SETTLEMENT AGREEMENT BETWEEN
THE UNITED STATES OF AMERICA AND
HIGHLINE MEDICAL CENTER

I. BACKGROUND

1. The parties (“Parties”) to this Settlement Agreement (“Agreement”) are the United States of America (“United States”) and Highline Medical Center.
2. Highline Medical Center is a hospital that provides inpatient and outpatient treatment programs, located at 16251 Sylvester Road SW, Burien, Washington.  Highline Medical Center’s services include surgery services and an emergency services department.
3. This matter was initiated by a letter of investigation provided to Highline Medical Center on January 27, 2016, regarding potential violations by Highline Medical Center of Title III of the Americans with Disabilities Act of 1990, as amended (“ADA”), 42 U.S.C. §§ 12181-12189, and the Department of Justice’s implementing regulation, 28 C.F.R. Part 36.  The investigation was opened in response to complaints raised by Complainant B.W., who is deaf and uses American Sign Language (“ASL”) as his primary means of communication.  Complainant was a patient at Highline Medical Center from January 28, 2014 to January 31, 2014 for a scheduled surgical procedure known as a cervical laminectomy.  Complainant alleged that despite making an advanced request for an ASL interpreter to be present before and after his surgery, Highline Medical Center only provided an ASL interpreter prior to his surgery and failed to provide an ASL interpreter for the period after the surgery and at various other times during his medical stay, including during communications with medical staff relating his surgery and recovery therefrom, and discharge instructions.  Complainant further alleged that Highline Medical Center failed to provide qualified sign language interpretive services when necessary to ensure effective communication with his wife, who is also deaf, and accompanied Complainant during the surgery at issue.  As a result, Complainant alleged that neither he nor his wife were able to effectively communicate with medical staff about important medical matters.

II. INVESTIGATION AND FINDINGS

4. The United States Attorney’s Office for the Western District of Washington (“U.S. Attorney’s Office”) is authorized to investigate alleged violations of Title III of the ADA.  28 C.F.R. §§ 36.502, 36.503.  The U.S. Attorney’s Office has the authority to, where appropriate, negotiate and secure the full range of relief available under Title III of the ADA, including equitable/injunctive relief, requiring the provision of auxiliary aids and services, and Seeking monetary damages and a civil penalty.

5. Complainant B.W. and his companion K.W. are both deaf and as such, are individuals with a “disability” within the meaning of the ADA.  42 U.S.C. § 12102; 28 C.F.R. § 36.104.

6. Highline Medical Center is a “public accommodation” within the meaning of Title III of the ADA, 42 U.S.C. § 12181(7)(F) and its implementing regulations, 28 C.F.R. § 36.104.  The ADA prohibits public accommodations, including hospitals, from discriminating on the basis of disability in the full and equal enjoyment of their goods, services, facilities, privileges, advantages or accommodations.  42 U.S.C. § 12182(a); 28 C.F.R. § 36.201(a).  Discrimination includes failing to take such steps as necessary to ensure that no individual with a disability is excluded, denied services, segregated, or otherwise treated differently than any other individual because of the absence of auxiliary aids and services.  42 U.S.C. § 12182(b)(2)(A)(iii); 28 C.F.R. § 36.303.

7. Highline Medical Center fully cooperated with the U.S. Attorney’s Office’s investigation in this matter.  Based on its investigation, the U.S. Attorney’s Office determined that Highline Medical Center failed to provide appropriate auxiliary aids or services, including a qualified interpreter where necessary, to ensure effective communication with an individual with a disability, including a companion with a disability, for post-operative communications with medical personnel.  This included communications regarding the fact that the surgeon found more damage in Complainant’s spine than expected, necessitating a bilateral decompression.  Complainant was also unable to effectively communicate regarding the significant pain he was experiencing and was unable to effectively ask questions regarding his condition.  Instead, the Hospital relied upon note-writing, despite the fact that Complainant was recovering from general anesthesia, was unable to move his head or neck, and was in significant pain, and was without the use of his reading glasses or hearing aids. Highline Medical Center also failed to provide an ASL interpreter during Complainant’s discharge from the hospital.  Further, Highline Medical Center failed to provide an ASL interpreter for Complainant’s companion, his wife, who is also deaf, during both of these times of critical communication.  These failures caused significant distress to both Complainant and his wife.

