SETTLEMENT AGREEMENT

BETWEEN

THE UNITED STATES OF AMERICA

AND

NORTHSHORE UNIVERSITY HEALTHSYSTEMS

U.S. DEPARTMENT OF JUSTICE COMPLAINT # 202-23-245

BACKGROUND

1. The parties (“Parties”) to this Settlement Agreement (“Agreement”) are the United States of America (“United States”) and NorthShore University HealthSystems (“NorthShore”), an Illinois non-profit corporation.
2. NorthShore provides a comprehensive, fully integrated, healthcare delivery system serving northern Illinois.  NorthShore owns and operates four hospitals in northern Illinois, including Skokie Hospital (the “Hospital”). This agreement applies to Skokie Hospital only.
3. This matter was initiated by a complaint filed with the United States against NorthShore, alleging violations of title III of the Americans with Disabilities Act (the “ADA”), 42 U.S.C. §§ 12181-12189, and its implementing regulation, 28 C.F.R. Part 36.  Specifically, Complainant R.A. and Complainant S.A. (the “Complainants”) alleged that Skokie Hospital personnel failed, during three separate visits, to provide sign language interpretive services when necessary to ensure effective communication with Complainant R.A., who is deaf.
4. Complainant R.A. is deaf  Complainant R.A. is the primary caretaker of his mother, Complainant S.A., who is 80 years old. 
5. Complainant S.A. was treated at the Hospital on three occasions in 2009: (1) August 21 (one-day emergency room visit); (2) October 20-23 (admission for four days); and (3) November  4-8 (admission for five days). Complainants allege that on each occasion, Complainant R.A. and his mother both requested an interpreter so Complainant R.A. could communicate with the Hospital’s medical personnel about his mother’s condition.  Complainants further allege that this request was denied on each occasion, and Complainant R.A. was told that the Hospital does not provide interpreters to family members of patients who are not hearing impaired.  NorthShore and Hospital deny these allegations.

INVESTIGATION AND FINDINGS

6. The United States Department of Justice (“Department”) and the U.S. Attorney for the Northern District of Illinois (“U.S. Attorney’s Office”) are authorized under 42 U.S.C.§ 12188 and 28 C.F.R. Part 36, Subpart E, to investigate the allegations of the complaint in this matter to determine Hospital’s compliance with title III of the ADA. They have the authority to, where appropriate, negotiate and secure voluntary compliance agreements, and to bring civil actions enforcing title III of the ADA should they fail to secure voluntary compliance.
7. Complainant R.A. is an individual with a “disability” within the meaning of the ADA. 42 U.S. C. § 12102; 28 C.F.R. § 36.104. Complainant S.A. is Complainant R.A.’s mother and as such has a known relationship or association with an individual with a disability.  42 U.S.C. 12182(b)(1)(E); 28 C.F.R. § 36.205.
8. NorthShore is a private, non-profit corporation, which owns and operates Skokie Hospital, licensed by the State of Illinois.  Skokie Hospital is a “public accommodation” within the meaning of title III of the ADA, 42 U.S.C. § 12181(7)(F), and its implementing regulation at 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 a public accommodation.  42 U.S.C. § 12182(a); 28 C.F.R. § 36.201(a).
10. On the basis of its investigation, the U.S. Attorney’s Office determined that the Hospital denied the Complainant R.A. appropriate auxiliary aids and services necessary for effective communication during all three above-referenced treatments at the Hospital, in violation of 42 U.S.C. § 12182(b)(2)(A)(iii); 28 C.F.R. § 36.303.  The Hospital fully cooperated in the U.S. Attorney’s Office investigation in this matter and denies the allegations made by complainants.
11. 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 “Hospital Personnel” means all employees, both full and part-time, and independent contractors with contracts to work on a substantially full-time basis for the Hospital (or on a part-time basis exclusively for the Hospital), including, without limitation, nurses, physicians, social workers, technicians, admitting personnel, billing staff, security staff, therapists, and volunteers, who have or are likely to have direct contact with Patients or Companions as defined herein.
14. The term “qualified interpreter” means an interpreter who, via a video remote interpreting (VRI) service or an on-site appearance, is able to interpret effectively, accurately, and impartially, both receptively and expressively, using any necessary specialized vocabulary.  Qualified interpreters include, for example, sign language interpreters, oral transliterators, and cued-language transliterators.  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 Hospital, whether as an inpatient or an outpatient.
16. The term “Companion” means a person who is deaf or hard of hearing 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 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).  Companions must be authorized pursuant to HIPAA and applicable state privacy laws to discuss the patient’s PHI with Hospital. 
17. “Effective Date of this Settlement Agreement” means the date of the last signature below.

