SETTLEMENT AGREEMENT BETWEEN
THE UNITED STATES OF AMERICA AND
LAWRENCE + MEMORIAL HOSPITAL, INC.,
AN AFFILIATE OF YALE NEW HAVEN HEALTH SERVICES CORPORATION
DJ# 202-14-226

I. BACKGROUND AND PARTIES

1. The parties (“Parties”) to this Settlement Agreement (“Agreement”) are the United States of America (“United States”) and Lawrence + Memorial Hospital, Inc. (the “Hospital”), an affiliate of Yale New Haven Health Services Corporation.
2. The Hospital is located in New London, Connecticut.  The Hospital, as referred to in this Agreement, also includes any hospital, clinic, or other medical facility offering services to the public acquired by the Hospital through the duration of this Agreement.  
3. This matter was initiated based on a complaint alleging that in or about November 2016, the Hospital was not in compliance with 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. pt. 36.  The complaint alleges that the Complainant, who is deaf and who uses American Sign Language (“ASL”) as her primary means of communication, was referred to the Hospital for an appointment.  The Complainant alleges that when she went to the Hospital for the appointment, there was no interpreter present despite the Hospital having provided the Complainant with an interpreter at a past appointment.  Further, the Complainant alleges that, despite requesting an interpreter at the time of the appointment, no interpreter was provided.  Because she was not provided with a qualified interpreter, the Complainant alleges she was not able to effectively communicate with the Hospital’s staff, including the healthcare providers caring for her.  The Hospital disputes the allegations of the complaint and maintains it provided effective communication to the Complainant at all times during her care.
4. The Hospital became affiliated with Yale New Haven Health Services Corporation on September 8, 2016.  As part of the affiliation agreement between the entities, Yale New Haven Health Services Corporation provides the Hospital with management support services, including, but not limited to compliance services.  At the time of the Complainant’s November 2016 appointment, the Hospital’s policies and procedures regarding effective communication required for compliance with the ADA and federal regulations were in a period of transition due to the recent affiliation between the Hospital and Yale New Haven Health Services Corporation.
5. The United States is authorized pursuant to 42 U.S.C. § 12188 and 28 C.F.R. pt. 36, Subpart E, to investigate the allegations of the complaint in this matter and to determine the Hospital’s compliance with Title III of the ADA.  28 C.F.R. § 36.502.  The United States 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 civil penalties.
6. The Complainant is deaf and, as such, is an individual with a “disability” within the meaning of the ADA.  42 U.S.C. § 12102; 28 C.F.R. § 36.104.
7. The Hospital facility is a “place of public accommodation” within the meaning of Title III of the ADA because it is a “professional office of a health care provider, hospital, or other service establishment.”  42 U.S.C. § 12181(7)(F); 28 C.F.R. § 36.104.  The Hospital is a “public accommodation” within the meaning of Title III of the ADA because it is a private entity that owns and operates hospitals, clinics, or medical facilities, which are places of public accommodation.  42 U.S.C. § 12181(7)(F); 42 U.S.C. § 12182(a).  
8. The ADA prohibits public accommodations, including hospitals and clinics, 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 as defined in Title III of the ADA 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.
9. The Parties have agreed that it is in the Parties’ best interests, and the United States believes that it is in the public interest, to resolve this dispute.  The Parties have therefore voluntarily entered into this Settlement Agreement.

II. DEFINITIONS

10. The term “Auxiliary Aids and Services” includes qualified interpreters, including ASL interpreters, provided either in-person or through video remote interpreting (“VRI”) services; note takers; real-time computer-aided transcription services (“CART”); 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; qualified readers; taped texts; audio recordings; Brailled materials and displays; screen reader software; magnification software; optical readers; secondary auditory programs (SAP); large print materials; accessible electronic and information technology; or other effective methods, services, or technology making aurally or visually delivered information available to individuals who are deaf, hard-of-hearing, or a combination thereof.  28 C.F.R. § 36.303.
11. The term “Hospital Personnel” means all employees, full-time and part-time, who have or are likely to have direct contact with Patients or Companions (as defined herein) at the Hospital.  Hospital Personnel also includes contractors and volunteers.
12. The term “Qualified Interpreter” means an interpreter who, via in-person appearance or VRI service, 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, deaf-blind interpreters, sign language interpreters, oral transliterators, and cued-language transliterators.  For purposes of this Agreement, a Qualified Interpreter must be experienced with medical terminology.
13. The term “Patient” shall be broadly construed to include any individual who is deaf, hard-of-hearing, blind, low-vision, or deaf-blind (or an individual accompanied by a Companion ) who is seeking to receive, or receiving health care services, including mental health services, from the Hospital (whether on an inpatient or outpatient basis), or seeking to use any other goods or services provided by the Hospital, such as the opportunity to donate blood or attend health education classes.  The broad construction of this term also includes (but is not limited to) an individual who is deaf, hard-of-hearing, blind, low-vision, or deaf-blind and seeking to communicate with Hospital Personnel regarding past, present or future health care services, such as scheduling appointments, obtaining test results, and discussing billing issues.  Notably, the term Patient as used in the agreement does not have the standard dictionary definition of patient but rather refers to those individuals who are deaf, hard-of-hearing, blind, low-vision, or deaf-blind and request services of any kind from the Hospital.

