SETTLEMENT AGREEMENT BETWEEN
THE UNITED STATES OF AMERICA
YAVAPAI REGIONAL MEDICAL CENTER,
PRESCOTT AND PRESCOTT VALLEY, ARIZONA
1. This matter originated with a complaint filed under title III of the Americans with Disabilities Act of 1990 (“ADA”), 42 U.S.C. §§ 12181-12189, with the United States Department of Justice ("United States") against the Yavapai Regional Medical Center (“YRMC”). The complainant alleges that YRMC discriminated on the basis of disability against individuals with disabilities by requiring such individuals to sign waiver of liability as a condition for the use of interpreters.
2. The Attorney General is authorized to investigate an alleged violation of the ADA and commence a civil action in federal court in any case that involves a pattern or practice of discrimination or that raises issues of general public importance, and to seek injunctive relief, monetary damages, and civil penalties. 42 U.S.C. § 12188(a)(2); 28 C.F.R. § 36.503.
3. Title III of the ADA prohibits public accommodations from discriminating against an individual on the basis of disability in the full and equal enjoyment of its goods and services. 42 U.S.C. § 12182(a); 28 C.F.R. § 36.201(a). Such discrimination includes the failure to provide an individual with an equal opportunity to benefit from the services of the public accommodation, and the denial of reasonable modifications or auxiliary aids. 42 U.S.C. §§ 12182(b)(1)(A)(ii), (b)(2)(A)(ii) & (iii); 28 C.F.R. §§ 36.201, 36.302 & 36.303.
4. Ensuring that a medical center does not discriminate against persons who are deaf or hard of hearing is an issue of general public importance. 42 U.S.C. § 12188(b); 28 C.F.R. § 36.503(b). This Agreement addresses the issues of appropriate auxiliary aids and services, including video remote interpreting services, and effective communication policies and procedures. It is not intended to cover any other issues at YRMC.
5. YRMC is a private entity that owns and operates a general acute care hospital. YRMC is, therefore, a place of public accommodation covered by title III of the ADA. 42 U.S.C. § 12181(7)(F); 28 C.F.R. § 36.104.
6. YRMC fully cooperated during the course of its investigation, while the United States reviewed documents and information provided by YRMC and the complainant. The United States found that:
a. For all language assistance (including the provision of interpreters), YRMC has required patients to sign a Consent or Decline Interpreter Services form. The form is used to assist YRMC in tracking the use of and need for interpreters, and to notify that YRMC offers free interpretation services. When YRMC and the patient decide to decline interpreter services or use an interpreter (other than YRMC’s contracted interpreters), YRMC would require the patient to sign the “decline” portion of the form.
b. On August 20, 2009, the complainant brought an interpreter with her for an appointment at YRMC. Both the complainant and YRMC had agreed to use the interpreter for the appointment. Since that interpreter was not one of the contracted interpreters, YRMC staff required the complainant to sign the “decline” portion of the form. At first, the complainant refused to sign the decline portion. The staff delayed her medical test until the complainant signed it. The following day, the complainant returned to YRMC to return heart monitoring equipment. No interpreter was provided.
c. YRMC has provided sign language interpreting services on-site or through video remote interpreting (VRI) services through contracts. YRMC has two VRI carts, one each at each campus.
7. YRMC has cooperated in the government's investigation of this matter. YRMC maintains that it is, and has always been, committed to full compliance with the ADA and denies that its actions and policies violate the ADA. YRMC has agreed to implement policies and procedures, set forth below, that are designed to afford persons who are deaf or hard of hearing a benefit equal to that provided to others, and to ensure that appropriate auxiliary aids and services will be provided where necessary to afford effective communication between YRMC and persons who are deaf or hard of hearing. This Settlement Agreement (“Agreement”) shall not be construed as an admission of liability by YRMC, all such liability being specifically denied by YRMC.
8. In consideration of the terms of this Settlement Agreement, and in particular the provisions in Sections III-V, the Attorney General of the United States agrees to refrain from undertaking further action in this case, except as provided in Paragraph 35.