8. On the basis of these determinations, the U.S. Attorney’s Office concluded that Highline Medical Center denied Complainant and his companion appropriate auxiliary aids and services necessary for effective communication in violation of 42 U.S.C. § 12182(b)(2)(A)(iii) and 28 C.F.R. § 36.303 at times during Complainant’s period of care from January 28 to 31, 2014.

9. This Agreement is neither an admission of liability by Highline Medical Center nor a concession by the United States that its claims are not well-founded.  By entering into this Agreement, Highline Medical Center does not admit the allegations alleged above, or to any violation of law, liability, fault, misconduct, or wrongdoing in connection with those allegations. The Parties have determined that the complaint filed with the United States can be resolved without litigation and have agreed to the terms of this Agreement.

III. DEFINITIONS

10. Examples of “Auxiliary Aids and Services” include qualified interpreters provided either on-site or through video remote interpreting (“VRI”) services; note takers; 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; 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.  28 C.F.R. § 36.303.

11. The term “Hospital Personnel” means all Highline Medical Center employees, full-time and part-time, who have or are likely to have direct contact with Patients or Companions as defined herein.

12. The term “Active Members of the Hospital Medical Staff” means all physicians who are credentialed to provide medical services at Highline Medical Center, whether or not they are direct employees of Highline Medical Center.

13. The term “Qualified Interpreter” means an interpreter who, via VRI service or an on-site appearance, is able to interpret effectively, accurately, and impartially, both receptively and expressively, using any necessary specialized vocabulary.  28 C.F.R. § 36.104.  Qualified interpreters include, for example, sign language interpreters, oral transliterators, and cued-language transliterators.  For purposes of this Agreement, a Qualified Interpreter must be knowledgeable with medical terminology.

14. The term “Patient” shall be broadly construed to include any individual who is Seeking access to, or participating in, the goods, services, facilities, privileges, advantages, or accommodations of Highline Medical Center, whether as an inpatient or an outpatient.

15. The term “Companion” means a person who is deaf or hard of hearing, as defined herein, and is a family member, friend, or associate of an individual Seeking access to, or participating in, the goods, services, facilities, privileges, advantages, or accommodations of Highline Medical Center, who, along with such individual, is an appropriate person with whom the public accommodation should communicate.  28 C.F.R. § 36.303(c)(1)(i).

16. The term “Deaf” refers to persons who are deaf or late-deafened.

17. The term “Hard of Hearing” includes persons who have a hearing deficit and who may or may not primarily use visual aids for communication and may or may not use auxiliary aids.

IV. EQUITABLE RELIEF

A. Prohibition of Discrimination

18. Nondiscrimination. Highline Medical Center shall provide appropriate Auxiliary Aids and Services, including Qualified Interpreters, where such aids and services are necessary to ensure effective communication with Patients and Companions who are Deaf or Hard of Hearing. Pursuant to 42 U.S.C. § 12182(a), Highline Medical Center shall also provide Patients and Companions who are Deaf or Hard of Hearing with the full and equal enjoyment of the services, privileges, facilities, advantages, and accommodations of Highline Medical Center as required by this Agreement and the ADA.
19. Discrimination by Association. Highline Medical Center shall not deny equal services, accommodations, or other opportunities to any individual because of the known relationship of that person with someone who is Deaf or Hard of Hearing. See 42 U.S.C. § 12182(b)(1)(E).
20. Retaliation and Coercion. Highline Medical Center shall not retaliate against or coerce in any way any person who made, or is making, a complaint according to the provisions of this Agreement or exercised, or is exercising, his or her rights under this Agreement or the ADA. See 42 U.S.C. § 12203.

