IN THE UNITED STATES DISTRICT COURT
DISTRICT FOR THE DISTRICT OF ARIZONA





Mark A. Bourdon,

Plaintiff,

United States of America,

Plaintiff-Intervenor,

v.

Scott T. Croft, M.D. et al.,

Defendants.


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No. CV-02-1233-PHX-FJM



CONSENT DECREE AND FINAL JUDGEMENT









The court grants the Joint Motion to Enter Consent Decree, as amended. The Attorney General of the United States intervened in this action against Arizona Bone & Joint Specialists, Ltd., Scott T. Croft, M.D. (Croft), and Lisa M. Croft (collectively, the “Defendants”) for their alleged violations of Title III of the Americans with Disabilities Act (ADA), 42 U.S.C. §§ 12181-12189, and section 504 of the Rehabilitation Act, 29 U.S.C. § 794. The United States and Plaintiff Mark A. Bourdon alleged that Defendants Arizona Bone & Joint Specialists, Ltd. and Dr. Croft operated their offices in violation of Section 302 of the ADA, 42 U.S.C. § 12182, and section 504 of the Rehabilitation Act, 29 U.S.C. § 794, because they denied Mark Bourdon, who has HIV disease, equal access to benefits and services. This Consent Decree (“Decree”) resolves all of the United States’ and Plaintiff Mark Bourdon’s allegations against the Defendants.

JURISDICTION AND VENUE

1. The Court has jurisdiction over this action under 28 U.S.C. §§ 1331 and 1345, 42 U.S.C. § 12188(b)(1)(B), and 29 U.S.C. § 794. The Court may grant the relief sought in this action pursuant to 29 U.S.C. § 794, 42 U.S.C. § 12188(b)(2), and 28 U.S.C. §§ 2201 and 2202.

2. Venue is proper in this district pursuant to 28 U.S.C. § 1391, since a substantial part of the acts and omissions giving rise to this action occurred in Maricopa County, Arizona. CONTENTIONS OF THE PARTIES

3. Arizona Bone & Joint Specialists, Ltd. is an orthopaedic and sports medicine practice with professional offices in Phoenix and Scottsdale, Arizona. Arizona Bone & Joint Specialists, Ltd. offices provide health care services, and the operations of these offices affect commerce; Arizona Bone & Joint Specialists, Ltd. is, therefore, a public accommodation within the meaning of 42 U.S.C. § 12181(7)(F), and a place of public accommodation within the meaning of 28 C.F.R. § 36.104.

4. Arizona Bone & Joint Specialists, Ltd. receives federal funds in the form of Medicaid and Medicare payments and is thus a federally assisted program within the meaning of Section 504 of the Rehabilitation Act, 29 U.S.C. § 794.
5. Dr. Croft is a practicing board-certified orthopaedic surgeon, and is a vice president and shareholder of Arizona Bone & Joint Specialists, Ltd. Dr. Croft practices at one or more Arizona Bone & Joint Specialists, Ltd. offices where medical services are provided in the State of Arizona, including offices located in Phoenix and Scottsdale, Arizona. Dr. Croft is a public accommodation because he owns, leases (or leases to), or operates Arizona Bone & Joint Specialists, Ltd. offices, which are places of public accommodation. See 42 U.S.C. § 12182(a); 28 C.F.R. § 36.104.

6. At all times relevant to this action, Dr. Croft’s office received Federal financial assistance for his medical service to patients.

7. Lisa M. Croft is the wife of Scott T. Croft, M.D. She was included as a defendant in this action only because her community property may be attached to satisfy any judgment awarded in this action.

8. The United States Department of Justice ("Department") is the federal
agency responsible for bringing litigation to enforce Title III of the Americans with Disabilities Act, 42 U.S.C. §§ 12181-12189, and section 504 of the Rehabilitation Act with respect to recipients of federal financial assistance, 29 U.S.C. § 794.

9. Mark Bourdon has HIV disease and is an individual with a disability as defined in the ADA, 42 U.S.C. § 12102(2); 28 C.F.R. § 36.104.