III.       EQUITABLE RELIEF

1. Prohibition of Discrimination
14. Nondiscrimination.  The Hospital 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, hard-of-hearing, blind, low-vision, or deaf-blind.  Pursuant to 42 U.S.C. § 12182(a), the Hospital shall also provide Patients and Companions who are deaf, hard-of-hearing, blind, low-vision, or deaf-blind with the full and equal enjoyment of the services, privileges, facilities, advantages, and accommodations of the Hospital as required by this Agreement and the ADA.
15. Discrimination by Association.  The Hospital 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, hard-of-hearing, blind, low-vision, or deaf-blind.  42 U.S.C. § 12182(b)(1)(E).
16. Retaliation and Coercion.  The Hospital shall not retaliate against or coerce in any way any person who made, or is making, a complaint according to the provisions of this Agreement or exercised, or is exercising, his or her rights under this Agreement or the ADA. 42 U.S.C. § 12203.
2. Effective Communication
17. Appropriate Auxiliary Aids and Services.  Consistent with 42 U.S.C. § 12182(b)(2)(A)(iii), the Hospital will provide any appropriate Auxiliary Aids and Services that are necessary for effective communication with Patients and Companions after making the assessment described in paragraphs 18-20 of this Agreement.  Appropriate Auxiliary Aids and Services will be provided as soon as practicable (without compromising patient care), except that the provision of in-person interpreters must be within the time frame described in paragraph 27 of this Agreement.  
18. 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 the Hospital 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, the Hospital will provide Patients or Companions with a notice of services and will utilize a model communication assessment form similar to the Model Communication Assessment Form attached to this Agreement as Exhibit A.  The Hospital may notify patients and/or Companions using electronic means and may incorporate the assessment form into its electronic medical records system.  The Hospital will utilize its Communication Assessment Form to assess all new Patients and their Companions.
19. Time for Assessment.  The determination of the appropriate Auxiliary Aids and Services for the Patient or Companion, 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 or, (b) at the time of arrival of the Patient or Companion at the Hospital (absent exigent circumstances affecting patient care which may extend the time for conducting the assessment), whichever is earlier.  If someone other than the Patient, such as a doctor’s office, schedules the appointment and the scheduler identifies that the Patient or Companion has a need for Auxiliary Aids and Services, then Hospital staff must ask the scheduler what Auxiliary Aids and Services are required, so that the Hospital may accommodate the Patient or Companion when they present in person.  When the Patient/Companion presents in person, Hospital staff must still conduct an independent assessment of the Patient/Companion to ensure that the appropriate Auxiliary Aids and Services were requested by the scheduler.  
20. Documentation of Assessment and Need for Re-assessment.  Hospital Personnel will document the results of the assessment in the Patient’s medical chart.  As long as the Patient or Companion does not inform Hospital Personnel of a change in need and as long as the Hospital continues to provides appropriate Auxiliary Aids and Services at subsequent visits, it may not be necessary to perform the assessment for each subsequent visit.  In the event that the initial form of communication is not effective or circumstances change, Hospital Personnel will reassess the appropriate Auxiliary Aids and Services that are required for effective communication, in consultation with the person with a disability, where possible, and provide such aid or service based on the reassessment.
21. Assistive Device Point Persons.  The Hospital will designate an employee or employees with the collateral title of Assistive Device Point Person.  The employee(s) so designated or his or her designee(s) will be on duty and/or available to 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(s) 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.
• The Hospital will include on its intranet, under the name “Assistive Device Point Person” phone directory, the 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 Patients.  
• The Assistive Device Point Person and his or her designee(s) will be designated by the Hospital no later than thirty (30) days following execution of this Agreement and notice of such designation will be provided to the United States.
22. Auxiliary Aid and Service Log. The Hospital will maintain records in a manner whereby it may produce a log of requests for Qualified Interpreters in-person or through video remote services.  The log will indicate:
1. The name of the Patient or, if a Companion, the relationship of the Companion to the patient;
2. The nature of the Auxiliary Aid or Service requested;
3. The time and date the request was made after assessing the needs of the Patient or Companion;
4. The name of the staff member making the request;
5. The type of visit, 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 nature 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 27 of this agreement, the log shall contain a detailed statement explaining the reason.  Such logs will be incorporated into the semi-annual Compliance Reports as described in paragraph 39 of this Agreement.  The Hospital will begin using the Auxiliary Aid and Service Log no later than one hundred and twenty days (120) days following execution of this Agreement.

