Language barriers pose risk to health and liability

One patient reported that he "would tell the doctor OK,’ but I didn’t understand anything." That is a quote from a patient surveyed in a new study that suggests language barriers increasingly pose a threat to patient safety and, as a result, are a growing liability risk for health care providers.

The survey report, "What A Difference An Interpreter Can Make: Health Care Experiences of Uninsured with Limited English Proficiency," is being released by The Access Project, a Brandeis University (Waltham, MA)-affiliated national resource center for local groups working to improve access to health care. The survey found that a significant portion of respondents who needed an interpreter, but did not get one, reported leaving the hospital without understanding how to take prescribed medications, says Mark Rukavina, Access Project director.

"A Hispanic man in Virginia was prescribed three medicines, but mistakenly assumed he should take all three at once," Rukavina says. "He wound up in the emergency room with a severe reaction. An interpreter was then found who explained in Spanish that he was not supposed to take all three at once."

Provider = burden

Dennis Andrulis, PhD, a research professor at SUNY Downstate Medical Center in Brooklyn, NY, and lead author of the report, says the findings should be of concern to health care risk managers. As it becomes more apparent that many patients need help communicating, the burden on providers grows, he says. Failure to provide that assistance could easily result in a lawsuit.

"The patients in our survey who could not speak English are sending a strong message: failure to communicate effectively may cost patients their health, and it may be bad business for doctors and hospitals," he says.

In addition to reducing medical errors and liability, Andrulis says providing an interpreter could help the organization’s bottom line. Survey results strongly suggest that having an interpreter may help non-English-speaking patients get information on financial assistance available to pay for medical care. More than half of the respondents who needed but did not receive interpreters said they were never asked if they needed help in paying for medical care, compared to just more than one-third of those who needed and got an interpreter.

The report found that patients who needed and received interpreter services were more likely to say the hospital was open and accepting than those who did not use interpreters and more inclined to say that they would use the hospital again if they become insured. 

Rukavina says the finding on medications has serious implications for a health system that is struggling to improve the quality of care for an increasingly diverse population. For patients not fluent in English, lack of an interpreter could lead to misdiagnosis and negative health outcomes. The lack of an interpreter could result in patients not complying with a prescribed treatment regimen. One survey respondent stated, "I didn’t buy my medicines because I didn’t understand the instructions."

"This is a wake-up call for hospitals that are worried about malpractice suits," he says. "If they care about preventing medical errors, they’ll pay close attention to our finding strong association between interpreters and understanding medication instructions."

Data were collected during the summer of 2000. The report is based on interviews with patients who had no health insurance and received care at one of 23 hospitals in 12 states: Arizona, California, Florida, Georgia, Idaho, Louisiana, Nevada, New York, North Carolina, Ohio, Tennessee, and Virginia. More than 44 million people speak a language other than English at home, according to the U.S. Census. In five states — California, New York, Texas, Hawaii, and New Mexico — more than 10% of the population has limited English proficiency.