9. In order to secure compliance by voluntary means and avoid the costs of litigation, the parties agree to resolve this matter as set forth below.
10. Auxiliary aids and services means qualified interpreters on-site or through video remote interpreting (VRI) services, notetakers, real-time computer-aided transcription services, written materials, exchange of written notes, telephone handset amplifiers, assistive listening devices, assistive listening systems, telephones compatible with hearing aids, closed caption decoders, open and closed captioning, including real-time captioning (for video display or education, for example); voice, text, and video-based telecommunications products and systems, including text telephones (TTYs), videophones, and captioned telephones, or equally effective telecommunications devices; videotext displays, accessible electronic and information technology; or other effective methods of making aurally delivered information available to individuals who are deaf or hard of hearing.
11. Companion means a family member, friend, or associate of an individual seeking access to, or participating in the goods, services, facilities, privileges, advantages, or accommodations of YRMC, who, along with such individual, is an appropriate person with whom YRMC should communicate. Companions include (a) a person whom the patient indicates should communicate with personnel about the patient, participate in any treatment decision, play a role in communicating the patient’s needs, condition, history or symptoms to personnel, or help the patient act on the information, advice or instructions provided by hospital personnel; (b) a person legally authorized to make health care decisions on behalf of a patient; or (c) such other person with whom the Medical Center Personnel defined below, would ordinarily and regularly communicate with concerning the patient’s medical condition, including, but not limited to, the patient’s next of kin or health care surrogate.
12. Complaint means a low-level concern about the provision of auxiliary aids and services that is easily resolved to the Patient’s or Companion’s satisfaction and that does not trigger the grievance process.
13. Grievance means a complaint about the provision of auxiliary aids and services that is not resolved to the Patient’s or Companion’s satisfaction.
14. Medical Center Personnel means all employees and independent contractors with contracts to work on a full-time or part time basis for YRMC including, without limitation, nurses, physicians, social workers, technicians, admitting personnel, billing staff, security staff and therapists and all volunteers, who have or are likely to have significant contact with “Patients” or “Companions,” as defined herein.
15. Qualified interpreter means: an interpreter who, via a video remote interpreting (VRI) service or an on-site appearance, is able to interpret effectively, accurately and impartially, both receptively and expressively, using any necessary specialized vocabulary. Qualified interpreters include, for example, sign language interpreters, oral transliterators, and cued-language transliterators. Someone who has only a rudimentary familiarity with sign language or finger spelling is not a “qualified sign language interpreter” under this Agreement. 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.
16. Patient means: a person who is deaf or hard of hearing and is seeking and/or receiving medical services at YRMC.
17. Video remote interpreting (VRI) service means an interpreting service that uses video conference technology over dedicated lines or wireless offering high-speed, wide-bandwidth video connection that delivers high-quality video images. See Paragraph 28(d).
IV. Terms Of Agreement
18. Implementation of Program
a. Within ninety (90) days of the effective date of this Agreement, YRMC will adopt a program (Program) that will effectively implement the provisions of this Agreement, including developing, coordinating and overseeing the development of specific procedures to fully implement this Agreement.
b. The Program will include, among other things:
(1) The designation of an individual who will maintain full information about access to and the operations of the Program (“Responsible Official”). The Responsible Official will maintain a combination voice/TTY telephone line or a dedicated TTY telephone line, publicize the Program’s purpose and telephone number broadly within YRMC and to the public, respond to telephone inquiries during normal business hours, and maintain a recording system for inquiries received after normal business hours.
(2) The designation of one or more Administrative Nursing Supervisors who will be available twenty-four (24) hours a day, seven (7) days a week, to answer questions and provide assistance and authorization for immediate access to and proper use of the appropriate auxiliary aids and services, including qualified sign language and oral interpreters available under the Program (as described below). Such Administrative Nursing Supervisors will know where the appropriate auxiliary aids are stored and how to operate them. Such Administrative Nursing Supervisors will know how to order contract interpreters. YRMC will circulate and post broadly within YRMC the names, telephone numbers, functions and office locations of such Administrative Nursing Supervisors, including a TTY telephone number that may be called by Patients and Companions in order to obtain the assistance of such Administrative Nursing Supervisors.
