In this interview, Senior Indigenous Justice Staff Attorney Preston Sanchez explains why access to language assistance is vital to the overall health of Indigenous people. The discussion stems from a lawsuit ACLU-NM and the Fine Law Firm filed against San Juan Regional Medical Center (SJRMC) for failing to provide Navajo elder, Larry Williams, with a certified Navajo language interpreter, leading to his misdiagnosis and untimely death in 2018.

One early, winter morning, Larry Williams’s family noticed that he was speaking incoherently and had difficulty keeping his balance. They rushed him to the nearest emergency room at the SJRMC in Farmington. His wife, Lenora Williams, who usually translated for him during medical visits, had to leave for her own dialysis appointment. She expressed anxiety about leaving him, but SJRMC staff assured her he would be well cared for. Two of his adult daughters, who are not fluent in Navajo, remained with him.

Photo left: Larry Williams dancing with his daughter.

According to medical records, SJRMC staff never considered Larry’s language needs nor provided him with a Navajo interpreter. In its failure to communicate adequately with Larry, SJRMC staff failed to observe his altered mental state – a common symptom associated with the onset of sepsis. Instead, they only treated Larry for a simple urinary tract infection and discharged him that afternoon. Larry’s undiagnosed condition continued to worsen. That same evening, his family rushed him back to SJRMC, where staff determined that he was suffering from severe septic shock. He died two days later.

"San Juan Regional Medical Center has a legal duty to provide language assistance to its patients who are limited English proficient; and that means providing them a Navajo interpreter."

Maria Archuleta (MA): Thanks for making the time, Preston. When I talk about this case with people, I get mixed reactions. Many, like me, are outraged. Others ask, “Why couldn’t his daughters, who were with him at the hospital, interpret for him?” or “Did he really not speak English?” Could you talk about Native elders who speak primarily Indigenous languages and why they need interpretation?

Preston Sanchez (PS): New Mexico is home to 23 tribal nations. Among them, seven different Native languages are spoken. In fact, many of our Native elders today grew up in households and communities where those languages were – and still are – the primary languages spoken day-to-day.   

In the case of Larry Williams, for example, who was 67 years old at the time of his death, he spoke primarily in Navajo with his family. He was also a union welder for a really long time, working with other Navajo speakers. Throughout his entire life he had been immersed in the Navajo language and culture. Only periodically was he required to consult with doctors in English. However, his wife usually translated for him during those visits – but those visits were never emergency related visits.

His daughters speak some Navajo, but they’re not fluent. More importantly, though, medical terminology is very technical for anyone to understand. It would be extremely difficult for any person who speaks Navajo — or any language other than English — to be a translator between a doctor and patients like Larry who are limited-English proficient. That is why certain legal standards exist that require hospitals to provide language assistance to limited-English patients, like Larry, to ensure adequate communication occurs between medical staff and the patients they serve.   

 

MA: This unfortunate scenario can take so many different forms. My family is from up north and my grandparents spoke primarily Spanish. My paternal grandparents definitely would’ve needed a language interpreter to communicate about their medical needs. There’s no way I could have translated for them. For that matter, with my very imperfect Spanish, I would need one myself if I had a medical emergency in a Spanish speaking country.

His daughters talked about his deep knowledge of the Navajo language and Navajo traditions. People would seek him out for his wisdom. The loss of a traditional elder has a ripple effect across many generations.

PS: Absolutely. Imagine you visit a country where you know only enough of the language to order tacos and a beer and maybe enough to haggle about a blanket at the local market. Maybe you even speak the language enough to have meaningful conversations with strangers. But, if you were to have a medical emergency like Larry’s, where you feel confused, disoriented, unable to walk in a straight line, and unable to breathe – then you might be in trouble at a hospital. No one can comprehend what you’re saying, and you have no one to speak on your behalf. Any one of us would need an interpreter to help us communicate about our medical needs in that situation. We all need to be able to communicate and comprehend pretty complicated medical jargon to survive.

MA: The staff assumed Larry Wiliams spoke English?   

PS: The doctor who diagnosed Larry did not think there was any language barrier. He was also not at all familiar with the term Limited-English Proficient and he didn’t know about any SJRMC policy or training requiring language assistance. According to the doctor, about 60% of the patients he serves are Navajo. This all points to a systemic problem at SJRMC and, we suspect, at other hospitals across the state. Medical staff appear to lack any awareness about potential language or cultural barriers.

MA: It’s beyond belief that the doctor could go through a whole treatment of a patient at a high risk of death and never notice that he wasn’t proficient in English. I know his daughters did their best to advocate for him, but could you tell me why we shouldn’t expect family and friends to interpret in situations like these?

Photo above: San Juan County Regional Medical Center in Farmington

PS: Even if Larry Williams’ daughters spoke perfect Navajo, it takes certified training to be able to convert medical terms from English to Navajo and vice-versa. Not every medical term can even be translated into Navajo because the words in Navajo just don’t exist. Most of us don’t understand much medical terminology, and it’s not easy to understand what’s going on even when you are completely fluent in English. The same is true for legal matters. I can speak just a little bit of Navajo – enough to communicate with Navajo speakers about the weather -- but would I be able to speak to clients about complex legal issues in Navajo. F** no. If I had a client who primarily speaks Navajo, he or she would obviously need a Navajo interpreter who specializes in legal matters. It would be unethical for me to assume that a limited English proficient client would understand me – and vice versa.   

