SETTLEMENT AGREEMENT
BETWEEN
THE UNITED STATES
AND
CENTRAL DUPAGE HOSPITAL
UNDER THE AMERICANS WITH DISABILITIES ACT

 


A. Background and Jurisdiction

1.        The Parties to this Settlement Agreement are the United States and Central DuPage Hospital (the "Hospital").

2.         The Hospital is located at 25 North Winfield Road in Winfield, Illinois, in the Northern District of Illinois.

3.         This matter was initiated by a complaint filed with the United States Attorney's Office for the Northern District of Illinois against the Hospital. The complaint was investigated by the United States Attorney's Office under the authority granted by Title III of the Americans with Disabilities Act ("ADA" or "the Act"), 42 U.S.C. §§ 12188(b)(1)(A)(i).

4.         The United States alleges that the Hospital discriminated against the complainant, who is deaf, by failing to provide appropriate auxiliary aids and services necessary for effective communication. Specifically, the United States alleges that the Hospital violated the ADA, 42 U.S.C. §§ 12181-12189, and the U.S. Department of Justice's implementing regulation, 28 C.F .R. Part 36, when the complainant was not provided with a sign language interpreter, despite her repeated requests, during the time complainant spent in the crisis stabilization unit of the Hospital from September 23 -28, 2005. The Hospital denies these allegations.

5.         The Hospital is a "public accommodation" as defined in section 301(7)(e) of the ADA, 42 U.S.C. § 12181, and its implementing regulation, 28 C.F.R. § 36.104, because it is a private entity that owns, operates, leases or leases to a place of public accommodation, specifically, a hospital. 42 U.S.C. § 12181(7)(A)(F).

6.         The ADA, 42 U.S.C. § 12182(a), prohibits a public accommodation from discriminating on the basis of disability in the full and equal enjoyment of the goods, services, facilities, privileges, advantages, or accommodations by a place of public accommodation. 28 C.F.R. § 36.201(a).

7.         On the basis of its investigation, the United States Attorney's Office has determined that the complainant was denied appropriate services necessary for effective communication, in violation of 42 U.S.C. § 12182(b)(2)(A)(iii) of the Act. The Hospital fully cooperated in the United States' Attorney's Office investigation in this matter and it expressly denies it has violated the ADA. This Agreement shall not be construed as an admission of liability by the Hospital.

8.         The Parties desire to settle this matter without resorting to litigation and have, therefore, entered into this Settlement Agreement. In consideration of the terms of this Settlement Agreement, the United States agrees to refrain from filing a civil suit against the Hospital relating to the allegations contained herein, except as provided in paragraph 55(a).

B. Definitions

9.         The term "Appropriate Auxiliary Aids and Services" includes, for example, qualified sign language, oral, or relay interpreters, note takers, computer-assisted real time transcription services, written materials, the exchange of handwritten notes, telephone handset amplifiers, assistive listening devices, assistive listening systems, telephones compatible with hearing aids, closed caption decoders, open and closed captioning, TTY's (see definition infra), acquisition or modification of equipment or devices, video interpreting services, and other methods of delivering effective communication to individuals with hearing impairments.

10.       The term "Companion" means a person who is deaf or hard of hearing and is one of the following:

a.         a person whom the Patient indicates should communicate with Hospital Personnel about the Patient; participate in any treatment decision; play a role in communicating the Patient's needs, condition, history, or symptoms to Hospital Personnel; or help the Patient act on the information, advice, or instructions provided by Hospital Personnel; or

b.         a person legally authorized to make health care decisions on behalf of the Patient; or

c.         such other person with whom the Hospital Personnel would ordinarily and regularly communicate concerning the Patient's medical condition.

11.       The term "Effective Date of this Settlement Agreement" means the date this Settlement Agreement is signed by both parties.

12.       The term "Hospital Personnel" means all employees and independent contractors with contracts to work on a substantially full-time basis for the Hospital (or on a part-time basis exclusively for the Hospital), including, without limitation, nurses, physicians, social workers, technicians, admitting personnel, billing staff, security staff, therapists, and volunteers, who have or are likely to have direct contact with Patients or Companions as defined herein.

13.       The term "Patient" means a person who is deaf or hard of hearing and is seeking and/or receiving medical services at the Hospital.