23. Complaint Resolution.  The Hospital will implement a grievance resolution mechanism for the investigation of complaints regarding effective communication with Patients and Companions.  In particular:
1. The Hospital will maintain records of all grievances regarding effective communication, whether oral or written, made to the Hospital and actions taken with respect thereto.
2. At the time the Hospital completes its assessment and advises the Patient and/or Companion of its determination of which appropriate Auxiliary Aids and Services are necessary, the Hospital will notify such Patients and/or Companions 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 and the responses thereto will be maintained by the Assistive Device Point Person for the entire duration of this Agreement.

24. Prohibition of Surcharges.  All appropriate Auxiliary Aids and Services required by this Agreement will be provided free of charge to the Patient and/or Companion.
3. Qualified Interpreters
25. Circumstances Under Which Interpreters May be Required.  Although the determination of whether and what Auxiliary Aids and Services are appropriate to a given situation is generally up to the Hospital, as informed by its assessment and the input or request of the Patient or Companion, some circumstances may require that the Hospital provide a Qualified Interpreter to Patients.  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 diagnostic purposes, and discussing medical condition, 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 a surgery or procedure and during physician’s rounds;

5. Obtaining informed consent for treatment, surgery or procedures;

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, organ or tissue donations;

9. Discussing powers of attorney, orders not to resuscitate, living wills, and/or complex billing, and insurance matters; or

10. During educational presentations, such as birthing or new parent classes, breastfeeding instruction, nutrition and weight management programs, and CPR and first-aid training.

In such circumstances, the Hospital will presume that a Qualified Interpreter is necessary for effective communication with a Patient or Companion who relies upon such Auxiliary Aids and Services.  In circumstances where communication with a Patient or Companion is not particularly complex or lengthy, such as the provision of basic nursing care, a Qualified Interpreter may not be required in order to ensure effective communication.  The determination of whether a Qualified Interpreter is required for effective communication when the information to be communicated is not particularly complex or lengthy shall be determined by the Hospital as informed by its assessment and the input or request of the Patient or Companion.

26. Chosen Method for Obtaining Interpreters.  Within thirty (30) days after execution of this Agreement, the Hospital will provide the United States with a list of the name(s) of the interpreter services currently used by the Hospital for securing qualified in-person interpreters as well as VRI services.  This list of interpreters should indicate the type of interpreter service provided by the interpreter named as well as the Hospital or clinic where the interpreter is able to provide services.   If the names of the interpreter services used by the Hospital changes during the term of this Agreement, the Hospital shall notify the United States of the change within thirty (30) days.
27. 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 less than twenty-four (24) hours before the Patient’s appearance at the Hospital for examination or treatment.  For non-scheduled interpreter requests, Hospital Personnel will complete the assessment described in paragraph 18-20 above.
   • A Qualified Interpreter (via VRI) will be provided as soon as practicable, but no more than one (1) hour from the time the Hospital completes the assessment (absent exigent circumstances affecting patient care which may extend the time for providing such service).
   • In the event that an in-person Qualified Interpreter is required, the Hospital shall request an in-person interpreter immediately, but no more than one (1) hour from the time it becomes clear that an in-person interpreter is necessary for effective communication.  Hospital Personnel shall promptly attempt to inform the Patient or Companion that an interpreter service has been contacted and an in person interpreter has been requested and shall attempt to convey to the Patient or Companion the likely wait time until the in-person interpreter will arrive. 