10. Mr. Bourdon alleges that he sought medical treatment from Dr. Croft for chronic shoulder pain on May 19, 2000. He alleges that he revealed his HIV status to Dr. Croft during the examination. Mr. Bourdon alleges that Dr. Croft indicated that, should nonsurgical treatment fail to relieve Mr. Bourdon’s shoulder pain, surgical intervention would be necessary to correct Mr. Bourdon’s shoulder condition. Mr. Bourdon alleges that he then embarked upon a course of physical therapy and reduced exercise for six weeks, but that this course of treatment failed to relieve his shoulder pain. He alleges that when he returned to Dr. Croft on July 6, 2000, Dr. Croft indicated that he would not perform surgery on Mr. Bourdon because of the risk of HIV exposure and infection to Dr. Croft, his staff, and his family.

11. Mr. Bourdon filed a separate complaint against the Defendants on July 2, 2002, in the District of Arizona, asserting a claim under Section 504 of the Rehabilitation Act and two state law claims.

12. Defendants denied all allegations of discrimination in their separate Answer to Plaintiff’s Complaint.

13. Mr. Bourdon filed a letter of complaint with the Department against the Defendants on December 22, 2000, asserting a claim under Title III of the Americans with Disabilities Act.

14. The Department investigated Mr. Bourdon’s allegations and concluded that Mr. Bourdon was denied surgery and other medical services while he was an Arizona Bone & Joint Specialists, Ltd. patient because of his HIV status in violation of Title III and section 504.

15. The United States sought permission to intervene in this action and lodged a Complaint in Intervention on March 4, 2003, because the Attorney General had reasonable cause to believe that the Defendants discriminated against Mr. Bourdon and that this discrimination raised issues of general public importance. See 42 U.S.C. § 12188(b)(1)(B). This Court granted the United States permission to intervene on April 17, 2003.

16. The United States’ Complaint in Intervention alleges that the Defendants unlawfully denied Mr. Bourdon medical services, including surgery, in violation of section 302 of the ADA, 42 U.S.C. §§ 12182, and its implementing regulation, 28 C.F.R. Part 36, and Section 504 of the Rehabilitation Act, 29 U.S.C. § 794, and its implementing regulation, 45 C.F.R. § 84.4(b)(1). The United States seeks declaratory and injunctive relief, damages, and civil penalties against the Defendants. Specifically, the United States’ Complaint in Intervention alleges that the Defendants’ violations of Title III include, but are not necessarily limited to:

A. Denying Mr. Bourdon, on the basis of his HIV disease, the opportunity to participate in or benefit from goods, services, facilities, privileges, advantages, or accommodations of the Defendants, in violation of 42 U.S.C. § 12182(b)(1)(A)(i) and 28 C.F.R. § 36.202(a);

B. Affording Mr. Bourdon, on the basis of his HIV disease, the opportunity to participate in or benefit from a good, service, facility, privilege, advantage, or accommodation that is unequal to that afforded to other individuals, in violation of 42 U.S.C. § 12182(b)(1)(A)(ii) and 28 C.F.R. § 36.302(b);

C. Imposing or applying eligibility criteria for the privilege or advantage of receiving medical services that screen out or tend to screen out persons with disabilities, including persons with HIV disease, from fully and equally enjoying the goods, services, facilities, privileges, advantages, or accommodations being offered by the Defendants, in violation of 42 U.S.C. § 12182(b)(2)(A)(i) and 28 C.F.R. § 36.301(a); and

D. Failing to make reasonable modification in policies, practices, or procedures where such modification is necessary to afford such goods, services, facilities, privileges, advantages, or accommodations to persons with HIV disease, in violation of 42 U.S.C. § 12182(b)(2)(A)(ii) and 28 C.F.R. § 36.302(a).

