The misinterpretation of a single Spanish word in ER leads to the quadriplegia of a young man

The misinterpretation of a single Spanish word “intoxicado” in an emergency room in Miami, FL in the 1980s, led to a misdiagnosis for an 18-year-old comatose man named Willie Ramirez which resulted in his becoming a quadriplegic (Price-Wise, 2008). The emergency room physician did not utilize a professional medical interpreter in the intake, but instead, spoke with the patient’s girlfriend’s mother—a Cuban woman, who was not fluent in English. She, sometimes, mixed Spanish and English words. The attending physician misinterpreted “intoxicado” to mean the same thing as the English word “intoxicated” (Price-Wise, 2008). Consequently, he treated Ramirez for an intentional drug overdose, rather than for the intra-cerebellar and subdural hematomas that were the underlying causes of Ramirez’s coma. Unlike the meaning of “intoxicated” in English which means “under the influence, or inebriated,” “intoxicado” in Cuban Spanish is an all-encompassing word that means “not well as a result of eating or drinking something” (Price-Wise, 2008). This is an example of a false cognate—a pair of words, each from a different language, that sound alike and are spelled either identically or similarly but have entirely different meanings. Please note that in some dialects of Spanish, such as Bolivian Spanish, "intoxicado" may denote intoxication as being in drunk. Neither party requested the assistance of a medical interpreter (Price-Wise, 2008).

In the United States, nearly 25 million or eight percent of the U.S. population are limited-English proficient (LEP) and say they do not speak English "very well" (Dietrich & Hernandez, 2022; Colby & Ortman, 2019). Most are foreign-born Asian Americans and Latin Americans (Dietrich & Hernandez, 2022). Sixty-eight million speak a language other than English in their household, with Spanish being the most widely spoken language after English (Dietrich & Hernandez, 2022; Colby & Ortman, 2019). Due to cultural and linguistic barriers, persons with LEP often encounter obstacles to receiving safe, quality health care services (Divi et al., 2007; Agency for Healthcare Research and Quality, 2018; Preciado, 2020; DeCola, 2011; Escobedo et al., 2023).

Health care providers (HCPs) have a legal and ethical responsibility to provide cost-free language assistance to patients with limited English proficiency (LEP), per Title VI of the U.S. Civil Rights Act of 1964 (American Medical Association, 2016; U.S. Department of Justice, n.d.a.). The failure to provide linguistically appropriate services (LAS) for patients with LEP can compromise patient safety and the quality of care, sometimes resulting in irreversible, adverse effects and in some cases, even death (Divi et al., 2007; Ku & Flores, 2005; Santoro, 2004; Quan & Lynch, 2010). As in the Ramirez case, this failure can result in civil liabilities for the provider (Ku & Flores, 2005; Price-Wise, 2008; DeCola, 2011; Quan & Lynch, 2010). The most often cited reason for health care providers not providing quality LAS was the costs associated with interpretation services (Loho & Rosenheck, 2022; Ku & Flores, 2005; DeCola, 2011), which are not always covered by the federal or state governments nor by private insurance companies (Youdelman, 2010).

Regardless of whether the costs of interpretation are covered, HCPs are required by law to take steps to ensure that people with limited English proficiency have meaningful access to health care services. The malpractice lawsuit filed by Ramirez's family resulted in a $71 million settlement, with the attending physician responsible for Ramirez's disability stating, “You don’t know the agony of being blamed for something like this” (Price-Wise, 2008).

DeCola, A. (2011). Making language access to health care meaningful: the need for federal health care interpreters' statute. Journal of Law and Health, 24(1), 151-182

Divi, C., Koss, R. G., Schmaltz, S. P., & Loeb, J. M. (2007). Language proficiency and adverse events in US hospitals: A pilot study. International Journal for Quality in Health Care, 19(2), 60-67. doi:https://doi.org/10.1093/intqhc/mzl069

Price-Wise, G. (2008). Language, Culture, and Medical Tragedy: The Case Of Willie Ramirez. Health Affairs, November/December issue https://www.healthaffairs.org/do/10.1377/forefront.20081119.000463/