Settlement Agreement - BETWEEN THE UNITED STATES AND DAVIS HOSPITAL AND MEDICAL CENTER

SETTLEMENT AGREEMENT BETWEEN

THE UNITED STATES OF AMERICA

AND

DAVIS HOSPITAL AND MEDICAL CENTER

re:

sign language interpreters and auxiliary aids and services

Settlement Agreement | DOJ Press Releases

SETTLEMENT AGREEMENT

This matter was brought by the United States against Davis Hospital and Medical Center ("Davis" or "Hospital") to enforce the provisions of title III of the Americans with Disabilities Act of 1990 ("ADA"), 42 U.S.C. §§ 12181-12189, and the Department of Justice’s implementing regulation, 28 C.F.R. Part 36, following the filing of a complaint by Janelle C. Deelstra with the Civil Rights Division of the United States Department of Justice ("the Department"). It is alleged,, inter alia, that Davis discriminated against Mrs. Deelstra by failing or refusing to provide a qualified sign language interpreter for Jerry Deelstra and his wife, Janelle Deelstra, who are both deaf and had requested an interpreter, when Mr. Deelstra received treatment at Davis’s hospital during the periods of August 17 and 18, 1998 and October 9 through 13, 1998, at which time the hospital was under previous ownership.

The United States and Davis desire to settle the action between them without the burden of prolonged litigation. This Settlement Agreement ("Agreement") resolves all allegations raised by the United States arising from the hospital stays of Jerry Deelstra during the periods of August 17 and 18, 1998 and October 9 through 13, 1998. This Agreement is not an admission of any liability on the part of Davis.
Therefore, in consideration of the mutual promises contained herein, the parties agree as follows:

DEFINITIONS

1 . The term "appropriate auxiliary aids and services" means: qualified sign language or oral interpreters, note takers, computer-assisted real time transcription services, written materials, telephone handset amplifiers, assistive listening devices, telephones compatible with hearing aids, closed caption decoders, open and closed captioning and TTY’s. 28 C.F.R. § 35.104; 28 C.F.R. § 36.303.1

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

3. The term "qualified sign language interpreter," "oral interpreter," or "interpreter" means: an interpreter who is 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 a Companion who is deaf or hard of hearing. 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 else signing and change their signed or finger spelled communication into spoken words is not a qualified sign language interpreter. 28 C.F.R. § 35.104, 28 C.F.R. § 36.104.

4. The term "TTY’s" or "TDD’s" means: devices that are used with a telephone to communicate with persons who are deaf or hard of hearing by typing and reading communications.

5. The term "undue burden" means: significant difficulty or expense. In determining whether an action would result in an undue burden, factors to be considered include:

a. The nature and cost of the action needed;

b. The overall financial resources of the site or sites involved in the action; the number of persons employed at the site; the effect on expenses and resources; legitimate safety requirements that are necessary for safe operation, including crime prevention measures; or the impact otherwise of the action upon the operation of the site;

c. The geographic separateness, and the administrative or fiscal relationship of the site or sites in question to any parent corporation or entity;
d. If applicable, the overall financial resources of any parent corporation or entity; the overall size of the parent corporation or entity with respect to the number of its employees; the number, type and location of its facilities; and

e. If applicable, the type of operation or operations of any parent corporation or entity, including the composition, structure and functions of the workforce of the parent corporation or entity. 28 C.F.R. § 36.104; 28 C.F.R. § 35.164.

EFFECTIVE COMMUNICATION

I. GENERAL OBLIGATIONS

A. Establishment of Program to Provide Appropriate Auxiliary Aids and Services.

1. As soon as practicable after the execution of this Agreement, Davis will design and institute a program ("Program") that will effectively implement the provisions of this Agreement, including without limitation:

a. developing, coordinating and overseeing the development of specific procedures to implement fully this Agreement:

b. scheduling, announcing and promoting all training required by this Agreement;

c. drafting, maintaining and providing all reports required by this Agreement.

2. The Program will include, among other things:

a. The designation of an individual or office at the Hospital that will maintain full information about access to and the operation of the Program ("Information Office"). The Information Office will maintain a combination voice/TTY telephone line or a dedicated TTY telephone line, will publicize its purpose and telephone number broadly within the Hospital and to the public, will respond to telephone inquiries during normal business hours and will maintain a recording system for inquiries received after normal business hours. The Information Office must be established within thirty (30) days after the entry Agreement.

b. The designation of one or more individuals ("Program Administrators"), within thirty (30) days after the entry of this Agreement, who will be available twenty-four (24) hours a day, seven (7) days a week, to answer questions and provide appropriate assistance regarding immediate access to and proper use of the appropriate auxiliary aids and services available under the Program (as described below). Such Program Administrators will know where the appropriate auxiliary aids are stored and how to operate them and will be responsible for their maintenance, repair, replacement and distribution. The Hospital will circulate broadly within the Hospital the names, telephone numbers, functions and office locations of such Program Administrators, including a TTY telephone number that may be called by deaf or hard of hearing Patients and Companions in order to obtain the assistance of such Program Administrators.

