SETTLEMENT AGREEMENT BETWEEN
THE UNITED STATES OF AMERICA,
SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP, AND
KAISER FOUNDATION HOSPITALS
U.S. DEPARTMENT OF JUSTICE COMPLAINT # DJ 202-12C-467
U.S. ATTORNEY'S OFFICE #2012V02299

BACKGROUND

1. The parties (“Parties”) to this Settlement Agreement (“Agreement”) are the United States of America (“United States”), Southern California Permanente Medical Group (“SCPMG”), and Kaiser Foundation Hospitals (“KFH”) (collectively “SCPMG/KFH”).
2. SCPMG operates the ambulatory care department of the Kaiser Permanente West Los Angeles Medical Center located at 6041 Cadillac Ave, Los Angeles, CA 90034 (the “Medical Center”).  KFH owns and operates the Medical Center. This agreement applies to the Medical Center only.
3. This matter was initiated by a complaint filed with the United States against the Medical Center, alleging violations of Title III of the Americans with Disabilities Act (the “ADA”), 42 U.S.C. §§ 12181-12189, and its implementing regulations, 28 C.F.R. Part 36.
4. Specifically, Complainant L.S. (the “Complainant”), who is deaf, alleged that Medical Center personnel failed to provide him with a qualified sign language interpreter, or other appropriate form of auxiliary aid or service when necessary to ensure effective communication with him.
5. Complainant L.S. alleged that, from 2012 through 2016, he visited the Medical Center for medical appointments, treatment, or emergency visits. Complainant alleged that when visiting the Medical Center, he had not been provided effective communication on a reliable basis, including multiple failures to provide appropriate auxiliary aids and services, such as qualified interpreters.  SCPMG/KFH state that they provide, free of charge, qualified interpreters for Patients and Companions who are deaf or hard-of-hearing. 

INVESTIGATION AND DETERMINATIONS

6. Ensuring that health care providers do not discriminate on the basis of disability is an issue of general public importance.  The United States, including the United States Attorney’s Office for the Central District of California (“U.S. Attorney’s Office”), is authorized to investigate alleged violations of title III of the ADA, to use alternative means of dispute resolution, where appropriate, including settlement negotiations to resolve disputes, and to bring a civil action in federal court in any case that raises issues of general public importance.  42 U.S.C. §§ 12188(b) & 12212; 28 C.F.R. §§ 36.502, 503 & 506.
7. Complainant L.S. is an individual with a “disability” within the meaning of the ADA.  42 U.S. C. § 12102; 28 C.F.R. § 36.104.
8. The Medical Center is a “place of public accommodation” within the meaning of title III of the ADA because it is a hospital or other service establishment, 42 U.S.C. § 12181(7)(F), 28 C.F.R. § 36.104(6).  SCPMG/KFH are “public accommodations” subject to title III of the ADA because they own and/or operate the Medical Center.  28 C.F.R. § 36.104.
9. The ADA prohibits discrimination on the basis of disability in the full and equal enjoyment of the goods, services, facilities, privileges, advantages, or accommodations by any person who owns, operates, leases or leases to a place of public accommodation.  42 U.S.C. § 12182(a); 28 C.F.R. § 36.201(a).  A public accommodation shall take those steps that may be necessary to ensure that no individual with a disability is excluded, denied services, segregated or otherwise treated differently than other individuals because of the absence of auxiliary aids and services, unless the public accommodation can demonstrate that taking those steps would fundamentally alter the nature of the goods, services, facilities, privileges, advantages and accommodations being offered or result in an undue burden.   42 U.S.C. § 12182(b)(2)(A)(iii); 28 C.F.R. § 36.303.
10. On the basis of its investigation, the U.S. Attorney’s Office determined that SCPMG/KFH did not provide the Complainant appropriate auxiliary aids and services necessary for effective communication during several of Complainant’s treatments at the Medical Center, in violation of 42 U.S.C. § 12182(b)(2)(A)(iii) and 28 C.F.R. § 36.303.  SCPMG/KFH have fully cooperated in the U.S. Attorney’s Office investigation in this matter.
11. SCPMG/KFH deny that they have violated 42 U.S.C. § 12182(b)(2)(A)(iii), 28 C.F.R. § 36.303, or any other law with regard to Complainant. This Agreement is neither an admission of liability by SCPMG/KFH nor a concession by the United States that its claims are not well-founded. By entering into this Agreement, SCPMG/KFH do 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. 