"We want New Mexico hospitals to know that they need to provide their Indigenous patients with adequate language assistance and that they’ll be held accountable if not."

Larry’s wife Lenora is fluent in Navajo and was usually with him at appointments, but she couldn’t miss her own dialysis appointment that day. But even if Lenora had been there, she shouldn’t have had to bear the burden of acting as a medical interpreter. Not to mention, SJRMC has a legal duty to provide language assistance to its patients who are limited English proficient; and that means providing them a Navajo interpreter.

MA: This tragic and senseless death shows the importance of how much education needs to happen about the needs of the diverse cultures in New Mexico.

PS: Absolutely, people’s lives depend on it.

It’s also important to remember that Larry’s death was not only a terrible loss to his family but to his entire community. His daughters talked about his deep knowledge of the Navajo language and Navajo traditions. People would seek him out for his wisdom. The loss of a traditional elder has a ripple effect across many generations. So, this situation is extremely unfortunate.

MA: One last question. What are you hoping to achieve with this case?

PS: We want New Mexico hospitals to know that they need to provide their Indigenous patients with adequate language assistance and that they’ll be held accountable if not. Language assistance is vital to the overall health of our Indigenous People.

MA: Thanks for talking to me.

PS: Anytime, Maria.

The 2023 legislative session stands as one of the ACLU’s most successful. In collaboration with community and legislative partners, the ACLU worked to pass bills strengthening voting rights and police accountability, ending life without parole for youthful offenders, and eliminating certain criminal fines and fees. All told, ten of our priority bills made it over the finish line, more than in any previous session.

Our multi-pronged approach to protecting civil liberties is so important – it will take every tool in our tool box of litigation, legislative advocacy, and public education to ensure New Mexico remains a place where every person can make their own medical decisions without government interference.

But surely no legislative achievement is more noteworthy than the passage of bills strengthening New Mexicans’ right to make independent decisions about their reproductive and gender-affirming health care. Now, the State of New Mexico affords unique protections to patients, helpers, and providers of gender-affirming care and abortion care against discrimination, harassment or prosecution from other states. It also explicitly forbids any “public body” from interfering with reproductive health or gender-affirming care.

These are substantive guarantees that further anchor the unique freedoms New Mexicans deserve in determining their own futures and planning their families as they choose.

They come at a critical time. In the wake of the Dobbs decision, counties and cities in southeastern New Mexico are conspiring with national anti-abortion activists to pass ordinances banning abortion care. The aim of these laws is not just to ban abortion care in parts of New Mexico but also to provoke legal challenges that could work their way up through the federal courts to give the U.S. Supreme Court further opportunity to ban abortion nationwide.

The overturning of Roe v. Wade thrust New Mexico to the fore of the national fight to preserve abortion access. Not only are we one of the few southwestern states where abortion remains safe and legal, but we are also home to one of the few clinics in the nation that continues to provide critical access to abortion care later in pregnancy. Anti-abortion extremists have their eyes on New Mexico and will stop at nothing to erase this crucial bastion of reproductive freedom from the map of abortion access.

The New Mexico constitution forbids the kinds of discriminatory health care restrictions that places like Hobbs, Clovis, and Roosevelt County have recently passed -- restrictions that have already caused panic, chaos, and confusion in our communities. In response, Attorney General Raul Torrez challenged these ordinances on several constitutional grounds and the ACLU of New Mexico just filed an amicus brief in the case arguing that local policymakers are attempting to deny their communities essential health care protected by the New Mexico constitution and statutory law.

We cannot shy from aggressively defending those rights at every turn.

This is where the importance of our legislative victories comes in. In addition to the constitutional safeguards already in place, by creating law that explicitly forbids local governments from imposing restrictions on health care access, the ACLU and its allies have given the courts another clear and unequivocal basis for rejecting the ordinances. Our multi-pronged approach to protecting civil liberties is so important – it will take every tool in our tool box of litigation, legislative advocacy, and public education to ensure New Mexico remains a place where every person can make their own medical decisions without government interference.

Over the last year, we as a nation have learned just how fragile the right to abortion and gender affirming care is. We cannot shy from aggressively defending those rights at every turn. But our every move must be careful and strategic. The futures of families are at stake.   

Immigration and Customs Enforcement (ICE) has new leadership, with the appointment last week of P.J. Lechleitner as acting director. ICE has not had a Senate-confirmed director since the Obama administration, making Lechleitner’s appointment as acting director more significant — and potentially likely to last through the end of Biden’s term.

The big question is whether Lechleitner is willing to move forward on a reform agenda that has been stalled for the last year. The good news is that in June, the Supreme Court removed a major obstacle to ICE reforms, shutting down litigation brought by anti-immigrant attorneys general in Texas and Louisiana that had aimed to force Biden to pursue a draconian deportation agenda. (The ACLU filed an amicus brief in the case).