17. Specifically, the United States’ Complaint in Intervention alleges that the Defendants’ violations of Section 504 include, but are not necessarily limited to:

A. Denying Mr. Bourdon, on the basis of his HIV disease, the opportunity to participate in or benefit from the aids, benefits, or services of the Defendants, in violation of 29 U.S.C. § 794 and 45 C.F.R. § 84.4(b)(1)(i);

B. Affording Mr. Bourdon, on the basis of his HIV disease, the opportunity to participate in or benefit from an aid, benefit, or service that is unequal to that afforded to other individuals, in violation of 29 U.S.C. § 794 and 45 C.F.R. § 84.4(b)(1)(ii);

C. Utilizing criteria for the privilege or advantage of receiving medical services that have the effect of subjecting qualified persons with disabilities, including persons with HIV disease, to discrimination on the basis of disability, in violation of 29 U.S.C. § 794 and 45 C.F.R. § 84.4(b)(4)(i); and

D Otherwise limiting qualified persons with disabilities, including persons with HIV disease, in the enjoyment of the rights, privileges, advantages, or opportunities enjoyed by others receiving aids, benefits, or services from the Defendants, in violation of 29 U.S.C. § 794 and 45 C.F.R. § 84.4(b)(1)(vii).

18. In order to avoid the costs, expense, and uncertainty of protracted litigation,
the parties agree to the terms set forth herein and to entry of this Decree. The parties agree that settlement of these matters without further litigation is in the public interest and that entry of this Decree is the most appropriate means of resolving these matters. Accordingly, they agree to the entry of this Decree without trial or further adjudication of any issues of fact or law. The parties further agree that by entering into settlement, these Defendants do not admit the allegations of discrimination or any other allegations. All such allegations are specifically denied.

The parties agree to the Court’s entry of this Decree, which provides as follows:

19. Definitions

19.1 “Medical staff” means any physician or other professional who provides patient care services at Arizona Bone & Joint Specialists, Ltd.

19.2 “Patient” means any person presenting to Arizona Bone & Joint Specialists, Ltd. for health care services, whether those services are provided at its current locations in Phoenix and Scottsdale, Arizona, or are provided by or on behalf of Arizona Bone & Joint Specialists, Ltd. at another location.

19.3 Having “HIV disease” means (1) having tested positive for antibodies to the Human Immunodeficiency Virus (HIV); (2) being infected with HIV; (3) having Acquired Immune Deficiency Syndrome (AIDS); or (4) having any AIDS-related opportunistic infection. For purposes of this Decree, having HIV disease also means having a record of being in one of the four categories listed above; being perceived or regarded as being in one of the first four categories listed above; or having a known association with an individual who may be included in one of these categories.

Injunctive Relief

20. Non-Discrimination. Arizona Bone & Joint Specialists, Ltd. by and through its physicians, agents and employees, shall not engage in any act or practice that has the purpose or effect of unlawfully discriminating against any person having HIV disease, in violation of Title III of the ADA and section 504 of the Rehabilitation Act.

21. Equal Treatment. Arizona Bone & Joint Specialists, Ltd. and its physicians, agents and employees, shall treat persons who have HIV disease in a manner equal to that in which they treat persons who do not have HIV disease. Thus, Arizona Bone & Joint Specialists, Ltd. physicians and other professional staff shall provide medical services to persons who have HIV disease, and shall not refer such persons to other physicians because the person has HIV disease.

22. Policy. Within sixty days of the date of entry of this Decree, Arizona Bone & Joint Specialists, Ltd. shall adopt a policy specifically regarding nondiscrimination against persons who have HIV disease. Arizona Bone & Joint Specialists, Ltd. shall communicate this policy, attached as Appendix A to this Decree, to all of its physicians and other professional staff, both orally and in writing. Arizona Bone & Joint Specialists, Ltd. shall require compliance with this policy as a condition of employment.

23. Notice. In the waiting room of any office operated by Arizona Bone & Joint Specialists, Ltd. and in a web page maintained upon any website operated by Arizona Bone & Joint Specialists, Ltd., Arizona Bone & Joint Specialists, Ltd. shall prominently display the following non-discrimination notice:

This office does not discriminate against any person on the basis of disability, including persons who have HIV disease or AIDS. Our staff provides services and treatment to persons with a disability, including those with HIV disease and AIDS, on the same terms and conditions that such services are provided to patients who do not have a disability.