DEFINITIONS

12. The term “auxiliary aids and services” includes 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; 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(b)(1).
13. The term “Medical Center Personnel” means all employees, both full and part-time, and independent contractors with contracts to work on a substantially full-time basis for the Medical Center (or on a part-time basis of 20 hours or more, or exclusively for the Medical Center), including, without limitation, nurses, physicians, social workers, technicians, admitting personnel, billing staff, security staff, therapists, and volunteers, whose job duties include having direct contact with deaf or hard-of-hearing Patients or Companions as defined herein.
14. The term “qualified interpreter” means an interpreter who, via a 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.  28 C.F.R. § 36.104.
15. The term “Patient” shall be broadly construed to include any individual who is seeking or receiving health care services from the Medical Center, whether as an inpatient or an outpatient.
16. The term “Companion” means a person who 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 a public accommodation, 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).
17. “Effective Date of this Settlement Agreement” means the date of the last signature below. 

EQUITABLE RELIEF

1. Prohibition of Discrimination
   18. Nondiscrimination. SCPMG/KFH shall continue to provide appropriate auxiliary aids and services, including qualified interpreters, where they 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), SCPMG/KFH shall also provide deaf and hard-of-hearing Patients and Companions with the full and equal enjoyment of the services, privileges, facilities, advantages, and accommodations of the Medical Center as required by this Agreement and the ADA.
   19. Discrimination by Association. SCPMG/KFH 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. SCPMG/KFH 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.
2. Effective Communication
21. Appropriate Auxiliary Aids and Services.  The U.S. Attorney’s Office acknowledges that SCPMG/KFH have policies in place at the Medical Center regarding effective communication for individuals who are deaf or hard-of-hearing.  However, SCPMG/KFH agree to review and modify their policies to address and include the provisions contained in this Agreement.
22. Diversity Coordinator. SCPMG/KFH shall have at least one Medical Center employee designated as a Diversity Coordinator at all times.   The Diversity Coordinator or his/her designee, shall be available 24 hours a day, 7 days a week, to answer questions and provide appropriate assistance regarding immediate access to, and proper use of, appropriate auxiliary aids and services necessary for effective communication, including qualified interpreters.  The Diversity Coordinator will know where the auxiliary aids are stored, how to obtain the aids or services, and how to operate any aids.  The Diversity Coordinator or his/her designee will be responsible for the maintenance, repair, replacement, and distribution of any auxiliary aids.  SCPMG/KFH will ensure that they circulate and post within the Medical Center the name, telephone number, function, and office location of the Diversity Coordinator(s) that Medical Center Personnel, Patients, Companions or members of the public can contact in order to obtain the Diversity Coordinator’s assistance.  The Diversity Coordinator will be responsible for the complaint resolution mechanism described in paragraph 24 of this Agreement. 
23. VRI and On-Site Interpreter Records. SCPMG/KFH will use its existing data collection methods to maintain records of VRI services and on-site interpreters requested by or provided to deaf or hard-of-hearing Patients and Companions at the Medical Center.  Where available through its existing data collection methods, records will include the date and time the request was made, the date and time of the scheduled appointment (if a scheduled appointment was made), and the date and time either VRI or an on-site interpreter was provided. If a deaf or hard-of-hearing Patient or companion requested VRI or an on-site interpreter but was not provided that requested auxiliary aid or service, the record shall contain a statement as to why the requested auxiliary aid or service was not provided. Such records will be maintained by the Diversity Coordinator for the entire duration of the Agreement, and will be incorporated into the semi-annual Compliance Reports as described in paragraph 42 of this Agreement.
24. Complaint Resolution.  SCPMG/KFH will utilize their established grievance resolution mechanism for the investigation of disputes regarding effective communication for deaf and hard-of-hearing Patients and Companions, except that SCPMG/KFH shall designate a specific person or Coordinator who the Complainant may contact directly to discuss or report any issue regarding the provision of effective communication to Complainant by SCPMG/KFH.  SCPMG/KFH will maintain records of all grievances lodged through the established grievance process, including the Complainant’s, regarding effective communication, whether oral or written, made to the Medical Center and actions taken with respect thereto. If SCPMG/KFH becomes aware that a deaf or hard-of-hearing Patient or Companion requested VRI or an on-site interpreter but was not provided one, SCPMG/KFH will notify that person of his or her grievance resolution mechanism, including to whom complaints should be made, and of the right to receive a written response to the grievance. 

