HospitalInspections.org

Based on observation, interview, record review, review of the Language Line Service Log, and review of the facility's policies, the facility failed to inform each patient of his/her rights in a language and a manner the patient could understand for 2 of 8 patients investigated for language services, Patient (P) 1 and P6.

The findings include:

Review of the facility's policy titled, "Patient Rights and Patient Responsibilities," revised 12/2019, revealed patients had a right to receive information including risks, benefits, and reasonable alternatives in a language they understood pertaining to their health status, current diagnosis, treatment plan, and prognosis in order to give informed consent or to refuse consent.

Review of the facility's policy titled, "Provision of Services for Limited English Proficient, Deaf/Hard of Hearing, and Blind/Visually Impaired Individuals," revised 03/2020, revealed patients at the facility were to receive services in their preferred language by qualified, approved interpreters utilized during the delivery of all significant health care services. Further review revealed significant health care services included: obtaining financial and insurance information, obtaining informed consent, and during treatment and testing. Continued review revealed staff was not permitted to rely on an adult accompanying the patient for interpretation services unless there was an imminent threat to the safety or welfare of an individual when there was no qualified interpreter present. Additionally, staff was required to use a qualified interpreter to verify a family member's translation to confirm complete and accurate communication with the patient.

1. Review of P1's "Face Sheet" revealed the facility admitted and discharged the patient on 11/07/2024 with no primary diagnosis listed. Further review revealed P1's primary language was Chinese. Continued review revealed no phone number, email address, or physical address were listed.

Review of P1's "Emergency Department [ED] Timeline," dated 11/07/2024, revealed P1 entered the ED at 12:48 PM and received an electrocardiogram (EKG, a measurement of the electrical function of the heart) at 1:13 PM. Further review revealed no further treatment was documented until 4:50 PM, when P1 received a dose of haloperidol (an antipsychotic agent that could be used to treat agitation) 5 milligrams (mg) and lorazepam (an antianxiety agent) 1 mg. Per the timeline, P1 had blood samples drawn at 6:13 PM; however, no urine sample was listed on the timeline. Continued review revealed P1's primary diagnosis was aggressive behavior. Additionally, no interpreter information was found in the "ED Timeline." Per interview with the Market Director of Quality on 12/16/2024 at 4:35 PM, the interpreter information would appear in the "ED Timeline" if it was documented.

Review of the "Language Line Service Log," for 11/07/2024, revealed a Mandarin Chinese translator was only in use from 1:00 PM to 2:53 PM for that day.

Observation and interview with P1 was not possible due to the patient no longer being at the hospital, and no contact information was listed.

In an interview on 12/17/2024 at 11:45 AM, the ED Unit Clerk (EDUC) stated she believed P1 spoke English because he/she cursed at the staff in English. She further stated the staff attempted to use the approved interpretation application on the tablets at the beginning of P1's ED encounter, but the patient was noncompliant with use of the interpreter line, so she did not believe they used it for each conversation with P1. In continued interview, the EDUC stated while RN1 collected a urine sample via urinary catheter from P1, P1 kept repeating "What the [expletive], man?"

In an interview on 12/18/2024 at 10:01 AM, Registered Nurse (RN) 5 stated she used the interpreter applications on the electronic tablet in the ED when she was caring for a patient who did not speak English fluently. In further interview, RN5 stated she was in P1's room several times during his/her ED course of treatment and never saw the interpreter electronic tablet in the room, including while RN1 was attempting to obtain a urine sample via catheterization.

In an interview on 12/18/2024 at 10:51 AM, RN1 stated she used the interpreter application on the electronic tablet when speaking with P1, but he/she was confused and noncompliant with use of the interpreter. She further stated P1 became agitated and violent immediately following urinary catheterization for sample collection. Per interview, the lab was unable to process the specimen, which RN1 believed was the reason the "ED Timeline" did not reflect the event.