B. Effective Communication

21. Appropriate Auxiliary Aids and Services. Consistent with 42 U.S.C. § 12182(b)(2)(A)(iii), Highline Medical Center will provide to Patients and Companions who are Deaf or Hard of Hearing any appropriate Auxiliary Aids and Services that are necessary for effective communication after making the assessment described in paragraphs 22-23 of this Agreement. Appropriate Auxiliary Aids and Services will be provided as soon as practicable (without compromising patient care), except that the provision of on-site interpreters must be within the time frame described in paragraph 30 of this Agreement.

22. General Assessment Criteria. The determination of appropriate Auxiliary Aids and Services, and the timing, duration, and frequency with which they will be provided, will be made by Highline Medical Center in consultation with the person with a disability. The assessment made by Hospital Personnel will take into account all relevant facts and circumstances, including, for example, the individual's communication skills and knowledge, and the nature and complexity of the communication at issue. To guide this determination, Highline Medical Center will provide all Patients or Companions who are Deaf or Hard of Hearing with a notice of services and model communication assessment form similar to the Model Communication Assessment Form attached to this Agreement as Exhibit A. Highline Medical Center will ensure that it provides a document substantially similar to Exhibit A to all new patients at intake at either the regular admissions desk or the Emergency Department within thirty (30) days of the Effective Date of this Agreement.
23. 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 (a) at the time an appointment is scheduled for the Patient who is Deaf or Hard of Hearing or, (b) on the arrival of the Patient or Companion who is Deaf or Hard of Hearing at the Hospital, whichever is earlier. If someone other than the Patient schedules the appointment then (1) that person must be asked if the Patient is Deaf or Hard of Hearing and if so, then what Auxiliary Aids and Services are necessary when the Patient presents in person and (.2) an independent assessment will be performed when the Patient who is Deaf or Hard of Hearing presents for their appointment. Hospital Personnel will perform an assessment informed by the information collected as described in paragraph 22 as part of each initial inpatient assessment and document the results in the Patient's medical chart. It is not necessary to perform the assessment for each subsequent visit to Highline Medical Center or to require the Patient to request auxiliary aids and services for each subsequent visit to Highline Medical Center. In the event that the initial form of communication is not effective or circumstances change (See paragraph 28, below), Hospital Personnel will reassess which appropriate Auxiliary Aids and Services are necessary, in consultation with the person with a disability, where possible, and provide such aid or service based on the reassessment.
24. Assistive Device Point Persons. Highline Medical Center will designate an Assistive Device Point Person. This Assistive Device Point Person or his or her designee(s) will always be on duty and available to Highline Medical Center staff, Patients, and Companions 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, including Qualified Interpreters.
    • The Assistive Device Point Person and his or her designees will know where the appropriate auxiliary aids are stored and how to operate them and will be responsible for their replacement and distribution. The Assistive Device Point Person will also be responsible for the maintenance and repair of the auxiliary aids.
    • Highline Medical Center will include in the Resource Book located in the House Supervisor's Office the name and telephone number through which the on-duty Assistive Device Point Person can be contacted twenty-four (24) hours a day seven days a week by Hospital Personnel providing services to individuals who are Deaf or Hard of Hearing.
    • The Assistive Device Point Person and his or her designees will be designated by Highline Medical Center no later than thirty (30) days following execution of this Agreement and notice of such designation will be provided to the United States Attorney's Office.
25. Auxiliary Aid and Service Log. Highline Medical Center will maintain a log in which requests for Qualified Interpreters on-site or through video remote interpreting ("VRI") for Persons who are Deaf or Hard of Hearing will be documented. The log will indicate:
    1. The name of the Patient or Companion who is Deaf or Hard of Hearing;
    2. Whether the request is for an in-person interpreter or for VRI;
    3. The time and date the request was made by the Patient or Companion (if applicable);
    4. The time and date the request was made by staff after assessing the needs of the Patient or Companion (if applicable);
    5. The time and date the request was made for, i.e. for immediate use (emergent need) or for a scheduled appointment (stating the date and time of the appointment);
    6. The time and date the request was fulfilled; and
    7. The type of the Auxiliary Aid or Service provided.