The Americans with Disabilities Act of 1990 is a federal law that protects persons with disabilities, including individuals who have HIV disease or AIDS, from discrimination in the provision of medical services. If you believe that you have been discriminated against in the provision of medical services because you have a disability, including HIV disease or AIDS, you should contact the United States Department of Justice in Washington, D.C. at 1-800-514-0301 or 1-800-514-0383 (TTY).

24. Disciplinary Action. In accordance with its standard policies and procedures, Arizona Bone & Joint Specialists, Ltd. shall undertake disciplinary actions in any instance where any person responsible for complying with the nondiscrimination policy stated in Appendix A has failed to comply with it. Such disciplinary actions may include termination.

25. Training. Within four months of the date of entry of this Decree, all Arizona Bone & Joint Specialists, Ltd. medical staff shall undergo at least three hours of training, to include presentations on medical treatment of persons with HIV disease; infection control procedures in the workplace; the ethical duty to treat persons with HIV disease; the nondiscrimination policy stated in Appendix A; and the nondiscrimination provisions of Title III of the ADA and section 504 of the Rehabilitation Act. The format and content of the training are to be submitted to the Department in the form of a script or outline for its approval. The script or outline shall be submitted to the Department at least sixty days before the scheduled commencement of the first training. New medical staff employees will be similarly trained in this area.

26. Approval of Script or Outline. In the event that the Department does not agree to the form and content of the relevant portions of the training as set forth in the script or outline, the Department will notify Arizona Bone & Joint Specialists, Ltd. in writing, of the specific provisions that it finds unacceptable no later than thirty days after receiving the script or outline submitted by Arizona Bone & Joint Specialists, Ltd. Arizona Bone & Joint Specialists, Ltd. will have thirty days to make changes to the portions of the outline or script specified. In the event that Arizona Bone & Joint Specialists, Ltd. does not agree to make changes that will make the script or outline satisfactory to the Department, it shall set forth its reasoning for such refusal in writing within thirty days. If the Department determines that the script or outline is still inadequate, it may seek enforcement of the Decree in the manner set forth in Paragraphs 31-37.

27. Compensation for the Individual Plaintiff. Arizona Bone & Joint Specialists, Ltd. agrees to pay Mr. Mark Bourdon the sum of $120,000. Within thirty days of the date of entry of this Decree, Arizona Bone & Joint Specialists, Ltd. shall send to counsel for Mr. Bourdon, return receipt requested, a release form, the contents of which are similar in content to Appendix B. Counsel for Defendants will submit a draft to the United States for approval. Within thirty days of receiving a signed release form, Arizona Bone & Joint Specialists, Ltd. shall send, return receipt requested, a check for the full amount due to Mr. Bourdon. Simultaneous to the mailing of the check, Arizona Bone & Joint Specialists, Ltd. shall provide the Department with a copy of the signed release and check disbursed to Mr. Bourdon.

28. Civil Penalties. Within thirty days after the entry of this Decree, Arizona Bone & Joint Specialists, Ltd. and Dr. Scott Croft shall each make a payment in the amount of $10,000 to the United States, pursuant to 42 U.S.C. § 12188(b)(2)(C) and 28 C.F.R. § 36.504(a)(3)(i).

29. Notice, Reporting, and Monitoring Requirements. The Department shall have the right, upon reasonable notice, to inspect and copy, at the Department’s expense, any and all Arizona Bone & Joint Specialists, Ltd. records related to its obligations stated in this Decree. The Department will state in writing the reason for inspection of any patient files or records. Patient files and records to be inspected will have patients' names, addresses, and other identifying information redacted, and those patients will be identified by patient number only. Patients' confidentiality and privacy rights will be maintained consistent with 5 U.S.C. § 552a(b) and any other applicable federal or state laws. The Department will use patient information gathered pursuant to this paragraph only for purposes of monitoring and enforcing Arizona Bone & Joint Specialist’s, Ltd. compliance with this Decree, Title III of the ADA, and section 504 of the Rehabilitation Act.

