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Misdiagnoses and Deaths: Why Medical Translations Must be Done by Professionals

Doctor Talking To Interracial-Couples About Medical Findings
Misdiagnoses and Deaths: Why Medical Translations Must be Done by Professionals
on October, 08 2015
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You may not believe it but it's a fact that medical translations or interpretation done incorrectly, has the ability to endanger lives. Poor translation, in particular, has adversely affected the lives of a number of people. There have been documented cases of faulty or incompetent medical translations that have caused severe complications, faulty diagnoses, and even death. Competent medical translation is indubitably important as demonstrated by the following cases:

Actual Cases of the Risks of Medical Translation

Over the years, there have already been several real cases that show why proper medical translation or interpreting is important. The following are just a few of them:

1. Willie Ramirez’s Quadriplegia

In 1980, baseball player Willie Ramirez was brought to a hospital in South Florida. He was already in coma. Unfortunately, something went awry when the assigned medical interpreter translated the words of the family members who spoke Cuban Spanish. The interpreter misinterpreted the Cuban Spanish word “intoxicado” as “intoxicated.” This “small” problem led to Ramirez waking up a quadriplegic.

The case of Ramirez is one of the most famous incidents that demonstrate the serious risks of faulty interpretation or translation in the medical field. Ramirez became quadriplegic because the doctors failed to properly employ the right medical options believing that he was merely “intoxicated.” In Cuban Spanish, being “intoxicado” does not translate to being intoxicated as how most English speakers know it. Being “intoxicado” in regular Cuban Spanish conversations is being sick after ingesting something. This something could be food, drug, or anything that could make a person feel sick.

With how “intoxicado” was translated to the doctors back then, the diagnosis given was drug overdose. This misdiagnosis prevented the doctors from considering other possible problems. Ramirez did not suffer drug overdose but actually had bleeding in his brain. The doctors belatedly realized this so it was already too late to introduce the proper medical treatment (neurosurgery) and permanent damage has already taken over Ramirez’s body.

2. Maria Guevera’s Induced Abortion

In the case of Spanish-speaking California resident Maria Guevera, she lost her baby because of a simple misunderstanding in the absence of a medical interpreter. Without a medical interpreter to help her in conversing with the doctor, she was mistakenly given a prescription to induce abortion. What makes this story even sadder is that this happened at a hospital that serves a population where nearly 4 out of 10 possible patients are Spanish speakers who have difficulty understanding and speaking English.

Guevera’s story happened two years ago and is now being widely circulated. Accordingly, Guevera quickly said “yes” to the doctor thinking that he asked if she wanted to keep the baby. It is not clear what exactly the question was but that simple “yes” changed her life forever. Some may say that it was also partly her fault that she did not ask for an interpreter but there are also those who say that it is the hospital’s responsibility to provide the needed language service especially in a highly diverse state like California.

3. Badly Translated Prostheses Instruction Manuals

Even in the written aspect of medical translation, serious mistakes also happen. One good example is a 2013 case in a hospital in Berlin. An inaccurately translated instruction manual led to the improper implanting of at least 47 knee prostheses. The prostheses should have come with the indication “prothèse non modifiable, doit être cimentée.” In English, they were supposedly non-modular cemented prostheses. However, the German translation given was "prothèse ne nécessitant pas de ciment," which in English means, “prosthesis requires no cement.” Relying on the information provided by the manual, the doctors proceeded to implanting the prostheses without cement.

Obviously, cemented prostheses are completely different from prostheses that don’t require cement. As such, when they were implanted, the results weren’t what was expected. Not so long after the operation, one third of the patients who received the prostheses complained that they had problems with their prostheses. Half of the 47 decided to have themselves re-operated to fix the defect. This unfortunate problem could have been avoided if proper medical translation was used.

Risks of Improper or Lack of Medical Interpreting and Translation

It’s not enough to simply have medical translation or interpreting. It’s very important to have competent medical translation and/or interpreting. This means that it should be accurate, in context, unbiased, and communication-enhancing. The verbal or written translation should properly represent what the patient and doctor are saying and should enable effective communication between the two. Otherwise, the following could happen:

  • Inappropriate treatment, complications, and even death due to misdiagnosis
  • Healthcare provider’s inability to provide services (referring the patient to other facilities) because of the language barrier
  • Delayed treatment because of the inability to properly diagnose a patient
  • Fear of doctors to provide care or treatment because they might be sued for the lack of a competent interpreter
  • Litigation as patients claim that they were not properly informed when they signed consent forms
  • Misinformation or misleading information when patient education materials (posters, handouts, pamphlets) are inaccurately translated

Legislation on Proper Medical Translations and Interpreting

In the United States, access to competent medical interpreters is already deemed as part of a patient’s rights. Federal law requires the provision of adequate assistance to patients who are incapable of inadequately competent in speaking English. There are also different state laws that emphasize this, especially in culturally diverse states like California and Texas. More than a dozen states even provide reimbursements for the competent language services used by patients on Medicaid and the Children’s Health Insurance Program. Unfortunately, many healthcare facilities continue to disregard policies on the use of qualified medical interpreters.

Healthcare Providers Should Hire Competent Medical Interpreters and Translators

If concern for the welfare of their patients does not suffice for a reason, maybe litigation should. Hospitals and other healthcare providers can be sued if they fail to provide a competent medical interpreter or translator. Even if no damage has been done yet, patients can still complain on the lack or use of unqualified medical translator in a healthcare facility. It is already being required by law in the United States. Other countries also likely have similar policies on this matter.

Penalties for healthcare providers that don’t use competent medical interpreters and translators can range from fines to imprisonment. If the incompetent translation leads to a malpractice, the persons involved could even be stripped off their licenses and sent to jail. Hospitals are also fined simply for the fact that they don’t have proper medical interpreters as they could be violating Title VI of the Civil Rights Act of 1964.

Family Members and Friends Shout Not Be Used as Interpreters

Aside from Google Translate and other automatic web-based language translators, family members and other companions of a non-English speaking patient should not be used in lieu of medical interpreters. This is what most medical organizations tell patients and healthcare providers. In many cases, patient companions or family members do more harm than good. The same applies to multilingual medical staffers who have not received proper training to become medical interpreters. It has to be emphasized that simple language-to-language translation is not enough. Some groups of people have different uses for certain words. In the Ramirez case mentioned above, for example, “intoxicado” may actually be translated to intoxicated in English but the Cuban Spanish speakers back then had a different meaning for the word.

Medical Translators and Interpreters Are Vital

The May issue of the Journal for Healthcare Quality published a report that found the prevalence of medication errors and lack of informed consent due to language barriers. Also, the website Modern Healthcare reported that almost all of the healthcare professionals they interviewed knew of at least one case where a hospital used the untrained and experienced medical translation or interpreting skills of their staff. Moreover, the 2012 Annals of Emergency Medicine published a study that analyzed and found thousands of serious errors in the audio recordings from visits at two large Massachusetts pediatric emergency departments.

Healthcare providers that serve multicultural and multilingual communities simply don’t have any reason not to hire medical translators and interpreters. The justification that using qualified interpreters delays the dispensation of treatment is not acceptable. The US Bureau of Labor Statistics already project that interpreter and translator employment is expected to grow by 46% by 2022 because of considerable increases in the number of non-English speakers in the United States. The government is well aware of the need for qualified translators and interpreters. Healthcare providers are similarly expected to know of this fact and should already be prepared to include proficient medical translation in their services.

AUTHOR
Day Translations Team

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  • Mila Baker

    The information presented here is very useful. Could you provide some sources for the data you cite here (newspaper articles reporting on the cases, or similar). Thank you!

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