The issue of lack of interpreters for refugees during medical appointments is the focus of an article in the Anchorage Press. The piece focuses on the case of a Sudanese single refugee mother who was coughing up blood, but who a medical clinic misdiagnosed as having “touch of pneumonia” while refusing any suggestion that she needed an interpreter. Doctors later correctly diagnosed her with a heart tumor and ovarian cancer, and operated on her twice – again with no interpretation provided. Medical personnel strapped her down, and then played western music and danced in a failed attempt to calm her as she panicked while not knowing what was happening.

According to the article there are now thousands of refugees residing in Anchorage, many of them given medical treatment at clinics and doctors offices without the use of interpreters.

…there are about 1,000 Southern Sudanese refugees, between 5,000 and 6,000 Hmong refugees, about 100-plus Somali refugees, maybe 50 Iraqi refugees, 100 Bhutanese refugees and about 500 former Soviet Union refugees. There are also various asylees from Gambia and South America, entrants from Cuba and refugees from African countries such as Togo and Congo…

…Many Alaska physicians are breaking the law—specifically, “Title VI of the 1964 Civil Rights Act, which requires that any health care provider who receives federal funds, including funding from Medicaid, Children’s Health Insurance Program or Medicare, to take reasonable steps to ensure meaningful access to its health services,” says Doreena Wong, a health policy expert and lawyer at the National Health Law Program, a public interest law firm based in Washington, D.C. 

“It is horrifying to watch a human being treated this way. If you look at it from the doctor’s office, they don’t want to get known for this,” says Karen Ferguson, the director of the Refugee Assistance & Immigration Services (RAIS) program in Anchorage. She has a packet of information and a stocked reserve of horrific stories—cases of doctors’ seemingly malicious abuse of refugees in ill health….here

As in other parts of the refugee resettlement program, providers here are ignoring laws and regulations at will. I should note that when people do report the problems, the government oversight agencies do little to correct them. It’s as if the U.S. refugee resettlement program is still stuck in the wild west phase of its development, with government bureaucrats who can not be shaken out of their comfort zones.

…Medicaid in Alaska reimburses physicians for medical services but not for interpreters. It’s simple. An interpreter can cost between $40 to $120 per hour. If you are being paid $150 for a visit, it doesn’t make sense to pay $100 for an interpreter.

Curiously, the Anchorage Neighborhood Health Center in Fairview provides interpreters for any and every client who needs it. According to Joan Fisher, its director, they accommodate “over 21 different languages.” How? It turns out that with the special designation as a Federally Qualified Health Center (FQHC), Fisher can bill the federal government for interpretation services. It’s no secret formula. Find the money and find interpreters. Alaska physicians are not malicious; they’re practical.

Thus one encounters the common “friends and family” solution—the free solution—a pernicious panacea, where the responsibility for finding an interpreter is passed on to the patient, who is recommended to enlist the help of a multilingual friend or family member. Of the nine providers interviewed for this article, eight said that they depend on friends and family for their patients with limited English.

Think about this: If you are a mother, and you have a son who is moderately bilingual, would you want him to interpret for you at your next appointment at the OB/GYN? If you are a father, and you have a daughter who is bilingual, would you want your daughter to interpret at your next prostate exam? Would you want your friend or family member to be the first to know that you have cancer?

In the Americans with Disabilities Act (ADA), the Department of Justice writes, “It is inappropriate to ask family members or other companions to interpret for a person who is deaf or hard of hearing. Family members may be unable to interpret accurately in the emotional situation that often exists in a medical emergency.” Are the Sudanese refugee and the deaf individual different in this respect?

If something goes wrong and the physician used a family member deemed inappropriate (such as a minor) as an interpreter, the provider is liable. The Health Law Program studied a cohort of malpractice cases and found that nearly three percent of all cases arose from such problems, costing doctors millions…

…Doreena Wong from the Health Law Program comments that “larger providers save money with interpreters.” For this reason, hospitals generally have systematic methods for interpretation needs. The problem is with small to medium private practices.

“The solution is simple,” says Barbara Richards, the regional director of the U.S. Department of Health & Human Services. If Alaska requests it, the federal government will provide the majority of the funding necessary to reimburse Alaska physicians for interpreters. Thirteen states have already implemented similar programs, including Washington, Hawaii, Iowa, Idaho, Kansas, Maine and Utah…

…The process to solve [this problem] is easy. Either the Alaska Legislature or the state director of Health & Human Services would need to recommend that interpretation services be included in the state Medicaid budget. Because law requires it, the federal government would immediately approve the expense. The state would cover a minority of the cost. Doctors would then be able to bill for interpreters.

Doctors want access to interpreters. Refugees need it. The law requires it. All the state needs to do is suggest it. In one of the most culturally diverse states in the nation, it only makes sense.

Just so readers know, language interpretation by phone is available to any organization that needs it via a company called Language Line. It is available 24/7 by phone in 175 languages and costs $2.90 to $3.90 per minute, with a $100 monthly minimum.