The San Juan Regional Medical Center (SJRMC) is the defendant in a new lawsuit brought by a Navajo family alleging that the hospital’s failure to provide family member and Navajo elder Larry Williams with a Navajo language interpreter led to the misdiagnosis of his medical condition and eventually, his death. Mr. Williams was limited English proficient (LEP) and communicated primarily in the Navajo language. The lawsuit claims that the hospital and the treating physician, Dr. Tull, were negligent in their care of Mr. Williams and committed medical malpractice. Plaintiffs also claim that the hospital is legally responsible for the conduct of Dr. Tull.
On March 1, 2023, plaintiffs filed a motion for summary judgment in state court with the First Judicial District Court of Santa Fe County. The motion asks the court to enter partial judgment in favor of the plaintiffs.
In 2018, according to the lawsuit, Williams experienced shortness of breath, disorientation, and hallucinations. He also was unable to walk. Williams’s family brought him to the San Juan Regional Medical Center in Farmington, New Mexico for emergency care.
Mrs. Williams, as claimed in the court case, usually interpreted for her husband during his medical visits. However, she is not a trained medical interpreter. Even when Lenora Williams interpreted for her husband, Mr. Williams still had trouble communicating with his doctors “because sometimes she [Mrs. Williams] could not successfully interpret English to Navajo for him,” according to plaintiffs’ motion for summary judgment.
Concerning Mr. Williams English proficiency, Mrs. Williams testified that:
“Q. And why do you say that he was not fluent in English? What did you observe?
A. He wasn’t because when I’m with him, you know, he talked to me in Navajo and then if he’s stuck on something or didn’t understand in English, you know, he needed somebody to verify or whatever. He’ll say in Navajo, “I don’t know what you mean” or, “what they mean.” He’ll say it to them in Navajo, too, you know, “I don’t know what you mean.”
Lenora Williams was unavailable during this hospital visit. The hospital’s staff assured her that they would take good care of her husband in her absence. Despite staff assurances, the hospital never evaluated Mr. Williams’ language assistance needs. They never provided him with a Navajo language interpreter.
As the lawsuit’s complaint states, San Juan Regional Medical Center did not effectively communicate with Mr. Williams: “After a brief evaluation, ER physician Dr. Graham Tull diagnosed him with a urinary tract infection and discharged him. “
After Mr. Williams’ discharge, his medical condition worsened, according to the lawsuit. His family then brought him back to San Juan Regional Medical Center where medical staff found Mr. Williams to be in serious condition suffering from severe septic shock, which caused his death, the plaintiffs’ complaint alleges.
In plaintiffs’ motion for summary judgment, plaintiffs cite the CLAS Standards, promulgated by the U.S. Department of Health and Human Services. CLAS stands for the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care.
Plaintiffs argue that the CLAS Standards are part of the medical standard of care that apply to the health care provided to patients. By not providing Navajo language assistance, plaintiffs argue, San Juan Regional Medical Center violated the standard of care for its patients. “These [CLAS] standards were generally accepted within the medical community as a minimum level of medical care that must be delivered by a healthcare provider,” according to the motion.
As the motion also states:
“It was standard of care for a provider to document the verbal and written communication of the information described in CLAS Standards 5 and 6.
CLAS Standards 9 and 10 called for SJRMC to “establish culturally and linguistically appropriate goals, policies, and management accountability, and infuse them throughout the organization’s planning and operations” and to “conduct ongoing assessments of the organization’s CLAS-related activities and integrate CLAS-related measures into measurement and continuous quality improvement activities.”
Given the age of the CLAS Standards (2000, revised 2013), SJRMC should have had policies and ongoing assessments in place well before the 2018 date of incident. However, in response to Plaintiffs’ request for a description of all measures that SJRMC took in the four years leading up to 2/7/18 to comply with the CLAS Standards, SJRMC identified only a two-page policy statement created in 2021, long after the time frame in question.”
The applicable CLAS Standards state:
Communication and Language Assistance:
- Offer language assistance to individuals who have limited English profciency and/or other communication needs, at no cost to them, to facilitate timely access to all health care and services.
- Inform all individuals of the availability of language assistance services clearly and in their preferred language, verbally and in writing.
- Ensure the competence of individuals providing language assistance, recognizing that the use of untrained individuals and/or minors as interpreters should be avoided.
- Provide easy-to-understand print and multimedia materials and signage in the languages commonly used by the populations in the service area. Engagement, Continuous Improvement, and Accountability:
- Establish culturally and linguistically appropriate goals, policies, and management accountability, and infuse them throughout the organization’s planning and operations.
- Conduct ongoing assessments of the organization’s CLAS-related activities and integrate CLAS-related measures into measurement and continuous quality improvement activities.
https://thinkculturalhealth.hhs.gov/clas/what-is-clas
The CLAS Standards are based on Title VI of the Civil Rights Act of 1964. Title VI prohibits discrimination on the basis of race, color, or national origin in any program or activity that receives federal funds or other federal financial assistance. National origin discrimination includes language based discrimination and the affirmative requirement for federally subsidized hospitals to provide language assistance to LEP people.
Plaintiffs’ complaint in this case does not allege Title VI national origin discrimination or seek damages for any Title VI federal civil rights violations.
© Bruce L. Adelson 2023. All Rights Reserved The material herein is educational and informational only. No legal advice is intended or conveyed.
Bruce L. Adelson, Esq., is nationally recognized for his compliance expertise. Mr. Adelson is a former U.S Department of Justice Civil Rights Division Senior Trial Attorney. Mr. Adelson is a faculty member at the Georgetown University School of Medicine and University of Pittsburgh School of Law where he teaches organizational culture, implicit bias, cultural and civil rights awareness.
Mr. Adelson’s blogs are a Bromberg exclusive.