B. Provision of Appropriate Auxiliary Aids and Services Under the Program.

1. Immediate Aids and Services. Within thirty (30) days after the entry of this Agreement, Davis will provide, to Patients and Companions who are deaf or hard of hearing, any of the following appropriate auxiliary aids and services that may be necessary for effective communication, as soon as practicable after making such determination: written materials, note takers, assistive listening devices, and sign language interpreters as specified in Sections II and III below.

2. 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 the Hospital Personnel who are otherwise primarily responsible for coordinating and/or providing patient care services, in consultation with the person with a disability where possible. The assessment will take into account all relevant facts and circumstances, including without limitation the following:

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

b. the individual’s communication skills and knowledge;

c. the Patient’s health status or changes thereto;

d. 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

e. the availability at the required times, day or night, of appropriate auxiliary aids and services.

3. Time for assessment. The determination of which appropriate auxiliary aids and services are necessary, and the timing, duration and frequency with which they will be provided, must be made be made at the time an appointment is scheduled or on the arrival of the Patient or Companion at the Hospital, whichever is earlier. Hospital Personnel will perform and document in the Patient’s record a communication assessment as part of each initial inpatient assessment.

4. Ongoing Relationships. If a Patient or a Companion who is deaf or hard of hearing has an ongoing relationship with the Hospital, with respect to each of these subsequent visits, the Hospital will continue to provide the appropriate auxiliary aids or services to the Patient or his or her Companion. Hospital Personnel will keep appropriate records that reflect the ongoing provision of auxiliary aids and services to Patients and Companions who are deaf or hard of hearing, such as notations in Patients’ records.

5. Medical Concerns. 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.

C. Complaint Resolution. The Hospital will maintain an effective complaint resolution mechanism regarding use of the Program by Patients and Companions and will maintain records of all complaints filed and actions take with respect thereto.

D. Prohibition of Surcharges. All appropriate auxiliary aids and services required by this Agreement will be provided free of charge to the Patient or Companion who is deaf or hard of hearing.

E. 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 Hospital Personnel have reason to believe that such person would benefit from appropriate auxiliary aids or services for effective communication, the Hospital will specifically inform the person that appropriate auxiliary aids and services are available free of charge.

F. Communication with Inpatients and Companions. The Hospital will take appropriate steps to see that all Hospital Personnel having contact with an inpatient 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.

II. SIGN LANGUAGE AND ORAL INTERPRETERS

A. Circumstances Under Which Interpreters Will Be Provided. The Hospital 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. The determination of when such interpreters will be provided to Patients or Companions will be made as set forth in Section I.B.2. (Assessment) above. The following are examples of circumstances when it may be necessary to provide interpreters:

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. religious services and spiritual counseling;
4. explanation of living wills or powers of attorney (or their availability);
5. diagnosis or prognosis of ailments or injuries;
6. explanation of procedures, tests, treatment, treatment options or surgery;
7. 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);
8. explanation regarding follow-up treatments, therapies, test results or recovery;
9. blood donations or apheresis;
10. discharge instructions;
11. provision of mental health evaluations, group and individual therapy, counseling and other therapeutic activities, including grief counseling and crisis intervention;
12. explanation of complex billing or insurance issues that may arise; and
13. educational presentations, such as classes concerning birthing, nutrition, CPR and weight management. The foregoing list of circumstances is neither exhaustive nor mandatory and does not imply that there are not other circumstances when it may be appropriate to provide interpreters for effective communication nor that an interpreter must always be provided in these circumstances.

B. Chosen Method for Obtaining Interpreters. Within thirty (30) days upon entry of this Agreement, the Hospital will enter into an agreement with a sign language interpreter service or services ("the SLI Service") to establish and operate a program ("the SLI Service Program") to provide qualified sign language and oral interpreters at the request of the Hospital.

