http://www.savannahnow.com/stories/052805/3062876.shtml
Hispanic community advocates say Memorial 'no habla Espanol'
Spanish-speaking patients find it difficult to navigate the system at Memorial Health; certified interpreters in short supply.
Anne Hart and Scott M. Larson
912.652.0374
[email protected]
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When Leticia Xotla-Herrera went to the emergency room at Memorial Health University Medical Center earlier this year, her dilemma was similar to that of an increasing number of ER patients in Savannah.
The 18-year-old was scared, sick and didn't speak English.
Having moved to the city from Mexico several months earlier, Leticia had difficulty communicating in English to the medical staff. They, in turn, had trouble understanding her Spanish.
She died in the hospital at 10 a.m. Feb. 19 of unknown causes, about 15 hours after she entered the ER for the second time.
Her father, Tomas Xotla, believes the failure of staff to communicate effectively in Spanish contributed to his youngest daughter's death. The young mother had planned to work for the Marriott Savannah Riverfront for a while before returning home to her two sons in Mexico with the money she'd saved.
Certified medical interpreters who translate for Memorial patients are more saddened than surprised by Leticia's death. The hospital, they say, lacks a formalized approach to communicating with non-English speaking patients.
"If she had had a medical interpreter there, one would hope there would have been a different outcome,'' said Marta Greenhoe Kaufman of Savannah, a certified medical interpreter, licensed social worker and spokeswoman for Savannah's Latin American Service Organization.
Whether the language barrier contributed to Leticia's death isn't known. Memorial officials declined to release details of her case citing patient privacy issues.
But Leticia's death prompted Memorial to seek input from Savannah's Hispanic community on how to improve staff communication in the face of an influx of non-English speaking Hispanic patients.
Memorial representatives met this month with LASO members, medical interpreters and other community leaders. A second meeting is set for June 7.
After the first meeting, some LASO members said Memorial continues to rely on an impersonal, inadequate national phone translation system or mostly volunteer interpreters.
The solutions they suggested include:
hire/contract paid, certified medical interpreters who'd be on-call on a 24/7 basis.
recruit more bilingual medical staff.
translate basic hospital forms and signs into Spanish or use signs with universally recognized symbols.
Making the improvements will cost Memorial money, but continuing to rely on current methods could prove even more costly, some LASO members said.
"What I would like to see here is nothing different than what they do at hospitals in Atlanta,'' said Jeannine Bonar-Dueno, medical interpreter and LASO board vice president.
"Memorial seems receptive to making those changes, but it comes down to dollars and cents,'' she said. "Many of these patients are indigent. The question is: Does Memorial value them the same?''
Changing demographics
Peter Doliber, Memorial's director of community affairs, said hospital officials will look into the requests and ready a response.
He declined to say whether Memorial will contract or hire paid medical interpreters to be on call around the clock.
"It's not something we've explored yet,'' Doliber said.
"Rather than just say 'This is the one answer,' we want to work with the Hispanic leadership to determine what is the most effective answer.''
Doliber points to Memorial's history of working with the community in general. The hospital also has a Hispanic outreach that is a part of the current dialogue with community leaders.
"We recognize the Hispanic community is growing and it behooves us to be responsive to their needs,'' Doliber said. "Our job is health care.''
St. Joseph's/Candler also has a Hispanic health care committee. That group has developed a program which plans to contract, train and pay certified interpreters in addition to relying on the national translation phone line.
The hospital system also plans to have directional signs marked with universally recognized symbols alongside the English explanation.
"They are moving on this, and hopefully Memorial will follow,'' Bonar-Dueno said.
The increase in Hispanic patients has been greatest at Memorial, particularly in its emergency room and obstetrics unit.
Bonar-Dueno says that growth has taken Memorial by surprise.
"It's not the fault of Memorial,'' said Dr. Miriam Rittmeyer, director of Community HealthCare Center. The center accepts indigent patients who don't have insurance, Medicare or Medicaid.
"It's just the demographics of Savannah are changing,'' Rittmeyer said.
"Translating all the forms, training the personnel, it's going to take a couple years.''
Overhaul needed?
Leticia went to the ER twice in February. The first time, at 11 p.m. Feb. 12, she was suffering from severe stomach pains.
She was released at 4 a.m. with a prescription for antibiotics and little understanding of what was wrong with her, aside from having a stomach infection, her father said through an interpreter.
Her symptoms then worsened.
Leticia's next ER visit came a week later.
It was her last.
Questions surrounding her death include the cause; whether the hospital had medical records of her first visit; and whether there was a medical interpreter present during her first visit.