    A written response to any grievance filed shall be completed within 30 days of receipt of the complaint, absent exigent circumstances.  Copies of all grievances related to the provision of services for deaf or hard-of-hearing Patients and/or Companions and the responses thereto will be maintained by the Diversity Coordinator for the entire duration of the Agreement.

25. Prohibition of Surcharges.  All appropriate auxiliary aids and services required by this Agreement will be provided free of charge to the deaf or hard-of-hearing Patient and/or Companion. 
26. Record of Need for VRI or On-Site Interpreters.  For all deaf or hard-of-hearing Patients who need interpreter services, SCPMG/KFH will continue to include this information in the Patient’s electronic medical record.  
3. Qualified Interpreters
27. Circumstances Under Which Interpreters Will Be Provided.  When a qualified interpreter is needed, SCPMG/KFH shall continue to provide such interpretation services to deaf or hard-of-hearing Patients and Companions.  Examples of circumstances when the communication may be sufficiently lengthy or complex so as to require a qualified interpreter include the following:
1. Discussing a Patient’s symptoms and medical condition, medications, and medical history (including medical, psychiatric, psychosocial, nutritional);
2. Explaining medical conditions, treatment options, tests, medications, surgery and other procedures;
3. Providing a diagnosis or prognosis and recommendation for treatment;
4. Communicating with a patient during treatment, testing procedures, and during physician’s rounds;
5. Reviewing, explaining or obtaining informed consent or permission for treatment;
6. Explaining medications prescribed (such as dosage, instructions for how and when the medication is to be taken, and side effects or food or drug interactions);
7. Determining any condition or allergy of a Patient that may affect the Patient’s choice of medication;
8. Explaining follow-up treatments, post-treatment activities, therapies, test results or recovery;
9. During the provision of mental health services, including group or individual counseling for patients and family members;
10. Providing information about blood or organ donations;
11. Discussing the Patient’s Bill of Rights, powers of attorney, living wills and/or complex billing and insurance matters;
12. During educational presentations, such as birthing or new parent classes, nutrition and weight management programs, and CPR and first-aid training.
28. Chosen Method for Obtaining Interpreters. SCPMG/KFH shall continue to contract with at least one interpreter agency that can provide qualified on-site interpretation services consistent with the terms of this Agreement at the request of the Medical Center.  SCPMG/KFH shall also contract with at least one vendor to provide VRI interpretation services at the Medical Center as further described in paragraph 29.
29. Provision of Qualified Interpreters in a Timely Manner.
1. Non-Scheduled Interpreter Requests: A “non-scheduled interpreter request” means a request for an on-site interpreter made by a deaf or hard-of-hearing Patient or Companion less than 7 days before the Patient’s appearance at the Medical Center for examination or treatment.  For non-scheduled interpreter requests, SCPMG/KFH shall provide VRI interpretation services within one hour of a request. If a deaf or hard-of-hearing Patient or Companion requests an on-site qualified interpreter for a non-scheduled interpreter request or SCPMG/KFH determine that an on-site qualified interpreter is necessary to provide effective communication under the circumstances presented, SCPMG/KFH will promptly call all vendors with whom they have a contract to provide qualified interpreters for the Medical Center and book the vendor that can provide the fastest service at the Medical Center, if a qualified interpreter is available.
2. Scheduled Interpreter Requests: A “scheduled interpreter request” is a request for a qualified interpreter made 7 or more days before the services of the interpreter are required.  For scheduled interpreter requests, if a Patient or Companion requests an on-site qualified interpreter or SCPMG/KFH determine that an on-site qualified interpreter is necessary to provide effective communication under the circumstances presented, SCPMG/KFH shall promptly contact an interpreter service to schedule an interpreter and use its best efforts to ensure that an on-site qualified interpreter is available at the time of the scheduled appointment. Unless requested or deemed necessary to have an on-site interpreter, SCPMG/KFH shall provide VRI interpretation services at the scheduled appointment. If an on-site interpreter fails to arrive for the scheduled appointment, upon notice that the on-site interpreter failed to arrive, the first Medical Center Personnel to learn of the failure will immediately call the interpreter service for another qualified on-site interpreter.
30. Data Collection on Interpreter Response Time and Effectiveness. SCPMG/KFH will monitor the performance of each qualified interpreter service they use to provide communication to deaf or hard-of-hearing Patients or Companions through their established process of monitoring outside vendors.
31. Video Remote Interpreting.  VRI can provide immediate, effective access to interpreting services in a variety of situations, including emergencies and non-scheduled visits.  When using VRI services, SCPMG/KFH shall ensure that they provide:  (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 due, for example, to a patient’s limited ability to move his or her head, hands or arms; vision or cognitive issues; significant pain; or due to space limitations in the room. SCPMG already offers VRI services at the Medical Center except in the medical offices which will have VRI services by January 1, 2018.  SCPMG/KFH are not responsible for power outages or service interruption due to acts of God or third-party problems.  If, based on the circumstances, VRI is not providing effective communication after it has been initiated or is not available due to circumstances outside of KFH’s control, an on-site interpreter shall be provided as set forth above.
32. Notice to Patients and Companions.  For non-scheduled visits, as soon as Medical Center Personnel know or have determined that a qualified interpreter is necessary for effective communication with a deaf or hard-of-hearing Patient or Companion, the 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. Medical Center Personnel will provide additional updates to the Patient or Companion as necessary until such interpreter is secured.  Notification of efforts to secure a qualified interpreter does not lessen SCPMG/KFH’s obligation to provide qualified interpreters in a timely manner as required by paragraph 29 of this Agreement.