C. Provision of Interpreters in a Timely Manner. The Hospital will require that the SLI Service maintains a response time of one (1) hour in at least eighty percent (80%) of non-scheduled incidents within any six (6) month period measured from the time beginning fifteen (15) minutes after it is determined that an interpreter is necessary for effective communication with a Patient or Companion who is deaf or hard of hearing. In one hundred percent (100%) of non scheduled incidents, the SLI Service’s response time will be two (2) hours or less. If the SLI Service does not provide, for reasons other than force majeure events, service meeting the requirements of this section twice within any six (6) month period, then Davis shall enter into a contract with a new SLI Service, which contract shall incorporate the requirements of this section.

D. Force Majeure Events. The foregoing response times are subject to "force majeure" events, i.e., any response time that is delayed because of a force majeure event is excluded from the determination whether the prescribed response criteria have been met. Force majeure events are events outside the reasonable control of the Hospital, the SLI Service or the interpreter called to respond, such as weather problems and other Acts of God, unanticipated illness or injury of the interpreter and unanticipated electronic transmission problems relating to computer-assisted sign language interpretation, or transportation problems (including without limitation mechanical failure of the interpreter’s automobile, automobile accidents and roadway obstructions).

E. Modification of Performance Standards. In the event that the response time performance standards set forth in clause II.C. above cannot be maintained despite the Hospital’s good faith efforts, the Hospital is entitled to request the consent of the Department to such 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 presented to the Court for approval and deemed an amendment to this Agreement.

F. Staff Interpreters. The Hospital may, but has no obligation to, satisfy its obligations under this Agreement by hiring or otherwise contracting with qualified staff 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 the Hospital is otherwise obligated to provide under this Agreement. The Hospital may assign other duties to staff interpreters.

G. Notice to Patients and Companions Who Are Deaf or Hard of Hearing. As soon as Hospital Personnel have determined that an interpreter is necessary for effective communication with a Patient or a Companion who is deaf or hard of hearing, the Hospital will inform such a person (or a family member or friend, if such person is not available) 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.

H. Other Means of Communication. The Hospital agrees that between the time an interpreter is requested and when an interpreter arrives, Hospital Personnel will continue to try to communicate with the Patient or Companion who is deaf or hard of hearing for such purposes and to the same extent as they would have communicated with the person but for the hearing impairment, using all available methods of communication. This provision in no way lessens the Hospital’s obligation to provide qualified interpreters in a timely manner as required by this Agreement.

I. Restricted Use of Certain Persons to Facilitate Communication. Due to confidentiality, potential emotional involvement and other factors that may adversely affect the ability to facilitate communication, the Hospital may never require or coerce a family member, companion, case manager, advocate or friend of a Patient or Companion who is deaf or hard of hearing to interpret or facilitate communications between Hospital Personnel and such Patient or Companion. In any case, such person may be used to interpret or facilitate communication only if the Patient or Companion who is deaf or hard of hearing does not object, if such person wishes to provide such assistance and if such use is necessary or appropriate under the circumstances, giving appropriate consideration to any privacy issues that may arise.

III. NOTICE TO COMMUNITY

A. Policy Statement. Within thirty (30) days of the entry of this Agreement, the Hospital will post and 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 be to the following effect:

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 Hospital Personnel or the Information Office at _____________ (voice/TTY), room ___________________.

These signs will include the international symbols for "interpreters" and "TTY’s."

B. Patient Handbook. The Hospital will include in all future printings 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 interpreters, TTY’s, notetakers, 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_____.

IV. NOTICE TO HOSPITAL PERSONNEL AND PHYSICIANS

The Hospital will publish, in an appropriate form, a written policy statement regarding the Hospital’s policy for effective communication with persons who are deaf or hard of hearing. The policy statement should include, but is not limited to, language to the following effect:

If you recognize or have any reason to believe that a patient, relative or companion of a patient is deaf or hard of hearing, you must advise the person that appropriate auxiliary aids and services will 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 appropriate Program Administrator. This offer and advice must likewise be made in response to any overt request from, or on behalf of, any of the deaf or hard of hearing individuals identified above, for appropriate auxiliary aids or services.

The Hospital will distribute this document within thirty (30) days of the entry of this Agreement to all Hospital Personnel and affiliated physicians (physicians with practicing or admitting privileges), and to all new Hospital Personnel and newly affiliated physicians upon their affiliation or employment with the Hospital.

V. TRAINING OF HOSPITAL PERSONNEL

A. .Emergency Department Personnel. The Hospital will provide mandatory in-service2 training to Hospital Personnel with patient responsibility who work or volunteer in the Emergency Department that addresses the special needs of deaf and hard of hearing Patients and Companions utilizing that department. This training will 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; and to use, when appropriate, flash cards and pictographs (in conjunction with any other available means of communication that will augment the effectiveness of the communication). Such training must be provided prior to the date on which the Hospital is scheduled to join the SLI Service Program and annually thereafter.