EQUITABLE RELIEF

A.            Prohibition of Discrimination

18. 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 deaf and hard of hearing Patients and Companions.  Pursuant to 42 U.S.C. § 12182(a), the Hospital 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 Hospital as required by this Agreement and the ADA.
19. 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 or hard of hearing.  See 42 U.S.C. § 12182(b)(1)(E).
20. 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. See 42 U.S.C. § 12203.

B.            Effective Communication

21. Appropriate Auxiliary Aids and Services.  Pursuant to 42 U.S.C. § 12182(b)(2)(A)(iii), the Hospital will provide to deaf or hard-of-hearing Patients and Companions 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 32 of this Agreement.  Hospital will advise Patients and Companions who require auxiliary aids or services that these can be available throughout the Patient’s hospitalization as requested by the Patient.
22. General Assessment Criteria.  The determination of appropriate auxiliary aids or 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.  A Model Communication Assessment Form is attached to this Agreement as Exhibit A, and Hospital will develop a form similar to Exhibit A within sixty (60) days of the Effective Date of this Agreement to be used at the Hospital. 
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 at the time an appointment is scheduled for the deaf or hard-of-hearing Patient or on the arrival of the deaf or hard-of-hearing Patient or Companion at the Hospital, whichever is earlier.  Hospital Personnel will perform an assessment (see paragraph 22) as part of each initial inpatient assessment and document the results in the Patient’s electronic medical chart.  In the event that communication is not effective, 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. Medical Concerns.  Nothing in this Agreement requires that electronic devices or equipment constituting an auxiliary aid must be used when their use may interfere with medical or monitoring equipment or may otherwise constitute a threat to the Patient’s medical condition.  Nothing in this Agreement requires that the assessment of the need for auxiliary aids and services will take precedence over the care of the patient. 
25. ADA Administrators.  Hospital will designate at least one employee at the Hospital as an ADA Administrator or ADA Co-Administrators, and at least one such employee will always be on duty and available twenty-four (24) hours a day, seven (7) days a week, to answer questions and provide appropriate assistance regarding immediate access to, and proper use of, the appropriate auxiliary aids and services, including qualified interpreters.  The ADA Administrator or ADA Co-Administrators will know where the appropriate auxiliary aids are stored and how to operate them and will be responsible for their maintenance, repair, replacement, and distribution.  Hospital will circulate and post broadly within the Hospital the name, telephone number, function, and office location of the Administrator(s), including a TTY telephone number, through which the ADA Administrator or Co-Administrator on duty can be contacted twenty-four (24) hours a day seven days a week by deaf or hard-of-hearing Patients and Companions. The ADA Administrator or Co-Administrators will be responsible for the complaint resolution mechanism described in paragraph 27 of this Agreement.  The ADA Administrator or Co-Administrators will be designated by Hospital no later than 30 days following execution of this Agreement
26. Auxiliary Aid and Service Log. Hospital will maintain a log in which requests for qualified interpreters on site or through video remote services will be documented. The log will indicate the time and date the request was made, the name of the deaf or hard-of-hearing Patient or Companion, the time and date of the scheduled appointment (if a scheduled appointment was made), the nature of the auxiliary aid or service provided, and the time and date the appropriate auxiliary aid or service was provided.  If no auxiliary aid or service was provided, the log shall contain a statement why the auxiliary aid and service was not provided.  Such logs will be maintained by the ADA Administrator for the entire duration of the Agreement, and will be incorporated into the semi-annual Compliance Reports as described in paragraph 46 of this Agreement.
27. Complaint Resolution. Hospital will utilize its established CMS grievance resolution mechanism for the investigation of disputes regarding effective communication with deaf and hard-of-hearing Patients and Companions. Hospital will maintain records of all grievances regarding effective communication, whether oral or written, made to Hospital and actions taken with respect thereto.  At the time Hospital completes its assessment described in paragraphs 22-23 and advises Patient and/or Companion of its determination of which appropriate auxiliary aids and services are necessary, Hospital will notify deaf and hard-of-hearing persons of its grievance resolution mechanism, 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 thirty (30) days of receipt of the complaint.  Copies of all grievances related to provision of services for deaf or hard-of-hearing Patients and/or Companions and the responses thereto will be maintained by the ADA Administrator for the entire duration of the Agreement.
28. 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.
29. Communication with Patients and Companions. Hospital will take appropriate steps to ensure that all Hospital Personnel are made aware of a Patient or Companion’s disability and auxiliary aid and services needed so that effective communication with such person will be achieved.  This will be done by designating this information in the electronic medical record.   In addition, Hospital will, through training discussed in paragraphs 40-45, ensure that all Hospital Personnel are aware of: (a) Hospital’s policies and procedures implementing this Agreement and the ADA; (b) Hospital’s policies and procedures governing requests for auxiliary aids and services by deaf and hard-of-hearing Patients and Companions; and (c) the role of the ADA Administrators described in paragraph 25 of this Agreement.