    If the requested Auxiliary Aid or Service was not provided, was not provided in the type requested, or was provided outside of the timeliness provisions contained in paragraph 30 of this agreement, the log shall contain a statement explaining why. (For Patients who are inpatients in the hospital, in lieu of documenting each and every time a VRI is utilized, if a VRI is maintained in the patient's room, the log can provide that the VRI was in the patient's room, in good working order, and was utilized for interactions with the patient during that time, so long as any problems with using the VRI are documented in the log.) Such logs will be maintained by the Assistive Device Point Person for the entire duration of the Agreement, and will be incorporated into the semi-annual Compliance Reports as described in paragraph 44 of this Agreement. The Hospital will implement the Auxiliary Aid and Service Log no later than thirty (30) days following execution of this Agreement.

26. Complaint Resolution. Highline Medical Center will implement a grievance resolution mechanism for the investigation of disputes regarding effective communication with Patients and Companions who are Deaf or Hard of Hearing. In particular:
    1. Highline Medical Center will maintain records of all grievances regarding effective communication, whether oral or written, made to Highline Medical Center and actions taken with respect thereto.
    2. At the time Highline Medical Center completes its assessment described in paragraphs 22-23 and advises the Patient and/or Companion of its determination of which appropriate Auxiliary Aids and Services are necessary, Highline Medical Center will notify persons who are Deaf or Hard of Hearing of its grievance resolution mechanism, to whom complaints should be made, and of the right to receive a written response to the grievance.
    3. A written response to any grievance filed shall be completed within thirty (30) days of receipt of the complaint.
    4. Copies of all grievances related to provision of services for Patients and/or Companions who are Deaf or Hard of Hearing and the responses thereto will be maintained by the Assistive Device Point Person for the entire duration of this Agreement.
27. Prohibition of Surcharges. All appropriate Auxiliary Aids and Services required by this Agreement will be provided free of charge to Patients and Companions who are Deaf or Hard of Hearing.

C. Qualified Interpreters

28. Circumstances Under Which Interpreters May be Required. Although the determination of whether and what Auxiliary Aids and Service is appropriate to a given situation is generally up to Highline Medical Center (as informed by its assessment (paragraphs 22 and 23) and the input or request of the Patient or Companion), some circumstances may demand that Highline Medical Center provide a qualified interpreter to Patients or Companions who rely upon such types of communications. Such circumstances typically arise when the communication is particularly complex or lengthy. For example, such circumstances include, but are not limited to:
    1. Discussing a patient's symptoms for any diagnostic purpose, and discussing medical conditions, medications, and medical history;
    2. Explaining medical conditions, treatment options, tests, medications, surgery, and other procedures;
    3. Providing a diagnosis or recommendation for treatment;
    4. Communications immediately preceding, during, and immediately after surgery or other procedures and during physician's rounds;
    5. Obtaining informed consent for treatment;
    6. Providing instructions for medications, post-treatment activities, and follow-up treatments;
    7. Providing mental health services, including group or individual counseling for patients and family members;
    8. Providing information about blood or organ donations;
    9. Discussing powers of attorney, living wills and/or complex billing, and insurance matters; or
    10. During educational presentations, such as birthing or new parent classes, nutrition and weight management programs, and CPR and first-aid training.

    In such circumstances, Highline Medical Center will presume that a qualified sign language interpreter or qualified oral interpreter is necessary for effective communication with a Patient or Companion who relies upon such auxiliary services or aids.

29. Chosen Method for Obtaining Interpreters. Within thirty (30) days after execution of this Agreement, Highline Medical Center will provide the name(s) of the interpreter services currently used by Highline Medical Center for securing qualified on-site interpreters as well as VRI services. If the names of the interpreter services used by Highline Medical Center changes during the term of this Agreement, Highline Medical Center shall notify the U.S. Attorney's Office of the change within thirty (30) days.
30. Provision of Interpreters in a Timely Manner.
    1. Non-scheduled Interpreter Requests: A "non-scheduled interpreter request" means a request for an interpreter made by a Patient or Companion who is Deaf or Hard of Hearing less than two (2) hours before the Patient's appearance at Highline Medical Center for examination or treatment. For non-scheduled interpreter requests, Hospital Personnel will complete the assessment described in paragraphs 22-23 above.
       • A Qualified Interpreter (via VRI) will be provided as soon as practicable, but no more than 30 minutes from the time Highline Medical Center completes the assessment (absent exigent circumstances affecting patient care which may extend the time for providing such service).
       • In the event that an on-site Qualified Interpreter is required, an interpreter will be provided as soon as practicable, but no more than two (2) hours from the time it becomes clear that a live interpreter is necessary for effective communication.

