Growing Hispanic population strains medical agencies
By CATHY DYSON
The Free Lance-star

GINNA CRUZ FACED one of the scariest moments of her pregnancy and couldn’t talk with those trying to help her.

She spoke Spanish, and the nurses around her at Mary Washington Hospital spoke English.

By mid-March, the woman from the Dominican Republic had been hospitalized for almost a week. Her baby boy was due in seven weeks, and his heart rate had slowed.

When nurses had questions or wanted to explain the need for more tests or monitors, they picked up the phone and called a national interpreting service.

A person on the other end talked with Cruz in Spanish, then passed along her questions to the nurses in English.

Cruz, a 24-year-old who’s in the United States legally with her husband, didn’t like the phone system, which put her in touch with a different interpreter almost every time. She wanted to talk with someone face to face.

On a Sunday night at 11, with an aching back and a worried mind, Cruz contacted one of the few bilingual people she knows in Fredericksburg.

“She was in tears,” said Gladys Brackett, a Spotsylvania County resident and volunteer interpreter. “There were things she couldn’t understand because there was nobody there who could speak Spanish.”

Cruz had many tests at the hospital during the last weeks of her pregnancy. She had an interpreter assigned to her twice, both times when The Free Lance–Star had asked the hospital for permission to accompany her.

During labor, Cruz was ready for an epidural anesthesia to relieve pain, but the interpreter had not arrived. An anesthesiologist pleaded with the newspaper’s photographer, who speaks Spanish, to explain the risks of the injection into the spinal cord.

Cruz’s pregnancy ended on a happy note. Her healthy baby, named Joshua, arrived before Easter, a time Hispanics consider sacred.

“He is my little gift from God,” Cruz said in Spanish. “Now we are a complete family.”

But the language barriers between Cruz and the hospital workers underscore the challenges faced by communities with growing numbers of Spanish-speakers.

The Hispanic population in the Fredericksburg area has more than doubled since 2000, according to U.S. Census Bureau estimates. About 22,000 people from Spanish-speaking countries live in the city and surrounding counties.

There are few places where the increase is more apparent than maternity clinics.

Cruz sought prenatal care through the Rappahannock Area Health District, which includes Fredericksburg and the counties of Stafford, Spotsylvania, King George and Caroline.

The district treated 965 women in 2005, said Dr. Donald Stern, district director. Half of them spoke Spanish.

By spring 2006, the percentage of Spanish-speakers had increased to about 65 percent in Spotsylvania and Stafford counties—and 90 percent in Fredericksburg.

“The growth in demand ... has been remarkable,” said Stern, who also stresses how important it is for immigrants to learn English.

A need for interpreters

The Rappahannock Health District considers itself “ahead of the game” in language services, Stern said. The district offers Spanish classes to employees and strives to hire bilingual staff members in all positions. A few of the doctors who treat maternity patients speak Spanish.

The district also has a full-time interpreter, Judith Santiago, who serves five localities. Santiago sits with Hispanic pregnant women as nurses ask them how they feel and what diseases they may have been exposed to in their homelands.

Santiago is among a handful of bilingual health-care workers, from North Stafford to the shores of the Northern Neck.

For instance, Three Rivers Health District covers 2,000 square miles east of Fredericksburg and has two bilingual employees. These two workers provide interpreting services in addition to their full-time jobs—and often are called upon by other area agencies.

Dennise Erwin, the administrator of a home health care agency in Spotsylvania, has to go north to Woodbridge or south near Richmond to find Spanish-speaking workers who are in the country legally.

“There’s never anyone in Fredericksburg,” she said.

Jane Willis, director of the Rappahannock Area Health Education Center in Warsaw, says finding money for interpreters is the latest dilemma “in an industry that already has financial problems.”

It’s also an industry where the wrong turn of phrase can have lethal consequences.

A current article in the New England Journal of Medicine highlights a horrible example.

An 18-year-old Hispanic man in Miami said he was “intoxicado,” or nauseated, before he stumbled and passed out.

His Spanish-speaking mother relayed that to paramedics, who thought the word meant “intoxicated.” Hospital staff treated him for a drug overdose.

When the patient was still in a coma more than 36 hours later, he was re-evaluated. Tests showed a burst artery and two blood clots in his brain.

