Language barriers blocking the proper in-person communication of medical treatment and diagnoses at a U.S. hospital or clinic are a serious problem in the country today. According to the latest available U.S. Census Bureau data, 21% of U.S. residents speak a non-English language at home, with Spanish being the second most popular language spoken in the United States. On the west coast of the country, the number soars to 32%.
In California, the percentage is 42%. Multiple foreign speaking patients use American hospital services every day and would do well to use a professional interpreter to communicate vital medical information.
In recent years, medical institutions have done a lot to address language barriers with the patient, but more needs to be done. According to the Institute of Medicine, “Individuals whose care is inhibited due to a communication barrier… may be at risk for poor outcomes.” A recent study of malpractice lawsuits found that 2.5% were originally filed due to unsurmountable language barriers or bad foreign language interpretations. In the vast majority of cases, a relative stood in as the interpreter rather than a professionally trained interpreter.
Opting for a family member to interpret what the doctor has to say is never a good idea. Medical terminology is complex and difficult to translate correctly. In addition, a relative might not want to communicate a difficult diagnosis, such as cancer, for instance, to the patient for emotional reasons.
In December 2012, a Spanish-speaking male patient was attended by emergency room hospital staff at the Anne Arundel Medical Center in Annapolis, Md. He exhibited the symptoms of abdominal pain, vomiting, and shortness of breath. Over two days at the medical center, he received IV fluids, underwent an abdominal CT scan, had his blood drawn, and had a urinary catheter inserted. It is possible he never understood that fluid was accumulating in his lungs and abdomen and that he could mortally succumb to the condition.
According to a subsequent hospital inspection report, no one informed him of his care plan in Spanish, the only language he spoke, until an hour and a half before he passed away.
As the United States becomes more culturally and linguistically diverse, some medical safety professionals note that not enough healthcare providers are using professional medical interpretation services to communicate with their patients and families. Amateur interpreters, such as patients' family members, are used instead which leads to the medical terminology often being lost in translation. The use of amateur interpreters heighten the risk of medication mistakes, avoidable readmissions, wrong procedures, unnecessary deaths and other negative events. Almost 9% of the population of the United States is at risk for a medically adverse event due to barriers of language, the Agency for Healthcare Research and Quality has found.
Most medical institutes advise against the use of a patient's friends or relatives. They also counsel against the use of bilingual clinical staffers who have not been certified as medical interpreters. But doctors and hospital staff often succumb to allowing the use of amateur translators, usually due to tight time constraints, a lack of knowledge about booking professional interpreters, or procedural complications regarding the calling in of professional interpreters.
What the Law Dictates
The Joint Commission requires hospitals to offer a professional interpreter to every patient who needs one. It also requires written medical documents to take into account the patient's language, age and ability to understand. The Department of Health and Human Services' Office of Minority Health last year revamped its National Standards for Culturally and Linguistically Appropriate Services that guides hospitals on complying with the Americans with Disabilities Act and Title VI of the Civil Rights Act.
Moreover, every state has passed language access laws in healthcare environments. Thirteen states and the District of Columbia cover interpretation services used by patients on the Children’s Health Insurance Program and Medicaid.
And yet studies show that the lack of interpretation services are causing medical problems. A June study conducted by the American Journal of Managed Care at a Los Angeles hospital found that non-English speaking patients were considerably more likely to be readmitted several times within a 30-day period. Speakers of Farsi, Russian and Spanish each accounted for a near 5% of patients with three or more hospital stays between July 2009 and December 2010, the study concluded.
A study undertaken by the National Health Law Program evaluated 35 insurance claims filed for one liability insurer in four states between January 2005 and May 2009. It found that the insurer paid over $2.8 million in legal fees and $2.3 million in settlements or damages for cases where the clinic did not contract a professional interpreter. Among the cases analyzed, five patients died and others suffered permanent medical outcomes, such as organ damage and leg amputations.
In the Tran family case, the patient, a 9-year old Vietnamese girl, reacted poorly to the drug Reglan and died. No professional interpreter had been used to bridge the communication between her doctor and the patient's family. Instead, case records indicate the 9-year-old patient and her 16-year-old brother interpreted the diagnosis and advised treatment for the family. The hospital and physician in this case settled for $200,000 in aggregate, with the Carrier paying legal fees of $140,000. The case violated several language access norms – there was a failure to use a professional interpreter, a young child was used as an interpreter, and the medical consent form was not translated.
In the lawsuit, the Trans family lawyer attorney summoned a professional interpreter. After looking over the medical records, the expert testified that: “Conducting the communications without a professional medical interpreter failed to meet the standards of care applicable for the physician and the facility. The effect is [that] she did not receive the care she should have.
“The parents were not able to adequately understand and address her medical needs. In my opinion, the failure of the doctor and the facility to provide a professional medical interpreter was a substantial factor in causing [the patient]’s death. The reasons for not using family members, friends and particularly minor children as interpreters are widely recognized.”
Hospitals must provide access to professional language interpreters as the American population grows increasingly diverse. The medical provider must provide Italian translation services to Italian patients, French interpretation services to French speakers, Portuguese interpretation services to Portuguese-speaking patients, and so on.
Effective communication must be pursued between insurers, medical providers and patients so that burdensome costs – both monetary and non-monetary – are not borne by any of the parties. Such costs include legal fees, patient damages, the time lost when dealing with a lawsuit, a tarnished reputation for the physician, and the distraction and stress of litigation.
The highest cost, however, remains that of the quality of life of the patient. Hospitals that offer professional language translation services serves the interests of all parties and is a small service to pay when one considers the high long-term costs of not contracting a professional to handle the vitally important patient-doctor communication.