Lost In Translation?

Have you ever received medical records in a language you cannot read? Most physicians know by now that federal law requires us to provide -- and sometimes pay for -- foreign language interpreters for patients who do not speak a language spoken by the physician. But regardless of the patient's spoken language, does any such requirement apply to medical records? It never occurred to me to ask until I received an authorization for release form in Spanish last week.

I asked a risk management consultant from my professional liability carrier. She suggested obtaining a summary, but confirmed my own belief that failure to review records can increase liability exposure. For example, a patient might neglect to tell you about a drug allergy recorded in the prior physician's chart. You prescribe the drug, and the patient dies. As a forensic psychiatrist, though, I never accept a summary. How do I know the person writing the summary will tell me what I want to know? Why would I accept a summary in a clinical case? And yet for all the admonitions to communicate and share records I can assure you that even without language problems physicians rarely request records, and the more voluminous the records, the less likely the physician will wade through them. This will get worse as electronic records become ever more bloated with boilerplate, templates, and cutting and pasting.

I also asked an attorney with the local Office of Civil Rights. She surprised me by telling me, if I got this right, that the requirement to supply an interpreter only applies if the physician accepts payment from Medicare Part A (hospital) or Medicaid. She implied that no clear policy, statute or case law now dictates who must pay for translation of foreign language medical records.

Finally, I contacted a translation service where a representative told me the price for translating records in an "easy" language like Spanish starts at $0.17 per word. The physician should use such a service, which may indemnify for errors, rather than trust either the patient or a family member to translate the record.

It occurs to me that this rare occurence offers a way to escape the costly interpreter requirement. Some physicians even now demand access to medical records prior to scheduling a first appointment. Who would want to take on a case if the records must be translated first, regardless of who pays for it?

The patient and the payer should bear the cost of translating medical records. Otherwise providers will either avoid treating patients with foreign language charts, or resent having to lose money for the privilege of treating them.

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