14.      The term "Qualified Interpreter" shall include "sign language interpreters," "oral interpreter," or other "interpreters" who are able to interpret competently, accurately, and impartially, both receptively and expressively, using any specialized terminology necessary for effective communication in a Hospital setting to a Patient or Companion. Not all interpreters are qualified for all situations. For example, an interpreter who is qualified to interpret using American Sign Language is not necessarily qualified to interpret orally. Also, someone who has only a rudimentary familiarity with sign language or finger spelling is not a "qualified sign language interpreter." Likewise, someone who is fluent in sign language but who does not possess the ability to process spoken communication into the proper signs or to observe someone signing and change their signed or finger-spelled communication into spoken words is not a qualified sign language interpreter. 

15.       The term "TTY" means a device that is used with a telephone to communicate with persons who are deaf or hard of hearing by typing and reading communications.

C. Prohibition of Discrimination

16.       Nondiscrimination. The Hospital shall provide appropriate auxiliary aids and services, including qualified sign language interpreters, where such aids and services are necessary, to ensure effective communication with deaf and hard of hearing Patients and Companions. Pursuant to 42 U.S.C. § 121S2(a), the Hospital shall also provide deaf and hard of hearing Patients and Companions with the full and equal enjoyment of the services, privileges, facilities, advantages, and accommodations of the Hospital as required by this Settlement Agreement and the ADA.

17.       Discrimination by Association. The Hospital shall not deny equal services, accommodations, or other opportunities to any individual because of the known relationship of the person with someone who is deaf or hard of hearing. See 42 U.S.C. § 12182(b)(1)(E).

18.       Retaliation and Coercion. The Hospital shall not retaliate against or coerce in any way any person who made or is making a complaint according to the provisions of this Settlement Agreement or exercised or is exercising his or her rights under this Settlement Agreement or the ADA. See 42 U.S.C. § 12203.

D. Effective Communication

19.       Provision of Appropriate Auxiliary Aids and Services. Pursuant to 42 U.S.C. § 12182(b)(2)(A)(iii), the Hospital shall provide to Patients and Companions any appropriate auxiliary aids and services that may be necessary for effective communication after making the assessment described below.

20.       Communication Assessment. The Hospital shall consult with individual Patients who are deaf or hard of hearing and Companions wherever possible to determine what type of auxiliary aid or interpretive service is needed to ensure effective communication.

a.         General Assessment Criteria.  The assessment shall take into account all relevant facts and circumstances, including without limitation the following:

1.         The nature, length, and importance of the communication at issue;

2.         The individual's communication skills and knowledge;

3.         The Patient's health status or changes thereto;

4.         The Patient's and/or Companion's request for or statement of need for an interpreter; and

5.         The reasonably foreseeable health care activities of the Patient (e.g., group or individual therapy sessions, medical tests or procedures, rehabilitation services, meetings with health care professionals or social workers, or discussions concerning billing, insurance, self-care, prognoses, diagnoses, history, and discharge).

b.         Time for Assessment.  The determination of which appropriate auxiliary aids and services are necessary for effective communication, and the timing, duration, and frequency with which they will be provided shall begin at the time an appointment is scheduled or on the arrival of the Patient or Companion at the Hospital, whichever is earlier. Hospital Personnel shall perform communication assessments and reassessments and shall detail such information in the Patient's medical chart and hospital logs, including the use of forms designed for that purpose. Hospital Personnel shall reassess the effectiveness of communication as necessary throughout the course of the Patient or Companion's visit. In the event that communication is not effective, Hospital Personnel shall reassess which appropriate auxiliary aids and interpretive services are necessary, in consultation with the Patient or Companion where possible.

21.       Successive Patient Visits.  The Hospital shall, to the extent it has not already done so, implement policies and procedures to expedite arrangements for the provision of auxiliary aids and interpretive services when a Patient or Companion requests appropriate auxiliary aids or services for successive visits to the Hospital. Hospital Personnel shall keep appropriate records that reflect the provision of auxiliary aids and services to Patients and Companions, such as notations in Patients' medical charts. During a Patient or Companion's successive visit, Hospital Personnel shall reference the individual's prior medical records, where available, as part of the Communication Assessment required by Section D.20.

22.       Medical Equipment. Nothing in this Settlement Agreement shall require that an electronic device or equipment constituting an appropriate auxiliary aid be used when or where its use may interfere with medical or monitoring equipment or may otherwise constitute a threat to the patient's medical condition. In such an event, the Hospital shall continue to comply with Sections D.19 and D.20.