B. Psychiatric Personnel and Social Workers. The Hospital will provide mandatory in-service training to Hospital Personnel with patient responsibility who work in the Department of Psychiatry (or its equivalent, if any) or are members of the Social Work Department (or its equivalent). This training will include the following objectives; to promptly identify communication needs and preferences of Patients and Companions who are deaf or hard of hearing; to secure qualified interpreter services as quickly as possible when necessary; and to facilitate appropriate interaction between Patients who are deaf or hard of hearing and other Patients, when appropriate (e.g., group therapy sessions and other times when interaction with persons other than Hospital Personnel is encouraged). Such training must be provided after the date on which the Hospital is scheduled to join the SLI Service Program and annually thereafter.

C. Other Key Personnel. Training will be given to the following Hospital Personnel not otherwise trained as provided above: all clinical directors and nursing supervisors; personnel who staff the Admission desk (or its equivalent for in-patient registration), the Central Registry desk (or its equivalent for out-patient registration), and the General Information desk; all triage nurses and other triage professionals; and all heads of each department in which communication with Patients occurs.

D. Such training must be provided after the date on which the Hospital is scheduled to join the SLI Service Program and annually thereafter.

E. Operators. All Hospital Personnel whose duties include receipt of incoming telephone calls from the public will receive special instructions on using TTY’s and the Utah Relay or similar services to make and receive telephone calls.

F. Affiliated Physicians.

1. Training Sessions. The Hospital 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 in any way with the Hospital (admitting or surgical privileges, etc.) to attend. The Hospital will provide training videotapes that contain substantially similar information to any affiliated physician upon request.

2. Written materials. Within ninety (90) days of the entry of this Agreement, the Hospital will distribute a set of materials to all affiliated physicians. These materials will contain at least the following: the Hospital’s policy statement and any relevant forms; a description of the Program; and a request that physicians’ staff members notify the Hospital of those Patients and Companions who are deaf or hard of hearing as soon as they schedule admissions, tests, surgeries or other health care services at the Hospital.

G. Others. The Hospital will develop and implement an internal program that will provide appropriate training to all Hospital Personnel not trained under the preceding sections. This training will take place at such times as may be necessary to permit the Hospital to meet all of its obligations under this Agreement.

H. General Provisions. The Hospital will provide the training specified above to new Hospital Personnel (including without limitation Emergency Department, Psychiatric and Social Work personnel) within a reasonable time after the commencement of their services for the Hospital. Such training must be comparable to training provided to specific departments as necessary. A screening of a video of the original training will suffice to meet this obligation.

VI. REPORTING, MONITORING AND VIOLATIONS

A. Hospital Compliance Reports. Six (6) months, and one (1) year following the entry of this Agreement, and annually thereafter for the duration of this Agreement, the Hospital must provide a written report ("Report") to the Department regarding its efforts to comply with this Agreement. Each Report must state the identity of individuals admitted to the Hospital or their Companion(s) who are deaf or hard of hearing and the auxiliary aid(s) or service(s) provided to the individual(s). In the event that the Hospital does not provide auxiliary aid(s) or service(s) to a Patient or Companion who is deaf or hard of hearing, the Report must state (1) the procedure followed by the Hospital in determining whether to provide auxiliary aids and services to the Patient or Companion and (2) the Hospital’s reasons for not providing auxiliary aids and services to the Patient or Companion. The Hospital must maintain appropriate records to document the information contained in the Report.

B. Notification of Complaints Against Hospital. During the term of this Agreement, the Hospital will notify the undersigned counsel for the United States if any individual brings any lawsuit, complaint, charge, or grievance alleging that the Hospital failed to provide auxiliary aids and services to deaf or hearing impaired Patients or their Companion(s). Such notification must be provided in writing via certified mail within fifteen (15) days of when the Hospital has received notice of the allegation and will include, at a minimum, the nature of the allegation and any documentation possessed by the Hospital relevant to the allegation.

C. Violation of Settlement Agreement.

1. If the Hospital violates this Settlement Agreement or any subpart of this Agreement, the United States will have such remedies as are allowed by law, provided that the first such violation by the Hospital will be deemed a first violation of the ADA for the purpose of calculating civil penalties, if any.

2. Notwithstanding the provisions of Section 1 above, in the event that the United States believes that the Hospital has violated any provision of this Agreement, the United States will give notice (including reasonable particulars) of such violation to the Hospital’s chief executive officer, and the Hospital must then respond to such notice and/or cure such non-compliance as soon as practicable but no later than 30 days thereafter. Any event of non-compliance that prevents or restricts a Patient from receiving urgent health care services must be cured without delay. The Parties will negotiate in good faith in an attempt to resolve any dispute relating thereto before seeking relief under Section 1 above.