33. Other Means of Communication. SCPMG/KFH agree that between the time a qualified interpreter is requested and the interpreter is provided, Medical Center Personnel will continue to try to communicate with the deaf or hard-of-hearing 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 SCPMG/KFH’s obligation to provide qualified interpreters in a timely manner as required by paragraph 29 of this Agreement. 
4. Notice to Community
34. Policy Statement.  Within 90 days of the Effective Date of this Settlement Agreement and to the extent not previously undertaken, SCPMG/KFH shall post and maintain signs of conspicuous size and print at all Medical Center admitting stations, the emergency department, and wherever a Patient’s Bill of Rights is required by law to be posted informing the public that auxiliary aids and services, including sign language interpreters, are available free of charge to people who are deaf or hard-of-hearing and who to contact to obtain such services.  The sign will also provide a telephone number that can be used to request such services.
35. Website. SCPMG/KFH will include on the Medical Center’s website the policy statement described above.
36. Patient Handbook. SCPMG/KFH will include in future printings of the Kaiser Permanente Patient Handbook (or equivalent) the policy statement set forth in paragraph 34, the types of auxiliary aids and services available, a description of their complaint resolution mechanism, and a contact phone number for any questions or concerns.  
5. Training
37. Training of Diversity Coordinator.  To the extent not previously provided, SCPMG/KFH will provide mandatory training for the Diversity Coordinator(s) and their designees within 90 days of the Effective Date of this Agreement.  Such training will be sufficient in duration and content to train the Diversity Coordinator(s) in the following areas:
1. to promptly identify communication needs of Patients and Companions who are deaf or hard-of-hearing and which auxiliary aids are effective in which situations;
2. to secure qualified interpreter services as quickly as possible when necessary;
3. how and when to use video remote interpreting services;
4. making and receiving calls using relay services; and
5. SCPMG/KFH’s complaint resolution procedure described in paragraph 24 of this Agreement.
38. Training of Medical Center Personnel.  SCPMG/KFH will provide mandatory training, in-service or on-line, to all Medical Center Personnel. 
1. The training will address the needs of deaf and hard-of-hearing Patients and Companions and will include the following objectives:
1. to promptly identify communication needs of Patients and Companions who are deaf or hard-of-hearing;
2. if Medical Center Personnel providing medical services to a Patient observes that the Patient or his or her Companion may need an auxiliary aid or service, such Medical Center Personnel will affirmatively ask that person if he or she needs an auxiliary aid or service for effective communication and the types of auxiliary aids or services that are available to provide effective communication;
3. who to contact to secure qualified interpreter services or video remote interpreting services for a Patient or Companion and to contact that person as quickly as possible when necessary;
4. the identity of the Diversity Coordinator;
5. how a Patient or Companion can file a complaint;
6. to inform a Patient or Companion of the grievance resolution mechanism, including to whom a complaint should be made and the right to receive a written response to the grievance, if a deaf or hard-of-hearing Patient or Companion requests VRI or an on-site interpreter but the requested auxiliary aid or service is not provided; and
7. for employees whose job duties include communicating with members of the public using the telephone, how to handle telephone calls made through relay services, and how to place telephone calls using relay services.
2. Such training must be provided within 6 months after the Effective Date of this Agreement.
3. New employees must be trained within 60 days of their hire, except that the new employees hired in 2019 must be trained within 90 days of hire.
39. Training of Telephone Operators.  All Medical Center Operators who receive incoming telephone calls from the public will receive training generally on how handle incoming relay calls, how to initiate relay calls, who to contact to secure qualified interpreter services or video remote interpreting services for a Patient or Companion and to contact that person as quickly as possible when necessary, the existence in SCPMG/KFH of a Diversity Coordinator, as detailed in paragraph 22 of this Agreement, and the complaint resolution process, as described in paragraph 24 of this Agreement.  Such training must be provided within 90 days of the Effective Date of this Agreement and will be conducted annually thereafter.
40. Training Attendance Sheets. SCPMG/KFH will maintain in electronic form for the duration of this Agreement, confirmation of training conducted pursuant to paragraphs 37-39 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.
41. Training of Affiliated Physicians. Within 6 months of the Effective Date of this Agreement, SCPMG/KFH will email affiliated physicians its policy on the communications needs of Patients or Companions who are deaf or hard-of-hearing. Thereafter, Kaiser will include in its annual communication to affiliated physicians, its policy on the communication needs of Patients or Companions who are deaf or hard-of-hearing. These communications will direct affiliated physicians to the Medical Center’s web page which will include Kaiser’s Policy Statement as described in paragraph 34.
6. Reporting, Monitoring, and Violations
42. Compliance Reports.  Beginning 6 months after the Effective Date of this Agreement and every 6 months thereafter for the duration of the Agreement, SCPMG/KFH will provide a written report (“Compliance Report”) to the U.S. Attorney’s Office regarding the status of their compliance with this Agreement.  The Compliance Report will include data relevant to the Agreement, including but not limited to:
1. the information required in VRI and on-site interpreter records described in paragraph 23.
2. the number of complaints received by Medical Center from deaf and hard-of-hearing Patients and Companions regarding auxiliary aids and services and/or effective communication and the resolution of such complaints including any supporting documents.