The young man was left paralyzed. A jury later awarded him a $71 million lifetime settlement.

A sudden diversity

Hospitals and health-care facilities have to provide adequate language services, according to the Civil Rights Act of 1964. Agencies that receive federal reimbursement—and most do—can’t refuse a patient who doesn’t speak English.

Since 1983, Mary Washington Hospital has handled many of its language needs through the phone service, which charges by the minute. The service cost about $6,000 a month in 2005, said Pamela Thorpe, who has worked for MediCorp Health System almost seven years.

In February, Thorpe became MediCorp’s first cultural services coordinator and has evaluated ways to serve a growing population of foreign-born residents.

She and Adelaide Buckner, assistant director of community programs, have been amazed by the sudden diversity.

“It’s like we woke up one morning, and we have all these people,” Buckner said.

As Thorpe did her research, she discovered many patients and staff shared Cruz’s dislike of the phone service.

This month, MediCorp will implement a new phone system that uses certified medical interpreters. Not all the interpreters with the previous system were medically certified.

MediCorp also will offer two training classes a year for employees who want to become interpreters.

Of the 4,000 associates who work in MediCorp’s various facilities, 52 speak another language, according to Thorpe’s survey.

Ten of them recently completed the 40-hour course to become interpreters. Seven of the 10 speak Spanish.

In states like Virginia, where the foreign-born population is growing, hospitals and health-care providers are facing the same language issues, said Glenn Flores. He’s a doctor in Wisconsin who wrote the recent report about the “intoxicado” incident.

Across the nation, one of every five people—or 50 million residents—speaks a language besides English at home.

“That’s a pretty big scale, if you think about it, whatever side of the [immigration] fence you happen to be on,” he said in a telephone interview.

He researched the use of “ad-hoc interpreters” for patients who don’t speak English. The interpreters made an average of 31 mistakes per visit, according to the study done at the Boston Medical Center.

“Ad-hoc interpreters” might be friends of the patient or medical staff who know a little of the language. Or, they could be the patient’s children, a situation that’s particularly awkward because it puts youngsters in an adult world, said Veronica Donahue, a Tappahannock resident and founding member of the Virginia Latino Advisory Commission.

“A 12-year-old boy has no business translating his mother’s gynecological exam,” Donahue said.

Flores believes certified medical interpreters are the solution, nationwide. He’s also quick to point out that the federal government will reimburse up to 60 percent of interpreting costs—of patients who receive state or federal benefits.

“It’s not fair, it’s not ethical and it’s not social justice to say that unless you know English, you’re not going to get good medical care,” he said.


‘A strain on our finances’

Cruz had no complaints about the care she received at Mary Washington Hospital, only the lack of face-to-face interpreters.

Cruz and her husband, Juan, who cleans houses and office buildings, purposely waited until they got to the United States to start their family.

Juan Cruz wanted his children to reap the benefits of American citizenship.

Juan and Ginna Cruz grew up in Santiago in the northern part of the Dominican Republic and enjoyed dipping their toes into the turquoise waters of the Caribbean. They got married when she was 15 and he was 23.

They were living in New York when they had their daughter, Shelyny, who turned 3 in June.

Because the children were born in America, they get Medicaid, the federal health-care program for low-income residents.

The parents do not.

The mother’s extended hospital stay and the baby’s birth cost more than $35,000, the Cruzes said recently. Emergency Medicaid and the hospital’s charity fund covered all but $1,900. The Cruzes said they can’t pay the remainder, and are applying to have the debt forgiven.

The Cruzes got free prenatal care through the Stafford Health Department.

Health departments are reimbursed for Medicaid patients they treat, but don’t get funding for those who don’t qualify for Medicaid. The health departments charge these patients a sliding-scale fee.

But three of four Hispanics treated locally have such low incomes they’re not required to pay anything, said Director Stern.

“That puts a strain on our finances,” he said. “We have no funding for this growing number of uninsured patients.”

But he believes the financial impact would be even higher if patients didn’t get prenatal care.

Blue Cross Blue Shield estimates—conservatively—that the lifetime medical costs for one premature baby are more than half a million dollars.

“Who ends up paying for that?” Stern asked. “We all do.”

To reach CATHY DYSON: 540/374-5425 cdyson@freelancestar.com

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