A recent Johns Hopkins study claims more than 250,000 people in the U.S. die every year from medical mistakes. Other reports claim the numbers to be as high as 440,000, since tracking these fatal errors are complicated by privacy regulations and sealed legal settlements.

And your chance of being maimed or killed from medical mistakes skyrockets if you have limited or no English language skills.

Recently, I landed in the hospital with a life-threatening infection. My involuntary journey through the complicated and frightening world of medical science in America was an eye-opening experience. All’s well that ends well, but before my happy ending, I learned firsthand about being your own health care advocate. My family and I constantly questioned my treatment, and yet medical mistakes were made – serious mistakes – that prolonged my recuperation.

While I was struggling to regain my strength from, among other things, serious surgery, as well as improperly administered temporary dialysis treatments, I thought about how much worse it could have been and yet how easy it was to fall prey to medical error – despite how prepared and informed I was about my condition. Then, it hit me: what if I couldn’t speak English or my English was limited?

There are certain things in life that require a total surrender of trust. Get on an airplane, and you have to totally trust the pilot flying the plane. Eat at a restaurant, and you trust the cook will not poison you. Traditionally, medical professionals have benefited from that same confidence over the years.  But a burgeoning health care industry based on a corporate profit and loss model that financially rewards tests and procedures regardless of outcome instead of patient success rates is the breeding ground for impersonal and inadequate care, and it is reaching epidemic proportions.

According to U.S. Census data more than 63 million Americans speak a language other than English at home, and more than 25 million self-identify as having limited English proficiency. For limited or non-English speakers, it is a clarion call. The lives of their family, friends and community are literally on the line unless more bilingual doctors, nurses and technicians are turned out by the higher education community. If that sounds like hyperbole, consider these examples of what can happen when patients can’t communicate with their doctors.

Mistranslation = Patient Left Paraplegic

Smithsonian Magazine chronicles the case of an 18-year-old Cuban American who was rushed to the hospital after passing out with a splitting headache. His family did not have access to an interpreter and did their best to tell the emergency room doctors what was wrong. They explained that their son was “intoxicado,” which doctors understood to mean that he overdosed on drugs or alcohol. But among Cubans and other Hispanics “intoxicado” refers to being sick because of something you ate or drank. The young man was given treatment for a drug overdose. Days later, the doctors ran additional tests and discovered he was suffering from a brain bleed. But the translation error resulted in brain damage, which left the patient a paraplegic.

Miscommunication = Children Taken From Family

Also featured in Smithsonian Magazine is the case of a two-year-old Hispanic girl in Massachusetts who was brought to the ER with shoulder pain by her upset Spanish-speaking mother, who told doctors “Se pegó, se pegó.” The attending physician interpreted that to mean the little girl was hit by another person when what the mother was trying to communicate was that her daughter fell off her tricycle and hit her shoulder on the ground. As a result of this miscommunication, child abuse was suspected, and the little girl and her four-year-old brother were removed from the family home. It took days for the family to get help from trained interpreters to regain custody of the two children.

No Translation = Wrong Organ Removed

Or take the case of Francisco Torres as chronicled by K International, a company that provides interpretation and translation services to companies. Torres, who did not speak English, was hospitalized to have one of his kidneys removed. The treatment was all laid out in the consent form that Torres was asked to sign. Unfortunately, the patient couldn’t read it, and a Spanish translation was not provided to him. The wrong kidney was listed on the form, and Torres wound up having both his kidneys removed when the surgeons realized the error.

Language Barrier = Nine-Year-Old’s Death

And translation issues aren’t limited to Spanish speaking patients. Also reported by K International is the catastrophic case of a nine-year-old Vietnamese girl who was having a bad reaction to a medication she was given, but she and her family couldn’t bridge the language barrier to convey what was happening. By the time the doctors did understand, the little girl died.  Additionally, when the girl was first released from the hospital and issued a medication that would lead to her death, no instructions about drug reactions or home care were translated into Vietnamese.

As an expert witness at the trial stated during the case the family brought following the little girl’s death, “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 and 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 Underfunded Solution

The dirty little secret here is that none of these language barrier medical mistakes and fatalities had to happen. Patients with little or no English language skills are guaranteed under current law to receive assistance with interpreters and translators when seeking medical treatment or advice. And they’ve had this right for more than 40 years – repeat, 40 years.

Title VI of the Civil Rights Act of 1964 prevents discrimination based on race, color, religion, sex or national origin by any organization receiving federal funding. In the 1974 case Lau v. Nicols, the Supreme Court ruled that language is a legal substitute for national origin, which guarantees equal educational opportunities to students who do not speak English as their first language.

According to Smithsonian Magazine, this ruling set the precedent that all health care providers that accept Medicare, Medicaid or some other form of federal funding, “cannot discriminate based on language and must supply an interpreter for limited English proficiency patients. These rights were reaffirmed in 2000, when President Bill Clinton issued an executive order that reiterated the requirements of Title VI and outlined expectations for health care providers.”