       As described below in section (c) of this paragraph, Highline Medical Center will document the on-site interpreter service's response time, including the time of contact and the time of arrival. Deviations from this response time will be addressed with the interpreting service provider, and performance goals will be reviewed with the U.S. Attorney's Office every six months. If no Qualified Interpreter can be located, Hospital Personnel will:

       1. Exert reasonable efforts (which shall be deemed to require no fewer than five (5) telephone inquiries and/or emails and/or text messages unless exceptional circumstances intervene) to contact any Qualified Interpreters or interpreting agencies already contracted with the Hospital and request their services;
       2. Inform the Assistive Device Point Person of the efforts made to locate an interpreter and solicit assistance in locating an interpreter;
       3. Inform the Patient or Companion (or a family member or friend, if the Patient or Companion is unavailable) of the efforts taken to secure a Qualified Interpreter and that the efforts have failed, and follow up on reasonable suggestions for alternate sources of Qualified Interpreters, such as contacting a Qualified Interpreter known to that person; and
       4. Document all of the above efforts.
    2. Scheduled Interpreter Requests. A "scheduled interpreter request" is a request for an interpreter made two (2) or more hours before the services of the interpreter are required. For scheduled interpreter requests, Highline Medical Center Personnel will complete the assessment described in paragraphs 22-23 above in advance, and, when a Qualified Interpreter is appropriate, Highline Medical Center will make a qualified interpreter available at the time of the scheduled appointment. If a Qualified Interpreter fails to arrive for the scheduled appointment, upon notice that the Qualified Interpreter failed to arrive, Highline Medical Center will immediately call the interpreter service for another Qualified Interpreter and comply with the timeframes set forth in paragraph 30(a).
    3. Data Collection on Interpreter Response Time. Highline Medical Center will monitor and document in the Auxiliary Aid and Service Log, described in paragraph 25, the response time of each Qualified Interpreter service it uses to provide communication to Patients or Companions who are Deaf or Hard of Hearing through its established process of monitoring outside vendors. Highline Medical Center will document and investigate, per the grievance process identified in paragraph 26, any complaints by the Patients or Companions who are Deaf or Hard of Hearing regarding the quality and/or effectiveness of services provided by the interpreter service.
31. Video Remote Interpreting ("VRI"). When using VRI services, Highline Medical Center shall 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. 28 C.F.R. § 36.303(f).

    VRI shall not be used when it is not effective, for example, due to: (1) a patient's limited ability to move his or her head, hands or arms; vision or cognitive issues; or significant pain; (2) space limitations in the room; (3) the complexity of the medial issue; or (4) any other time when there are indicators that VRI is not providing effective communication. Whenever, based on the circumstances, VRI does not provide effective communication with a Patient or Companion who is Deaf or Hard of Hearing (after it has been provided or is not available), VRI shall not be used as a substitute for an on-site Qualified Interpreter, and an on-site Qualified Interpreter shall be requested by Highline personnel and provided. The on-site Qualified Interpreter shall be requested and provided in a timely manner as required by paragraph 30 of this Agreement; the two hours begins when it becomes evident that VRI cannot provide effective communication.

