Hey, it ain't just the ER's, Janet. I've been spending a lot of time lately in a coastal hospital, and Spanish is the language of about half the occupants -- including the people working there (white males are limited pretty much to only being there if they happen to have MD appended to their name).
Who's paying for all the fun? All you have to do is look at the brochures (all helpfully in Spanish) and listen to the Social Workers (who are all, conveniently, fluent in Espanol). The answer is...MediCare, MediCal, and in my county, MediCruz. Oh and WIC (application forms helpfully available in the hospital), California Childrens Services (CCS), etc.
In other words...we are.
It's a real eye-opener.
I guess we're lucky...the first person you see when you come into our hospital does't speak a word of Spanish. She flunked out of HS Spanish at Apollo HS in Phoenix.
She's bull-headed enough to make the patients speak English to get what they want. And you know what? 99% of them do. It isn't necessarily that they can't speak it. They won't.