Don't cut interpreter services for Washington's Medicaid patients

COMMUNICATION is a two-way street. Now imagine being sick and not being able to communicate with your physician — to describe your symptoms and to hear your doctor's diagnosis and instructions for care.

In medicine, without clear communication, diagnoses are missed, inappropriate tests are ordered, medication is not understood, and follow-up appointments fall through the cracks.

In Washington, legal residents with limited or no English proficiency are able to get health-care coverage through the Medicaid program. With that coverage comes interpreter services for the patient. However, if the current version of the governor's budget passes, interpreter services will be cut, having a devastating impact on the care of Medicaid patients, not to mention an increased cost to taxpayers.

Interpreters are a necessary part of the care team for patients with limited English-speaking skills.

Without the help of an interpreter, a patient must struggle to find a friend or perhaps one of their children to interpret on their behalf, which can result in serious harm. Medical interpreters have added training in health care. The physician and the patient rely on interpreters, not only to translate a patient's symptoms but to translate complicated medical instructions and assist in providing informed consent for medical procedures.

There have been frightening examples of inaccurate interpretations reported to the Legislature and in the media. One woman went to the physician complaining of stomach pain. Having a friend interpret for her, the woman thought she consented to having her appendix removed. She found out 14 years later that her uterus was also removed during that procedure — something she did not consent to.

It is estimated that more than 150,000 patients will be impacted if these crucial services are eliminated. According to the Department of Social and Health Services, in 2009, 43 percent of all interpreter services were provided to children and pregnant women.

The sad truth is that if the state chooses to not cover the cost of an interpreter, many of these patients will not find a physician willing to care for them. The costs of doing so represent a substantial loss to the physician's practice.

Currently, the cost of a typical office visit to a physician is $90. Medicaid pays the doctor approximately $37 for the visit. So for every Medicaid patient visit, a physician already loses about $53.

Now add the expense of an interpreter. An interpreter costs between $75 and $175 per visit. By forcing the physician to provide this unfunded mandate, the physician would lose $127-$227 per limited- or non-English-speaking patient. For those few physicians who see Medicaid patients, many will not be able to absorb these added overhead expenses at a greater loss to their businesses.

Without a physician to treat them, these patients will go without care or will turn to our already overburdened hospital emergency departments. Such action puts a huge financial strain on the overall health-care system. Patients get sicker, costs go up, waste is multiplied; the impact is substantial and avoidable.

Medical care cannot be delivered effectively with a language barrier. For some, the absence of a medical interpreter can be a matter of life and death.

The Legislature needs to fund interpreter services in the supplemental budget. Failure to do so will be disastrous for many of our fellow citizens and will burden all of us with increased costs.