30. Six months and one year following the date of entry of this Decree, Arizona Bone & Joint Specialists, Ltd. shall provide the Department with written progress reports setting forth in detail the progress made regarding each of the steps Arizona Bone & Joint Specialists, Ltd. is required to take pursuant to this Decree.

31. During the time that this Decree is in effect, Arizona Bone & Joint Specialists, Ltd. shall notify the Department if any individual files any lawsuit, complaint or written allegation alleging discrimination on the basis of disability by Arizona Bone & Joint Specialists, Ltd. or any of its physicians or other professional staff. Such notification shall be provided in writing within ten days of when Arizona Bone & Joint Specialists, Ltd. has received a written notice of a filed complaint and shall include, at a minimum, information describing the nature of the allegation, the name of the individual making the allegation, and any documents possessed by Arizona Bone & Joint Specialists, Ltd. relevant to the allegation.

Implementation and Enforcement of the Consent Decree


32. This Decree shall be a full, complete, and final disposition and settlement of all of the United States’ claims arising out of the Complaint in Intervention and Plaintiff Mark Bourdon’s Complaint. This Decree shall also be a full, complete and final disposition of all state claims arising from Plaintiff Mark Bourdon’s complaint.

33. This Decree and the exhibits attached hereto constitute the entire agreement between the parties on the matters raised herein, and no other statement, promise, or agreement, either written or oral, made by any of the parties or agents of any of the parties, that is not contained in this written Decree, shall be enforceable unless that statement, promise, or agreement is in any conciliation agreement between the State of Arizona and the Defendants, to resolve any issue arising from the reasonable cause determination issued by the Office of the Arizona Attorney General on December 15, 2003, that adopts or incorporates the terms of this Decree by reference. Plaintiff Mark Bourdon agrees to sign a release form under any conciliation agreement in addition to the release form he is required to sign under Paragraph 27 of this Decree. This Decree does not purport to resolve any other potential violations of Title III of the ADA, section 504 of the Rehabilitation Act, or any other federal law other than those arising from the allegations of Plaintiff’s Complaint and the Complaint in Intervention referenced herein. This Decree does not affect the continuing responsibility of Arizona Bone & Joint Specialists, Ltd. to comply with all aspects of the ADA, the Rehabilitation Act, and any other applicable laws. It also does not affect in any way the Department’s ability to enforce any provision of the ADA or any other civil rights law with regard to Arizona Bone & Joint Specialists, Ltd. at any time except as specifically stated herein. No other contract or agreement that conflicts with the terms stated herein shall in any way limit this Decree or any of its provisions.

34. The Department may review Defendants’ compliance with their obligations under this Decree at any time. If the Department believes that this Decree or any provision of it has been violated, the Department shall promptly advise Arizona Bone & Joint Specialists, Ltd. in writing of the nature of that violation. Within thirty days of receipt by Arizona Bone & Joint Specialists, Ltd. of written notice from the Department, Defendant shall resolve the violation and report in writing its resolution to the Department. In the event that the resolution is not to the satisfaction of the Department, the Department may seek enforcement of the terms of the Decree in this Court. In the event the Court determines that the Defendants have failed to comply with any term in this Decree, Defendants agree that such failure to comply may constitute a subsequent violation of Title III of the ADA, and that the United States may seek, and the Court may assess, a civil penalty as provided in 42 U.S.C. § 12188(b)(2)(C)(ii). Alternatively, the Department may bring an action to enforce compliance with the ADA and its implementing regulations in any United States District Court where jurisdiction and venue are proper.

35. Failure by the United States to seek enforcement of or relief under this Decree, or any of its provisions, shall not be construed as a waiver of the United States’ rights under this Decree.

