Language difficulties can create a wall of confusion and misunderstanding between health professionals and the people we are trying to serve, essentially becoming barriers to quality care. Our nation must increase its determination to serve diverse populations by providing culturally and linguistically appropriate care to our patients. – Richard H. Carmona, M.D., Surgeon General of the United States 2002-2006.

Home to a vast proportion of people with limited English proficiency (LEP), the United States has enacted Federal and State laws that take care of the interests of these people, with specific reference to health care access.

The following demographics best illustrate the number of non-English speaking people residing in the US:

Total population (age 5+): 230.4 million (1990); 262.4 million (2000)

LEP population: 14 million (1990); 21.3 million (2000)

The percentage of LEP people as of year 2000 was 8.1% of the total American population.

Spanish, Chinese, French, German, Tagalog, Italian & Vietnamese are the top 7 languages (after English) spoken in the US, and Spanish speakers account for 10.7% of total population.

Health care centers must make interpretation and translation services available

Not many people are aware that Federal laws and guidelines require that all health care providers who receive federal funding must provide meaningful access to translation services, to people with limited English proficiency (LEP). People with LEP are to be provided trained interpreters in health care settings, and failure to provide language services and interpretation can lead to serious medical errors and even liability for malpractice. (Language Services Action Kit cmwf.org/usr_doc/LEP_actionkit_reprint_0204.pdf)

Faulty interpretation and translation services resulting in flawed treatments

In a major revelation from the recently concluded study of medical mistakes caused by language barriers in a pediatric hospital in Boston, the clinical consequences of flawed translation services by interpretation were fully borne out. The patient-interpreter-physician encounters were audio-taped and transcribed in a hospital outpatient clinic, and a Spanish language interpreter was used. Each error in medical interpretation was studied to see if it had a potential clinical consequence, and the findings were rather startling.

Errors of omission leading to clinical consequences included the omission of questions about possible drug allergies and about instructions on the dose, frequency, and duration of antibiotics and re-hydration fluids. In one instance, the interpreter added his own input to the effect that hydro-cortisone cream must be applied to the entire body, instead of only to facial rash as directed by the physician! Another example was that of a mother being asked to administer oral antibiotics into the ears of her child.

There is another classic example of how the misinterpretation of just a single word led to delay in giving emergency care to a patient, resulting in quadriplegia. The Spanish-speaking 18-year-old said he felt "intoxicado" just before he collapsed, and all he meant was that he was feeling nauseous. As a result, the patient was treated for drug overdose for over 36 hours, during which he remained comatose. Upon re-evaluation later, he was diagnosed with an intracerebellar hematoma with brain stem compression and other complications -- and by then it was too late: he became a quadriplegic. The hospital was facing a lawsuit, and had to part with a $71 million malpractice settlement.

Such serious consequences of a simple mistake can be traumatic not only to the patient and his family, but also to health care providers.

Need for trained, qualified interpreters

Translation services people and interpreters working in a sensitive area like health care bear the burden of responsibility that is much higher than in any other field. They must possess certain core skills and knowledge, apart from an abiding commitment to follow the ethical practices. Knowledge of medical terminology and concepts in English and all languages to be used for interpreting is an absolute must for interpreters. Accuracy and completeness of the interpretation of the content in every exchange between patient and physician is another crucial aspect of interpretation, and the interpreter must take care not to add his own opinion, even though the temptation to do so may be hard to resist. Above all, interpreters must be non-judgmental about the patient or anything he says, and must be ever mindful of the need to maintain strict confidentiality about the patient and his condition.