(3) YRMC will ensure auxiliary aids are maintained in good working order and replaced or repaired as necessary.
19. Provision of Appropriate Auxiliary Aids and Services. Within ninety (90) days of the effective date of this Agreement, YRMC will provide to Patients and Companions appropriate auxiliary aids and services that may be necessary for effective communication after making the assessment described below.
20. Communication Assessment. YRMC will consult with individual Patients and Companions whenever possible to determine what type of auxiliary aid or interpretive service is necessary to ensure effective communication. While consultation is strongly encouraged, the ultimate decision as to what measure to take to ensure effective communication rests with YRMC, provided that the method chosen results in effective communication. In order to be effective, auxiliary aids and services must be provided in accessible formats, in a timely manner, and in such a way as to protect the privacy and independence of the individual with a disability.
a. General Assessment Criteria. The determination of which appropriate auxiliary aids and services are necessary, and the timing, duration and frequency with which they will be provided, will be made by YRMC Personnel in consultation with the Patient or Companion where possible. The assessment will take into account all relevant facts and circumstances, including without limitation the following:
(1) The nature, length and complexity 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, including the Patient’s or Companion’s request for the provision of interpreting services through VRI services or through an on-site interpreter;
(5) The reasonably foreseeable health care activities of the Patient (e.g., group 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); and
(6) The availability at the required times, day or night, of appropriate auxiliary aids and services.
b. Time for Assessment. Prior to hospitalization, Patients or their Companions may request auxiliary aids and services to facilitate communications relevant to a patient’s health condition by notifying YRMC Personnel. Patients seeking admission, emergency care, or diagnostic services will be identified at the point of registration and will be assessed to determine communication skills and the requirement for auxiliary aids and services. YRMC Personnel will document a Patient’s or their Companion’s communication skills in the Patient’s medical records. If YRMC Personnel concludes that requested services are not warranted, documentation will be made as provided in Paragraph 23, below. If that determination is made by YRMC Personnel, Administrative Nursing Supervisors or YRMC Administration will be notified. Nurses, doctors and other providers are to document the presence and use of interpreters or other auxiliary aids or services in the Patient’s medical record. YRMC shall reassess which appropriate auxiliary aids and services are necessary, in consultation with the Patient or Companion where possible, in the event that communication is not effective.
21. Ongoing Relationships. YRMC uses software that allows either the patient's doctor or the Medical Center to enter permanent identifier that a particular patient is deaf or hard of hearing. Whenever that particular patient is scheduled for a subsequent visit to the YRMC, the identifier appears on the patient's record alerting YRMC Personnel. YRMC trains its registration staff to check all indicators and identifiers when scheduling patients or checking patients in for a scheduled visit. When the identifier shows the patient needs a signing interpreter, YRMC will automatically arrange for an interpreter.
22. Medical Equipment. Nothing in this Agreement will 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 a Patient’s medical condition.
23. Determination Not to Provide Auxiliary Aid or Service. If, after conducting a communication assessment, YRMC determines that the circumstances do not warrant provision of an auxiliary aid or service that has been requested, YRMC Personnel shall so advise the person requesting the auxiliary aid or service and shall document in the Patient’s medical record the date and time of denial, the name and title of YRMC Personnel who made the determination, and the basis for the determination.
24. Maintenance of Log. YRMC will maintain a log of each request for an auxiliary aid and service, the time and date the request is made, the Patient’s (and Companion’s, where applicable) name, the time and date of the scheduled appointment (if a scheduled appointment was made), the time and date the auxiliary aid and service was provided, or a statement that the auxiliary aid and service was not provided. Such logs, and the documentation described in Section III.F, will be maintained by YRMC Administration.
