VOLUNTARY COMPLIANCE AGREEMENT
BETWEEN THE UNITED STATES OF AMERICA
AND STERLING URGENT CARE
UNDER THE AMERICANS WITH DISABILITIES ACT
U.S. Attorney No. 2016V00299
DJ No. 202-22-79

This Voluntary Compliance Agreement (the "Agreement") is entered into between the United States of America and Sterling Urgent Care (collectively, the "Parties").

BACKGROUND

1. The parties to this Agreement are the United States Department of Justice (the "Department") and Sterling Urgent Care.
2. This matter is based on a complaint received by the Department alleging that Sterling Urgent Care discriminated against a patient on the basis of his disability in violation of title III of the Americans with Disabilities Act of 1990, as amended ("ADA"), 42 U.S.C. § 12181 et seq. Specifically, the complainant, who is deaf, alleges that Sterling Urgent Care failed to provide a sign language interpreter when he requested one for an appointment. The complainant alleges that a sign language interpreter was needed to allow for effective communication and to afford him an opportunity to derive the same benefits from the appointment as other individuals who are not deaf or hard of hearing.
3. The Department, of which the United States Attorney's Office is a component, is responsible for enforcing title III of the ADA, 42 U.S.C. §§ 12181 -12189, and its implementing regulation, 28 C.F.R. Part 36.
4. Sterling Urgent Care is a place of public accommodation covered by title III of the ADA. 42 U.S.C. § 12182 (7)(F); 28 C.F.R. § 36.104. Accordingly, Sterling Urgent Care is obligated to comply with the requirements of title III of the ADA. 28 C.F.R. § 36.104. Under title III of the ADA, no person who owns or operates a place of public accommodation may discriminate against an individual on the basis of disability in the full and equal enjoyment of goods, services, privileges, advantages, or accommodations, and must provide auxiliary aids and services when necessary to ensure effective communication. 42 U.S.C. §§ 12182(a), 12182(b)(1)(A)(ii), 12182(b)(2)(A)(iii); 28 C.F.R. §§ 36.201(a), 36.202, 36.303.

TERMS OF THE AGREEMENT

Consideration

5. 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 Agreement.

Definitions

6. The term "patient" shall be broadly construed to include any individual who is deaf or hard of hearing and who is seeking or receiving health care services from Sterling Urgent Care.
7. The term "companion" means a person who is deaf or hard of hearing and is either (a) a person whom the patient, consistent with privacy regulations, indicates should communicate with Sterling Urgent Care about the patient, participate in any treatment decision, play a role in communicating the patient's needs, condition, history or symptoms to Sterling Urgent Care, or help the patient act on the information, advice or instructions provided by Sterling Urgent Care; (b) a person legally authorized to make health care decisions on behalf of a patient; or (c) such other person with whom Sterling Urgent Care would ordinarily and regularly communicate with concerning the patient's medical condition including, but not limited to, the patient's next of kin or health care surrogate.
8. The term "auxiliary aids and services" includes qualified interpreters on-site or through video remote interpreting (VRI) services; note takers; real-time computer-aided transcription services; written materials; exchange of written notes; telephone handset amplifiers; assistive listening devices; assistive listening systems; telephones compatible with hearing aids; closed caption decoders; open and closed captioning, including real-time captioning; voice, text, and video-based telecommunications products and systems, including text telephones (TTYs), videophones, and captioned telephones, or equally effective telecommunications devices; videotext displays; accessible electronic and information technology; or other effective methods of making aurally delivered information available to individuals who are deaf or hard of hearing. 28 C.F.R. §36.303.
9. 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.

Remedial Action

10. Consistent with the ADA, Sterling Urgent Care will not discriminate against any individual, including patients and their companions, on the basis of disability, in the full and equal enjoyment of the goods, services, facilities, privileges, advantages, or accommodations available at Sterling Urgent Care by excluding or providing unequal treatment to persons with disabilities. 42 U.S.C. § 12182.
11. Immediately as of the effective date of this Agreement, Sterling Urgent Care will provide, free of charge, appropriate auxiliary aids and services, including qualified interpreters, to individuals who are deaf or hard of hearing whenever it is necessary to ensure effective communication for those individuals, unless it can be demonstrated that an undue burden or a fundamental alteration would result.
12. If VRI services are used, Sterling Urgent Care will ensure that the service 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).
13. The determination of appropriate auxiliary aids and services, and the timing, duration, and frequency with which they will be provided, must be made at the time a patient schedules an appointment, or upon the arrival of the patient or companion at Sterling Urgent Care, whichever is earlier. Sterling Urgent Care's staff will provide a communication assessment form, consulting with the patient, and documenting the results in the patient's medical chart. A Model Communication Assessment Form is attached to this Agreement as Exhibit A, and will be used by Sterling Urgent Care upon the effective date of this Agreement. Sterling Urgent Care may develop a more comprehensive form similar to Exhibit A. This new form will be subject to approval by counsel for the United States prior to implementation
14. The determination of appropriate auxiliary aids or services, and the timing, duration, and frequency with which they will be provided, will be made by Sterling Urgent Care in consultation with the person with a disability whenever possible. In making these determinations, Sterling Urgent Care and/or its staff will take into account all relevant facts and circumstances, including, but not limited to, the following:
    1. the nature, length, complexity, and importance of the communication at issue;
    2. the individuals communication skills and knowledge;
    3. the patients' health status or changes thereto; and
    4. the patients' and/or companions' request for, or statement of need for, an interpreter.