C.            Qualified Interpreters

30. Circumstances Under Which Interpreters Will Be Provided.  For complicated and interactive communications, it may be necessary for the Hospital to provide a qualified interpreter to ensure effective means of communication for patients and companions.  The Hospital shall provide qualified sign language interpreters to Patients and Companions who are deaf or hard-of- hearing and whose primary means of communication is sign language, and qualified oral interpreters to such Patients and Companions who rely primarily on lip reading as necessary for effective communication.  Examples of circumstances when the communication may be sufficiently lengthy or complex so as to require an interpreter include the following:
    1. Discussing a patient’s symptoms and medical condition, medications, and medical history;
    2. Explaining medical conditions, treatment options, tests, medications, surgery and other procedures;
    3. Providing a diagnosis and recommendation for treatment;
    4. Communicating with a patient during treatment, testing 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;
    10. During educational presentations, such as birthing or new parent classes, nutrition and weight management programs, and CPR and first-aid training.
31. Chosen Method for Obtaining Interpreters. Within thirty (30) days after execution of this Agreement, the Hospital will identify one or more interpreter services and will make appropriate arrangements with said services to provide qualified on site interpreters as well as VRI services at the request of the Hospital.
32. Provision of Interpreters in a Timely Manner.
    1. Non-scheduled Interpreter Requests: A “non-scheduled interpreter request” means a request for an interpreter which is made less than three hours before the appearance at the Hospital by a deaf or hard-of-hearing Patient or Companion for examination or treatment that was not scheduled prior to the time such Patient or Companion came to the Hospital.  For non-scheduled interpreter requests, Hospital Personnel will make the Hospital’s request for an interpreter within sixty (60) minutes after completing the assessment described in paragraphs 22-23 above.  However, the time within which the interpreter is provided shall be no more than (a) three hours from the time the call is placed to the interpreter service if the service is provided through a contract interpreting service or a staff interpreter who is located off-site at the time the need arises or (b) 30 minutes from the time the Patient’s or Companion’s request is made if the service is provided through a Video Remote Interpreting service as described in paragraph 33 below.  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.
    2. Scheduled Interpreter Requests. A “scheduled interpreter request” is a request for an interpreter in which there are three (3) or more hours between the time when a deaf or hard-of-hearing Patient or Companion makes a request for an interpreter and when the services of the interpreter are required.  For scheduled interpreter requests, Hospital will make a qualified interpreter available at the time of the scheduled appointment.  If an interpreter fails to arrive for the scheduled appointment, upon notice that the interpreter failed to arrive, the Hospital will immediately call the interpreter service for another qualified interpreter.
    3. Data Collection on Interpreter Response Time and Effectiveness.  Hospital will  monitor the performance of each qualified interpreter it uses to provide communication to deaf or hard-of-hearing Patients or Companions through its established process of monitoring outside vendors.  As part of the Auxiliary Aid and Service Log, described in paragraph 26, the Hospital shall collect information regarding response times for each request for an interpreter.
33. Video Remote Interpreting (VRI). VRI can provide immediate, effective access to interpreting services in a variety of situations including emergencies and unplanned incidents. When using VRI services, 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 due, for example, to a patient’s limited ability to move his or her head, hands or arms; vision or cognitive issues; or significant pain; or due to space limitations in the room.  Within 120 days of the Effective Date of this Agreement, Hospital shall establish the capability for offering VRI services.  Hospital is 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 provided or is not available due to circumstances outside of the Hospital’s control, VRI shall not be used as a substitute for an on-site interpreter, and an on-site interpreter shall be provided in accordance with the timetable set forth above.
34. Notice to Deaf or Hard-of-Hearing Patients and Companions. As soon as Hospital Personnel have determined that a qualified interpreter is necessary for effective communication with a deaf or hard-of-hearing Patient or Companion, 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 lessen Hospital’s obligation to provide qualified interpreters in a timely manner as required by paragraph 32 of this Agreement.
35. Other Means of Communication. Hospital agrees that between the time an interpreter is requested and the time an interpreter arrives at the Hospital to interpret, Hospital 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, including using sign language pictographs.  This provision in no way lessens Hospital’s obligation to provide qualified interpreters in a timely manner as required by paragraph 32 of this Agreement.

