(electric buzzing) - I come from Cambodia, Phnom Penh.

When I was 25, 28 years old, I left my country.

I came to the United States on 1987.

I come to Seattle and I didn't speak any English at all at that time.

I had depression during that time.

Every time I saw people I just cry, because you didn't speak the language, it's so hard.

You cannot tell what you feel and what you need.

And when your kid's sick, you don't know how to ask for help, yeah.

- [Narrator] Yvone Ung is an interpreter at a health clinic in Seattle's Chinatown International District.

- [Doctor] And I have the result from yesterday.

(Yvone speaking Cambodian) - [Narrator] She knows five languages and spends her days helping patients who aren't fluent in English.

- [Yvone] I didn't see a doctor for 10 years, myself.

No physical checkup, nothing.

I'd just stay home and get sick sometimes.

One day I get a kidney stone.

My goodness, so painful!

I didn't want to go, because I didn't know how to tell them and how they understand me.

(electronic buzzing) - [Narrator] Every day, patients in Washington state rely on interpreters like Yvone to communicate with their doctors, pharmacists, dentists, and other providers.

These language access services are in fact required by both federal and state law.

- People are supposed to be able to receive healthcare services in the language that they prefer or speak best.

What's actually happening is that that law isn't really very strongly enforced.

And so there's a lot of variation in what patients experience.

- [Narrator] In Washington state, one in seven residents is foreign born, either an immigrant or a refugee.

About 20% of the population speaks a language other than English at home.

According to the latest figures, around 9% of Washingtonians are reported to have limited English proficiency.

That's over half a million people.

Though experts say it's likely an under count.

This LEP population has grown substantially in the past few decades at one of the fastest rates in the country.

The most commonly spoken languages in Washington are Spanish by a long shot, followed by Vietnamese, Russian, Ukrainian, Tagalog, Korean, Somali, and over 200 more languages.

So how are these folks accessing healthcare services?

Asefech Tessema is from Ethiopia.

- My first language is Tigrinya.

I speak too Amharic.

- [Staff] Hello, Asefech.

(Asefech speaking indistinctly) Hello.

- How are you?

- [Staff] Good, how are you?

- Good.

- [Staff] Good.

You going somewhere fancy?

(Asefech speaking indistinctly) Yes.

- How good to see you.

- [Staff] How good to see you.

- I'm going to my daughter.

- [Staff] Okay, have fun.

- Thank you.

- [Staff] 'Kay, buh-bye.

- [Narrator] He says he could get by without an interpreter, but it's better to have one.

- [Asefech] There are technical words, medical words that I don't understand.

So to make sure, it is good to have a translator.

- [Doctor] Anything else bothering you that I didn't ask you about?

(Translator speaking foreign language) - [Narrator] In a healthcare setting, miscommunication can have serious and costly repercussions.

Patients who aren't fluent in English might avoid going to the doctor, miss appointments, or leave an appointment missing crucial information, like how to prepare for a surgery or how to take medication.

- When health services aren't provided in the right language, it leads to more errors, more time getting people well.

- [Narrator] Over time, these language barriers lead to longer hospital stays, more readmissions, and worse health outcomes.

- [India] It ends up costing society more, because people show up in the emergency room at late stages of disease, because they haven't been able to get the preventative care that they needed.

- [Narrator] Tessema is in luck here.

Experts say that large systems such as Harborview and the University of Washington Medical Center offer robust language services of all kinds.

These include in-person interpreters, tele-interpretation over the phone, as well as through video remote service, and written translations.

But at some clinics and offices, it's another story.

- We hear about the lack of interpreters, or patients being asked to bring their own interpreter, or being turned away from care, because they need language assistance.

All those things are illegal, but they happen all the time.

- Many places just aren't able to provide services in all the languages that their patients need, and many don't know their own rights.

And so they don't know to ask for those kinds of services, and there's a lot of variation and quality even when they get them.

- [Narrator] Take Medicaid patients in Washington who put in over 320,000 requests for interpreter services in 2020.

The state aims to fill 90% of interpreter requests for these seven most requested languages.

For languages that are less frequently spoken but still in high demand, it aims to fill 70% of requests.

But it's still falling short in many places, leading patients to fall through the cracks.

(ominous music) Many patients don't know they have the right to translated documents or an interpreter, or they're afraid they'll have to pay for interpretation, so they don't request it.

It's up to the individual to file a complaint, but experts say that's not likely to happen given how disenfranchised these patients feel in the current political climate.

- [Joanna] We have a very diverse population now and a big growth of people who need language assistance.

We have particularly in Western Washington people from all over the world, but we have fallen behind in actually having communication services be available for everyone who needs them when they need them.

There can't be diagnosis and treatment without communication.

(indistinct talking) - [Narrator] This series is made possible in part by the generous support of Premera Blue Cross.