For 14 years, Manuela Zepeda didn’t know she could not have children. In 1976, she went to a Portland clinic and, with no medical interpreter, she explained in Spanish that she had stomach pain. The doctors operated then sent her home.

“I had appendicitis, so they took that out, but they also took out my uterus – without my consent,” Zepeda said through tears. She did not know about the hysterectomy until 2000 when she went to another clinic, where she was provided a trained medical interpreter. “When I found out, I was so depressed. I kept crying and crying.”

Zepeda came from her home in Burlington to Olympia to tell elected officials to restore funding for medical interpreter services and other language access programs. She was one of nearly 200 immigrants who came to Olympia on Tuesday, January 26, as part of “Immigrants’ Day at the Capitol”, which was sponsored by OneAmerica. They came to advocate for language access, citizenship programs and progressive tax reform so services for all low-income people could be maintained.

Manuela Zepeda attends legislative training as part of Immigrants Day at the State Capitol, organized by OneAmerica. (c) 2010 Carina A. del Rosario

The Governor is proposing to plug the state’s $2.6 billion budget hole with a series of cuts, including eliminating $16.6 million for medical interpreter services for 400,000 limited English proficient immigrants; $160.6 million for the Basic Health program that insures 65,000 low-income individuals; and $118.9 million for the General Assistance Unemployable Medical Services program, which provides health care to 20,000 people, among other programs.

Lilia Ortiz, who came to Olympia with Zepeda, said through an interpreter, “It makes me very sad to hear about these cuts because one small misunderstanding could leave mothers without sons. It could leave people dying.”

Ortiz said she had gone to the doctor while she was pregnant. After examining her, the doctor gave her a piece of paper to sign. The paper was in English and there was no one at the clinic to interpret it. A friend who knew English read the paper and told her that the doctor had recommended an abortion because he thought there was something wrong with the fetus.

Lilia Ortiz (left) and Manuela Zepeda (right) prepare to meet with their legislators. They came down from Burllington, Wash., with other family members to speak with their elected officials about cuts to medical interpreter services. (c) 2010 Carina A. del Rosario

She said, “I ignored him and didn’t go to the abortion clinic. Now I have my Nicky,” who was born healthy 13 years ago.

“The reality is that immigrants are bearing the burden of these cuts. People’s health should not depend on whether they can speak English,” said Pramila Jayapal, executive director of OneAmerica. “Twelve percent of the state’s population is foreign born, and 14 percent of our workforce is foreign born. Immigrants are critical to the fabric of our economy,” Jayapal said. Denying them access to health care and other basic services ultimately affects everyone in the state and the economy, she added.

Medical interpreters say they have a solution: cut the middlemen out. The state Dept. of Social and Health Services pays 40-47% of the total medical interpretation costs to brokerage firms and foreign language agencies, according to Interpreters United, a campaign spearheaded by the Washington Federation of State Employees (WFSE).

“Right now, you have 20,000 appointments needing medical interpreters. For each one, the health care provider calls the broker. The broker calls the language school. The language school calls the interpreter to schedule the appointment. Then the language school calls the broker. The broker calls the provider to confirm the appointment. This is why it takes 72 hours to get an appointment,” says Megan Parke of WFSE AFSCME Council 28.

Interpreters are supporting House Bill 3062 and Senate Bill 6726, which call for eliminating the use of brokerage firms and having DSHS handle verification of patient eligibility, scheduling of appointments and payment of independent providers. Similar to home health care and child care providers, the bills also propose having collective bargaining for medical interpreters.

Rep. Zack Hudgins (D-11th District), one of the co-sponsors of the bill, said, “Here’s a possibility of realizing some savings and also improving services.”

Hudgins said he supports HB 3062 because of the great need for medical interpreters in his district, which covers most of Tukwila and has over 100 languages spoken in schools. He says cutting medical interpreter services would cost the state $12.2 million in federal matching funds and ultimately cost the state more if limited English proficient (LEP) residents get sicker and have to go to the emergency room.

Dr. Carey Jackson agrees. “Communication is the most basic of human needs,” said Jackson, medical director of the International Medicine Clinic and Interpreter Services at Harborview Medical Center. “In medicine, without clear communication, diagnoses are missed, inappropriate tests are ordered, medication is not understood, and tests, and follow-up appointments are unkept. The human suffering and extraordinary expense that results to the system overall is substantial and avoidable. The absence of interpretation throughout the system will multiply expense and waste, and the cost in the ERs, clinics, and hospitals will far outweigh the superficial savings proposed on a spreadsheet.”

Rep. Cary Condotta (R-12th District) serves on the House Labor and Commerce Committee and conducted a public hearing on the bill Jan. 26. “The medical interpreter program itself is important and I think the current delivery system has worked relatively okay. But is collective bargaining the way to go? It’s a radical move and we need to discuss other options,” he says.

Condotta, whose district includes Wenatchee and a large Latino population, says he supports the part of the bill that calls for a legislative workgroup to look at ways to cut administrative and overhead costs, improve timeliness for medical providers, stabilize the pool of qualified interpreters and prevent fraud and abuse.

The House Labor and Commerce committee has until Feb. 2 to make amendments and vote on the bill. The Senate Committee on Labor and Commerce & Consumer Protection will have a public hearing on its version of the bill, SB6726, on the same day.