Can Language Barriers in Health Care Lead to Adverse Events?

A preview of two cases to be discussed at the upcoming 2010 IMIA Conference

Minimizing risk is a crucial piece of any hospital’s or provider’s work: though medicine is inherently unpredictable, they all follow programs, procedures, and plans designed to make treatments effective and reduce the chances of harming patients or providing services that stimulate lawsuits. Barbara Lightizer, MS, MA, CPHRM, director of Risk Management, Patient Relations and Interpreter Services at Newton-Wellesley Hospital, uses this definition of risk management: “The process of making and carrying out decisions that will help prevent adverse consequences and minimize the negative effects of accidental losses on an individual or an organization.” So how do interpreters for low English proficiency (LEP) patients fit into the risk management picture at hospitals and providers’ offices? Trained, screened and qualified interpreters are crucial parts of patient care teams in many health care institutions, but they are not as ubiquitous as we – or LEP patients – might hope. According to the findings of a Joint Commission research study of 60 of the nation’s hospitals, “Of the hospitals that provide language services through bilingual staff, just over half (53%) train and/or assess them.” Furthermore, the study reports, “Interview participants at more than one-third (40%) of our sample hospitals told us that they would use a family member to interpret. Of these, participants at eight hospitals told us that the use of a family member to interpret was one of the preferred mechanisms for communication with LEP patients.” (The Joint Commission, Wilson-Stronks and Galvez, 2007:55-56) Barbara, together with Greg Figaro, president of CultureSmart, developed a presentation that examines two adverse events in two different health care organizations –one in the Northeast and one in California- that all resulted in a patient’s death.

Sadly, both cases involve the failure of providers and institutions to use trained interpreters at crucial points in the patients’ care. Though it’s impossible to say with 100 percent certainty that trained interpreters would have saved these patients’ lives, each situation shows an obvious breakdown of patient-provider communication that directly or indirectly resulted in undesirable outcomes. *

Patient A, a male scheduled for kidney removal, was a high-risk patient who died after an operation where the wrong kidney was removed. Unfortunately, the hospital neither provided the patient with standard safeguards nor observed his patient rights, including his right to receive information in his primary language, Spanish, or a universal protocol for preventing an operation on the wrong site. The patient’s son interpreted during the patient’s interviews, and the son said he “assumed” the consent form that he translated for his father to sign was correct. The consent form specified the wrong kidney. To compound the problems, a “time out” – the meeting between the surgical team and the patient – and a marking of the surgical site with the patient did not occur before the operation. *

Patient B, a female infant with apnea, was removed from life support after brain damage caused by oxygen deprivation. The patient had a lung infection that went undiagnosed until her autopsy. The hospital emergency room where she was brought after she stopped breathing did not use an interpreter to interview her family: multiple providers interviewed her uncle, who communicated with “broken English” and gestures. A Spanish-speaking doctor eventually took history from the patient’s mother and ran tests, but the family received hand-written discharge instructions that were primarily in English. A professional interpreter was present when the patient returned to the hospital the next day and was placed in intensive care, but oxygen had already damaged her brain. In a wrongful death case, a court found the defendants negligent, citing the lack of a careful assessment of the patient and failure to diagnose her condition.

View slide handouts from presentation.

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