Laotian refugee Ker Moua, ailing and unable to speak English, enlisted her 12-year-old son as her medical interpreter.
"She tells me where it hurts and then we go to the doctor together. But I don't really know what a uterus is," said her son, Jue, whose English is peppered with words from his sixth-grade textbooks and the football field.
"She tells me things I don't know how to say. Sometimes I tell the doctor something else."
His mother's problem was diagnosed as a prolapsed uterus, the result of bearing 14 children. She began taking medication in the doses her son described, but soon felt so dizzy she couldn't get out of bed for two days.
Jue's mistranslation of the doctor's orders caused his mother to take the wrong amount of medicine. While the error didn't cause lasting harm, it's exactly the kind of problem California medical officials want to correct.
The use of children as medical interpreters is a common practice in immigrant-rich states such as California. Yet recent research has described the potentially lethal consequences of faulty translations.
Now California is considering rules that would prevent children from interpreting at private hospitals, doctors' offices or clinics. The rules would not apply in emergencies.
This month, the California Department of Managed Health Care is holding hearings on the proposed regulations. A group representing the state's largest managed care plans estimates the bold proposal to hire qualified translators could cost $15 million.
California would be the first state to implement such a wide-ranging ban, said Mara Youdelman, attorney with the National Health Law Program in Washington. Other states have restrictions, but none goes as far as California's proposal. Rhode Island, for example, requires all hospitals to provide interpreters older than 16, but the rule does not extend to doctor's offices or clinics.
Experts say children lack the vocabulary and emotional maturity to serve as effective interpreters. In a state in which 40 percent of the population speaks a language other than English at home, policy makers say California could set a national precedent.
"The federal government has acknowledged it's a form of discrimination not to provide adequate interpretation," said Dr. Glenn Flores, who directs the Center for the Advancement of Underserved Children at the Medical College of Wisconsin. "States around the country will be saying that if California finally does something about it, we can do it, too."
Who will pay for those services is expected to be a key point of debate in the months ahead.
"This is going to be a battle," said Cindy Ehnes, director of the Department of Managed Health Care, which regulates the industry. "There is no question that hospitals are extremely concerned about additional costs."
Many hospitals already are using cheaper alternatives, such as telephone or video interpreter services. But the health care industry says the new rules could raise the cost for everyone.
If approved, the new rules could take effect in March and would require private health plans to provide patients with trained, adult interpreters.
The rules also concern physicians worried about the costs of professional interpreters. Some could be forced to end services to immigrants who don't speak English, said Tom Riley, director of government relations at the California Academy of Family Physicians, which represents family doctors.
"You may be the doc in the trenches doing all the right things, caring for a diverse limited-English-proficient population, but you could be hit by this bill in a way that you cannot economically survive," he said.
The estimated $15 million in costs doesn't even include the cost of a measure state Assemblyman Leland Yee is proposing. The Los Angeles Democrat's bill would prevent children from translating for their parents at hospitals and clinics that get public funding.
"I was extremely uncomfortable when my parents asked me to interpret for them," said Yee, whose parents spoke Cantonese. "We have got to understand that it is not an appropriate role for children."
Support for a prohibition against child interpreters is not universal.
State Sen. Abel Maldonado, R-Santa Maria, said there should be a place in the health care system for children to translate for their parents, if that's what the family wants.
For years, Maldonado interpreted for his father, a former guest worker who speaks only Spanish.
"To have a bill in place that would keep a person like me away from their father or mother, I just can't agree with," Maldonado said.
