The 71-Million-Dollar Word

There are documented cases of poorly translated medical translations or interpretations that caused severe complications, misdiagnosis, and even death, as was the case of Willie Ramirez who, in 1980, then 18, was admitted to a Florida hospital in a coma. His friends and family, who spoke only Spanish, tried to describe his condition to paramedics and doctors, but the medical team did not understand Spanish. The translation (interpretation) was performed by a member of the medical staff who claimed to be bilingual, and he translated “intoxicado” as “intoxicated.”

A professional medical expert would know that “intoxicado” more closely resembles “poisoned,” and does not carry the connotations of drug or alcohol use that the word “intoxicated” does.

Ramirez’s family believed he was suffering from food poisoning. He was, in fact, suffering from an intracerebral haemorrhage, but doctors administered the care as if he were suffering from an intentional drug overdose – a condition that may present some of the patient’s symptoms at the time.

Because of the delay in proper care, Ramirez developed quadriplegia. He received a medical malpractice claim of 71 million USD.

There are Many Errors, and the Potential for Risk is Even Greater

Verbal or written translation should adequately represent what the patient and the physician are saying and should allow effective communication between the two. If the translation or interpretation is not correct and accurate, if it does not comply with its context and is not impartial, the risks can be disastrous, ranging from improper treatment to complications leading to death due to misdiagnosis.

The ability of the healthcare provider to provide care or referral to other facilities may be impaired because of the language barrier. A delay in treatment due to the inability to accurately diagnose a patient may worsen the condition or result in their death.

Poor communication also causes doctors to be afraid of providing the necessary care or treatment because they may be prosecuted for lack of a competent interpreter. Patients may claim that they were not properly informed when they signed a consent form or agreed to a particular line of treatment.

Legislation on the Use of Medical Translation and Interpretation

In Brazil, neither CRM (Regional Medical Boards) nor ANVISA (Brazilian Regulatory Health Agency) have guidelines or ordinances that guide hospitals on the use of a translator or interpreter. This is a shame, because, as according to Federal Police data, 1,847,274 foreigners resided in Brazil during March of 2015. Of these, 1,189,947 were permanent, 595,800 were temporary, 45,404 were provisional, 11,230 were cross-border residents, 4,842 were refugees, and 51 were asylum seekers.

List of Current Immigrants in Brazil by Country of Origin

Country Total Observation
1 Bolivia 350,000 – 550,000 The number varies depending on the source
2 Portugal 277,727  
3 United States 70,000  
4 Haiti 50,000  
5 Japan 49,038 – 91,042 The number varies depending on the source
6 Paraguay 39,222  
7 Italy 37,146 – 73,126 The number varies depending on the source
8 Spain 30,723 – 59,985 The number varies depending on the source
9 Argentina 29,075 – 42,202 The number varies depending on the source
10 Chile 28,371  

In the United States, access to competent medical interpreters is already considered part of a patient’s rights. There is a federal law that requires proper care for patients who are not entirely fluent in English. There are also different state laws that require the same kind of assistance, especially in culturally diverse states such as California and Texas. More than a dozen states even reimburse language services used by patients covered by Medicaid and the federally funded Child Health Insurance Program (CHIP). Unfortunately, many healthcare facilities continue to disregard policies requiring the use of qualified medical interpreters.

Neither Relatives Nor Friends Should Serve as Translators or Interpreters

In many cases, the patient’s chaperons, friends, or family members do more harm than good. The same applies to multilingual medical staff who have not been adequately trained to become medical interpreters, as merely translating from one language to another is not enough. Some countries have different uses for certain words.

For example, in the case of Willie Ramirez (mentioned above), “intoxicated” actually can be translated into intoxicated in English, but Cuban speakers of Spanish, at that time, gave the word a different meaning.

In addition, doctors may ask the patient questions that they do not want to answer in front of friends and family, or they may use terminology that only a professional medical interpreter knows.

The May 2014 issue of the Journal for Healthcare Quality published a report that found a prevalence of medication errors and lack of informed consent due to language barriers.

Also, the Modern Healthcare website reported that almost all of the healthcare professionals interviewed for an article published in August 2014 knew at least one hospital case that performed medical translation or interpretation using its staff, who were not trained translators or interpreters, but members of the medical or administrative staff.

Healthcare providers serving multicultural and multilingual communities simply have no reason not to hire medical translators and interpreters. The justification that the use of qualified interpreters delays the provision of care and treatment is unacceptable.

The US Bureau of Labor Statistics projects a 46% growth in demand for translators and interpreters by 2022 due to a considerable increase in the number of non-English speakers in the United States. As a result, health care providers need to consider this and be prepared to hire experienced, skilled, and reputable translators and interpreters.

This is a Portuguese-to-English translation of one of our posts, originally published here.

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