In a health care system built on communication, what happens when patients and providers don’t speak the same language?

That question was at the heart of a recent Candello study group webinar led by Adam Schaffer, MD, MPH, a physician and data analyst at CRICO. Drawing from more than two decades of medical professional liability (MPL) data, Dr. Schaffer and his team explored the role of language barriers in malpractice cases—and what they found was both sobering and actionable.

A Silent Risk with Loud Consequences

Roughly 8 percent of the U.S. population—more than 25 million people—have limited English proficiency (LEP). These individuals are more likely to experience misunderstandings about treatment plans, lower satisfaction with care, and, as the data now confirms, a higher risk of medical harm.

Candello’s analysis of more than 107,000 closed MPL cases from 2000 to 2024 identified 1,057 in which a language barrier was a contributing factor. While these cases represented just 1 percent of the total, their impact was disproportionately large:

• Higher odds of payment: Language barrier cases were significantly more likely to close with an indemnity payment.
• Larger payouts: The median indemnity payment in these cases was $263,048—substantially higher than the $226,935 median for other cases.
• Greater severity: Nearly half of the language barrier cases involved high clinical severity, including death.

In short, when language fails, the consequences can be catastrophic—for patients, providers, and institutions alike.

Where the Risks Are Concentrated

The data revealed clear patterns in where and how language barriers contribute to malpractice risk. Obstetrics and gynecology stood out: while OB/GYN accounted for 10 percent of non-language barrier cases, it represented 20 percent of language barrier cases. Labor and delivery units, in particular, emerged as high-risk zones.

Why? Dr. Schaffer offered a hypothesis: “Labor and delivery is a setting where high-stakes decisions are made quickly. If a patient doesn’t fully understand the risks or options, especially during informed consent, the potential for harm—and litigation—rises sharply.”

Other high-risk moments include:

• Emergency department triage and discharge
• Inpatient discharge instructions
• Fall prevention education
• Any brief, information-dense interaction where clarity is critical

Interpreters: Not All Are Created Equal

The study also examined the types of interpreter services used in clinical settings. While nearly 80 percent of outpatient physicians reported using interpreters with LEP patients, only 30 percent regularly used professional interpreters. Many relied on ad hoc solutions—bilingual staff, family members, or even Google Translate.

That’s a problem.

Research shows that professional interpreters significantly reduce clinically consequential errors. In one study, 12 percent of errors made by professional interpreters were potentially harmful, compared to 22 percent for ad hoc interpreters and 20 percent when no interpreter was used. 

Video remote interpreting (VRI) is gaining traction for its accessibility and cost-effectiveness, especially in off-hours or for less common languages. But it’s not a perfect substitute. Providers and interpreters themselves consistently rate in-person interpretation higher for quality and comfort—especially in sensitive or complex conversations.

Documentation: A Missed Opportunity

Even when interpreters are used, documentation often falls short. Best practice calls for noting the interpreter’s name or ID in the medical record, but this step is frequently skipped. That omission can become a liability if a case goes to court.

The good news? Interpreter services—especially VRI—often maintain their own logs, including patient medical record numbers. These can serve as corroborating evidence if needed, but proactive documentation remains the gold standard.

Patient Portals: A New Frontier for Language Equity

As more communication shifts to digital platforms, language barriers are following. LEP patients are significantly less likely to activate or use patient portals. Even when portals offer language toggles (e.g., English to Spanish), the translated content is often limited to static pages—leaving clinical messages untranslated and inaccessible.

Some institutions are making strides. Mass General Brigham, for example, translated more than 1,000 patient questionnaires into six languages and integrated them into their portal. But such efforts remain the exception, not the rule.

What Can Be Done—And Where to Start

The Candello study didn’t just identify problems; it pointed to practical solutions:

• Target interpreter resources to high-risk areas like labor and delivery.
• Ensure informed consent forms are available in multiple languages.
• Document interpreter use consistently in the EHR.
• Audit patient portals for language accessibility and usability.
• Avoid over-reliance on tools like Google Translate for clinical communication.

As Dr. Schaffer noted, “This is a solvable problem. With reasonable resources and thoughtful implementation, we can dramatically reduce the risk that language barriers pose to patient safety.”