23.      Determination Not to Provide Auxiliary Aid or Service.  If, after conducting a Communication Assessment required by Section D.20, Hospital Personnel determine (i) the circumstances do not warrant provision of an auxiliary aid or service; (ii) to provide a different auxiliary aid or service from that preferred by the Patient or Companion; or (iii) to provide an auxiliary aid or service at a time, or for a duration or frequency, different from that preferred by the Patient or Companion, then Hospital Personnel will so advise the person requesting the auxiliary aid or service and shall document (a) the date and time of the denial; (b) the name and title of the Hospital Personnel who made the determination; and (c) the basis for the determination. A copy of this documentation shall be made available to the Patient or Companion when the circumstances allow or upon request, shall be maintained with the log described in Section D.24, infra, and shall be contained in the Patient's medical chart.

24.       Maintenance of Log. The Hospital shall maintain a log of (i) each request for an auxiliary aid or service; (ii) the type of auxiliary aid requested by the Patient or Companion; (iii) the type of auxiliary aid provided by the Hospital; (iv) the time and date the request is made; (v) the identity of the Patient and Companion in a manner that appropriately protects the confidentiality of the Patient; (vi) the name of the Hospital Personnel who performed any communication assessment or reassessment under Section D.20; (vii) the name of the Hospital Personnel responsible for the determination of the auxiliary aids) or service(s) to be provided; (viii) the time and date of the scheduled appointment (if a scheduled appointment was made); (ix) the time and date the auxiliary aid or service was provided, or a statement that the appropriate auxiliary aid or service was not provided and the basis for such determination.

25.       Complaint Resolution/Grievance Procedure.  The Hospital shall maintain a written complaint resolution/grievance procedure regarding the provision, or lack thereof, of auxiliary aids or services to Patients and Companions. The Hospital shall maintain records of all complaints/grievances, whether oral or written, made to the Hospital and actions taken with respect thereto. The Hospital shall post and continue to post at appropriate places, including but not limited to, the Emergency Department waiting room and the Emergency Department triage center, its statement of patient rights and responsibilities, which notifies persons, including those who are deaf or hard of hearing, of the Hospital's complaint resolution/grievance procedure mechanism, to whom complaints should be made, and the right to receive a written response to the complaint if requested. Copies of all complaints/grievances or notes reflecting oral complaints/grievances and the responses thereto shall be maintained by the Hospital. Within four weeks of receipt of the complaint/grievance, the Hospital shall provide a written response to the complaint/grievance, and shall, for grievances relating to the Hospital's responsibilities under the ADA or this Settlement Agreement, provide a copy of both the complaint/grievance and the response to the United States.

26.       Prohibition of Surcharges.  All appropriate auxiliary aids and services required by this Settlement Agreement shall be provided free of charge to the Patient or Companion.

27.       Individual Notice in Absence of Request.  If a Patient or Companion does not request appropriate auxiliary aids or services but Hospital Personnel, following the Communication Assessment required by Section D.20, have reason to believe or conclude that such person would benefit from appropriate auxiliary aids or services for effective communication, the Hospital shall inform the person that appropriate auxiliary aids and services are available free of charge.

28.       Communication with Inpatients and Companions.  The Hospital shall take appropriate steps to ensure that all Hospital Personnel having contact with a Patient or Companion are made aware of such person's disability so that effective communication with such person is achieved. The Hospital shall take appropriate steps to ensure that all Hospital Personnel having contact with a Patient or Companion are aware of the Hospital's effective communication policies.

E. Qualified Interpreters

29.       Circumstances Under Which interpreters Shall Be Provided. The Hospital shall provide Qualified Interpreters to Patients and Companions as necessary for effective communication for its programs, services, and activities. The determination of when such interpreters shall be provided to Patients or Companions shall be made as set forth in Section D.20 (Communication Assessment) above. Examples of circumstances when it may be necessary to provide interpreters include, but are not limited to, the following:

a.         Determination of a Patient's medical history or description of ailment or injury;

b.         Provision of Patients' rights, informed consent or permission for treatment;

c.         Diagnosis or prognosis of ailments or injuries;

d.         Explanation of procedures, tests, treatment, treatment options or surgery;

e.         Explanation of medications prescribed (such as dosage, instructions for how and when the medication is to be taken, and side effects or food or drug interactions);

f.          Explanation regarding follow-up treatments, therapies, test results or recovery;

g.         Blood donations or aphaeresis (removal of blood components);

h.         Discharge planning and discharge instructions;

i.          Provision of mental health evaluations, group and individual therapy, counseling and other therapeutic activities, including grief counseling and crisis intervention;

j.           Explanation of complex billing or insurance issues;

k.          Educational presentations, such as classes concerning birthing, nutrition, CPR, and weight management;

l.           Explanation of living wills or powers of attorney (or their availability);

m.         Filing of administrative complaints or grievances against the Hospital Personnel;

n.          Religious services and spiritual counseling provided by the Hospital; and

o.          Any other circumstance in which a qualified sign language interpreter is necessary to ensure a Patient's privacy, confidentiality, or other rights provided by federal, state, or local law.