D.            Notice to Community

36. 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, the emergency department, and wherever a Patient’s Bill of Rights is required by law to be posted.  Such signs shall be to the following effect:

Sign language and oral interpreters, TTYs, and other auxiliary aids and services are available free of charge to people who are deaf or hard-of-hearing.  For assistance, please contact any Hospital Personnel or the Information Office at _____________(voice/TTY), room ______.

These signs will include the international symbols for “interpreters”  and “TTYs.”

37. Website.  The Hospital will include on its website the policy statement described above.
38. Patient Handbook. The Hospital will include in all future printings of its Patient Handbook (or equivalent) and all similar publications a statement to the following effect:

To ensure effective communication with Patients and their Companions who are deaf or hard-of-hearing, we provide appropriate auxiliary aids and services free of charge, such as: sign language and oral interpreters, video remote interpreting services, TTYs, note takers, 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.

E.            Notice to Hospital Personnel and Physicians

39. The Hospital shall publish on its intranet, in an appropriate form, a policy statement regarding the Hospital’s policy for effective communication with persons who are deaf or hard-of-hearing for use by persons working at the Hospital. This policy statement shall include, 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, note takers, 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 at _____________ and reachable at ________________.

The Hospital will deploy this policy on the intranet within thirty (30) days of the Effective Date of this Agreement to all Hospital Personnel and both employed and affiliated physicians (physicians with practicing or admitting privileges), and to all new Hospital Personnel and newly employed or affiliated physicians upon their affiliation or employment with the Hospital.

F.            Training

40. Training of ADA Administrator. Hospital will begin to provide mandatory training for the Administrator(s) within sixty (60) days of designation as provided in paragraph 24 of this Agreement.  Such training will be sufficient in duration and content to train the Administrator 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. to encourage medical staff members to notify Hospital of deaf and hard-of-hearing Patients and Companions as soon as Patients schedule admissions, tests, surgeries, or other health care services at the Hospital.
    4. to use, when appropriate, flash cards and pictographs (in conjunction with any other available means of communication that will augment the effectiveness of the communication).
    5. how and when to use video remote interpreting services;
    6. making and receiving calls through TTYs and the relay service; and
    7. the Hospital’s complaint resolution procedure described in paragraph 26 of this Agreement.

Such training shall be completed within 120 days of the signing of this Agreement.

41. Training of Hospital Personnel. Except for affiliated physicians, who are governed by paragraph 45 of this Agreement, Hospital will provide mandatory  training to all Hospital Personnel.  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.  to secure qualified interpreter services or video remote interpreting services as quickly as possible when necessary; and
    3. to use, when appropriate, flash cards and pictographs (in conjunction with any other available means of communication that will augment the effectiveness of the communication).

Such training must be provided within 90 days of the Effective Date of this Agreement.

