Lost in hospital translation?

One issue that adds to the healthcare reform debate is that of hospitals and translators. According to Adam Gurvitch, director of health advocacy at the New York Immigration Coalition," most hospitals will likely rely on volunteers, bilingual staff and telephone translation agencies..." when it comes to meeting state rules regarding the use of translators. New York is an example of a state that has laws set in place for all hospitals to require "skilled" translators for its non-English speaking patients. www.msnbc.msn.com/id/14838695/.

I recently reviewed a medical record of a patient that was non-English speaking. The patient was about to undergo a procedure in the past, but started complaining to staff and appeared to be in a lot of pain. Finally, after the hospital staff spent a considerable amount of time treating the patient's perceived pain, a family member arrived, translated, and relayed to the staff that the patient "wanted a Pepsi" to drink. Fortunately, in that situation, the family member was a reliable source.

But take the case of an 18-year-old man in Florida, told by Mara Youdelman of the National Health Law Program. www.npr.org/templates/story/story.php?storyId=111066555. Unfortunately, his girlfriend or mother didn't speak English. It's too bad that the Spanish word for nauseated is "intoxicado". The man went on to receive 36 hours of unnecessary treatment for a suspected drug overdose. Staff thought the man was intoxicated or "high on drugs."

I received my bachelor's degree in Spanish in 1998. 11 years have gone by. Speaking as a Registered Nurse, a hospital employee, legal nurse consultant, husband and father, I have issues with going to translate when called upon to do so at my hospital/employer. I have close friends that I speak Spanish with on a regular basis. I have traveled to Chile, Argentina and Uruguay, and spoke some Spanish there. I have translated for a number of patients in an emergency room, a labor and deliver unit, and multiple acute/critical care units. I recently used some Spanish when consulting with an attorney on a health-related case. Despite the degree, the practice with friends, the experience in the hospital and with the attorney, am I "skilled"? Sometimes I feel like I am. Then I think of the time I translated for an anesthesiologist who was placing an epidural for a lady in labor. I think I got most of the dialogue correct, but I sure felt a little uneasy after leaving the birthing suite. The woman was in intense pain, moaning and grunting just like my wife did when she was going through labor. The moaning and the grunting made it difficult to understand all her words. Thank God that the anesthesiologist placed the epidural line successfully.

It's great that New York put forth a plan for "skilled" translators a couple years ago. I think a lot of hospitals and states would have many different definitions for "skilled", however.

Most facilities will agree that patient safety comes first. The challenge lies in relying on family members, volunteer staff, telephone interpreters vs. "skilled" full-time interpreters. Then there's the whole issue of who pays for these "skilled" interpreters.

Until we figure this out, I'll keep practicing my Spanish.

By Brian Brandser, RN, BSN, CCRN, CLNC