25. Complaint/Grievance Resolution. YRMC Administration will maintain a written Complaint/Grievance resolution mechanism regarding the provision of auxiliary aids and services to Patients and Companions and will maintain records of all grievances, whether oral or written, made to YRMC and actions taken with respect thereto. YRMC will post at appropriate places its Bill of Rights, which notifies individuals with disabilities of YRMC’s Complaint/ Grievance resolution mechanism and to whom complaints should be made. YRMC will maintain a written record of all grievances filed by Patients or Companions and the responses thereto. Upon request, YRMC will provide the Patient or Companion a written response to the Grievance within a reasonable time following 'PATIENT or FAMILY GRIEVANCE / COMPLAINT' Corporate Policy.
26. Individual Notice in Absence of Request. If a Patient or a Companion who is deaf or hard of hearing does not request appropriate auxiliary aids or services but YRMC Personnel have reason to believe that such person would benefit from appropriate auxiliary aids or services for effective communication, YRMC will specifically inform the person that appropriate auxiliary aids and services are available free of charge.
27. Communication with Inpatients and Companions. YRMC will take appropriate steps to ensure that all YRMC Personnel having significant contact with a Patient or Companion who is deaf or hard of hearing are made aware of such person’s disability so that effective communication with such person will be achieved. In addition, YRMC will take appropriate steps to ensure that all YRMC Personnel having significant contact with a Patient or Companion who is deaf or hard of hearing are aware of YRMC’s Program and Administrator(s).
28. Sign Language and Oral Interpreters
a. YRMC will provide qualified sign language interpreters to Patients and Companions who are deaf or hard of hearing and whose primary means of communication is sign language, and qualified oral interpreters to such Patients and Companions who rely primarily on lip reading, as necessary for effective communication.
b. The determination of the circumstances in which such interpreters will be provided to Patients or Companions will be made as set forth in Paragraph 20 (Communication Assessment) above. Examples of circumstances when it may be necessary to provide interpreters include, but are not limited to, the following:
(1) Determination of a Patient’s medical history or description of ailment or injury;
(2) Provision of Patients’ rights, informed consent, or permission for treatment;
(3) Diagnosis or prognosis of ailments or injuries;
(4) Explanation of procedures, tests, treatment, treatment options or surgery;
(5) 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);
(6) Explanation regarding follow-up treatments, therapies, test results or recovery;
(7) Blood donations or apheresis (removal of blood components);
(8) Discharge planning and discharge instructions;
(9) Provision of mental health evaluations, group and individual therapy, counseling and other therapeutic activities, including grief counseling and crisis intervention;
(10) Explanation of complex billing or insurance issues that may arise;
(11) Educational presentations, such as classes concerning birth, nutrition, CPR and weight management;
(12) Explanation of living wills or powers of attorney (or their availability); and
(13) Any other circumstance in which a qualified sign language interpreter is necessary to ensure a Patient’s rights provided by law.
The foregoing list 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.
c. Chosen Method for Obtaining Interpreters. YRMC has entered into one or more arrangements with an interpreter service provider or providers (“the IS Provider”) to establish and operate a plan (“IS Plan”) to provide qualified sign language and oral interpreters at the request of YRMC.
d. VRI Service. When choosing to provide qualified interpreters via VRI service, YRMC will ensure that it provides:
(1) Real-time, full-motion video and audio over a dedicated high-speed, wide-bandwidth video connection or wireless connection that delivers high-quality video images that do not produce lags, choppy, blurry, or grainy images, or irregular pauses in communication;
(2) A sharply delineated image that is large enough to display the interpreter’s face, arms, hands, and fingers, and the participating individual’s face, arms, hands, and fingers, regardless of his or her body position;
(3) A clear, audible transmission of voices; and
(4) Adequate training to users of the technology and other involved individuals so that they may quickly and efficiently set up and operate the VRI.
e. Provision of Requested Interpreters in a Timely Manner.