The ugly politics of immigration remain a major barrier. House Republicans are still trying to impeach Department of Homeland Security Secretary Alejandro Mayorkas — Lechleitner’s boss — over his handling of the border, although they have not been able to muster the votes. Lechleitner will need to overcome the chilling effect of the threatened impeachment proceedings, as well as pre-presidential election anxieties around immigration.

But there are common-sense, impactful changes that Lechleitner can make as acting ICE director — ones that will help President Biden show that he’s made good on his campaign promises. Here are three of them:

On average, ICE is detaining about 29,000 people a day in dozens of detention sites around the country — the overwhelming majority of which are run or operated by for-profit prison companies.

During his campaign, then-candidate Biden promised to “end for-profit detention centers.” In April 2021, he told activists in Georgia that “there should be no private prisons, period, none, period. … Private detention centers: they should not exist, and we are working to close all of them.” A poll we commissioned supported Biden’s convictions: 68 percent of voters wanted to see the federal government stop pursuing contracts with for-profit prison corporations.

Though Biden’s pledge only focused on for-profit detention, activists and the ACLU have called on him to dismantle the mass detention system more broadly. So far, ICE has closed or discontinued use of a handful of facilities, but far more is needed. ICE’s new acting director should order a new, comprehensive review of ICE detention facilities for health, safety and due process issues — and swiftly act to close abusive facilities.

High on his list should be Baker County Detention Center in Macclenny, Florida, described as a “living hell” by a person formerly detained there. The ACLU of Florida has documented sexual voyeurism, such as staff watching women when they use the restroom; women being denied sanitary napkins and clean clothes as punishment, leading to infections and being forced to sleep in blood-soaked sheets; medical neglect and beatings; and much more.

These examples are disturbing, but sadly, not exceptional. The ACLU and our partners have documented horrific conditions and shameful treatment in ICE detention sites across the country — under Biden’s watch. Leichleitner should lean into the issue — and move forward on closing detention sites.

President Biden also promised to roll back ICE’s 287(g) program, which taps local law enforcement to help identify people for arrest and deportation. Through 287(g) and related programs, local police have helped ICE ensnare thousands of people in an indiscriminate deportation dragnet — the opposite of the limited approach the Biden administration initially promised. As a candidate, Biden recognized that turning local police into immigration agents harms public safety by making people in immigrant and mixed-status households afraid to access protection and public services . He pledged to end agreements initiated in the prior four years.

The Trump administration aggressively recruited sheriffs to join the 287(g) program, using anti-immigrant hate as a selling point, and the program exploded to five times its Obama-era size. Despite its alarming growth under Trump — and recent protests by activists around the country — the Biden administration has left the 287(g) program mostly intact. An April 2022 ACLU report detailed how, through the 287(g) program, the Biden administration is empowering sheriffs with records of racism, anti-immigrant hate, and civil rights violations in direct contravention of its racial justice commitments.

Biden has likely failed to cut back on 287(g) because reform-minded officials believed that ICE’s enforcement priorities, which direct ICE agents to focus their arrests and deportations on immigrants with particular immigration or criminal law violations, would staunch abuses by local law enforcement agencies. But history suggested it wouldn’t work, as we warned early on. Priorities are far from a panacea: Data obtained by the American Immigration Council and Immigrant Legal Resource Center shows that under Biden nearly half of ICE’s requests to other law enforcement agencies to hold people for deportation purposes (known as detainers) were for people who fell outside ICE’s enforcement priorities.

And because many ICE agents are not applying the priorities in practice, anti-immigrant local law enforcement officers can use 287(g) as a tool to promote indiscriminate deportations. Empowering those officers, particularly ones from departments with a track record of anti-immigrant and racist statements and actions, to make decisions about immigration enforcement effectively invites abusive practices like stopping Black and Brown individuals in traffic stops under pretexts, and funneling them into a deportation pipeline.

Lechleitner should move to end 287(g) agreements with abusive sheriffs, starting with the ACLU’s list of 54 sheriffs with egregious records.

The Biden administration fulfilled an important pledge to end worksite raids, which the Trump administration had used alongside other mass raids, for political ends. But it’s all too easy to imagine a future administration deploying ICE agents on America’s streets in a drive to make this a hostile, dangerous place for our immigrant neighbors and loved ones.

As we have documented, in the past ICE agents have impersonated police, disguised themselves as day laborers, represented themselves as probation officers and tricked people into locating a family member so they can arrest them. The ACLU has filed lawsuits challenging these practices in California and Illinois.

Lechleitner should look at lasting reforms to ICE’s arrest practices, including putting ICE agents under meaningful supervisory pre-approval constraints and prohibiting them from impersonating local police.

These are just three ways that the Biden administration, under Lechleitner’s new tenure, can take meaningful steps toward reforming harmful ICE detention and enforcement practices. But the work doesn’t end there, and we will continue to push the administration to use all the tools at its disposal to build a more humane immigration system.