New research has found that one in five Asian patients at Waikato Hospital who needed an interpreter did not get one before signing a consent form for surgery, raising fresh questions about how the public health system looks after people who do not speak fluent English.
The study, published in the New Zealand Medical Journal on Friday, reviewed the records of more than 540 Asian patients treated at the Hamilton hospital across 2022 and 2023. Of that group, 173 were identified as having limited English proficiency. While 136 of them, or 79 percent, were given a professional interpreter when they were asked to consent to a procedure, 37 patients, or 21 percent, were not.
A smaller group of 14 patients, around 2.6 percent of everyone in the review, were flagged by clinicians as likely to have trouble understanding English yet received no interpreter support at all. The researchers argued that this gap matters a great deal, because consent that is signed without genuine understanding is not really consent.
As RNZ reported, the analysis showed that patients left without language support can struggle to follow what they are being told, which leads to higher anxiety, a greater chance of misunderstanding and a real risk that the consent they give does not meet the standard the law expects.
The work was carried out by Pablo Ritchly, a consultation-liaison psychiatrist at Waikato Hospital, alongside Samantha Turnwald from the University of Auckland’s Faculty of Medical and Health Sciences and David Menkes from the university’s Department of Psychological Medicine. Their central message was that the safest approach is to remove the guesswork. Where there is any doubt about whether a patient understands English well enough to make a serious medical decision, an interpreter should simply be brought in.
The authors recommended that hospitals adopt policies “mandating interpreter use for all patients with suspected as well as definite limited English proficiency, reducing reliance on clinician discretion.” In plain terms, the call is to stop leaving the decision to a busy clinician’s judgement in the moment and instead make professional interpreting the default whenever a language barrier is even suspected.
One pattern in the data stood out. Indian patients were significantly less likely than other Asian patients to be offered language support, a finding the researchers said deserves closer attention given how many people it could affect. The study did not pin down a single cause, but it points to the danger of assuming that someone who can manage everyday conversation in English can also follow the detailed and often stressful information that comes with surgery.
The patients who needed interpreters were also noticeably older. Their average age was 65.4 years, compared with 47.4 years for the patients who were comfortable in English. That age gap makes the group more vulnerable on two fronts at once. Older patients tend to face more complex operations and more serious risks, and they are also more likely to be navigating an unfamiliar medical system in a language they learned later in life, if at all.
The right to understand what is happening to you is not simply good manners. New Zealand’s Code of Health and Disability Services Consumers’ Rights guarantees every patient the right to effective communication, including the right to a competent interpreter when one is needed. When a hospital asks someone to sign for a procedure they cannot fully understand, it is not only a clinical problem. It sits awkwardly against a right that every person in the country is supposed to be able to rely on.
While the study focused on Asian patients, the underlying issue is language rather than ethnicity, and the fix would help anyone who arrives at a hospital without strong English. That includes recent migrants, refugees, seasonal workers and older New Zealanders who have lived here for decades but never needed to discuss surgical risk in a second language. A clear rule that interpreters are provided by default, rather than offered only when a clinician thinks to ask, lifts the standard of care for all of them at once.
The findings also land at a moment when the numbers are heading in one direction. According to the 2023 Census, there were already 34,308 Chinese and 18,720 Indian residents aged 65 and over. Stats NZ projects the Asian population aged 65 and over will grow more than fourfold, from around 72,900 to 299,800 by 2048, including roughly 120,700 Chinese and 80,500 Indian older people. A health system that already misses one in five patients who need an interpreter will find that gap widening unless interpreting is built into the way hospitals work.
Professional interpreting is not free, and it does add a step to an already crowded surgical schedule. But the researchers’ argument is that the cost of getting it wrong is higher still, measured in distressed patients, decisions made without real understanding and the legal exposure that comes when informed consent is not properly obtained. Phone and video interpreting services have made it far easier than it once was to reach a qualified interpreter quickly, which weakens the old excuse that there was no one available in time.
For now the study is a snapshot of one large hospital over two years, not a verdict on the whole country. But the people who carried it out clearly hope it prompts a wider look at how consistently interpreters are offered across the public system, and whether the current reliance on individual judgement is good enough when so much can ride on a single conversation.
Have you or someone in your family struggled to understand a medical conversation in English, or had a good experience with a hospital interpreter? Tell us in the comments below. We read every one.
This article was written by AI, briefed to report the facts, hopefully without some of the bias people bring to the job 🙂
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