VII. RELIEF FOR JANELLE DEELSTRA

The Hospital will deliver a check in the amount of $130,000 payable to Janelle C. Deelstra as compensatory damages. Simultaneous with the mailing of the check, the Hospital will provide to the undersigned counsel for the United States copies of the check for its records.

VIII. RELEASE

In order to receive any of the relief to be offered by Davis under this Settlement Agreement, Mrs. Deelstra must complete a Release Form attached as Exhibit A. Within fifteen (15) days of the Hospital’s receipt of Mrs. Deelstra’s executed Release Form, the Hospital will pay to Mrs. Deelstra the monetary award described in paragraph VII above.

IX. MISCELLANEOUS

A. Term of the Agreement. The duration of this Settlement Agreement will be three (3) years from the date hereof, after which time its provisions will be terminated.

B. Public Agreement. This Settlement Agreement, along with its exhibits, constitutes a public agreement and a copy of it, or any information concerning its contents, may be made available to any person.

C. Changing Circumstances. During the three (3) years in which this Agreement will be in effect, there may be a change in circumstances such as, for example and without limitation, an increased or decreased availability of qualified sign language 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 Patients and Companions who are deaf or hard of hearing more efficiently or effectively than is required under this Agreement, or create difficulties not presently contemplated in the provision of appropriate auxiliary aids and services, it may propose changes to this Ageement by presenting written notice to the Department, which will not unreasonably withhold its approval.

D. Binding. This Agreement is final and binding on all entities named in the Release which appears as Attachment A hereto. Each Party has a duty to so inform any successor in interest for the duration of this Agreement.

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

F. Discrimination by Association. The Hospital 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.

G. Retaliation and Coercion. The Hospital agrees not to retaliate against or coerce in any way any person who is trying to exercise his or her rights under this Agreement or the ADA.

H. Severability. In the event that the Court determines that any provision of this Agreement is unenforceable, such provision will be severed from this Agreement and all other provisions will remain valid and enforceable, provided, however, that if the severance of any such provision materially alters the rights or obligations of the Parties hereunder, they will, through reasonable, good faith negotiations, agree upon such other amendments hereto as may be necessary to restore the Parties as closely as possible to the relative rights and obligations initially intended by them hereunder.

IN WITNESS WHEREOF, the undersigned counsel of record, AGREE and CONSENT to the form, content, and obligations of this Settlement Agreement on this 18th day of January, 2001:

Agreed and Consented to:

BILL LANN LEE
Assistant Attorney General
Civil Rights Division
_________________________________
JOHN L. WODATCH
ALLISON J. NICHOL
M. LUCIA BLACKSHER
Attorneys
Disability Rights Section
Civil Rights Division
U.S. Department of Justice
P. O. Box 66738
Washington, D.C. 20035-6738
(202) 514-6016

FOR THE UNITED STATES

_________________________
BILLY J. MABRY
IASIS HEALTH CARE CORP.
113 Seaboard Lane
Suite A200
Franklin, TN 37067
(615) 846-3004

FOR DAVIS HOSPITAL AND MEDICAL CENTER

APPENDIX A

RELEASE FORM

STATE OF UTAH
________________COUNTY

For and in consideration of the payment of monetary compensation made by Davis Hospital and Medical Center, pursuant to the provisions of the Settlement Agreement between the United States of America and Davis Hospital and Medical Center, I, Janelle C. Deelstra, on behalf of myself and my late husband, Jerry Deelstra, and our legal representatives, agents, executors, administrators, successors and assigns, hereby release and forever discharge Davis Hospital, its predecessors, parents, subsidiaries, affiliates, insurers, successors and assigns, and its current, past and future officers, directors, shareholders, employees and agents, of and from any and all claims arising out of DJ 202-77-28, United States v. Davis Hospital and Medical Center.

This Release constitutes the entire agreement between myself and Davis Hospital and Medical Center without exception or exclusion. This Release will be considered null and void in the event that Davis Hospital and Medical Center fails to send me a check in the amount of $130,000 within fifteen (15) days of its signing of the Settlement Agreement. I acknowledge that a copy of the Settlement Agreement in this action 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 _________, 2001.

________________________________
Janelle C. Deelstra

Social Security Number: ___________________
Other Identification: _______________________
Sworn and subscribed to before me this _______ day of __________, 2001

____________________________________
NOTARY PUBLIC
My commission expires: ________________

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