Stories about communication problems in the hospitals and clinics of the Las Vegas Valley make the rounds among the area's health-care professionals.
A woman at a lab had breast cancer, but lab employees couldn't find anyone to explain her test results to her in Spanish.
On another occasion a 12-year-old boy had to tell his mother she needed a hysterectomy because the doctor didn't speak Spanish and no interpreter was available.
In an area where nearly one of four residents is Hispanic, it's becoming an increasing problem.
Now a study published in the January issue of Pediatrics magazine shows that the absence of interpreters for Spanish-speaking patients can lead to errors with medical consequences, and even professional interpreters commit errors if they are not adequately trained.
Most of the stories on communication snafus are anonymous because the medical professionals who witness them don't want to rock the boat in the absence of national or state standards on medical interpreting. In addition, many of the patients affected by inadequate services are undocumented immigrants who prefer to avoid attention.
Still, interviews with local hospitals and school-based clinics with high numbers of Hispanic patients, as well as with those who study the issue, show a growing problem that may be overburdening the health-care system financially and creating the potential for serious errors and medical malpractice lawsuits.
"The situation we have now is time-consuming, costly, and not very good health care," said Barbara Ludwig, who directs three school-based clinics run by the Clark County Health District.
The study showed that an average of 31 errors were committed each time a Spanish-speaking pediatric patient met with a doctor.
Seventy-seven percent of the errors committed by so-called "ad hoc" interpreters had potential clinical consequences, while 53 percent of the errors by paid interpreters had potential clinical consequences.
"Accuracy plays a big role in the health-care provider coming up with an evaluation of the patient's situation," said Mariteresa Rivera-Rogers, administrator for the 8th District Court interpreter program.
"The consequences of not providing appropriate services at the outset may be worse at the end, since a totally wrong diagnosis can cost the system more," she said.
"In this sense, I think it is everybody's issue."
Michelle Sotero, who coordinates a project to provide interpreters for patients at the University Medical Center, said the study also points to another problem in meeting the need for health care in Spanish.
"We don't have standards for interpreting in the medical field," she said.
In January 2002 Nevada adopted a nationally standardized system for testing and certifying court interpreters, but no such system is in place for hospital interpreters, Sotero said.
"We do the best we can ...(and) take the best practices from other states," Sotero said.
Since October 2000 the hospital has hired interpreters from Clark County's court program. The hospital also now translates some documents into Spanish, recruits bilingual employees and tests employees for proficiency in Spanish. It is also developing a glossary of medical terms in Spanish. The hospital spends $450,000 a year on the program.
The women's clinic and pediatric outpatient clinic are where interpreting is most needed, Sotero said. More than 75 percent of the women's clinic's 13,000 annual patients are Hispanic, while 60 percent of the pediatric clinic's 22,000 annual patients are Hispanic.
The problem is also evident at Lake Mead Hospital in North Las Vegas, where some neighborhoods are up to 83 percent Hispanic, according to the Census Bureau.
Annette Kinsman, director of business development for the hospital, said that at least 25 percent of its 11,000 patients each year are Hispanic. She said that Lake Mead Hospital deals with the need to speak Spanish to many of these patients by developing a list of people in the hospital who are bilingual.
About 20 people have volunteered to be on the list, ranging from maintenance and kitchen staff to clinical staff, she said. They take a three-page test to determine if they're fluent in Spanish, but Kinsman said she didn't know who wrote the test.
"I know we don't have qualified medical interpreters, because we're just not a hospital with enough money to deal with that," she said.
The study in Pediatrics magazine recommends that other states follow the lead of Hawaii, Maine, Minnesota, Vermont and Washington. Those states have Medicaid and Medicare reimburse interpreters who work with patients on those insurance plans.
"But we've never had a problem with the issue," Kinsman said. "Our Hispanic patients are well taken care of."
Ludwig, of the school-based clinics, retorted, "Hospitals in the Las Vegas Valley that don't think they have to deal with this are in denial -- using a chaplain or housekeeping staff is not enough."
One source of future interpreters may soon come from the Community College of Southern Nevada, where Hyla Winters, associate dean of health sciences, is developing a medical interpreter certificate program. CCSN worked with the county Health District on a private grant that would have allowed local hospitals to hire interpreters. The grant was denied in October.
"Now we're trying to meet this important need through an educational program," she said.
At Roy Martin Middle School, site of one of the county's three school-based clinics, about 85 percent of the nearly 200 patients each month are Hispanic. The other two schools in the program are Valley High School and Squire Elementary School. The program is funded with $400,000 of tobacco settlement money for 2003-2004.
On a recent visit to Roy Martin, Griselda Montes was having her daughter Leticia's ears examined.
After an earlier visit to the clinic, she had to visit a specialist. First she had to find a friend who spoke English, however.
"If I didn't have him with me, I don't know what I would have done," she said.
Ramona de Lemos was also at the clinic with her four children. If any of them gets sick on the weekend or during summer vacation, she takes care of them at home, she said.
The problem, she says, is not knowing if the doctors or nurses at any other hospital or clinic near her North Las Vegas home would understand her.
"You feel really uncomfortable," de Lemos said in Spanish.
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