Navigating the World of Interpretation & Translation in This Cosmopolitan Age

Issue #2: Malpractice Suits: What Went Wrong?
Language barriers are one of the leading causes of malpractice suits when certain steps are not taken to assure good communication.

A study was undertaken by Kelvin Quan, JD MPH, Assistant Dean of the University of California, Berkeley School of Public Health. The report divides communication problems on several levels.

Those levels are:

  1. FAILURE TO PROVIDE COMPETENT INTERPRETATION
  2. DEFECTIVE INFORMED CONSENT AND LACK OF WRITTEN TRANSLATIONS
  3. INADEQUATE DOCUMENTATION
  4. ALLEGATIONS OF DISCRIMINATION
In the present installment we will analyze a Case Study to illustrate Point #1 and Point #2 (above).

CASE STUDY


LANGUAGE: VIETNAMESE
AGE OF PATIENT: 9 YEARS OLD
MEDICAL OUTCOME: DIED FROM A REACTION TO THE DRUG REGLAN
INTERPRETATION USED: NO COMPETENT INTERPRETER USED. PATIENT & 16-YEAR OLD BROTHER WERE USED.
ECONOMIC LOSS: THE PHYSICIAN AND HOSPITAL SETTLED FOR $200,000 IN AGGREGATE, WHILE THE INSURANCE CARRIER PAID LEGAL FEES OF $140,000.
NOTES:
The case demonstrates failure to provide language access on multiple fronts: the failure to utilize a competent interpreter; the use of a minor child as an interpreter; lack of a translated informed consent form. The patient had an infection with a rapid onset and great severity, low blood volume, and a heart attack, which ultimately resulted in death. The emergency room physician misdiagnosed the patient’s condition as gastro-enteritis. He admitted that he failed to advise the patient’s parents of Reglan’s side effects or warning, and that Reglan was not recommended for pediatric use.

In the lawsuit, the prosecuting attorney retained an expert witness who was a professional interpreter. After reviewing the medical records, the expert witness testified that “Conducting the communications without a professional medical interpreter failed to meet the standards of care applicable for the physician and the facility. The effect is [that] she did not receive the care she should have. The parents were not able to adequately understand nor address her medical needs. In my opinion, the failure of the doctor and the facility to provide a professional medical interpreter was a substantial factor in causing [patient]’s death”.

The emergency room physician said that he discussed with the family that they should bring their daughter back to the emergency room if side effects arose. The written hospital discharge instructions included warnings to “call your doctor if the patient has diarrhea. Return immediately to the ER if...” All documents from the outpatient and the ER visits were in English; these documents were signed by the parents and countersigned by the hospital nurse.



This case study exemplifies violations of Title VI of the Civil Rights Act (See previous issue). No competent interpreter was used. Consent forms were not translated into Vietnamese, nor was there a professional interpreter present that might have been able to ‘Sight Translate’ from the written English consent form into oral Vietnamese. The economic loss to all the parties involved, including the insurance carrier, was impressive. This one case reflects two of the four failure levels mentioned above. What can we learn from other cases? Please see our next installment!

Gene S. Rainone is the CEO of Verbatim Language Services, Inc.