36. If any term of this Decree is determined by any court to be unenforceable, the other terms of this Decree shall nonetheless remain in full force and effect.

37. This Decree shall remain in effect for five years after the date of its entry.

38. The United States’ Complaint in Intervention and Plaintiff Mark Bourdon’s Complaint against the Defendants shall be dismissed with prejudice, except that the United States may petition the Court, at any time during the duration of this Decree, to enforce the Decree, and this Court shall have jurisdiction to enforce this Decree as it would any other final judgement. The parties to this Decree shall endeavor in good faith to resolve informally any differences regarding interpretation of and compliance with this Decree prior to bringing such matters to the Court for resolution.

Authorization of Signatories

39. A signer of this document, in a representative capacity for a partnership, corporation, or other entity, including a governmental agency, represents that he or she is authorized to bind such partnership, corporation, or other entity or agency to the terms of this Decree.

Notice to Parties

40. In any instance where this Decree requires that notice be given or progress reports provided to any or both of the parties, such notice shall be provided in writing, sent via hand-delivery or certified or registered U.S. Mail, return receipt requested, to the following individuals in their capacities as representatives of the parties to this Decree:

Martha Ching
Chief Financial Officer
Arizona Bone & Joint Specialists, Ltd.
13640 North 7th Street
Phoenix, AZ 85022
(602) 863-2040

Cristina M. Chait, Esq.
Jones, Skelton & Hochuli, P.L.C.
2901 North Central Avenue, Suite 800
Phoenix, AZ 85012
(602) 263-7391

John L. Wodatch, Section Chief
Disability Rights Section
Civil Rights Division
U.S. Department of Justice
950 Pennsylvania Avenue N.W.
New York Avenue Building, Room 4039
Washington, DC 20530
Attn: Eugenia Esch
(202) 514-3816

41. Successors in Interest

This Decree shall be binding on Arizona Bone & Joint Specialists, Ltd., its parents, controlled affiliates, agents, and subsidiaries. Arizona Bone & Joint Specialists, Ltd. has a duty to notify any successors in interest of these obligations and to obtain, in any future transfer of any right or interest in subject to this Decree, agreement to comply with this Decree.

42. Disclosure of Consent Decree and Appendices

No disclosure of this Decree will be made by Plaintiff Mark Bourdon except that disclosure may be made (1) to Mr. Bourdon’s accountant, financial advisor, tax attorney, and/or preparer of tax returns, (2) to the Board of Directors of the Arizona Center for Disability Law, (3) to agencies that provide funding to the Arizona Center for Disability Law and (4) where required by law. Arizona Bone & Joint Specialists, Ltd. shall either provide a copy of this Decree upon request or refer any person who inquires about obtaining a copy of this Decree to the Department of Justice at the address and telephone number listed in paragraph 40 of this Decree.

43. Headings

The headings in this Decree are for convenience only and shall not be deemed to affect in any way the language of the provision to which they refer.

44. Retaliation and Coercion

Defendants agree not to retaliate against or coerce in any way any individual who is trying to exercise his or her rights under this Decree, the ADA, or the Rehabilitation Act.

Agreed and consented to:
FOR ARIZONA BONE &
JOINT SPECIALISTS, LTD:

BY:__________________________
Martha Ching
Chief Financial Officer
Arizona Bone & Joint Specialists, Ltd.
13640 North 7th Street
Phoenix, AZ 85022


______________________________
Date


BY:___________________________
Scott T. Croft, M.D.
Arizona Bone & Joint Specialists, Ltd.
5620 East Bell Road
Scottsdale, Arizona 85254



BY:___________________________
Cristina M. Chait
Jones, Skelton & Hochuli, PLC
2901 North Central Avenue, Suite 800
Phoenix, Arizona 85012



BY:___________________________
Stephen F. Palevitz
Arizona Center for Disability Law
100 North Stone, Suite 305
Tucson, Arizona 85701