32. Notice to Patients and Companions Who are Deaf or Hard of Hearing. As soon as Highline Medical Center Hospital Personnel have determined that a Qualified Interpreter is necessary for effective communication with a Patient or Companion who is Deaf or Hard of Hearing, Highline Medical Center will inform the Patient or Companion (or a family member or friend, if the Patient or Companion is not available) of the current status of efforts being taken to secure a Qualified Interpreter on his or her behalf. Highline Medical Center will provide additional updates to the Patient or Companion as necessary until an interpreter is secured. Notification of efforts to secure a Qualified Interpreter does not lessen Highline Medical Center's obligation to provide Qualified Interpreters in a timely manner as required by paragraph 30 of this Agreement.
33. Other Means of Communication. Highline Medical Center agrees that between the time an interpreter is requested and the Qualified Interpreter is provided, 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 disability, using all available methods of communication, for example, using sign language pictographs. This provision in no way lessens Highline Medical Center's obligation to provide qualified interpreters in a timely manner as required by paragraph 30 of this Agreement.
34. Restricted Use of Certain Persons to Facilitate Communication. Highline Medical Center will not rely on an adult friend or family member of the Patient or Companion who is Deaf or Hard of Hearing to interpret except:
    1. In an emergency involving an imminent threat to the safety of an individual or the public where there is no interpreter available; or
    2. Where the Patient or Companion who is Deaf or Hard of Hearing specifically requests that the adult friend or adult family member interpret, the accompanying adult agrees to provide such assistance, and reliance on that adult for such assistance is appropriate under the circumstances. Highline Medical Center shall provide a medically certified interpreter regardless of Patient or Companion consent to use an adult friend or adult family member in the circumstances set forth in paragraph 28.

    Highline Medical Center will not rely on a minor child or Patient to interpret except in the limited circumstances described in (a) above.

D. Notice to the Community

35. Policy Statement. Within ninety (90) days of the entry of this Agreement, Highline Medical Center shall post and maintain signs of conspicuous size and print at all Highline Medical Center admitting stations and wherever a Patient's Bill of Rights is required by law to be posted, with substantially similar language to that provided in the Sample Posting attached as Exhibit B notifying the public of the availability of Auxiliary Aids and Services and their related rights. These signs will include the international symbol for "ASL interpreter."
36. Website. Within ninety (90) days of the entry of this Agreement, Highline Medical Center will include on its website the same or substantially similar policy statement, conspicuously linked from the main website, currently available at: https://www.chifranciscan.org/highline-medical-center.html.
37. Patient Handbook. Highline Medical Center 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 and oral interpreters, video remote interpreting services, TTYs, written materials, telephone handset amplifiers, assistive listening devices and systems, telephones compatible with hearing aids, televisions with caption capability or 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 _________________.

    Highline Medical Center will also include in its Patient Handbook a description of its complaint resolution mechanism.

E. Notice to Highline Medical Center Hospital Personnel and Physicians

38. Website. Within ninety (90) days of the entry of this Agreement, Highline Medical Center shall publish on its intranet a policy statement regarding Highline Medical Center's policy for effective communication with persons who are Deaf or Hard of Hearing. This policy statement includes, but is not limited to, language to the following effect:

    If you recognize or have any reason to believe that a Patient or a relative, close friend, 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 remote interpreting services, TTYs, written materials, telephone handset amplifiers, assistive listening devices and systems, telephones compatible with hearing aids, televisions with captioning or closed caption decoders, and open and closed captioning of most hospital programs, will be provided free of charge when appropriate. 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 ADA Administrator(s) at _____________ and reachable at ________________.

39. Notice to Personnel. Within ninety (90) days of the entry of this Agreement Highline Medical Center's policy for effective communication with persons who are Deaf or Hard of Hearing will be accessible to all Hospital Personnel and Active Members of the Hospital Medical Staff. The policy will also be provided to all newly hired Hospital Personnel and all Active Members of the Hospital Medical Staff upon their affiliation or employment with Highline Medical Center.

