PORTLAND — Interpreting from one language to another is a tricky business, and when it comes to interpreting between a doctor and patient, the stakes are even higher.

Consider the story of 18-year-old baseball player Willie Ramirez.

Ramirez was taken to a South Florida hospital in a coma, says Oregon certified medical interpreter Helen Eby. “His family apparently used the word ‘intoxicado’ to talk about this person,” she says. “Well, ‘intoxicado’ in Spanish just means that you ingested something. It could be food, it could be a drug, it could be anything that has made you sick.”

Patient Isidro Hernandes communicates with Dr. Angela Alday through Spanish interpreter Armando Jimenez. (Photo by Tuality Healthcare/Jeff Schilling)

But, Eby continues, “the interpreter interpreted this as ‘intoxicated’ so the doctor immediately made a diagnosis of drug overdose. They had him in the hospital for two days before they figured out they should call in a neurologist and found that he had a couple of hematomas in his brain. The guy ended up quadriplegic.”

Eby says doctors and hospitals also often turn to a family member for help, but that can be problematic, too.

“You know, you’ve got a 10-year-old in a gynecology appointment. Is this where you would normally take a 10-year-old?” she says.  “Not likely. Or have a child, an adult child even, interpret a parent’s cancer diagnosis. That’s got to be highly traumatic.”

Thirteen years ago, the state of Oregon recognized the problem and required doctors and hospitals to start using interpreters. The Affordable Care Act also broadens what hospitals and insurers are required to translate for people who don’t speak English.

But even more than a decade after the state law has been on the books, it still poses challenges in Oregon. Many hospitals and doctors turned to a phone service, where they can quickly get help in several languages.

But the people who work for those language services often aren’t certified medical interpreters, and that can lead to difficulties.

Isidro Hernandes is 48 and lives in Cornelius, in Oregon’s fertile Willamette Valley. Recently, he was a patient at Hillsboro’s Tuality Hospital.

The 48-year-old landscaper was at work when he started to feel a tightness in his chest. He’s feeling better now that his heart problems are being addressed, but speaking through interpreter Armando Jinenez, Hernandes says he prefers in-person interpreters to those on the phone.

“A lot of times the over-the-phone interpreter can’t see what you’re doing, can’t describe or relay that message. And sometimes they might have errors or mistakes in communications,” Jinenez relays in English for Hernandes.

Tuality Hospital has been using a phone service to provide qualified interpreters, but the director of corporate communications, Gerry Ewing, says they’re planning to use more in-person interpreters.

“We’re trying to reflect the demographics of our community, which is changing rapidly,” he says.  “Washington County is around 25 percent Hispanic, so we need to reflect that in the services we provide our patients.”

Hernandes’ doctor, Angela Alday, says that five to 20 percent of her patients require an interpreter. She said the hospital encourages her to use a phone service when necessary, which she does. But she says sometimes, when dealing with a touchy issue, she will use a family member.

“One problem that I run into with the translator phone is a lot of our elderly patients seem to be kind of confused by it,” Alday says. “You know some of them don’t hear very well so that can be a problem. And then, particularly if the patient has dementia, sometimes using the telephone translator is confusing. They don’t know what’s going on. But I feel like if there’s a family member standing there beside them, then they understand more what’s happening.”

She’s pleased the hospital is planning to use more in-person interpreters in the future.

Oregon has about 3,500 medical interpreters. But Eby says only 32 are certified and another 64 qualified, “So you have a three percent chance of getting a qualified or certified interpreter in Oregon right now,” she says. “That’s pretty low, in my opinion.”

It takes a long time and costs a lot of money to become certified, she adds. And after a person goes through all that training, they find they can make more money and have a more stable lifestyle in another career, like translation for court reporting. That’s because medical interpreters tend to be consultants and don’t get paid to travel. The hours can also be sparse and sporadic.

But Eby remains hopeful. Now that the Affordable Care Act is penalizing hospitals for readmissions, such a reduction in errors could save them significant sums.

A 2012 study by the American College of Emergency Physicians looked at interpreter errors. It found that the error rate was significantly lower for professional interpreters than for ad hoc interpreters — 12 percent as opposed to 22 percent. And for professionals with more than 100 hours of training, errors dropped to 2 percent.

Oregon’s Office of Equity and Inclusion plans to increase training and add 150 new interpreters in the next two years.