(1) Provision of interpreters pursuant to a request in non-scheduled incidents. For “non-scheduled incidents,” YRMC will make an interpreter available within: (a) thirty (30) minutes when it makes an interpreter available through either VRI service or an on-site staff interpreter, and (b) three (3) hours when it makes an on-site interpreter available through either a contracting interpreting service or its staff interpreter who is located off-site at the time the non-scheduled incident arises. “Non-scheduled incidents” are situations in which there are less than two (2) hours (or less than four (4) hours if a request is made between the hours of 8 p.m. and 8 a.m. or on a weekend or holiday) between the time when a Patient or a Companion makes a request for an interpreter and the time when the services of an interpreter are required.
(2) Provision of interpreters pursuant to a request in scheduled incidents. For “scheduled incidents,” YRMC will make an interpreter available at the time of the scheduled appointment. “Scheduled incidents” are situations in which there are two (2) or more hours (or four (4) or more hours if a request is made between the hours of 8 p.m. and 8 a.m. or a weekend or holiday) between the time when a Patient or a Companion makes a request for an interpreter and when the services of the interpreter are required.
g. Modification of Performance Standards. In the event that the response time performance standards set forth in Paragraph 28(e), above, cannot be maintained despite YRMC’s good faith efforts, YRMC is entitled to request modifications of such performance standards as may be reasonable under the circumstances. The Department will consider any such request reasonably and in good faith, and any such modification that is agreed to will be deemed an amendment to this Agreement.
h. Compliance with Applicable Laws. The United States consent to modification or amendment of this Agreement does not affect YRMC’s independent responsibilities under any applicable federal, state or local laws or regulations.
i. Staff Interpreters. YRMC may, but has no obligation to, satisfy its obligations under this Agreement by hiring qualified staff and/or contract interpreters. Staff interpreters must meet the definition of “qualified interpreters.” Patients and Companions who are provided with staff interpreters must have the same level of coverage (for both duration and frequency) as YRMC is otherwise obligated to provide under this Agreement. YRMC may assign other duties to staff interpreters, but the staff interpreters’ performance of those other duties will not excuse YRMC’s requirements under this Agreement.
j. Notice to Patients and Companions Who Are Deaf or Hard of Hearing. As soon as YRMC Personnel have determined that an interpreter is necessary for effective communication with a Patient or a Companion, YRMC will inform such person (or a family member or friend, if such person is unavailable) of the current status of efforts being taken to secure a qualified interpreter on his or her behalf. Additional updates are to be provided thereafter as necessary until an interpreter is secured. Notification of efforts to secure a qualified interpreter does not lessen YRMC’s obligation to provide qualified interpreters in a timely manner as required by this Agreement.
k. Other Means of Communication. Between the time that an interpreter is requested and when an interpreter is made available, YRMC Personnel will 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 all available methods of communication. This provision in no way lessens YRMC’s obligation to provide qualified interpreters in a timely manner as required by this Agreement.
l. Restricted Use of Certain Persons to Facilitate Communication.
(1) Due to confidentiality, potential emotional involvement, and other factors that may adversely affect the ability to facilitate communication, YRMC may never rely on a family member, Companion, case manager, advocate, or friend of a Patient or Companion to interpret or facilitate communications between YRMC Personnel and such Patient or Companion, except—
(A) In an emergency involving an imminent threat to the safety or welfare of an individual or the public where there is no interpreter available; or
(B) Where the individual with a disability specifically requests that the accompanying adult interpret or facilitate communication, the accompanying adult agrees to provide such assistance, and reliance on that adult for such assistance is appropriate under the circumstances.
(2) YRMC will not rely on a minor child to interpret or facilitate communication, except in an emergency involving an imminent threat to the safety or welfare of an individual or the public where there is no interpreter available.
(3) This provision in no way lessens YRMC’s obligation to provide appropriate auxiliary aids and services as required under this Agreement where necessary for effective communication.