F. Training

40. Training of the Assistive Device Point Person and His or Her Designees. Highline Medical Center will provide mandatory training for the Assistive Device Point Person and his or her designees as set forth in paragraph 24 of this Agreement. Such training will occur within sixty (60) days of designation of the Assistive Device Point Person and/or his or her designees unless such training has been provided in accordance with Highline Medical Center's training schedule within the same calendar year of the Effective Date of this Agreement. Such training will be sufficient in duration and content to train the Assistive Device Point Person and his or her designees in the following areas:
    1. to promptly identify communication needs of Patients and Companions who are Deaf or Hard of Hearing, including when an in-person Qualified Interpreter is necessary;
    2. to secure Qualified Interpreter services or VRI services as quickly as possible when necessary;
    3. to use, when appropriate, flash cards and/or pictographs (in conjunction with any other available means of communication that will augment the effectiveness of the communication);
    4. how and when to use VRI services, including how to make and receive calls;
    5. to encourage Active Members of Highline Medical Center's Medical Staff to notify the Assistive Device Point Person or his or her designee of Patients and Companions who are Deaf or Hard of Hearing as soon as Patients schedule admissions or other health care services at Highline Medical Center; and
    6. Highline Medical Center's complaint resolution procedure described in paragraph 26 of this Agreement.
41. Training of Hospital Personnel. Except for Active Members of the Hospital Medical Staff, who are governed by paragraph 43 of this Agreement, Highline Medical Center will provide mandatory in-service training to all Hospital Personnel who have contact with Patients.
    1. The training will address the needs of Patients and Companions who are Deaf or Hard of Hearing and will include the following objectives:
       1. to promptly identify communication needs of Patients and Companions who are Deaf or Hard of Hearing, including when an in-person Qualified Interpreter is necessary;
       2. to secure Qualified Interpreter services or VRI services as quickly as possible when necessary;
       3. to use, when appropriate, flash cards and/or pictographs (in conjunction with any other available means of communication that will augment the effectiveness of the communication); and
       4. how and when to use VRI services, including how to make and receive calls.
    2. Such training must be provided within ninety (90) days of the Effective Date of this Agreement, unless such training has been provided within the same calendar year of the Effective Date of this Settlement in accordance to Highline Medical Center's training schedule and annually thereafter.
    3. New employees must be trained in the same manner within thirty (30) days of their hire.
42. Training Attendance Records. Highline Medical Center will maintain for the duration of this Agreement, confirmation of training conducted pursuant to paragraphs 40-41 of this Agreement, which will include the names and respective job titles of the attendees, as well as the date and time of the training session.
43. Training of Active Members of the Hospital Medical Staff. Highline Medical Center will provide Active Members of the Hospital Medical Staff a hard copy of its policy on the communication needs of Patients or Companions who are Deaf or Hard of Hearing by delivering it to their office addresses. The policy shall be accompanied by a cover letter that:
    1. indicates the additional availability of the policy on the intranet,
    2. invites the recipient to reach out to the Assistive Device Point Person if they have questions about the policy; and
    3. requests that if and when they become aware that a Patient or Companion who is Deaf or Hard of Hearing will be visiting Highline Medical Center for health care services, that they promptly notify the Assistive Device Point Person of the expected visit.

G. Reporting, Monitoring, and Violations

44. Compliance Reports. Beginning six months after the Effective Date of this Agreement and every six (6) months thereafter for the entire duration of the Agreement, Highline Medical Center will provide a written report ("Compliance Report") to the U.S. Attorney's Office regarding the status of its compliance with this Agreement. The Compliance Report will include data relevant to the Agreement, including but not limited to:
    1. the information required in Auxiliary Aid and Service Log described in paragraph 25.
    2. the information maintained in the complaint records described in paragraph 26, including the number of complaints received by Highline Medical Center from Patients and Companions who are Deaf or Hard of Hearing regarding Auxiliary Aids and Services and/or effective communication, and the resolution of such complaints including any supporting documents.

    Highline Medical Center will maintain records to document the information contained in the Compliance Reports and will make them available, upon request, to the U.S. Attorney's Office.

45. Complaints. During the term of this Agreement, Highline Medical Center will notify the U.S. Attorney's Office if any person files a lawsuit, complaint, or formal charge with a state or federal agency, alleging that Highline Medical Center failed to provide Auxiliary Aids and Services to Patients or Companions who are Deaf or Hard of Hearing or otherwise failed to provide effective communication with such Patients or Companions. Such notification must be provided in writing via certified mail within twenty (20) days of the date Highline Medical Center received notice of the allegation and will include, at a minimum, the nature of the allegation, the name of the person making the allegation, and any documentation of the allegation provided by the complainant. Highline Medical Center will reference this provision of the Agreement in the notification to the U.S. Attorney's Office.