The foregoing list is neither exhaustive nor mandatory, and does not imply that an interpreter must always be provided in these circumstances. Nor does it suggest that there are not other circumstances when it may be appropriate to provide interpreters for effective communication.

30.       Method for Obtaining Qualified Interpreters. The Hospital shall strive to continue to engage fifteen (15) local interpreters who can be called directly and are located near the Hospital. If none of these interpreters is available, the Hospital shall continue to engage one of the interpretive services providers (IS Providers), the Chicago Area Interpreter Referral Service (CAIRS) or the Chicago Hearing Society, with whom it has an ongoing relationship.

31. Provision of Interpreters in a Timely Manner.

a.         Scheduled Appointments. For scheduled appointments (appointments scheduled two or more hours in advance, or four or more hours in advance if a request is made between the hours of 8 p.m. and 8 a.m. or a weekend or holiday), the Hospital shall make an interpreter available at the time of the scheduled appointment, if necessary for effective communication.

b.        Non-scheduled Incidents. "Non-scheduled incidents" refer to all situations not covered by the definition of "scheduled appointments." For non-scheduled incidents, in which a patient requests a live (on-site) interpreter, the Hospital shall make an interpreter available as soon as practicable. However, the time within which the live (on-site) interpreter is provided shall be no more than two hours from the time the request is made. Emergency interpreting services pursuant to paragraphs 36 and 37 shall continue to be provided while waiting for an interpreter and shall occur within 30 minutes of the time the Patient's or Companion's request is made.

32.       Force Majeure Events.  Any response time that is delayed from the times set forth above because of a force majeure event is excluded from the determination of whether the prescribed response criteria have been met. Force majeure events are events outside the reasonable control of the Hospital, the IS Provider, or the interpreter called to respond, such as severe weather problems and other Acts of God, unanticipated illness or injury of the interpreter while en route to the Hospital, and unanticipated transportation problems (including, without limitation, mechanical failure of the interpreter's automobile, automobile accidents and roadway obstructions, other than routine traffic or congestion).

33.       Modification of Performance Standards.  In the event that the response time standards set forth above cannot be maintained despite the Hospital's good faith efforts, the Hospital may propose to the United States such modifications as may be reasonable under the circumstances. The United States will consider any such request reasonably and in good faith, and any such modification to which the parties agree will be deemed an amendment to this Settlement Agreement.

34.       Staff Interpreters.  The Hospital may, but has no obligation to, satisfy its obligations under this Settlement Agreement by hiring qualified staff and/or contract interpreters. Staff interpreters and contract interpreters must meet the definition of Qualified Interpreters. Patients and Companions who are provided with staff/contract interpreters must have the same level of coverage (for both duration and frequency) as the Hospital is otherwise obligated to provide under this Settlement Agreement. The Hospital may assign other duties to staff interpreters, but the staff interpreters' performance of those other duties shall not interfere with interpreter coverage responsibilities under this Settlement Agreement.

35.       Notice to Patients and Companions.  As soon as Hospital Personnel have determined that an interpreter is necessary for effective communication with a Patient or Companion, the Hospital shall inform such a person (or a family member or friend, if such Patient/Companion is not available) of the current status of efforts being taken to secure a qualified interpreter on his or her behalf. Additional updates shall be provided periodically thereafter until an interpreter is secured. Notification of efforts to secure a qualified interpreter does not lessen the Hospital's obligation to provide qualified interpreters in a timely manner as required by this Settlement Agreement.

 36.      Video Interpreting Services.  Video interpreting services can provide immediate, effective access to interpreting services seven days per week, twenty-four hours a day in a variety of situations including emergencies and unplanned incidents and can also be used as a stop-gap measure until a qualified interpreter is available. When using video interpreting services, the Hospital shall ensure that a) the service delivers high quality, clear, delay-free full-motion video and audio over a dedicated high-speed Internet connection; b) the service provides a clear and sharply delineated picture of the interpreter's and the Patient's or Companion's heads, arms, hands, and fingers, regardless of the body position of the Patient or Companion; and c) voices being transmitted are clear and easily understood. Provision of Video Interpreting Services shall be provided in accordance with the conditions provided in Exhibit A.

