To the Editor:We applaud the publication of the report regarding a 65-year-old woman who underwent an incorrect operation on the left hand, and we commend Ring et al. (Nov. 11 issue) 1 for making the case public. We agree with the discussion noting that the patient's limited English proficiency contributed to this error. Limited English proficiency has been associated with medication errors 2 and with a lack of informed consent for invasive procedures. 3 Limited English proficiency may also be associated with procedural errors when safety strategies, such as checklists or "time-outs," are not appropriately modified to surmount language barriers, as was apparently the case here. We suggest that operating room checklists prompt the staff to call for professional interpreters when the patient has limited English proficiency; this will allow both the surgeon and the staff to follow routine safety protocols. This modification has been incorporated into informed-consent checklists elsewhere. 4 In addition, although Ring may have excellent Spanish skills, many physicians choose to get by with limited skills, thereby placing patients at risk. 5,6 Hospitals will need to increase their capacity to provide timely professional interpretation if they wish to eliminate ethnic disparities in patient safety.University of California, San Francisco San Francisco, CA afernandez@medsfgh.ucsf.edu No potential conflict of interest relevant to this letter was reported. The discussants reply: Fernandez et al. detail the importance of limited English proficiency as a contributing factor to the case we reported. Our hospital policy for medical-interpretation services discourages the use of staff members as medical interpreters. We identified multiple opportunities to get our medical-interpreter service involved in mitigating the risks identified here. These opportunities included having the surgeon's office schedule an interpreter for the day of surgery, paging the available interpreter at the time of surgery, and using our phone and video interpreter programs. As noted by Fernandez et al., availability is not enough. We need to hardwire the use of interpreter services into our clinical operations. The suggestion to include an additional element of safety related to universalprotocol performance in procedures involving patients with limited English proficiency is an excellent one that we will incorporate into an upcoming policy revision.
Case Records of the Massachusetts General
Quantifying Oxidant-Scavenging Ability of BloodTo the Editor: Screening the voluminous literature describing the quantifications of antioxidant levels in patients with various clinical disorders and after the administration of supplements has revealed that nearly all the studies have exclusively involved measurements in plasma. Since the classic tests have mainly quantified levels of low-molecular-weight antioxidants and albumin in human plasma but not those associated with erythrocyte enzymes and hemoglobin, such studies have not taken into account the ro...