"From 1990 to 2000, the number of residents with limited English proficiency grew by 7 million, to 21 million, or 8.1% of the population, according to U.S. Census figures. Yet, one study showed that no interpreter was used in 46% of emergency department cases involving such patients, says Glenn Flores, an expert on language barriers in health care who based his conclusions on his own studies and those done by other researchers."

The article went on to cite various mishaps which have occurred due to this language barrier. In one example, a Florida hospital paid out a $71 million settlement when it misinterpreted an 18-year-old's claim of being "intoxicado." Apparently, they thought he was suffering from a drug overdose, when in fact he had a brain aneurysm (intoxicado means nauseated in some parts of Latin America).

I remember once, in my younger days when I was working in an hospital emergency room, a man came in screaming in Spanish. He was gesturing wildly and seemed unable to calm down. No one on the staff could understand him, but we were lucky to have a lady in the waiting room who could, and she translated. It turned out he had appendicitis, and had put off coming in because he didn't have insurance. By the time he got to us, he was in such pain that he wasn't thinking clearly enough to even point at where it hurt. It took someone speaking his language in a calm voice to get through. I immediately signed up for a remedial Spanish course after that particular incident.

In a fast-paced time where medical innovations seem mainly technical or lab-oriented, it's easy to forget that a simple thing like anticipating a patient's language can mean the difference between life and death. Personally, I think the law in California should be nationwide. The U.S. is a nation of immigrants, and that is a reality our healthcare should reflect.

Medicaid instituted a new requirement last year that users provide proof of citizenship. This was done to prevent illegal immigrants from using the system. Sounds simple, right? Well, it turns out there's a little problem: thousands of U.S. citizens are losing coverage because they are having trouble providing documentation.

This from a recent article in the New York Times:

"Under a 2006 federal law, the Deficit Reduction Act, most people who say they are United States citizens and want Medicaid must provide 'satisfactory documentary evidence of citizenship,' which could include a passport or the combination of a birth certificate and a driver's license.'

In Louisiana, agencies have been flooded with hundreds of original drivers licenses and passports. Many poor people are having trouble paying the fees required to receive a birth certificate for documentation. It's a horrible mess.

Of the two Georgia congressmen who created the legislation, one is dead and the other, Nathan Deal, feels all of these problems are just "bumps in the road." He will supposedly fight any attempt to repeal this law, and in fact wants it expanded to the Children's Health Insurance Program.

It seems like a sign of the times. Politicians want to respond to a policy that is unpopular and not working by making it worse. States that had been making strides in increasing enrollment and giving Medicaid to deserving Americans falling through the net in our horrible healthcare system are losing important ground. We, as healthcare professionals, know how devastating this can be to real people.

I believe this article in the Times is a wake-up call.