37.       Other Means of Communication.  Between the time when an interpreter is requested and when an interpreter is made available, Hospital Personnel shall continue to try to communicate with the Patient or Companion for such purposes and to the same extent as they would have communicated with the person but for the disability, using the most effective means of communication, particularly Video Interpreting Services, written notes or sign language pictographs. This provision in no way lessens the Hospital's obligation to provide qualified on-site interpreters in a timely manner as required by this Settlement Agreement.

38.       Restricted Use of Certain Persons to Facilitate Communication. Due to considerations of confidentiality, potential emotional involvement, and other factors that may adversely affect the ability to facilitate communication, the Hospital shall not require, coerce, or rely upon a family member, companion, caregiver, case manager, advocate, or friend of a Patient or Companion to interpret or facilitate communications between Hospital Personnel and such Patient or Companion, except that such person may provide such assistance if (i) he or she wishes to do so, and (ii) if the Patient or Companion provides written agreement to the use of such person to interpret or facilitate communication, and (iii) if such use is necessary or appropriate under the circumstances, giving appropriate consideration to any privacy issues that may arise; provided, however, that in time-sensitive life-threatening situations, the Hospital may rely upon communication through a Companion until a Qualified Interpreter is obtained.

F. Other Appropriate Auxiliary Aids and Services

39.Telephones.

a.        Public Telephones. As soon as practicable but no later than ninety (90) days after the Effective Date of this Settlement Agreement, the Hospital shall:

1.         Provide a portable TTY at the desk in the Surgery waiting area at all times. See Standards 4.1.3(17)(c)(iii).

2.         Post a sign at the public phones in the inpatient Crisis Stabilization Unit, which includes the international TDD symbol and gives directions to the TTY at the nurses' station. See Standards 4.30.7(3).

In addition, the Hospital shall:

3.         Maintain the portable TTYs currently at all information desks and the Emergency Department, and the permanent pay TTY at the entrance from the parking garage. See Standards 4.1.3(17).

4.        Maintain all existing signage indicating the location of TTY s. See Standards 4.30.7(3).

b.         Telephones in Patient Rooms.

1.         Timeliness.  The Hospital shall make the equipment required by this section available within 30 to 60 minutes of a Patient's arrival in a Patient room. The Hospital shall notify all relevant Hospital Personnel of the availability and location of this equipment.

2Portable access technology - General Obligations. The Hospital shall continue to make available portable access technology1 for use in rooms of Patients who are deaf or hard of hearing in a manner that is equivalent to telephones provided to hearing patients. In units of the Hospital where Patients normally do not have telephones in their rooms, if hearing patients are given access to common area telephones other than the public phones identified in this Settlement Agreement, the Hospital shall maintain in each such unit appropriate portable access technology that can be used by deaf or hard of hearing Patients and Companions so that such persons have equal access to outgoing calls and incoming calls as that of hearing persons. The Hospital shall ensure that each volume control telephone and each visual notification device for incoming telephone calls complies with the ADA. See 28 C.F.R. § 36.303(d); Standards 4.30.7,4.31.5.
 

40.       Closed Captioning.

a.         The Hospital shall continue to ensure that televisions with built-in captioning capability are available to deaf or hard of hearing Patients and Companions at no additional cost; and that the directions for use of the closed caption capability are clearly stated in the Patient Handbook (or equivalent publication) or otherwise available in each Patient room and public area containing a television with captioning capability. See 28 C.F.R. § 36.303(e).

1 Portable access technology includes TTYs with printout capability, visual notification devices for incoming telephone calls, volume control telephones, and telephones that are hearing aid compatible.

b.        Within ninety (90) days after the Effective Date of this Settlement Agreement, the Hospital shall ensure that all videos or DVDs purchased, obtained, or created by the Hospital and all pre-recorded programs produced by the Hospital for the purpose of providing educational or training information to Patients are closed captioned, whenever closed captioning is available as an option with such product. If closed captioning is not available with such product, the Hospital shall provide written program material that conveys the same information as contained on the video or DVD product for which closed captioning is not available.

G. Notice to Community

41.       Policy Statement. The Hospital shall continue to post and maintain signs of conspicuous size and print at all Hospital main entrance desks and the Emergency Department. Such signs shall continue to be to the following effect: Qualified Interpreters, TTY s, and other auxiliary aids and services are available free of charge to people who are deaf or hard of hearing. For assistance, please contact any Hospital Personnel or the Information Office at ___________(voice/TTY),  room_____. These signs shall include the international symbols for "interpreters" and "TTYs."

