A Compelling Case for the Provision of Interpretive and Culturally-Sensitive Services in Healthcare Settings

Close your eyes for a moment and imagine that you and your family are on vacation in a foreign country. One of your children becomes acutely ill. You rush him to the nearest hospital where absolutely no one speaks English. You are extremely frightened. Somehow you’ve got to make the doctor understand your child’s symptoms and past medical history, including allergies. You gesture frantically and draw pictures hoping that he’ll catch on to what you are trying to say. All of a sudden, the doctor smiles and pats your child’s head. The light bulb seems to have gone on: it’s clear that he finally gets it. He nods reassuringly. He administers an injection and gives you the thumbs up. An hour later, your child dies, the result of a fatal drug reaction and a colossal failure to communicate.

Our Healthcare System and the Need for Interpretive and Culturally-Sensitive Medical Services

Think that scenario couldn’t happen in this country? You’re sorely mistaken. For the 25+ million people living in the U.S. with limited English proficiency, navigating our complex medical system is fraught with peril and creates barriers to accessing necessary medical care. A 2010 study by the National Health Program analyzed medical malpractice claims of one malpractice insurance provider covering just four states to identify when language barriers may have directly or indirectly affected a patient’s health outcomes. The findings shed light on the adverse effects of what can happen when healthcare provides fail to use appropriate language services,

In 35 claims filed for malpractice:

  • Two children and three adults died. In one case, the child was serving as the interpreter until she went into full cardiac arrest. Other patients suffered irreparable harm: one was rendered comatose; another had a leg amputated; one child suffered major organ damage.
  • In the vast majority of these cases—32 of 35—competent interpreters were not provided. Instead, the healthcare provider relied on family members and even children as interpreters (hence my emphasis on appropriate language services). It is difficult enough to speak English well and to grasp “medicalese”, the complex terminology that permeates medical institutions. Can you image being less than proficient in English and first having to comprehend; and then translate a diagnosis, treatment and prognosis?
  • In some cases, healthcare providers assumed that just because an interpreter was of the same national origin as the patient, they would be able to understand one another. This was particularly true in the case of Asian patients where physicians failed to appreciate distinctions between Cantonese, Mandarin and other Chinese dialects as well as Vietnamese, Taiwanese and Macau. Researchers found that none of these cases documented a provider asking the patient to clarify his/her primary language.

The Case in St. Louis and Outstate Missouri

Before assuming that this problem is probably more endemic to big cities like New York and Chicago than to St. Louis and the cities and towns lying in outstate Missouri, you should know that  language barriers pose just as big of a problem, if not greater, here than in big cities where access to interpretive services is more readily available. St. Louis attracts 3,000 to 6,000 new immigrants a year from an exceptionally diverse range of countries. Among others, these include Bosnia, India, the People’s Republic of China, Vietnam, Somalia, Afghanistan, Nepal…and that’s just the beginning. Census data collected from 2005-2011 showed that the St. Louis metropolitan area serves as home to immigrants and refugees from nearly 130 countries of origin. A friend of mine who worked at an inner-city pediatric health clinic told me that her staff encountered challenges related to language barriers and cultural differences on a daily basis despite routinely providing interpretive services. These included such issues as:

  • Differences in cultural and religious norms related to modesty and disrobing, especially for female patients in the presence of male doctors.
  • Reluctance to divulge sensitive and important medical history if the interpreter lived in the same community as the patient.
  • Fear of retaliation in cases where the patient’s family came from countries torn by civil war. Patients, often afflicted by post-traumatic stress, were often paranoid that the interpreter could have ties to the opposition (even though all interpreters were professionally-certified and pledged confidentiality).
  • Reliance on children to serve as interpreters and refusal to use a professional interpreter.
  • Lack of interpretive services for every point of patient access, from check-in to check-out: for example, interpreters were available for the exam but were not always accessible upon admission when important forms like medical history and consent forms had to be filled out or for the trip to the pharmacy where medical instructions are dispensed in English.

The Problem in Small Town America

The problem in small towns and mid-sized communities where immigrants and refugees work in agricultural occupations (picking produce, for example) and food production (e.g., meat-packing plants) is even more acute due to an overwhelming lack of interpretive services and the failure to recognize its importance. My parents live in a small town near a meat-packing plant that employs many Hispanics. Until very recently, the hospital relied (and may still rely) on well meaning Spanish-speaking volunteers to provide interpretation. Very few of these volunteers had a health background.

Existing Laws and New Mandates under the Affordable Care Act

Recognizing the potential for malpractice and discrimination claims as well as the need to provide equal access to quality medical care, many healthcare providers have put interpretive and cultural sensitivity programs into place. However, many—especially smaller practices—have not and will need to do so in the wake of existing civil rights laws as well as newer mandates under the provisions of the 2010 Affordable Care Act. As I have told my folks (my father served on the local hospital’s board of directors), it’s a matter of either paying now or paying later. We are a country that takes great pride in our “melting pot” identity. We cannot afford to stick our collective heads in the sand when it comes to providing equal access to medical care and treatment outcomes, unencumbered by differences in language and culture. To my father’s protest that a small town does not have ready access to interpreters from every corner of the world, I gently remind him that we are now in the computer age, and that many such interpretive services are based on Skype capability.

Call for a Free, No Obligation Legal Consultation with a Top Trial Attorney

If you or a loved one has suffered injuries and/or unnecessarily prolonged or intense medical treatment due to complications arising from language or cultural barriers, please call one of our top trial lawyers for a free, no-obligation consultation to discuss your legal options. We will provide an appropriate, competent interpreter if you need one. There is absolutely no excuse for rendering inadequate medical care due to language or cultural barriers. In a country defined by a heritage of diverse cultures and rich traditions, we can do better than that.  Call us at 314-409-7060 or 855-40-CRASH (toll free). We’re standing by to help you get the compensation you need and deserve.

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