“If you have someone who is limited English proficient who comes in for services, you need to ensure that they have meaningful access to your programs,” Mara Youdelman, managing attorney at the National Health Law Program in Washington, D.C., told Smithsonian Magazine. “You can’t turn them away because they don’t speak English. You can’t say, ‘Come back next Wednesday when my bilingual staff person is here.’ You can’t make them bring their own interpreters. These patients should have the same access as an English-speaking patient does.”

This sounds great. So, what’s the problem? The catch is that Title VI did not come with targeted funding. Like so many things that are legislated, neither state nor federal agencies have a mandate to fund interpreter services. It is, at best, a wish list difficult to enforce. It takes the good will of legislators to make this matter.

The bad news is that just 13 states and Washington, D.C., have agreed to reimburse the costs of medical interpreters through Medicaid. The rest, which include Florida and California, make the case that the current reimbursements should already include language services.  In essence, providers for these states bear the extra expense of language services, so they are forced to cut back on these services as a result. This sets the stage for disastrous errors. As Smithsonian Magazine concludes, “Medicare and many private insurers refuse to pay for interpreters, despite the efforts of many policymakers to get Medicare reimbursement in the Affordable Care Act.”

But Title VI is part of the Civil Rights Act, right? So, how can medical providers get away with violations of this law? A combination of red tape, fear of reprisal or deportation by the undocumented, and a lack of appetite to aggressively enforce the law are reasons that there is little incentive to improve this dangerous environment in our hospitals, clinics and medical facilities. Also, the system is set up to make it next to impossible for individuals to assert their right to language services. Of course, they can file a complaint with the Office of Civil Rights at the Department of Health and Human Services, but that takes for granted that these individuals, who aren’t fluent in English, know their rights and can easily navigate the application process. Not likely.   

Let’s assume for argument sake that a complaint is successfully filed. The Office for Civil Rights must determine whether the medical provider acted intentionally or unintentionally. In the end, it doesn’t really matter. The Office of Civil Rights has a chat with the offending provider and offers suggestions for fixing what led to the complaint. And even if changes are made by the provider, some medical providers don’t feel compelled to fully implement the changes they agree to make because there is little fear of punishment for repeat offenders. What the Office of Civil Rights has the power to do is strip these violators of their federal funding, but it has yet to take such aggressive action.

Present Troubles And Future Hopes

For now, those on the front line of medical care are making do with whatever they have on hand. The scarcity of trained interpreters has doctors using translation apps, but that’s not the best solution. Not only is it problematic to accurately translate complicated medical terminology and treatment protocols to patients, but looking up words with nuanced definitions on Google, for instance, can lead to incorrect information. In the end, there is no substitute for personal contact and the professional interpreters as mandated by law.

On a more positive note, also in this issue are lists of schools granting the most degrees and enrolling the most Hispanic students in medical professions. The numbers continue to improve each year, but we need many more Hispanic medical professionals in the future. For many patients, their lives will literally depend on this. •

How to Protect Yourself

Whether you are an English-speaking or non-English speaking individual, the most important thing you can do to protect yourself from medical error is to be your own advocate, and here’s how:

1. Question Everything

If you are given a pill or an injection, find out what it is for. Don’t blindly submit to treatment without understanding exactly what’s going to happen to you. Refuse treatment until someone thoroughly explains things to you in a manner and language you understand.

2. Don’t Automatically Sign On The Dotted Line

Don’t sign any consent forms that you can’t read or understand. Insist that the form be presented to you in a form that allows you to offer your informed consent and keep a copy of it for your records.

3. Phone A Friend

If you are admitted to the hospital, immediately ask to speak to your in-house patient representative and/or hospital social worker. Their name should be posted on the wall in your room. They can help you advocate for yourself and get the assistance you need to navigate your treatment.

4. Get A Second Opinion

It is never a bad idea to have your case reviewed by another medical expert. Don’t worry about offending your doctor. It’s standard practice. The diagnosis might be the same, but treatment options sometimes differ widely. It’s worth finding out. Knowledge is power.

5. Know The Rules Of The Game

Federal and state regulations are changing all the time. For example, private dialysis centers only recently were approved for reimbursement by Medicare and certain other insurance carriers for treatment of out-patient acute kidney injury patients. Speaking to a social worker, I was told that her own facility was not up to speed and their staff was not adequately trained to care for acute patients – which require much different treatment protocols than chronic and end of life patients receive. Don’t take for granted that a treatment facility is equipped to care for you or the ones you love, even if it is legally licensed to do so.