       Examples of circumstances when it may be necessary to provide interpreters include, but are not limited to, obtaining a patient's medical history or description of ailment; explaining or discussing a patient's diagnosis or prognosis; explaining or discussing follow-up care, including a patient's or companion's questions regarding the patient's condition and/or previous or future procedures, tests, and/or treatment; and medications prescribed.

15. In the event that communication is not effective, Sterling Urgent Care's staff will reassess, in consultation with the patient or companion, as applicable, which auxiliary aids and services are needed to ensure effective communication, and will document the results accordingly.
16. If a patient or companion has an ongoing relationship with Sterling Urgent Care, with respect to subsequent visits, Sterling Urgent Care will continue to provide the appropriate auxiliary aids or services to the patient or companion without requiring a request for the appropriate auxiliary aids or services by the patient or companion for each visit. Sterling Urgent Care will keep appropriate records that reflect the ongoing provision of auxiliary aids and services to patients and companions, such as notations in a patient's medical charts.
17. If a patient and/or companion does not request auxiliary aids or services, but Sterling Urgent Care has reason to believe that such person would benefit from auxiliary aids or services, Sterling Urgent Care will specifically inform the patient and/or companion that auxiliary aids and services are available free of charge.
18. Immediately, as of the effective date of this Agreement, Sterling Urgent Care will maintain a log of each request for an auxiliary aid or service. The log will record the time and date of the request, the name of the individual who made the request, the name of the individual for whom the auxiliary aid or service is being requested (if different than the requestor), the specific auxiliary aid or service requested, the time and date of the scheduled appointment (if a scheduled appointment was made), the time and date the auxiliary service was provided, the type of auxiliary aid or service provided, if different than what was requested, and, if applicable, a statement that the requested auxiliary aid or service was not provided, along with the reason it was not provided.
19. Within sixty (60) days of the effective date of this Agreement, and annually thereafter, Sterling Urgent Care will provide mandatory ADA training for all employees, staff members, and other individuals who might interact with patients and/or companions. Such training, which can be provided by a third-party, will be sufficient in duration and content to train the individual in:
    1. the various degrees of hearing impairment, language, and cultural diversity in the deaf community;
    2. identification of communication needs of persons who are deaf or hard of hearing;
    3. the office's auxiliary aids and services policy,
    4. recommended and required charting procedures governing requests for auxiliary aids and services;
    5. types of auxiliary aids and services available;
    6. the proper use and role of qualified interpreters;
    7. the proper use and role of VRI services;
    8. making and receiving calls through TTYs and the relay service;
    9. any other applicable requirements of this Agreement.
20. Within sixty (60) days of the effective date of this Agreement, Sterling Urgent Care shall post in the reception or waiting area, examination rooms, and wherever a Patient's Bill of Rights is required by law to be posted, signs of conspicuous size and print stating:

    In compliance with the Americans with Disabilities Act (ADA), qualified interpreters and other auxiliary aids and services are available free of charge to people who are deaf or hard-of-hearing.

    These signs will include the international symbols for "interpreters," and list the name and contact information for the person(s) to whom a patient or companion should speak in order to request auxiliary aids or services. The signs shall also contain the following statement: "For more information about the Americans with Disabilities Act (ADA), call the Department of Justice's toll-free ADA Information Line at 1-800-514-0301 (voice), 1-833-610-1264 (TTY), or visit the ADA Home Page at www.ada.gov."

21. Sterling Urgent Care will include on its website language similar to that in Paragraph 21, conspicuously linked from the main website, currently at https://sterlingurgentcare.com.
22. Within thirty (30) days of the effective date of this Agreement, Sterling Urgent Care will enter a contract with one or more qualified interpreters or interpreter agencies to obtain services of qualified interpreters.
23. Sterling Urgent Care will notify the United States in writing when he has completed the actions described in paragraphs 20-22. If any issues arise that affect the anticipated completion dates set for such actions, Sterling Urgent Care will immediately notify the United States of the issue(s).
24. Sterling Urgent Care shall not discriminate or retaliate against any person because of his or her participation in this matter.

Enforcement Provisions

25. The United States may review compliance with this Agreement or title III of the ADA at any time. If the United States believes that Sterling Urgent Care has failed to comply in a timely manner with any requirement of this Agreement without obtaining sufficient advance written agreement with the United States for a modification of the relevant terms, the United States will so notify Sterling Urgent Care in writing, and will attempt to resolve the issue or issues in good faith. If the United States is unable to reach a satisfactory resolution of the issue or issues raised within thirty (30) days of the date it provides notice to Sterling Urgent Care, it may institute a civil action in federal district court to enforce the terms of this Agreement or title III and may, in such action, seek any relief available under law.
26. Failure by the United States to initiate any provision of this Agreement is not a waiver of its right to enforce other provisions of this Agreement.
27. In the event Sterling Urgent Care is sold or transferred, and the successor or assignee intends to carry on the same or similar use of the entity, as a condition of sale, Sterling Urgent Care shall obtain the written accession of the successor or assign to any obligations remaining under this Agreement for the remaining term of this Agreement.
28. This Agreement constitutes the entire agreement between the United States and Sterling Urgent Care on the matter 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 does not purport to remedy any other potential violations of the ADA or any other federal law. This Agreement does not affect the continuing responsibility of Sterling Urgent Care to comply with all aspects of the ADA.
29. This Agreement will remain in effect for three (3) years from its effective date.
30. The effective date of this Agreement is the date of the last signature below.
31. The person signing for Sterling Urgent Care represents that he or she is authorized to bind Sterling Urgent Care to this Agreement.