   As described below in section (c) of this paragraph, the Hospital will document the in-person interpreter service’s response time, including the time of contact and the time of arrival.  The Hospital shall not be held responsible for circumstances beyond its control in obtaining in-person interpreter services, such as delays due to weather or interpreter service response or interpreter unavailability, as long as the Hospital makes all of the following reasonable efforts to obtain in-person interpreter services in a timely manner and documents those efforts.  If no in-person Qualified Interpreter can be located, Hospital Personnel will:

   1. Inform the Assistive Device Point Person of the efforts made to locate an interpreter and solicit assistance in locating an interpreter;
   2. Exert reasonable efforts (which shall be deemed to require no fewer than three (3) 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;
   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 twenty-four (24) or more hours before the services of the interpreter are required.  For scheduled interpreter requests, the Hospital will complete the assessment described in paragraphs 18-20 above in advance, and, when a Qualified Interpreter is appropriate, the Hospital will make a Qualified Interpreter available at the time of the scheduled appointment.
3. Data Collection on Interpreter Response Time.  The Hospital will monitor and document the response time of each Qualified Interpreter service it uses to provide communication to Patients or Companions.  The Hospital will document and investigate, per the grievance process identified in paragraph 23, any complaints by Patients or Companions regarding the quality and/or effectiveness of services provided by the interpreter service.  

28. Video Remote Interpreting (“VRI”).  When using VRI services, the Hospital 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 medical 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 (after it has been provided or is not available), VRI shall not be used as a substitute for an in-person Qualified Interpreter, and an in-person Qualified Interpreter shall be requested and provided.  The in-person Qualified Interpreter shall be requested and provided in a timely manner.  If the Qualified Interpreter fails to arrive, upon notice that the Qualified Interpreter failed to arrive, the Hospital will immediately call the interpreter service for another Qualified Interpreter.

29. Notice to Patients and Companions. As soon as the Hospital’s Personnel have determined that a Qualified Interpreter is necessary for effective communication with a Patient or Companion, the Hospital 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.  The Hospital 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 obviate the Hospital’s obligation to provide Qualified Interpreters in a timely manner.
30. Other Means of Communication.  The Hospital agrees that between the time an interpreter is requested and the interpreter is provided, Hospital Personnel will continue to try to communicate with the Patient or Companion for such purposes and to the same extent as they would have communicated with the person but for the disability, using all available methods of communication, for example, using sign language pictographs.  This provision in no way obviates the Hospital’s obligation to provide Qualified Interpreters in a timely manner.
31. Restricted Use of Certain Persons to Facilitate Communication.  The Hospital will not rely on an adult friend or family member of the Patient or Companion 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 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.  If the requested adult friend or adult family member is not a Qualified Interpreter, the Hospital may also provide a Qualified Interpreter at no cost to the Patient or Companion.  The adult friend or adult family member will not be compensated by the Hospital for the time a Qualified Interpreter is required.  When such a request is made by a Patient or Companion, Hospital Personnel must inform the Patient or Companion of the need for a Qualified Interpreter who is familiar with medical terminology in order to effectively communicate with the Patient or Companion and inform the Patient or Companion that the Hospital is responsible for providing such a Qualified Interpreter.  Hospital Personnel must document: (1) all requests from a Patient or Companion for an adult friend or adult family member to interpret; (2) that the Hospital Personnel informed the Patient or Companion of the need for a Qualified Interpreter familiar with medical terminology; and (3) that the Patient or Companion declined the Hospital’s provision of a Qualified Interpreter.  A Qualified Interpreter is required for the situations listed in paragraph 25. 

The Hospital will not rely on a minor child or Patient to interpret except in the limited circumstances described in (a) above.  Notwithstanding, the Hospital may elect to have a more restrictive policy than described above regarding the use of certain persons to facilitate communication.

4. Notice to the Community
32. Policy Statement. Within ninety (90) days of the entry of this Agreement, the Hospital shall post and maintain signs of conspicuous size and print at all Hospital 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 “interpreter.”
33. Website. The Hospital will include on its website the same or a substantially similar policy statement.  All new and redesigned web pages, web applications, and web content (“Web Pages”) published by the Hospital must act in accordance with the Web Content Accessibility Guidelines 2.0 principles of Perceivable, Operable, Understandable and Robust.
34. 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, hard-of-hearing, blind, low-vision, or deaf-blind, we provide appropriate auxiliary aids and services free of charge to the Patient or Companion, such as: sign language, tactile, 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 _________________.

