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$71 million for one word misinterpreted
Thread poster: LegalTranslatr2

Luis Arri Cibils  Identity Verified
Local time: 10:20
Member (2003)
English to Spanish
+ ...
My last post, James, on the subject. Jul 24, 2006

James Visanji DipTrans PhD wrote:

What was the general statement? I was querying, specifically, the accuracy of the $71M lawsuit claim - the title of the thread. I found several conflicting versions of the story - some describing the event as "recent" when it's over 20 years old. When I finally tracked down (through nested citations) the supposed source of the claim it isn't in the relevant index. Then I cannot find papers citing this article that predate the paper in Paediatrics - which was cited by the NEJM article ... None of this fills me with confidence about the veracity of the claim - if it is true, it will turn up and I will backpedal fast (I fully expect to have to do this - more than likely someone got the original citation wrong or we have the 1/1,000,000 event of a pubmed error).

The "general" issue for me here, is that an interpretation was allegedly offered by a non-professional interpreter, we don't even know if the "interpreter" spoke a single word of Spanish. We also don't know if the hospital was obliged to provide interpreting services and in what timeframe. Thus this settlement, if it was made, has little relevance to professional interpreters. It is, however, of relevance to American hospitals.

On the face of it this claim has more merit as medical malpractice than linguistic malpractice.


James,

You question whether the incident ever occurred, mainly based on the difficulties in finding the oft-quoted Harsham’s paper. Maybe it is just a note, maybe it is misquoted, maybe the reference should be to that other article on Md Econ of the same year. I don’t know. Certainly, old references are often quoted without ever bothering looking for them.

While I can’t answer that, I found suspicious that so many relatively serious publications did not question the facts. Thus, I decided to look at that issue with the info that I had at hand. Did that event ever occur?

From some of the articles, I found the name of the alleged victim, William Ramirez, and the place where the event allegedly took place, Miami.

I went to the archives of the Miami Herald and did first a blank search (I could not get the browser to work without doing that), restricting then the result to the following string: "Ramirez AND paramedics AND intoxicated AND intoxicado AND nauseous AND Spanish" (i.e., an article containing all those words). I found just one, dated November 4, 1983, the right timeframe. The headline plus the beginning of the article are as follows:

QUADRIPLEGIC TO RECEIVE MILLIONS

Source: AL MESSERSCHMIDT Herald Staff Writer
Willie Ramirez watched quietly Thursday as lawyer Murray.. Sams Jr. thumbed through yellowed newspaper clips, high school yearbooks and carefully saved snapshots -- memories of days when Ramirez slugged home runs and played second base for high school teams in Key West and Dade. "I still can't believe it," Ramirez said. "I can't believe it.". A self-described "sports freak" who once dreamed of

Published on November 4, 1983, Page 1D, Miami Herald, The (FL)

I did not download the full text. You are welcome to do it. It’ll cost you only $2.95

Are hospital practicing racism or discrimination? I don’t believe so, not today. They are too much of a deep pocket to even dare doing it. Unconscious "cultural assumptions" may still be a problem with some of the individual providers of medical care.

Were the hospitals at that time required to provide interpreters? I don’t know. The Civil Rights Act of 1964 did impose on them, however, certainly obligations as to providing medical attention regardless of language. Was that case a violation? I do not know. But the victim did recover.

So long,

Luis





[Edited at 2006-07-24 01:21]

[Edited at 2006-07-24 01:22]

[Edited at 2006-07-24 01:25]


 

Ford Prefect  Identity Verified
Burkina Faso
Local time: 15:20
German to English
+ ...
... Jul 24, 2006

Excellent Luis, thanks for finding that.

So the event is real - the problem is with how some of the facts seem to have changed with time.

1) "The case was settled for $71M"
According to the Miami Herald, the plaintiff receives monthly and annual payments. The $71M is an estimate of what he _might_ get if he lives until he is 74. He could get more or less depending on how long he lives and the size of "additional" payments, which are highly variable.

2) "A paramedic took the word to mean intoxicated"
True, but this also ended up in hospital records, so at least one doctor did as well.

3) "The Pediatrics article refers to a "successful lawsuit"."
The case was settled out of court and the hospital explicitly refused to accept liability.

4) Most intriguing from the professional linguist's viewpoint:
"The lawsuit said none of the hospital staff that night spoke Spanish and Fernandez (Ramerez's girlfriend) had to translate."
Ramirez was also conscious (but very unwell) at least part of the time he was at the hospital. If the doctors genuinely suspected attempted suicide or a drug overdose they should have at least tried to ask him and his family to confirm.

