 I had surgery to remove cancer from my intestine. Today, I have cancer in my hand and prostate. While my primary care physician speaks Chinese, none of my spe-

cialists who treat my cancer, speak Chinese. I always have to arrange my doctor’s ap-pointments around my sister’s and son’s work-schedules. I know that it is out of the question for me to ever come alone.

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