42.      Rights and Responsibilities Brochure and Patient Handbook.  The Hospital shall include in all future printings of its Rights and Responsibilities Brochure and all similar publications a statement to the following effect: To ensure effective communication with patients and their companions who are deaf or hard of hearing, we provide appropriate auxiliary aids and services free of charge, such as sign language and oral interpreters, TTY's, note takers, written materials, telephone handset amplifiers, assistive listening devices and systems, telephones compatible with hearing aids, closed caption decoders, and open and closed captioning of most Hospital programs. Please ask your nurse or other Hospital personnel for assistance, or contact the Information Office at___________ (voice or TTY), room _____.  The Hospital shall also include in the Rights and Responsibilities Brochure a description of the Hospital's complaint resolution mechanism. The Hospital shall provide all Patients who seek treatment at the Hospital's Emergency Department and all Companions a copy of the Rights and Responsibilities Brochure when they are evaluated in triage or when they register, whichever occurs first. The same language shall be included in all future printings of the Patient Handbook, which is given to patients who are admitted and their companions.

43.       Website. The Hospital shall continue to include on its website the statement referenced in G.42 above.

H. Notice to Hospital Personnel and Physicians

44.       Within thirty (30) days of the Effective Date of this Settlement Agreement, the Hospital shall publish its revised Effective Communication with Patients Policy and associated procedures, subject to review and approval by the United States. The Hospital shall maintain this policy and associated procedures in an easily-accessed on-line location, and provide this policy in written form to any interested entity or individual requesting it, and incorporate this policy into its standard operating procedures.

45.       The Hospital shall publish, in appropriate form, the following notice regarding the Hospital's provision for providing effective communication with persons who are deaf or hard of hearing. The notice should include, but is not limited to, language to the following effect: If you recognize or have any reason to believe that a patient or companion of a patient is deaf or hard of hearing, you must advise the person that appropriate auxiliary aids and services such as sign language and oral interpreters, video interpreting services, TTYs, note takers, written materials, telephone handset amplifiers, assistive listening devices and systems, telephones compatible with hearing aids, closed caption decoders, and open and closed captioning of most hospital programs shall be provided free of charge. If you are the responsible health care provider, you must ensure that such aids and services are provided when appropriate. All other personnel should direct that person to the [responsible] Communications Director, located at __and available at telephone extension __. This offer and advice must likewise be made in response to any overt request for appropriate auxiliary aids or services.

46.       The Hospital shall distribute the notice in the above paragraph and its revised Effective Communication Policy, within forty-five (45) days of the Effective Date of this Settlement Agreement, to all Hospital Personnel and affiliated physicians (physicians with practicing or admitting privileges), to all new Hospital Personnel and newly affiliated physicians upon their affiliation or employment with the Hospital, and to all Hospital Personnel on an annual basis.

I. Training of Hospital Personnel

47.       Emergency Department Personnel.  The Hospital shall ensure that mandatory in-service training 2 that addresses the special needs of deaf for hard of hearing Patients and Companions utilizing that department is provided to all Hospital Personnel with Patient responsibility who work or volunteer in the Emergency Department. This training shall include the following objectives: to promptly identify communication needs and preferences of persons who are deaf or hard of hearing; to secure qualified interpreter services as quickly as possible when necessary, including how to operate any video interpreting services equipment; to use, when appropriate, flash cards and pictographs (in conjunction with any other available means of communication that shall augment the effectiveness of the communication); and an explanation of all policies described and/or modified pursuant to this Settlement Agreement. The Hospital has provided this training since the time of the complaint referenced above in Section A.3 and shall ensure that such training is provided on an annual basis.

2 In-service training, for the purposes of this Settlement Agreement, includes, without limitation, such means of training or familiarization used by the Hospital to inform Hospital Personnel of policies, procedures, expectations, etc. Examples of in-service training could include, without limitation, written policies and procedures, on-line training modules, videotapes, training materials or sessions, seminars, conferences, and the like.

48.       Psychiatric Personnel and Social Workers. The Hospital shall provide specialized mandatory in-service training to Hospital Personnel with Patient responsibility who work in the Department of Psychiatry (or its equivalent) or are members of the Social Work Department (or its equivalent). This training shall include the following objectives: to promptly identify communication needs and preferences of deaf or hard of hearing Patients and Companions; to secure qualified interpreter services as quickly as possible when necessary, including training regarding how to operate any video interpreting services equipment while waiting for live interpreters; to facilitate appropriate interaction between deaf or hard-of-hearing patients and other patients, when appropriate (e.g., group therapy sessions and other times when interaction with persons other than Hospital personnel is encouraged); and an explanation of all policies modified pursuant to this Settlement Agreement. The Hospital has provided this training since the time of the complaint referenced above in Section A.3 and shall ensure that such training is provided on an annual basis.