_______________________________
Date
FOR UNITED STATES OF AMERICA
R. Alexander Acosta
Assistant Attorney General

John L. Wodatch, Chief
L. Irene Bowen, Deputy Chief
Philip L. Breen, Special Legal Counsel



BY:_____________________________
Eugenia Esch
Heather A. Wydra
Trial Attorneys
Disability Rights Section
Civil Rights Division
U.S. Department of Justice
950 Pennsylvania Avenue, NW
Washington, DC 20530


Paul K. Charlton
United States Attorney
District of Arizona



BY:____________________________
Ronald R. Gallegos
Assistant United States Attorney
Two Renaissance Square
40 North Central Avenue, Suite 1200
Phoenix, Arizona 85004-4408



BY:____________________________
Mark A. Bourdon
10410 N. Cave Creek Road, #2040
Scottsdale, Arizona 85254


________________________________
Date



IT IS SO ORDERED this _____12th___day of __February___________, 2004.
This action is dismissed with prejudice. This is a final judgement. The clerk is directed to enter final judgement on its docket. The case is terminated.

________________________________________
Frederick J. Martone
United States District Judge

APPENDIX A

PATIENTS WITH HIV DISEASE

1. Policy. It is the policy of Arizona Bone & Joint Specialists, Ltd, that medical treatment shall not be denied or withheld on the basis of the patient’s HIV disease status. Having HIV disease means (1) having tested positive for antibodies to the Human Immunodeficiency Virus (HIV); (2) being infected with HIV; (3) having Acquired Immune Deficiency Syndrome (AIDS); or (4) having any AIDS-related opportunistic infection. Any employee, contractor, or other member of the Arizona Bone & Joint Specialists, Ltd. medical staff refusing to follow this policy shall be subject to termination.

2. Example and Discussion. For example, a physician may not refuse to perform surgery or another procedure or discourage surgery or another procedure for a patient because the patient has HIV disease. If a physician has a question about whether surgery or another procedure would benefit a patient with HIV disease, and if the procedure would be indicated in the absence of such condition, the physician shall request appropriate consultation with an infectious disease specialist or other appropriate specialist as time and circumstances permit, before making a final decision or recommendation to the patient.

3. Universal Precautions. “Universal Precautions,” as outlined in infection control guidelines published by the federal Centers for Disease Control (CDC), and other special precautions as appropriate, address the manner in which Arizona Bone & Joint Specialists, Ltd., medical staff may resolve concerns about their risk of exposure to infectious diseases. Universal Precautions are designed to address real or perceived risks of surgery or other procedures for patients with infectious diseases. Such concerns may not, therefore, influence treatment decisions or recommendations to a patient with an infectious disease.

APPENDIX B

RELEASE OF ALL CLAIMS


For and in consideration of the acceptance of the relief offered to me by Arizona Bone & Joint Specialists, Ltd., pursuant to the Consent Decree between the United States of America and Arizona Bone & Joint Specialists, Ltd. in United States Department of Justice Matter Number 202-35-99:

I, Mark A. Bourdon, release and discharge Arizona Bone & Joint Specialists, Ltd., and its current, former, and future agents, employees, officials, and designees, of and from all legal and equitable claims under Title III of the Americans with Disabilities Act and section 504 of the Rehabilitation Act related to my treatment by Arizona Bone & Joint Specialists, Ltd. from May 19, 2000, to July 6, 2000, inclusive.

I understand that the payment offered to me does not constitute an admission by Arizona Bone & Joint Specialists, Ltd. of the validity of any claim raised by me or on my behalf.

I acknowledge that a copy of the Consent Decree resolving the matter between the Parties has been made available to me.

I HAVE READ THIS RELEASE AND UNDERSTAND THE CONTENTS THEREOF AND I EXECUTE THIS RELEASE OF MY OWN FREE ACT AND DEED.

Signed this ______ day of _________________, 2004.


___________________________________
Mark A. Bourdon


Subscribed and sworn to before me this

____________ day of _____________, 2004.
________________________________
Notary Public

My Commission expires on: ________________________________






March 12, 2004