Limited-English speakers struggle to access and receive appropriate health care in D.C.'s hospitals and clinics, a new report finds.

Of the 72 limited-English-speaking community members surveyed by the D.C. Language Access Coalition, about half of whom were uninsured, many told stories of trouble accessing medical services. The District's population includes about 27,000 people who acknowledge speaking poor English, according to the 2008 American Community Survey.

The study's subjects struggled to communicate their concerns and understand the instructions of their providers. They spoke of having appointments canceled because no interpreter was available, of being "left for last" while waiting for care, of struggling to have questions answered over the phone, and of not having access to important forms and documents in their native language.

Vital documents are rarely available in any foreign language other than Spanish, the study found.

There are success stories, especially among D.C. hospitals that provide extensive translation assistance through expensive special phones, but "it is clear that many people are still falling through the cracks," the report concluded.

"They're required to do it, and they all make every reasonable efforts to do that," Robert Malson, chief executive officer of the D.C. Hospital Association, said of hospitals meeting the needs of the non-English-speaking population. "Do people fall in between the cracks? Absolutely."

Some interviewees said they resorted to using hand signals. One woman said she was subjected to blood tests because facility staff confused her with someone else with the same last name. Others said they were teased. Patrick Coonan, deputy director of the access coalition, said the next step was to engage facilities and "bring these barriers to their attention." Hospitals are the larger problem, he said, because most community clinics have been formed to serve specific populations. "The problem is when [patients] get referred out," he said, "they run into barriers that they don't find at the safety net clinics." Sharon Baskerville, chief executive officer of the D.C. Primary Care Association, said the city has done well to provide for Spanish speakers. Language services, she said, are critical but there's no system for them and "no one's figured out how to pay for it."