A 9-year old Vietnamese girl suffering from an infection was rushed to the hospital by her parents and 16-year old brother. Her parents spoke primarily Vietnamese. The hospital failed to provide an interpreter at any point in the medical encounter, relying instead on the girl and her brother to interpret for the physician and parents.
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The emergency room physician misdiagnosed the girl's condition as gastroenteritis, prescribed a drug not recommended for pediatric use, failed to inform the parents of the potential side effects of the drug, and failed to provide discharge instructions to the parents in their native language.
The little girl suffered a severe allergic reaction to the drug and subsequently died. An expert witness in the malpractice case that resulted from this incident stated:
"The failure of the doctor and the facility to provide a professional medical interpreter was a substantial factor in causing the patient's death."
In addition to the cost in human life and suffering, the physician and hospital in this case settled for $200,000 in aggregate and the insurance company paid legal fees of $140,000.
Sadly, this case, reported in The University of California, Berkeley School of Public Health's "The High Cost of Language Barriers in Medical Malpractice", is by no means a unique occurrence. Medical errors resulting from inadequate translation and interpretation between medical professionals and patients represent a serious issue in the modern practice of medicine.
The Medical Challenge of LEP Patient Populations
The Migration Policy Institute reports that, as of 2014, 21 percent of the U.S. population speaks a language other than English at home. 9 percent of the U.S. population, or approximately 25.7 million people, are classified as limited English proficient (LEP).
This presents a challenge for the medical profession. American Family Physician's "Appropriate Use of Medical Interpreters" observes about the LEP patient population: "This population is less able to access health care and is at higher risk of adverse outcomes such as drug complications and decreased patient satisfaction."
Providing interpreters for LEP patients results in better patient outcomes.
MedLeague.com's "Language Barriers and Medical Malpractice" notes: "Non-English speaking patients are less likely to have a usual source of medical care, to receive preventative medical care and have an increased risk of not following instructions to take medications. For example, a mother thought the oral antibiotic prescribed for an ear infection should be placed in the ear."
Communication Key in Emergency Situations
Title VI of the Civil Rights Act of 1964 states that medical facilities receiving federal funds are required to provide interpretation services as a matter of non-discrimination.
In addition to the legal requirement, medical facilities also have an ethical obligation to provide adequate care for all of their patients. Adequate care must involve communication that is clear and understandable between the medical staff and patients.
Inadequate communications can lead to delays in diagnosis, incorrect diagnosis, and treatment errors on the part of medical professionals. Additionally, patients who misunderstand communications may take medication inappropriately, fail to follow up with medical staff when needed, and suffer unnecessary health complications.
Perhaps nowhere in a hospital setting is accurate communication more important than in the Emergency Department. The article "Professional Translation Services in the ED Can Reduce Errors and Prevent Adverse Outcomes" notes: "Non-English-speaking individuals are more at risk of having reduced access to healthcare, and thus are more likely to use the ED for emergency and routine care. In addition, the volume of patients that pass through the ED is inherently greater than the number of patients who are admitted to the hospital, so the need for capable translators is usually greatest in the ED. Understanding what medications a patient is taking or when he or she last ate may make the difference between a successful treatment or an adverse event."
Understandable communication is key to success in emergent situations.
The Cost Benefit of Professional Translation Services
A 2012 study published in the Annals of Emergency Medicine highlights the importance of providing adequate translation and interpretation services in an emergent setting. Examining 57 interactions at two large pediatric emergency departments in Massachusetts, researchers found 1,884 errors in translation or interpretation, 18 percent of which were deemed as having potential clinical consequences.
For professionally trained interpreter with at least 100 hours of training, that percentage dipped to just 2 percent. For professionally trained interpreters with less than 100 hours of training, the percentage of translation errors rose to 12 percent.
However, in cases where no professional interpreter was used and the ED staff relied on family members of the patient or bilingual staff members to interpret, the errors rose to 22 percent.
Take a moment to consider these outcomes. Judging from the results of this study, an emergency department utilizing a professional translation service can potentially eliminate 10 to 20 percent of medical malpractice errors resulting from poor communication with patients.
In addition to providing the best standard of patient care, the cost benefits of eliminating such errors is significant. While some medical facilities have been slow to adopt strong policies to provide for adequate interpretation and translation services due to perceived costs involved, the reality is that failure to provide such services is potentially much more costly in terms of patient outcomes and medical malpractice issues.
Does your facility provide appropriate linguistic and cultural support for your patients?
For instance, in The University of California, Berkeley School of Public Health study noted above, reviews of 35 cases in which medical facilities failed to provide adequate language support revealed that the total cost of damages and legal fees paid was $5,082,800.
Dynamic Language's Team of Professional Interpreters
Medical facilities without an in-house language support department can find appropriate language support with a professional translation and interpretation service agency. Additionally, a professional language service provider can help medical facilities provide language support in uncommon dialects on an as-needed basis.
Dynamic Language has qualified staff for over 150 languages and dialects, and our interpreters are highly aware of the linguistic and cultural factors that impact communication and affect a patient's personal health decisions. Contact us for more information about our medical interpretation and translation services, and learn how we can help you provide adequate communication services to improve patient outcomes and reduce costly medical errors today.