Hospitals Look to Overcome Language Gaps
September 1, 2003
By LAURAN NEERGAARD, AP Medical Writer
WASHINGTON (AP) -- The nurse ordered an oral antibiotic to clear up the
7-year-old's ear infection. But the mother spoke no English - and a bystander
pulled in to translate told her to pour the drug into the girl's ears.
It was one of dozens of dangerous translation errors Dr. Glenn Flores uncovered
when he taped exams of 70 Spanish-speaking children in some Boston emergency
rooms and clinics. And that's just examining the nation's most common foreign
language - imagine the difficulty when a hospital encounters its first patient
speaking, say, Hmong.
About 21 million p eople in the United States speak limited or no English - 50
percent more than a decade ago - and health workers are struggling to care for
Hospitals "are reeling from the major change in the number and diversity of
languages they're encountering," says Ellen Pryga of the American Hospital
Association. "The reality is ... if someone shows up who needs services and
doesn't speak English, you have to figure out how to communicate with them. It
doesn't matter if they're the only one you've ever encountered who speaks
Unable to hire an interpreter for every language, they're trying creative
methods: volunteer translator clubs, telephone interpreters, teaching foreign
phrases to doctors, and hiring bilingual nurses, clerks, even janitors who can
translate in a pinch.
But the question is what works. Special training is probably crucial because
general fluency in a language seldom guarantees knowledge of complex medical
terms, says Yolanda Partida of Hablamos Juntos, a program started by the Robert
Wood Johnson Foundation to improve Spanish health communication.
Hablamos Juntos is funding 10 experiments around the country to find innovative
solutions, especially in hard-hit rural areas like central Nebraska. Six
counties where the Hispanic population more than tripled in the 1990s are
preparing to test a videoconferencing system that would let emergency rooms and
maternity wards share 24-hour access to Spanish-speaking interpreters - and
train additional translators long-distance.
Doctors generally can't turn away sick patients because of language barriers.
Civil rights law requires health facilities that accept any federal funding to
make provisions for non-English speakers.
Just how many languages different facilities must be able to tackle, and using
what methods, the law doesn't make clear. The government this month proposed an
updated set of guidelines to help sort that out. Nor are there good statistics
on how often or how well translation services are
But studies show many non-English speakers go without an interpreter - and thus
shun health care until they're so sick they wind up in the emergency room - or
use untrained bystanders.
"The default position of many providers is to rely on family members and friends
because that's what's convenient and the provider doesn't have to worry about
how to pay for it," says Mara Youdelman of the National Health Law Program. "The
end result is there are significant medical errors."
Indeed, research by Flores, of the Medical College of Wisconsin, suggests that
avoiding risky errors requires professional interpreters with more than 100
hours of health training. Yet one survey suggests just a quarter of hospitals
train interpreters; how much varies widely.
Often children do the interpreting, even if a parent or sibling is being
diagnosed with a serious disease. Legislation under consideration in California
would ban child interpreters.
Then there's false fluency - health workers who think they understand a word but
don't. Flores recounts a 2-year-old who fractured her collar bone. "Se pego,"
her mother told the doctor, who thought that meant the child had been hit and
reported possible abuse. The mother lost custody for 48 hours until interpreters
clarified that the girl had fallen from her tricycle and struck - se pego - her
Interpreter services are supposed to be free to patients, but health workers
report paying from $7 an hour to $50 an hour for professional interpreters.
Medicaid allows states to draw federal matching funds to help cover the costs
but only nine - Idaho, Hawaii, Maine, Massachusetts, Minnesota, Montana, New
Hampshire, Washington and Utah - so far do. Pennsylvania and Kansas are
"Ultimately this is costing the system more" to skip an interpreter, says
Flores, citing research that found access to interpreters increases cheaper
EDITOR'S NOTE - Lauran Neergaard covers health and medical issues for The
Associated Press in Washington.
Copyright 2003 Associated Press. All rights reserved.