Thus despite the clear implication that a "paramedic" was interpreting, it was actually the plaintiff's girlfriend. This makes it hard to blame the hospital for the language barrier, but it's still easy to blame them for not spotting what was wrong with this man. $71M for one word seems a slight exaggeration to me - there were actually several things that went wrong.

Guys - let's worry when we get judgments like these against individual linguists, in this case settlement was made by the hospital even when the patient was effectively providing his own interpreter. Unfortunately, we still don't know if the hospital had an obligation to provide a professional linguist and this could be crucial.

Unconscious "cultural assumptions" may still be a problem with some of the individual providers of medical care.


True. One of the doctors sued by Ramirez was called "J Carlos Richards"


 

Ford Prefect  Identity Verified
Burkina Faso
Local time: 15:20
German to English
+ ...
... Jul 24, 2006

I've now got hold of a copy of the Med.Econ. article.

This makes clear the suit was for MEDICAL malpractice. There was no mention of the hospital being obliged to provide an interpreter. The article quotes one doctor who stated s/he would refuse to see patients who could not speak English or who were not accompanied by a professional interpreter.


Non Spanish-speaking paramedics and ER personnel sizing up Ramirez's condition, interpreted the word to mean intoxicated - or, more specifically, the victim of a drug overdose


The ER physician understood that the boy had fought with his girlfriend, that he was very upset, and that he'd "taken something", says Rex Conrad, attorney for Coral Reef General. "That's on the ER report".



...hospital attorney Conrad believes there had been drug use on this occasion, and that Ramirez's neurological damage stemmed from the combination of drug and a defective artery



Plaintiff's attorney ... says ER personnel got mentally "locked into" that diagnosis...


I think us linguists do not need to worry excessively about a 22 year-old medical malpractice case that did not involve a professional linguist. Had it involved a professional linguist, the outcome might have been better for Ramirez, and that to my mind is the lesson to learn from this. Also, keep your insurance up to date though - especially in the USA which is infamous for the enormous size of malpractice settlements.

[Edited at 2006-07-24 12:56]


 

Luis Arri Cibils  Identity Verified
Local time: 10:20
Member (2003)
English to Spanish
+ ...
Hospitals and interpreters Jul 24, 2006

James Visanji DipTrans PhD wrote:

Unfortunately, we still don't know if the hospital had an obligation to provide a professional linguist and this could be crucial.


James, the answer as to whether a hospital, TODAY, has an obligation or not to provide an interpreter will not likely be found in a 26-year-old case, particularly a case that did not have a court ruling, other than the court accepting the settlement agreement.

A better starting point is the website of the Office of Civil Rights of U.S. Department of Health and Human services (http://www.hhs.gov/ocr/lep/), where it can be found guidance as to how certain recipients of federal money (many/most/all/whatever hospital are recipients) should protect the medical care rights of LEP (Limited English Proficiency) persons under Title VI of the Civil Rights Act of 1964 (prohibiting discrimination based on national origin). (The states may have their own regulations). I am copying below excerpts from the Summary. Much more info can be found at the site.

Note that the patient may opt for having a relative to interpret, but the provider (if recipient of federal aid) must provide an interpreter free of charge (“…the recipient should make the LEP person aware that he or she has the option of having the recipient provide an interpreter for him/her without charge, or of using his/her own interpreter..”). There is case law that the relative cannot be a minor (even a US-born child, ready to graduate from HS).

In Workers Comp. cases, the insurance companies will send a professional interpreter even though a family member is available. I had to interpret in a case where the patient had a decent command of the English language and his girlfriend, US-born and fluent in Spanish, was there.

In those cases where the medical provider is not covered by the guidance, a medmal cause of action is likely available if the doc took the info from the faulty translation and misdiagnosed the case, as much if the doc had relied to make the diagnosis based on a faulty reading of the thermometer by a nurse. Many providers are not taking chances, motivated by their insurance companies.

As to the interpreter’s liability: it will always be there (call it professional malpractice, negligence, whatever). That there have not been 71 million dollar claims talks more about the shallowness of the interpreters' pockets, not of their potential liability. (Also, many jurisdictions have capped the amount of punitive damages to a certain, small multiple of actual damages). If I owe $10,000 to a bank, I have a problem, but if I owe $71 million, the bank has the problem.

Of course, as more interpeters get insurance, becoming thus deep pockets, we may hear more about lawsuits against them. Thus, it is always good advice to get insurance; it might also be good advice to keep it quiet.

