Mistranslation and Misinterpretation, 12. Medical-legal Consequences

In English-speaking countries like USA, Canada and Australia, where there is a long tradition of immigration from non-English-speaking countries, the existence of large numbers of immigrants from many countries has led to the setting up of extensive and expensive interpreting and translating services to assist them in their new country. Anecdotal evidence that the systems are subject to great pressure and do not always work well, as well as of the potentially serious consequences of not using interpreters in medical situations involving non-English-speaking citizens, is contained in excerpts from the following reports.

“Unfortunately, cases in which language barriers cause compromised quality of care and preventable medical errors may become increasingly common in the United States. Almost 50 million Americans speak a primary language other than English at home, and 22.3 million have limited English proficiency (LEP), defined as a self-rated English-speaking ability of less than “very well.” The last decade witnessed a 47% increase in the number of Americans speaking a non-English language at home and a 53% increase in the number of LEP Americans.”

“High-profile cases are accumulating of medical errors due to language barriers. Lack of an interpreter for a 3-year-old girl presenting to the emergency department with abdominal pain resulted in several hours’ delay in diagnosing appendicitis, which later perforated, resulting in peritonitis, a 30-day hospitalization, and two wound site infections. A resident’s misinterpretation of two Spanish words (se pegó misinterpreted as “a girl was hit by someone else” instead of “the girl hit herself” when she fell off her tricycle) resulted in a 2-year-old girl with a clavicular fracture and her sibling mistakenly being placed in child protective custody for suspected abuse for 48 hours.
Misinterpretation of a single Spanish word (intoxicado misinterpreted in this case to mean “intoxicated” instead of its intended meaning of “feeling sick to the stomach”) led to a $71 million dollar malpractice settlement associated with a potentially preventable case of quadriplegia.(15)”
(From http://www.medscape.com/viewarticle/534045_2. Note: It is necessary to register with Medscape.com as a health practitioner or as “Consumer/Other” before accessing their professional articles.)

The brief mention of that latter case offers an example of the dangers of not using a qualified interpreter in medical situations. It also gives an insight into the idiosyncrasies of the American system of litigation. Further details are available here.

“Providing adequate translation is also a safety issue and a potential liability issue, Flores said, noting a successful $71 million Florida lawsuit in the case of a teenager who was left a quadriplegic.
“He was an 18-year-old who went to a sporting event at his high school, wasn’t feeling well and walked over to his girlfriend’s house. Just before he collapsed he said, ‘Me siento intoxicado.’ The paramedics came along, and the girlfriend didn’t speak a lot of English, and the mother of the girlfriend didn’t, either. They mentioned that word, and the paramedics said, “Oh, yeah, intoxicado, that means intoxicated. So they took him to the emergency room.
“He ended up going to the intensive-care unit because he had gone into a coma, and for 48 hours they were working him up for drug abuse. Then they finally did a CT scan, and it turned out he had actually had a brain aneurysm and that it burst, and he got a huge intracranial bleed,” Flores said.
Intoxicado, in fact, can mean nausea.
“That is one example of why, if you spent $30 for an interpreter, you wouldn’t have had to spend $71 million to settle a lawsuit,” he said.”

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2 Comments on “Mistranslation and Misinterpretation, 12. Medical-legal Consequences”

  1. Steve Says:

    It’s great that interpreters are being made more widely available. But this account of the case in Florida is incorrect. Here’s the story:

    http://healthaffairs.org/blog/2008/11/19/language-culture-and-medical-tragedy-the-case-of-willie-ramirez/

    Most significant, neither the paramedics nor the boy were the source of the word “intoxicado”. A family friend who accompanied him to the hospital said it to the ER doctor, but clarified that he was a good boy and had not taken any drugs.

    In my opinion, and I’m not a doctor, this doctor is the one most responsible for the victim’s condition, not the interpreter. As the fictitious TV doctor Gregory House used to say, “Patients lie”.

  2. Brian Says:

    Thanks, Steve.
    I am sure some readers will accept your invitation to follow up this aspect of the blog.
    Brian


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