49.       Other Key Personnel. The Hospital shall provide training to other Hospital Personnel not otherwise trained as provided above who have direct contact with deaf or hard of hearing Patients, families of deaf or hard of hearing Patients, and Companions, to include all clinical directors and nursing supervisors; all senior level administrators; personnel who staff the admissions desk (or its equivalent for in-patient registration); all triage nurses and other triage professionals; and heads of each department in which communication with Patients occurs. The Hospital shall provide to personnel responsible for billing and insurance issues who routinely interact with Patients and Companions training on the availability of auxiliary aids and services and the existence in the Hospital of Interpreter Services and the Communications Director(s). The Hospital shall ensure that such training is provided annually.

50.       Operators. The Hospital shall provide to Hospital Personnel who receive telephone calls from the public, special instructions on using telecommunication relay services, including, but not limited to, TTY's, to make and receive telephone calls and training generally on the existence in the Hospital of Interpreter Services, the Communications Director(s), and complaint resolution processes. The Hospital shall ensure that such training is provided annually.

51.       Affiliated Physicians.

a.         Training Sessions. The Hospital shall annually provide one or more training opportunities on the communication needs of persons who are deaf or hard of hearing and shall invite all physicians who are affiliated in any way with the Hospital (admitting or surgical privileges, etc.) to participate. In addition, the Hospital shall provide training videotapes or appropriate website information that contains substantially similar information to any affiliated physician upon request.

b.         Written materials. Within sixty (60) days of the Effective Date of this Settlement Agreement, the Hospital shall distribute a set of materials to all affiliated physicians. These materials shall contain at least the following: the Hospital's policies revised pursuant to this Settlement Agreement; any relevant forms; and a request that physicians' staff members notify the Hospital about deaf or hard of hearing Patients and Companions as soon as they schedule admissions, tests, surgeries, or other health care services at the Hospital. These materials may be provided on-line. 

52.       Other Personnel. The Hospital shall develop and implement an internal program that shall provide appropriate training to all Hospital Personnel not trained under the preceding sections who should be trained in order to meet the obligations under this Settlement Agreement. This training shall take place at such times as may be necessary to permit the Hospital to meet all of its obligations under this Settlement Agreement.

53.       General Provisions.  The Hospital shall provide the training specified above to new Hospital Personnel (including without limitation Emergency Department, Psychiatric and Social Work personnel) as part of any Orientation. Such training shall be comparable to training provided to specific departments as necessary. Watching the entire video of the original training shall suffice to meet this obligation. The Hospital shall maintain attendance sheets of all training conducted pursuant to Section I of this Settlement Agreement, which shall include the names and respective job titles of the attendees, as well as the date, time, duration, and location of the training session.

J. Reporting, Monitoring and Violations

54.       Reports.

a.         Compliance Reports. Three, nine, fifteen, and twenty-one months following the Effective Date of this Settlement Agreement, the Hospital shall provide a written report ("Report") to the U.S. Attorney's Office regarding its efforts to comply with this Settlement Agreement. Each Report must state the identity of each deaf or hard of hearing Patient or Companion in a manner that appropriately protects their confidentiality and the auxiliary aid(s) or service(s) provided to the individual(s), and whether interpreters were used. In the event that the Hospital does not provide the particular auxiliary aide s) or service(s) requested by the Patient or Companion, or provides no auxiliary aide(s), or service(s), the Report must state (a) the procedure followed by the Hospital in determining whether to provide auxiliary aids or services to the Patient or Companion, and (b) the Hospital's reasons for not providing the particular auxiliary aid(s) or service(s) requested by the Patient or Companion, including an explanation regarding which aid or service was requested and what, if any, aid or service was provided. The Hospital shall maintain appropriate records, including, but not limited to, those described in this Settlement Agreement, to document the information contained in the Report.

b.         Complaints.  During the term of this Settlement Agreement, the Hospital shall notify the U.S. Attorney's Office if any individual brings any lawsuit, complaint, charge, or grievance alleging that the Hospital failed to provide auxiliary aids or services to deaf or hard of hearing Patients or Companions. Such notification shall be provided in writing via certified mail within fifteen (15) days of the date the Hospital received notice of the allegation and shall include, at a minimum, the nature of the allegation, the name of the individual bringing the allegation, and any documentation possessed by the Hospital relevant to the allegation.