H. Remuneration for Complainants and Release

46. Compensatory Relief for B.W. Within ten (10) days after receiving the executed Agreement, B.W.'s signed release (a Blank Release Form is at Exhibit C), and an executed IRS Form W-9, Highline Medical Center will send by FedEx, a check in the amount of TWENTY-FIVE THOUSAND DOLLARS ($25,000) made out to Complainant. This check is compensation to the Complainant pursuant to 42 U.S.C. § 12188(b)(2)(B), for the effects of the alleged discrimination suffered as described in paragraphs 7 and 8. The check shall be mailed to:

    Christina Fogg
    Assistant United States Attorney
    U.S. Attorney's Office for the Western District of Washington
    700 Stewart Street, Suite 5220
    Seattle, WA 98101

47. Compensatory Relief for K.W. Within ten (10) days after receiving the executed Agreement, K.W.'s signed release (a Blank Release Form is at Exhibit C), and an executed IRS Form W-9, Highline Medical Center will send by FedEx, a check in the amount of TEN THOUSAND DOLLARS ($10,000) made out to K.W. This check is compensation to K.W. pursuant to 42 U.S.C. § 12188(b)(2)(B), for the effects of the alleged discrimination suffered as described in paragraphs 7-8. The check shall be mailed to:

    Christina Fogg
    Assistant United States Attorney
    U.S. Attorney's Office for the Western District of Washington
    700 Stewart Street, Suite 5220
    Seattle, WA 98101

I. Payment of Civil Penalty to the United States

48. Within 30 days of the effective date of this Agreement, Highline Medical Center will pay a civil penalty to the United States in the amount of TEN THOUSAND DOLLARS ($10,000), pursuant to 42 U.S.C. § 12188(b)(2)(C) to vindicate the public interest.

J. Enforcement and Miscellaneous

49. Duration of the Agreement. This Agreement will be in effect for three (3) years from the Effective Date.
50. Enforcement. In consideration of the terms of this Agreement as set forth above, the United States agrees to refrain from undertaking further investigation or from filing a civil suit under Title III in this matter, except as provided in paragraph 51. Nothing contained in this Agreement is intended or shall be construed as a waiver by the United States of any right to institute proceedings against Highline Medical Center for violations of any statutes, regulations, or rules administered by the United States or to prevent or limit the right of the United States to obtain relief under the ADA for violations unrelated to this matter.
51. Compliance Review and Enforcement. The United States may review compliance with this Agreement at any time and can enforce this Agreement if the United States believes that it or any requirement thereof has been violated by instituting a civil action in U.S. District Court. If the United States believes that this Agreement or any portion of it has been violated, it will raise its claim(s) in writing with Highline Medical Center, and the parties will attempt to resolve the concern(s) in good faith. The United States will allow Highline Medical Center thirty (30) days from the date it notifies Highline Medical Center of any breach of this Agreement to cure said breach, prior to instituting any court action to enforce the ADA or the terms of the Agreement.
52. Entire Agreement. This Agreement and the attachments hereto constitute the entire agreement between the parties on the matters raised herein, and no other statement, promise, or agreement, either written or oral, made by either party or agents of either party, that is not contained in this written agreement, shall be enforceable. This Agreement is limited to the facts set forth herein and does not purport to remedy any other potential violations of the ADA or any other federal law.
53. Binding. This 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. Each party has a duty to so inform any such successor in interest.
54. Non-Waiver. Failure by any party to Seek enforcement of this 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.
55. Effective Date. The effective date of this Agreement is the date of the last signature below.
56. Execution. This Agreement may be executed in counterparts, each of which constitutes an original and all of which constitute one and the same Agreement. Electronically transmitted signatures shall constitute acceptable, binding signatures for purposes of this Agreement.