SCPMG/KFH 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.

43. Complaints.  During the term of this Agreement, SCPMG/KFH 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 the Medical Center failed to provide auxiliary aids and services to deaf or hard-of-hearing Patients or Companions or otherwise failed to provide effective communication with such Patients or Companions.  Such notification must be provided in writing via certified mail within 45 days of the date the 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 possessed by SCPMG/KFH relevant to the allegation. SCPMG/KFH will reference this provision of the Agreement in the notification to the U.S. Attorney’s Office.
7. Compensatory Relief for Complainant and Release
44. Within 21 days of the entry of this Agreement and provided that the U.S. Attorney’s office has delivered to counsel for SCPMG/KFH a release signed by the complainant, SCPMG/KFH will send by certified mail, return receipt requested, a check in the amount of $17,000.00 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 paragraph 5.  The check shall be mailed to: 

Office of the United States Attorney
300 North Los Angeles Street, Suite 7516
Los Angeles, California  90012
Attn: Acrivi Coromelas

45. Within 10 days of the Effective Date of this Agreement, the U.S. Attorney’s Office will deliver to counsel for SCPMG/KFH a release signed by the Complainant.  The release is attached as Exhibit B.
8. Payment of Civil Penalty to the United States
46. Within 21 days of the Effective Date of this Agreement, SCPMG/KFH will pay to the United States of America the sum of $3,250.00 pursuant to 42 U.S.C. §12188(b)(2)(C).
9. Enforcement and Miscellaneous
47. Duration of the Agreement.  This Agreement will be in effect for 3 years from the Effective Date.
48.  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 of the ADA in this matter, except as provided in paragraph 49.  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 SCPMG/KFH 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.
49.  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 SCPMG/KFH, and the parties will attempt to resolve the concern(s) in good faith.  The United States will allow SCPMG/KFH 30 days from the date it notifies SCPMG/KFH 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. 
50. 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. 
51. 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. 
52. 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.