Cyra Whaa?!: Cautionary Tales About ER Folks Who Didn't Use Skilled Translators

Example of a translation error: In China there is a restaurant called “Translate Server Error” because the restaurant owner used an online website to translate the Chinese word for “restaurant” into English.

We know using skilled translators has many benefits such as improving patient outcomes, satisfaction, pain control, and number of medical errors (see sidebar below). In the United States, healthcare providers have increasingly been encountering patients who have limited English proficiency (LEP), with 15% of people reporting they spoke English “not well” and an additional 7% spoke English “not at all.”¹ In 2006 New York State required all hospitals to provide skilled translators free of charge to patients.²Several surveys have shown skilled translation services have been underutilized. Dr. Lisa Meister conducted a survey of 52 ER residents in 2012 and found that 56% of residents did not use professional services for encounters with LEP patients.³ A national survey in Annals of Emergency Medicine also found a propensity to use unapproved translators and a lack of training on appropriate medical translation policies.⁴

Evidence for using skilled translators is bountiful, and there is little more I can add in support of their use without inducing nausea. Instead I wish to entice readers with something appetizing, sapid, and memorable: Three cautionary tales demonstrating the high cost of language barriers in medical malpractice. Physicians who experience language barriers may deliver “delayed, incorrect, or improper medical care, potentially leading to a costly, time-consuming medical malpractice lawsuit”.⁵^,⁶

Three Cautionary Tales:

Case 1

On January 22, 1980, an 18-year-old Spanish-speaking male was brought in to the ED by his girlfriend after he had driven to her house and then collapsed. He had been suffering from severe headaches and dizziness for the past several weeks. Prior to becoming unconscious, he told her he was “intoxicado”, a Spanish word that has several meanings, including being nauseated. Paramedics reported to the hospital that the patient was “intoxicated” and that this was a possible suicide or drug overdose. The patient was seen in the ER and admitted and treated for being “intoxicated”, despite negative drug tests. The patient had waxing and waning consciousness over the next 24 hours, but no staff was available who spoke Spanish. The lawsuit claims that the hospital relied solely on the patient’s mother and girlfriend for translation. It was later discovered that the patient had a ruptured aneurysm and subsequently became quadriplegic. The malpractice suit was settled for 71 million dollars. ^7,8

Case 2

On June 6th, 2004, a Korean man in his 40s visiting family on a tourist visa presented to the ED at Jamaica Hospital in Queens following a soccer injury. There he received CT scan and other testing, however staff was not available who spoke Korean. Instead, underage children, friends, neighbors, and relatives in Boston provided translation. Three days later at the time of discharge, the hospital translator arrived to tell the family that he was being discharged and to “just take some Tylenol”. While follow-up appointments were scheduled for the patient, it wasn’t until a month later when the patient died, did the family become aware of the head injury, treatment options, and the option to apply for emergency Medicaid for his pricey medical care. The family never went to the follow up appointments because they were unable to afford the medical bills and did not understand the gravity of his injury nor the financial assistance available to them. The patient’s widow has become an activist for healthcare translation reform. Details of financial settlement are not public.^9,10

Case 3

A 9-year old Vietnamese girl presented to the ED with GI complaints and sepsis which was misdiagnosed as gastroenteritis. The patient and her parents did not speak English. The patient’s 16-year-old brother was used as the interpreter during the visit and no professional interpreter was offered. The patient subsequently died from a severe reaction to Reglan. The ED physician admitted that he did not inform the parents that Reglan was not recommended for pediatric use. Additionally, there was doubt about the brother’s ability to adequately translate resulting in the parents not being fully informed and able to consent to care and the patient’s physician not being able to correctly diagnose and treat the patient. Settlement for $200,000.¹¹

At the end of the day, using professional translators isn’t just about avoiding lawsuits, it’s about doing what’s best for the patient. People come to our ER when they’re sick, vulnerable, and afraid. Using a professional translator helps us better care for our patients by minimizing barriers as well as letting our patients know we really care about what they have to say.

By Dr. Wendy Chan

References

Ryan, Camille. Language Use in the United States: 2011. N.p.: U.S. Census Bureau, 2003. Print.
Pub. L. 88-352, Title VI of the 1964 Civil Rights Act, Sec. 601, July 2, 1964, 78 Stat. 252.
Meister, Lisa, MD. “Patients with Limited English  proficiency in the Emergency Department: Why We Can and Should Do Better.” SUNY EM Senior Lecture. 21 Oct. 2012. Lecture.
Flores, Glenn, Milagros Abreu, Cara Pizzo Barone, Richard Bachur, and Hua Lin. “Errors of Medical Interpretation and Their Potential Clinical Consequences: A Comparison of Professional Versus Ad Hoc Versus No Interpreters.” Annals of Emergency Medicine 60.5 (2012): 545-53. Web.
Van Kempen, Abigail. “Legal Risks of Ineffective Communication.” Virtual Mentor. AMA, Aug. 2007. Web. 1 Sept. 2014.
Lee KC, Winickoff JP, Kim MK, Campbell EG, Betancourt JR, Park ER, Maina AW, Weissman JS. “Resident physicians’ use of professional and nonprofessional interpreters: a national survey.” JAMA. 2006;296(9):1050-3.
“Quadriplegic to Receive Up to $71 Million in Suit.” The Palm Beach Post, 5 Nov. 1983. Web. 1 Sept. 2014.
Harsham P. A misinterpreted word worth $71 million. Medical Economics. 1984;61(5):289-292.
Quintero vs Encarnacion et al. U.S. Court of Appeals 10th Circuit. 29 Nov. 2000. Print.
Santora, Marc. “Caught in the Health Care Maze: A Korean Family’s Story.” The New York Times. The New York Times, 25 July 2004. Web. 1 Sept. 2014.
Kwan, Kelvin, JD MPH. “The High Costs of Language Barriers in Medical Malpractice.” National Health Law Program (2010): n. pag. Web. 1 Sept. 2014.

The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.