    The Hospital will also include in its Patient Handbook a description of its complaint resolution mechanism.

5. Notice to Hospital Personnel and Physicians
35. Website.  The Hospital shall publish on its intranet a policy statement regarding the Hospital’s policy for effective communication with Patients and Companions.  
36. Notice to Personnel.  The Hospital policy for effective communication with Patients and Companions will be accessible to all Hospital Personnel.  The policy will also be provided to all newly hired Hospital Personnel upon their affiliation or employment with the Hospital.
6. Training
37. Training of the Assistive Device Point Person and His or Her Designees. The Hospital will provide mandatory training for the Assistive Device Point Person(s) and his or her designees as set forth in paragraph 21 of this Agreement.  The training will occur within ninety (90) days of the effective date of this Agreement.  Such training will be sufficient in duration and content to train the Assistive Device Point Person(s) and his or her designees in the following areas:
1. to promptly identify communication needs of Patients and Companions, 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 Hospital Personnel to notify the Assistive Device Point Person(s) or his or her designee of Patients and Companions as soon as Patients schedule admissions or other health care services at the Hospital; and
6. the Hospital’s complaint resolution procedure described in paragraph 23 of this Agreement.

38. Training of Hospital Personnel.  The Hospital will provide mandatory in-service training in accordance with annual training policies to all Hospital Personnel who have contact with Patients and Companions.
1. The training will address the needs of Patients and Companions and will include the following objectives:
   1. to promptly identify communication needs of Patients and Companions, 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 one hundred twenty (120) days of the Effective Date of this Agreement, unless training related to the needs of Patients and Companions has been provided within the same calendar year of the Effective Date of this Settlement in accordance with the Hospital’s training schedule and annually thereafter.

3. New employees must be trained in the same manner within thirty (30) days of their hire.

7. Reporting, Monitoring, and Violations
39. Compliance Reports.  Beginning six (6) months after the Effective Date of this Agreement and every six (6) months thereafter for the entire duration of the Agreement, the Hospital will provide a written report (“Compliance Report”) to the United States 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; and

2. the information maintained in the complaint records described in paragraph 23, including the number of complaints received by the Hospital from Patients and Companions regarding Auxiliary Aids and Services and/or effective communication, and the resolution of such complaints.

The Hospital will maintain records to document the information contained in the Compliance Reports and will make them available, upon request, to the United States.

40. Complaints.  During the term of this Agreement, the Hospital will notify the United States if any person files a lawsuit, complaint, or formal charge with a state or federal agency alleging that the Hospital failed to provide Auxiliary Aids and/or Services to Patients or Companions or otherwise failed to provide effective communication to such Patients or Companions.  Such notification must be provided in writing via electronic mail and parcel carrier within twenty (20) days of the date the Hospital received notice of the allegation.  The Hospital will reference this provision of the Agreement in the notification to the United States.
8. Remuneration for Complainants and Release
41. Compensatory Relief for Complainant.  Within thirty (30) days after receiving the executed Agreement, Complainant’s signed release (a Blank Release Form is at Exhibit C), and an executed IRS Form W-9, the Hospital will send by common carrier, a check in the amount of eight thousand five hundred dollars ($8,500) made out to the Complainant.  This check is compensation to the Complainant pursuant to 42 U.S.C. § 12188(b)(2)(B).  The check shall be mailed to:

    Jessica H. Soufer
    Assistant United States Attorney
    U.S. Attorney’s Office for the District of Connecticut
    157 Church Street, 25th Floor
    New Haven, CT 06510

9. Enforcement and Miscellaneous
42. Duration of the Agreement.  This Agreement will be in effect for three (3) years from the Effective Date.
43. 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 44.  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 the Hospital or any other entity under the auspices of the Hospital or affiliated with the Hospital 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.
44. 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 United States 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 counsel for the Hospital, and the Parties will attempt to resolve the concern(s) in good faith.  The United States will allow the Hospital thirty (30) days from the date of notification of any breach of this Agreement to cure said breach, prior to instituting any court action to enforce the ADA or the terms of this Agreement.
45. 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.
46. 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.
47. 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.
48. Effective Date.  The effective date of this Agreement is the date of the last signature below.