Regards,
Luis

http://www.hhs.gov/ocr/lep/summaryguidance.html
Office for Civil Rights
Guidance to Federal Financial Assistance Recipients Regarding Title VI and the Prohibition Against National Origin Discrimination Affecting Limited English Proficient Persons - Summary
The U.S. Department of Health and Human Services has published revised Guidance to Federal Financial Assistance Recipients Regarding Title VI Prohibition Against National Origin Discrimination Affecting Limited English Proficient (LEP) Persons. The Revised LEP Guidance is issued pursuant to Executive Order 13166. It is effective immediately and replaces the Guidance issued August 30, 2000. You can print out a copy of the Guidance from OCR's website at http://www.hhs.gov/ocr/lep or contact one of the OCR Regional Offices listed below.
LEGAL AUTHORITY
Title VI and Department of Health and Human Services regulations, 45 C.F.R. Section 80.3(b)(2), require recipients of Federal financial assistance from HHS to take reasonable steps to provide meaningful access to Limited English Proficient (LEP) persons. Federal financial assistance includes grants, training, use of equipment, donations of surplus property, and other assistance. Recipients of HHS assistance may include hospitals, nursing homes, home health agencies, managed care organizations, universities and other entities with health or social service research programs, State, county, and local health agencies. It may also include State Medicaid agencies, State, county, and local welfare agencies, programs for families, youth, and children, Head Start programs, public and private contractors, subcontractors, and vendors, and physicians and other providers who receive Federal financial assistance from HHS.
DEFINITION OF LIMITED ENGLISH PROFICIENT INDIVIDUALS
Individuals who do not speak English as their primary language and who have a limited ability to read, write, speak, or understand English may be LEP and may be eligible to receive language assistance with respect to the particular service, benefit, or encounter.
FACTORS USED TO DETERMINE THE TITLE VI OBLIGATION TO ENSURE MEANINGFUL ACCESS FOR LEP PERSONS
Recipients are required to take reasonable steps to ensure meaningful access to their programs and activities by LEP persons. The Guidance explains that the obligation to provide meaningful access is fact-dependent and starts with an individualized assessment that balances four factors: (1) the number or proportion of LEP persons eligible to be served or likely to be encountered by the program or grantee; (2) the frequency with which LEP individuals come into contact with the program; (3) the nature and importance of the program, activity or service provided by the recipient to its beneficiaries; and (4) the resources available to the grantee/recipient and the costs of interpretation/translation services. There is no "one size fits all" solution for Title VI compliance with respect to LEP persons, and what constitutes "reasonable steps" for large providers may not be reasonable where small providers are concerned.
USE OF FAMILY MEMBERS AND FRIENDS
Some LEP persons may feel more comfortable when a trusted family member or friend acts as an interpreter. When an LEP person attempts to access the services of a recipient of federal financial assistance, who upon application of the four factors is required to provide an interpreter, the recipient should make the LEP person aware that he or she has the option of having the recipient provide an interpreter for him/her without charge, or of using his/her own interpreter. Recipients should also consider special circumstances that may affect whether a family member or friend should serve as an interpreter, such as whether the situation is an emergency, and whether there are concerns over competency, confidentiality, privacy, or conflict of interest. Recipients cannot require LEP persons to use family members or friends as interpreters.


[Edited at 2006-07-24 18:03]

[Edited at 2006-07-24 18:05]


 

Petra Fischbäck  Identity Verified
Local time: 17:20
Member (2007)
English to German
+ ...
What a terrible story! Jul 31, 2006

Thanks for that very drastic way of teaching me what "intoxicado" means in Spanish. I will never forget that word again.

The poor man.


 

Jonathan Sanders (X)  Identity Verified
Local time: 17:20
In this case... Aug 22, 2006

Petra_44 wrote:

Thanks for that very drastic way of teaching me what "intoxicado" means in Spanish. I will never forget that word again.

The poor man.



"Intoxicado" does NOT mean "nauseated" in Spanish. It means "poisoned" and usually "food poisoned". This particuar patient may of been using that word in this way for whatever reason, or he may have been saying I "feel food-poisoned" and the medical staff heard "intoxicado" and assumed it was "intoxication", as they don't speak Spanish. That's just the ignorance of believing that complexity of Spanish is reduced to adding an "o" to the end of any English word, which still exists unfortunately.


 

Javier Wasserzug  Identity Verified
United States
Local time: 08:20
English to Spanish
+ ...
Intoxicated?, no never May 21, 2015

I would never interpret intoxicado for intoxicated. I would say food poisson or simply "it was something I ate"

 
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