29. Development of Policies and Procedures for Ensuring Effective Communication.
a. Within ninety (90) days of the effective date of this Agreement, YRMC shall develop and submit for the Department’s approval policies and procedures for ensuring effective communication with Patients that satisfy the requirements of this Agreement. YRMC shall implement the policies and procedures within thirty (30) calendar days of receiving the Department’s approval.
b. YRMC will distribute this document within ninety (90) days of the effective date of this Agreement to:
1. All YRMC Personnel;
2. All volunteers;
3. Affiliated hospital based physicians (to include but may not limited to, Hospitalist and Emergency Room Physicians;
4. Any new YRMC Personnel and newly affiliated hospital based physicians.
The Corporate Policy will be distributed to all YRMC Personnel on an annual basis or upon substantial revisions.
30. Notice to Community.
a. Policy Statement. YRMC has posted and will maintain signs of conspicuous size and print at all Hospital admitting stations, the emergency department, and wherever a Patient’s Bill of Rights is required by law to be posted. Such signs will provide, in essential part:
Sign language and oral 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 Medical Center Personnel or the Information Office at ____________ (voice/TTY), room ________.
These signs will include the international symbols for “interpreters” and “TTY’s.”
b. Patient Handbook. YRMC will include in all future printing of its Patient Handbook (or equivalent) 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.
Please ask your nurse or other personnel for assistance, or contact the Information Office at ____________ (voice or TTY), room ____.
YRMC will also include in the handbook a description of YRMC’s complaint resolution mechanism.
c. Website. YRMC will include in its website a statement to the effect of the statement set forth in Paragraph 30(b), above.
31. Training of Hospital Personnel.
a. Personnel to Be Trained: YRMC will provide training to its employees, volunteers and affiliated physicians who have significant contact with Patients, families of Patients, and Companions. Training as provided by this Agreement will be provided to Therapists, Nurses, Nursing Assistants, Technologists, Social Workers, Chaplains, Emergency Department Staff Physicians; Department Directors, Nursing Supervisors, Senior Level Administrative Staff, Registration Clerks, Scheduling staff, Patient Representatives, Billing and Financial representatives, Case Managers, and Telephone Switchboard Operators.
b. Schedule of Training:
(1) New Employees. Newly hired individuals and new volunteers are required to attend General Hospital Orientation. Training for Accommodating the Deaf and Hard of Hearing has been included in the curriculum of General Hospital Orientation. Documentation of New Hire General Orientation will be recorded in the individual’s Human Resources file.
Newly affiliated physicians will be trained through their respective employer. YRMC will include language in future contracts to reflect this required training.
(2) Initial Training for Current Employees. Current employees are required to complete annual training and education inclusive of various significant training subjects. Training for Accommodation of the Deaf and Hard of Hearing will be included in Annual Training. Documentation of the Initial Training for current employees is recorded in the individual’s educational database. During the next twelve (12) months, May 1, 2011 – April 30, 2012, specific and separate record monitoring will occur to allow monitoring of initial training for these employees. Initial training for current employees has already begun.
(3) Ongoing Training. All employees are required to complete Annual Training each year. Each year hereafter will include annual training for all employees as documented in the individual's educational database. Senior Administration and Department Directors currently receive routine reports of completion of Annual Training in order to monitor compliance with the Annual Training Requirement.
c. Training Content
(1) The attendee will be instructed concerning his/her responsibilities in accommodating deaf or hard of hearing individuals.
(2) The attendee will be instructed on how effectively to identify communications requirements and preferences of individuals who are deaf or hard of hearing in their work setting.
(3) The attendee will be instructed on how to access the hospital policy, “Effective Communication with Patients or Companions who are Deaf or Hard of Hearing.”
(4) The attendee will be instructed on the procedure for accessing the Administrative Nursing Supervisor to obtain assistance for individuals who are deaf and hard of hearing.
(5) The attendee will be instructed regarding the auxiliary aids and services at YRMC and their appropriate use.
(6) The attendee will be instructed on how to recognize when qualified interpreters, TTY or other auxiliary aids or services are required in order to protect the patient’s privacy, confidentiality or right to informed unbiased information or those circumstances when appropriate personnel should be contacted to perform a communication assessment form to determine whether, TTY or other auxiliary aids and services are necessary to ensure effective communication with the patient and companion.
d. Affiliated Physicians.