6. Check Your Records

Most hospitals offer a service to patients that allows them to log in to check their tests and treatment history once they leave the hospital. It’s a good idea to do that for reasons other than having a complete and downloadable record to refer to and pass along to new practitioners. Mistakes in your record are sometimes made that you should correct, but only if you know that they are there. During my recent hospital stay, I signed up to check my records and found that my records were completely incorrect since they belonged to someone who shared my name. So, it does happen.

7. Form Your Own Support Team

Once you are on your own and out of the hospital, you don’t have to go it alone. There are companies and services that do a wonderful job assisting outpatients and taking care of their needs. For me, the services of Wellcare of Singac in Little Falls, New Jersey, was indispensable for my recovery. Joseph Lisella, Marianne DeRosa and Sharon Dupas provided what can only be described as medical concierge service to me. They knew just what medical equipment I needed to get back to normal. They were so well-versed in a variety of medical and pharmaceutical matters that they were able to offer me advice and expert tips that made me heal faster and feel supported in my recovery. These are the kinds of people you need to surround yourself with. Don’t shy away from utilizing visiting nurses if they are offered to you, and feel free to call medical suppliers and pharmaceutical companies if you have questions that need answers. •

Help Is On the Way

The need for more Spanish-speaking medical professionals is just a part of the looming medical crisis facing the United States in the not-so-distant future. According to a study by the Association of American Medical Colleges (AAMC), by 2025 the United States will have a shortage of anywhere between 46,000 and 90,000 medical doctors. That number includes more than 30,000 fewer primary care physicians.

Similarly, an AAMC study paints a grim picture of the demographic makeup of medical school graduates as it relates to Hispanics. In 2015, while Whites represent almost 60 percent of graduates, Hispanics represent 4.6 percent of graduates.

The need is demonstrated, the solution is clear, but betting on the federal government to come to the rescue to mitigate a looming national health crisis is a losing wager. As a matter of fact, the government is partly responsible for this problem. According to the AAMC, 20 years ago the federal government limited financial support for physician training, which has stunted the development of resident programs.

What will emerge to fill this void? One of the answers may be found at Ponce Health Sciences University. Under the leadership of President and CEO Dr. David Lenihan, the University focuses on the disciplines of Medicine, Clinical Psychology, Biomedical Sciences and Public Health. To meet future challenges in the health care industry, the University launched a selection of masters and certificate programs specifically designed to fill service gaps within the profession and enhance the health care community with highly trained practitioners, including Spanish-speaking medical professionals.

HO reached out to Dr. Lenihan for his insights on this pressing issue in the Hispanic community. The following Q and A reveals more of his school’s philosophy and explains the obstacles that complicate possible solutions to the problem.

HO:  While many people understand that there is a growing need for bilingual doctors in the U.S., not many people understand that it’s not just a matter of having doctors that speak Spanish. It’s an understanding of dialects and culture that makes the greatest impact. How does your program take these nuances into consideration as your doctors are trained?

LENIHAN: That nuance is highly important. At PHSU, we call it Cultural Competency, and it’s a huge part of our curriculum. When we say Cultural Competency, what we want to get across to our students is that they must understand their patients on a personal level in order to craft the right care plans for them. You must understand what your patients eat at home, what their family dynamics look like and what they might be scared to tell you. Once you build this Cultural Competency, not only can you craft the right care plan for your patients, you can also communicate it to them in a way they will understand, engage with and trust.

HO: Some medical facilities rely on Google translate or other language translation programs to communicate with Hispanic patients. What are the drawbacks of this method of communication?

LENIHAN: That approach is very limited. It assumes that language is the only barrier that would prevent a patient from truly understanding and trusting their doctor. Ask any doctor in the U.S. whether their English-speaking patients fully understand their directions, and the answer will be a resounding “no!” Effectively communicating with patients goes beyond simple language, and well beyond the limitations of a language translation program.

HO: What impact has your program made on the shrinking population of Hispanic doctors in the U.S.? Do you have statistical information about the seriousness of this shortage and your success rate in turning out doctors to deal with this looming crisis?

LENIHAN: Our last U.S. census showed that there are over 38,000,000 people in the United States who speak Spanish as a first language, and this number is increasing rapidly. Puerto Rico turns out more Spanish speaking doctors than any state in the U.S. For this reason, Puerto Rico might be the most important health care hub in the country. Our students at PHSU serve in health facilities across the United States, including many cities with large Hispanic populations such as New York, Houston, Los Angeles and Miami.

HO: What are the long-term goals and mission of your program? Are there plans to expand or make your courses available as distance learning options for medical schools rather than just for study at Ponce?

LENIHAN: Our vision is to reduce the clinician shortage by providing outstanding health sciences education to underserved populations across the globe. In order to achieve this goal, we’re developing a variety of effective distance learning models that can lower the cost of education and make it accessible to everyone. We’ve also opened up a brand-new campus in St. Louis, which is going to be focused on reducing the clinician shortage in Mo. while providing employment opportunities for students of all backgrounds. •