55.      Violation of Settlement Agreement.

a.         The Department may review compliance with this Agreement at any time and may enforce this Agreement if the United States believes that it or any requirement thereof has been violated. The United States may bring a civil action in federal district court to enforce this Agreement or title III, and may in such action seek any relief available under law.

b.         Notwithstanding the provisions of Section J.55(a), in the event the United States believes the Hospital has violated any provision of this Settlement Agreement, the United States will give written notice (including reasonable particulars) of such violation to the Hospital's chief executive officer, and the Hospital shall then respond to such notice and/or cure such non-compliance as soon as practicable but no later than thirty days thereafter. Any event of non-compliance that prevents or restricts a Patient from receiving urgent health care services shall be cured without delay. The United States and the Hospital shall negotiate in good faith in an attempt to resolve any dispute relating thereto before the United States seeks relief under Section J.55(a) above.

K. Compensatory Relief for Complainant and Release

56.       On October 1, 2007, the United States sent to counsel for the Hospital, a release signed by Natasha Koziol.

57.       On October 15, 2007, the Hospital sent a check in the amount of Eleven Thousand dollars ($11,000.00) made out to Natasha Koziol to the Office of the United States Attorney. This check was compensation for the effects of the alleged discrimination suffered as described in Section A.4.

L. Miscellaneous

58.       Duration of the Settlement Agreement.  This Settlement Agreement shall remain in effect for two (2) years from the date hereof, after which time the Settlement Agreement shall terminate.

59.       Entire Agreement.  This Settlement Agreement constitutes the entire agreement between the parties relating to this matter and no other statement, promise, or agreement, either written or oral, made by any party or agents of any party, that is not contained in this written Settlement Agreement, including its attachments, shall be enforceable.

60.       Changing Circumstances. During the term of this Settlement Agreement, there may be a change in circumstances such as, for example and without limitation, an increased or decreased availability of qualified sign language, relay, or oral interpreters or developments in technology to assist or improve communications with persons who are deaf or hard of hearing. If the Hospital determines that such changes create opportunities for communicating with such persons more efficiently or effectively than is required under this Settlement Agreement, or create difficulties not presently contemplated in the provision of appropriate auxiliary aids and services, it may propose changes to this Settlement Agreement by presenting written proposals to the United States Attorney's Office. Such changes shall then be made to the Settlement Agreement if the United States, upon review, grants its approval, which approval shall not be unreasonably withheld.

61.       Binding Effect.  This Settlement Agreement is final and binding on the parties, including all principals, agents, executors, administrators, representatives, successors in interest, beneficiaries, assigns, heirs and legal representatives thereof. The Hospital has a duty to so inform any successor in interest. In the event the Hospital seeks to transfer or assign all or part of its interests in any facility covered by this Settlement Agreement, and the successors or assign intends on carrying on the same or similar use of the facility, as a condition of sale the Hospital shall obtain the written accession of the successor or assign to any obligations remaining under this Settlement Agreement for the remaining term of this Agreement.

62.       Non-Waiver.  Failure by the United States to seek enforcement of this Settlement Agreement pursuant to its terms with respect to any instance or provision shall not be construed as a waiver to such enforcement with regard to other instances or provisions.

63.       Compliance with Applicable Laws.  Any modification or amendment of this Settlement Agreement does not affect the Hospital's independent responsibilities under any applicable federal, state, or local laws or regulations.
 

For the United States of America:

10/6/2008

PATRICK J. FITZGERALD
United States Attorney

By:_________________
JOAN LASER
Assistant United States Attorney
219 S. Dearborn Street -5th Floor
Chicago, Illinois 60604
(312) 353-1857

 

For Central DuPage Hospital:

JAMES T. SPEAR

_________________
Executive Vice President and Chief Financial
Officer
Central DuPage Hospital
25 North Winfield Road
Winfield, Illinois 60190
(630) 933-1600

 

 

Exhibit A

The Hospital shall ensure that appropriate Hospital Personnel are trained, available, and able to operate and connect the VIS system quickly and efficiently at the Hospital at all times.

Training shall include attention to the limitations of VIS technology, such as with respect to:

(i) Patients who have limited ability to move their heads, hands, or arms;

(ii) Patients who have vision problems, or cognitive or consciousness issues;

(iii) Patients who are in considerable pain;

(iv) Patients who maybe moved to areas of the Hospital that do not have a designated high speed internet line; and

(v) Patients who will be treated in rooms where space configurations mitigate against using the VIS service.

 





April 21, 2009