(1). Training Sessions. YRMC will annually conduct one or more training sessions on the communication and psychological needs of persons who are deaf or hard of hearing, and will invite all physicians who are affiliated ( hospital based) to attend. YRMC may provide training videotapes that contain substantially similar information to any affiliated physician upon request.
(2) Written materials. Within ninety (90) days of the effective date of this Agreement, YRMC will distribute the hospital policy, “Effective Communication with Patients or Companions who Are Deaf and Hard of Hearing” to all affiliated hospital based physicians. YRMC will request that physician’s staff members notify YRMC about Patients and Companions who are deaf or hard of hearing as soon as they schedule admissions, tests, surgeries or other health care services at YRMC.
YRMC will also offer written materials to community physician offices.
32. Miscellaneous Injunctive Relief.
a. Discrimination by Association. YRMC will 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.
b. Retaliation and Coercion. YRMC will not retaliate against or coerce in any way any person who is trying to exercise his or her rights under this Agreement or the ADA.
V. Enforcement and Implementation
33. Compliance Reports. Six (6) months after the effective date of this Agreement, and annually thereafter during the term of this Agreement, YRMC must provide a written report (“Report”) to the Department of Justice regarding its efforts to comply with this Agreement. YRMC must maintain appropriate records, including, but not limited to, those described in this Agreement, to document the information contained in the Report.
34. Complaints. During the term of this Agreement, YRMC will notify the Department if any individual brings any lawsuit alleging that YRMC failed to provide auxiliary aids and services to Patients or Companions. Such notification must be provided in writing via certified mail within fifteen (15) days of when YRMC has received notice of the lawsuit and will include, at a minimum, the nature of the allegations, the name of the individual bringing the lawsuit, and any documentation possessed by YRMC relevant to the allegations.
35. Notification of Noncompliance.
a. If YRMC violates this Agreement or any subpart of this Agreement, the Department will have such remedies as are allowed by law.
b. The Department may review compliance with this Agreement at any time and may enforce this Agreement if the Department believes that it or any requirement thereof has been violated. If the Department believes that this Agreement or any portion of it has been violated, it will raise its concern(s) with the Hospital and the parties will attempt to resolve the concern(s) in good faith.
c. The Department will give the Hospital twenty-one (21) days from the date it notifies the Hospital of any breach of this Agreement to cure that breach, prior to instituting any court action.
36. Non-Waiver. Failure by the Department to enforce any provision or deadline of this Agreement shall not be construed as a waiver of its right to enforce other provisions or deadlines of this Agreement.
37. Effective Date and Term of Agreement. The effective date of this Agreement is the date of the last signature below. This Agreement will remain in effect for three (3) years from the effective date of this Agreement.
38. Technical Assistance. The Department agrees to provide appropriate technical assistance to YRMC regarding compliance with the terms of this Agreement as requested and as reasonably necessary.
39. Signatories Bind Parties. The person signing for the Parties represent that they are authorized to bind their respective Parties to this Agreement.
40. Entire Agreement. This Settlement Agreement constitutes the entire agreement between the parties relating to the complaint in Paragraph 1, 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 will be enforceable.
41. Modifications of Entire Agreement. This Agreement may only be modified by mutual agreement of the Parties in writing.
42. Public Document. A copy of this document will be provided to any person by YRMC or the Department upon request.
43. YRMC’s Continuing Obligations. This Agreement does not purport to remedy any other potential violations of the ADA or any other Federal law not specifically referenced herein. This Agreement does not affect YRMC’s continuing responsibility to comply with all aspects of the ADA.
44. Severability. If any term of this Agreement is determined by any court to be unenforceable, the other terms of this Agreement shall nonetheless remain in full force and effect, provided, however, that if the severance of any such provision materially alters the rights or obligations of the parties, the United States and YRMC shall engage in good faith negotiations in order to adopt mutually agreeable amendments to this Agreement as may be necessary to restore the parties as closely as possible to the initially agreed upon relative rights and obligations.