42. Training of New Employees. Hospital will provide the training specified in the preceding paragraph to new Hospital Personnel within thirty (30) days after the commencement of their services for Hospital.  Such training must be comparable to training provided to specific departments as necessary.  A screening of a video of the original training will suffice to meet this obligation.
43. Training of Telephone Operators.  All Hospital Personnel who receive incoming telephone calls from the public will receive special instructions by Hospital on using TTYs or relay services to make, receive, and transfer telephone calls and will receive training generally on the existence in the Hospital of an ADA Administrator, as detailed in paragraph 25 of this Agreement, and the complaint resolution process, as described in paragraph 27 of this Agreement.  Such training must be provided within 90 days of the signing of this Agreement and will be conducted annually thereafter.
44. Training Attendance Sheets. Hospital will maintain in electronic form for the duration of this Agreement, confirmation of training conducted pursuant to paragraphs 40-43 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.
45. Training of Affiliated Physicians.  Hospital will create and send an email blast advising affiliated physicians of its policy on the communication needs of Patients or Companions who are deaf or hard of hearing and will invite all physicians who are affiliated with Hospital (admitting or surgical privileges, etc.) to complete computerized training.  This email will direct affiliated physicians to the Hospital web page which will include: (1) Hospital’s Policy Statement for persons working at the hospital as described in paragraph 36 and any relevant forms; and (2) a request that physicians’ staff members notify Hospital of deaf and hard-of-hearing Patients and Companions as soon as they schedule admissions, tests, surgeries, or other health care services at the Hospital.

G.            Reporting, Monitoring, and Violations

46. Compliance Reports. Beginning six months after the Effective Date of this Agreement and every six months thereafter for the entire duration of the Agreement, Hospital 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 26.
    2. the number of complaints received by Hospital at the Hospital by 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.

Hospital 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.

47. Complaints.  During the term of this Agreement, Hospital 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 Hospital 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 twenty (20) days of the date Hospital 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 Hospital relevant to the allegation. Hospital will reference this provision of the Agreement in the notification to the U.S. Attorney’s Office.

H.            Compensatory Relief for Complainants and Release

48. Within fifteen (15) days of the entry of this Agreement, the Hospital will send by certified mail, return receipt requested, a check in the amount of forty-seven thousand nine hundred and ninety ($46,990.00) dollars made out to C.A. sole heir of the estate of R.A., Deceased, and ten ($10.00) dollars made out to S.A.  This check is compensation to the Complainants 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
219 S. Dearborn Street
9th Floor
Chicago, Illinois 60604
Attn: Patrick Johnson.

49. Within five (5) days of the Effective Date of this Agreement, the U.S. Attorney’s Office will deliver to counsel for the Hospital a release signed by Complainant R.A. and a release signed by Complainant S.A.  These releases are attached as Exhibits B-1 and B-2.

I.            Payment of Civil Penalty to the United States

50. Within fifteen (15) days of the Effective Date of this Agreement, the Hospital will pay to the United States of America the sum of three thousand ($3,000.00) dollars pursuant to 42 U.S.C. §12188(b)(2)(C).

J.            Enforcement and Miscellaneous

51. Duration of the Agreement.  This Agreement will be in effect for three (3) years from the Effective Date.
52. Changing Circumstances.  During the term in which this Agreement will be in effect, there may be a change in circumstances such as, for example and without limitation, an increased or decreased availability of qualified interpreters or developments in technology to assist or improve communications with persons who are deaf or hard-of-hearing.   If the Hospital determines that such changes create opportunities for communicating with Patients and Companions who are deaf or hard-of-hearing more efficiently or effectively than is required under this Agreement, or create difficulties not presently contemplated in the provision of appropriate auxiliary aids and services, it may propose changes to this Agreement by presenting written proposals to the U.S. Attorney’s Office.  Such changes will then be made to the Agreement if the United States, upon review, grants its approval, which approval will not be unreasonably withheld.
53. Enforcement.  In consideration of the terms of this Agreement as set forth above, the Attorney General agrees to refrain from undertaking further investigation or from filing a civil suit under title III in this matter, except as provided in paragraph 54. 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 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.
54. 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 Hospital, and the parties will attempt to resolve the concern(s) in good faith.  The United States will allow Hospital thirty days from the date it notifies Hospital 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.
55. 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.
56. 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.
57. 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.