When a woman who didn’t speak English arrived at the overrun emergency room of a Brooklyn hospital last week, she was initially placed in a unit for patients who didn’t have the coronavirus.
But on Thursday, a doctor realized she had a cough and fever and should be treated for COVID-19. The doctor brought her over to the coronavirus unit with a warning: “Good luck. She speaks Hungarian.”
She died the following night.
A medical resident who treated her believes she would have gotten better care if she spoke English.
In the ER, where no one has enough time, particularly now, the resident said he could tell that no one wanted to work with an interpreter to take down the woman’s medical history. He placed his phone on the woman’s shoulder and dialed the interpreter service on speakerphone. Between the N95 mask covering his mouth and the helmet covering his ears, it was difficult to speak clearly and to hear.
“When they asked what language,” he said, “I spent five minutes just yelling: ‘Hungarian! Hungarian!’ And they were like, ‘Spanish?’”
The woman may have died even if she spoke English, but the episode and others like it demonstrate how those who speak a foreign language are at a disadvantage in New York City’s chaotic and crowded hospitals.
“It takes 10 minutes of sitting on the phone to get an interpreter, and that’s valuable time when you’re inundated,” the resident said. “So this utilitarian calculus kicks in. And the patients that are most mainstream get the best care.”
Even in normal times, those who don’t speak English have worse health outcomes for a range of routine procedures and can struggle to gain access to interpreters. Some research also shows that professional interpreters make clinically significant errors substantially less often than ad hoc interpreters, such as family members.
Those gaps are magnified in times of crisis. ProPublica spoke to 11 New York City health care workers about their experiences caring for coronavirus patients who didn’t speak English. While their employers ranged from top-tier nonprofit facilities in Manhattan to safety net hospitals in Brooklyn, they all described broken communication and hastily improvised stopgaps.
They’re worried that language barriers will leave immigrants with COVID-19 in a particularly dire situation: alone, confused and without the appropriate care.
One doctor in the Bronx described a colleague working in his facility’s triage tent, trying to assess patients using the Google Translate app on his smartphone.
In another situation, the Brooklyn emergency room resident said he felt comfortable enough with Spanish that he decided to forgo an interpreter while taking the medical history of an incoming Hispanic patient. Her symptoms weren’t severe, but he thought she told him she had heart surgery three years ago, so he admitted her into the hospital because that put her at risk. Later, he realized she’d said she had heart surgery when she was 3 years old. If he had known that, he would’ve sent her home.
A resident at another Brooklyn hospital treated a woman on Sunday who only spoke French Creole. The oxygen mask over her face meant the interpreter couldn’t fully understand her, the resident said, and the patient clearly remained very confused. She died the next day.
A Manhattan hospital-based physician described how he calls interpreters on his cellphone outside patients’ rooms and places the phone in his breast pocket so it doesn’t get covered in virus particles. Then he puts on a yellow protective gown over his scrubs and enters the room, standing at a distance from the patients. But all of these steps make it hard for the patient and the interpreter to hear each other. “Then we tell them they have a virus that is killing people all over the world,” he said. “We tell them they can’t have any visitors, they can’t leave the room. And then we shut the door.”
About 1 in 5 Americans speaks a language other than English at home, according to census data. Among New Yorkers, it’s 49%. But with more than 40,000 confirmed coronavirus cases within New York City limits, when residents without a strong grasp of English get sick, providers point to a number of ways the language gap could lead to worse care. Patients well enough to go home may misunderstand their discharge instructions, causing them to not quarantine properly or to not return to the ER if they take a turn for the worse. Mistakes could be made during triage, as underlying conditions get overlooked.
The Civil Rights Act of 1964 has long been understood to require hospitals to provide access to language interpretation if they receive federal funding (such as Medicare and Medicaid), with failure to do so considered “discrimination by national origin.” Regulations put in place in 2016 to implement part of the Affordable Care Act bolstered that mandate. Hospitals now must use a “qualified interpreter” — patients have the right to sue if they don’t — and the use of family members and bilingual but untrained staff is restricted. (There are exceptions, like translating through family members in emergencies.)
Elena Langdon, former chair of the National Board of Certification for Medical Interpreters, said she recognizes doctors may be unable to always provide the quality of care they’d like to right now, but that equity and the right to interpretation can’t fall by the wayside. “While it’s made more difficult by the situation, it doesn’t mean you don’t have to do it,” she said. “It’s a public health issue.”
She said hospitals may need to have a staff member on site dedicated to coordinating language access. Several hospital systems at which the examples in this story occurred did not return emails or phone calls seeking comment.
Even outside of pandemics, providers acknowledge these provisions are often violated, like by having a grandchild translate instead of a professional.
Such options are now unavailable, however. Many hospitals in the city have prohibited visitors, making it impossible for English-speaking family members to help patients communicate. In-person interpreters would be at risk of infecting themselves or others, and the use of personal protective equipment makes talking on the phone hard.
An ICU nurse in a third Brooklyn hospital said that at her facility, when she needs an interpreter, she calls an operator through a big, blue corded phone installed in each room. Then she sits on hold until an interpreter becomes available. The wait time depends on the language. Spanish is relatively fast, she said; Mandarin takes 10 or 15 minutes; some uncommon Asian dialects take over an hour.
Now that visitors are forbidden, the nurse worries, patients are left without advocates, and the family is kept out of the loop. “At this point,” she said, “we’re not going to call unless we need consent or they die.”
Last week, a Spanish speaker in his early 40s was admitted into the hospital’s ICU where the nurse works. He seemed relatively healthy, and while he was a little overweight, he had no underlying health conditions, the nurse said. Nevertheless, he soon was on a ventilator. Despite the hospital’s policy against visitors, his wife showed up and she spoke less English than her husband did. “His wife hadn’t been able to see him or talk to him,” the nurse explained. “She kept just saying: ‘I don’t understand. He was OK.’ … It’s part of our job as nurses to go up to a family member you see like that and explain what’s going on. But these conversations aren’t happening with translation patients. In this scenario, I don’t have the time.”
“And then he died,” she said. “And they had to tell her over the phone.” She’s not sure if the hospital used an interpreter or just winged it.