In an interview on 12/19/2024 at 9:54 AM, the Language Services Lead (LSL) stated she educated nursing management and staff to always contact the hospital language services line to set up an in-person interpreter for confused patients. She further stated the interpreter services on the electronic tablets could be used while waiting for an in-person interpreter to arrive. She stated if staff had called her when P1 was in the ED on 11/07/2024, she could have contacted an in-person interpreter to see if they were available for Mandarin Chinese interpretation. Additionally, the LSL stated the language services page on the hospital intranet had communication boards with pictures and written Mandarin Chinese that could have been used as a tool to attempt to communicate with P1. The LSL stated it was unacceptable for hospital staff to attempt to insert a urinary catheter on P1 with no interpreter on the line because the patient had a right to know what was happening to them and to refuse the procedure if he/she desired.

In an interview on 12/18/2024 at 2:27 PM, the Market Director for Emergency Services stated she believed the staff used the approved interpreter services for P1, but the patient's dialect was difficult for the interpreter to understand. She stated this made communication with P1 difficult. The Market Director stated staff signed they read the hospital policy on interpreter services as re-education following P1's stay in the ED, but the re-education did not include a post test to check for understanding of the policy.

2. Review of P6's "Face Sheet" revealed P6 arrived to the ED on 12/12/2024 with a chief complaint of back pain. Further review revealed P6's primary language was Spanish.

Observation on 12/12/2024 at 11:19 AM revealed Patient Advocate Representative (PAR) 1 spoke to P6, who was Spanish speaking, through Family Member (F) 1 as an interpreter. Further observation revealed no approved interpreter was used.

In an immediate interview, F1 stated hospital staff offered an interpreter, but it was the family preference that F1 did the interpreting for P6.

In an interview on 12/20/2024 at 10:37 AM, PAR1 stated she did not typically work in the ED. She further stated she usually used the tablet application to contact an approved interpreter, but if a patient's family member stated they preferred to act as the patient's interpreter, she honored that preference and did not call an approved interpreter to verify the family member's interpretation.

Further observation on 12/12/2024 at 11:57 AM revealed an electronic tablet marked for language services. The observation revealed Emergency Department Technician (EDT) 1 was not able to open the language line application on the tablet without assistance.

In an immediate interview, EDT1 stated she did know how to access the interpreter application on the tablet, but she had been on vacation. She further stated she did not recognize the log in screen that initially displayed on the tablet because it was for a secondary interpretation application that she did not use, and she had been unable to utilize the technology to navigate to the primary interpretation application.

In an interview on 12/18/2024 at 10:01 AM, RN5 stated hospital staff was expected to use an approved interpreter, usually on the electronic tablet, for every conversation with a patient with limited English proficiency. She further stated staff should use the electronic tablet interpreter as a means of verifying family language interpretations to ensure the accuracy of the information conveyed to the patient.

In an interview on 12/18/2024 at 3:18 PM, the Emergency Department Supervisor (EDS) stated her expectation for use of interpreter services in the ED was for staff to get an interpreter on the line via the electronic tablets and to keep that interpreter on the line with that patient until the patient was sent home or admitted to a floor upstairs. She further stated it was her expectation that staff kept an approved interpreter on the line, even if the patient's family member was also interpreting, to verify the family member gave the patient accurate information.

In an interview on 12/18/2024 at 4:48 PM, the Emergency Department Manager (EDM) stated staff needed to use an approved interpreter to accurately determine the needs of the patient. He further stated if the patient wanted to use a family member to interpret, staff needed to have an approved interpreter on the electronic tablet verify the family member's interpretation of what was said.

In an interview on 12/12/2024 at 11:32 AM, the Market Director for Emergency Services stated there was no in-person interpreter services available at the hospital. She further stated she expected staff to use the interpreter applications on the electronic tablet to interpret each conversation with patients with limited English proficiency. Per interview, if a patient requested a family member to interpret, the Market Director expected staff to use the approved interpreter application to verify the accuracy of the family member's translation.

In an interview on 12/20/2024 at 9:33 AM, the Market Director for Patient Access and Patient Logistics stated she expected staff to use an approved interpreter for each interaction with a patient with limited English proficiency. She further stated the facility had an obligation to attempt to get an in-person interpreter for a confused patient.

In an interview on 12/20/2024 at 12:47 PM, the interim Chief Nursing Officer (CNO) stated her expectation for interpretation with limited English proficiency patients was for staff to utilize available language services to ensure the patient had a clear understanding of what was happening. She further stated it was important to have a clear path of communication back and forth with the patient to ensure staff met the needs of the patient.