SETTLEMENT AGREEMENT BETWEEN
THE UNITED STATES OF AMERICA AND
VIRGINIA PSYCHIATRIC COMPANY, INC.
d/b/a DOMINION HOSPITAL

BACKGROUND

1. The parties (“Parties”) to this Settlement Agreement (“Agreement”) are the United States of America (“United States”) and the Virginia Psychiatric Company, Inc., d/b/a Dominion Hospital (“Dominion Hospital” or “the Hospital”).
2. Dominion Hospital is a psychiatric hospital that provides inpatient and outpatient treatment programs, located at 2960 Sleepy Hollow Road, Falls Church, VA 22044. Dominion Hospital is among the facilities within the healthcare network commonly referred to as the HCA Virginia Health System.
3. This matter was initiated by a complaint filed with the United States against Dominion Hospital, alleging violations of Title III of the ADA, 42 U.S.C. §§ 12181-12189, and its implementing regulation, 28 C.F.R. Part 36. Specifically, the Complainants, V.L. and N.C., allege that Dominion Hospital failed to provide sign language interpretive services when necessary to ensure effective communication during numerous interactions related to their adult son, Complainant D.L., who was a patient at the hospital.
4. The Complainants are deaf and use American Sign Language as their primary means of communication. Complainants are the parents and companions of D.L., who was admitted to the Hospital.
5. The Complainants allege that they were unable to communicate adequately with Hospital Personnel while their adult son, D.L., was receiving medical treatment at the Hospital. From September 30, 2010, through November 24, 2010, D.L. was enrolled in an inpatient treatment program at the Hospital, and from November 29, 2010, to December 15, 2010, D.L. was enrolled in an outpatient treatment program. The Hospital did not provide V.L. and N.C. interpreters at the time of D.L.’s admission, during visiting hours while D.L. was an inpatient, or at one family meeting while D.L. was an outpatient. Complainants allege that during this one family meeting in which he was the topic of discussion, the Hospital utilized D.L. to act as a communication facilitator after the scheduled interpreter failed to appear. Complainants dispute the Hospital’s contention that an offer to reschedule the meeting with an interpreter was made at that time. According to the Complainants, V.L. and N.C., they were unable to communicate effectively with Hospital personnel on these occasions.

INVESTIGATION AND FINDINGS

6. The United States Attorney for the Eastern District of Virginia (“United States Attorney”) is authorized to investigate alleged violations of Title III of the Americans with Disabilities Act of 1990, as amended (“ADA”). 42 U.S.C. § 12188(b); 28 C.F.R. §§ 36.502, 36.503. It has the authority to, where appropriate, negotiate voluntary settlements, and to bring civil actions enforcing Title III of the ADA should the terms of the settlement be breached.
7. Complainants V.L. and N.C. are deaf and as such, are individuals with a “disability” within the meaning of the ADA. 42 U.S.C. § 12102; 28 C.F.R. § 36.104. Complainant D.L. is Complainants’ adult son 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. Dominion Hospital is a “public accommodation” within the meaning of Title III of the ADA, 42 U.S.C. § 12181(7)(F) and its implementing regulations, 28 C.F.R. § 36.104.
9. The ADA prohibits public accommodations, including hospitals, from discriminating on the basis of disability in the full and equal enjoyment of their goods, services, facilities, privileges, advantages or accommodations. 42 U.S.C. § 12182(a); 28 C.F.R. § 36.201(a). Discrimination includes failing to take such steps as necessary to ensure that no individual with a disability is excluded, denied services, segregated, or otherwise treated differently than any other individual because of the absence of auxiliary aids and services. 42 U.S.C. § 12182(b)(2)(A)(iii); 28 C.F.R. § 36.303.
10. On the basis of its investigation, the United States Attorney’s Office determined that Dominion Hospital denied Complainants appropriate auxiliary aids and services necessary for effective communication in violation of 42 U.S.C. § 12182(b)(2)(A)(iii); 28 C.F.R. § 36.303 during the following: (1) the admission of D.L. to Dominion Hospital; (2) visiting hours; and (3) the last family meeting with Dominion Hospital staff after the scheduled interpreter failed to appear. Dominion Hospital further violated the ADA by relying upon D.L. to act as a communication facilitator during the last family meeting in which he was the topic of conversation. Dominion Hospital fully cooperated with the United States Attorney’s Office’s investigation in this matter.
11. This Agreement is neither an admission of liability by the Hospital nor a concession by the United States that its claims are not well founded. By entering into this Agreement, the Hospital does not admit the allegations in paragraphs 5 and 10, 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 provided either on-site or through video remote interpreting (“VRI”) services; note takers; real-time computer-aided transcription services; written materials; exchange of written notes; telephone handset amplifiers; assistive listening devices; assistive listening systems; telephones compatible with hearing aids; closed caption decoders; open and closed captioning, including real-time captioning; voice, text, and video-based telecommunications products and systems, including text telephones (“TTYs”), videophones, and captioned telephones, or equally effective telecommunications devices; videotext displays; accessible electronic and information technology; or other effective methods of making aurally delivered information available to individuals who are deaf or hard-of-hearing. 28 C.F.R. § 36.303.
13. The term “Hospital Personnel” means all employees, full-time, part-time, and pro re nata (“PRN”), who have or are likely to have direct contact with Patients or Companions as defined herein.
14. The term “Active Members of the Hospital Medical Staff” means all physicians who are credentialed to provide medical services at Dominion Hospital, whether or not they are direct employees of the Hospital.
15. The term “qualified interpreter” means an interpreter who, via VRI service or an on-site appearance, is able to interpret effectively, accurately, and impartially, both receptively and expressively, using any necessary specialized vocabulary. Qualified interpreters include, for example, sign language interpreters, oral transliterators, and cued-language transliterators. 28 C.F.R. § 36.104.
16. 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.
17. 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).
18. The term “deaf” refers to persons who are deaf, late-deafened, or hard-of-hearing. The term “hard-of-hearing” includes persons who have a hearing deficit and who may or may not primarily use visual aids for communication and may or may not use auxiliary aids.

EQUITABLE RELIEF

A. Prohibition of Discrimination

19. Nondiscrimination. Dominion 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.
20. Discrimination by Association. Dominion 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).
21. Retaliation and Coercion. Dominion 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

22. Appropriate Auxiliary Aids and Services. Consistent with 42 U.S.C. § 12182(b)(2)(A)(iii), Dominion 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 23-24 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. Dominion Hospital will advise Patients and Companions who require auxiliary aids or services that these will continue to be made available as required by the ADA.
23. 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. The Hospital will ensure that the Notice of Services for Deaf and Hard-of-Hearing Persons at Dominion Hospital is provided to all persons with hearing disabilities in accordance with the Human Rights Plan Accommodating Patients with Special Needs – Section 504 policy. A Model Communication Assessment Form is attached to this Agreement as Exhibit A, and Dominion Hospital will ensure that its existing Notice of Services Form is similar to Exhibit A within thirty (30) days of the Effective Date of this Agreement.
24. 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 23) 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.
25. ADA Administrators. Dominion Hospital will designate at least one employee at the Hospital as an ADA Administrator or ADA Co-Administrators, and at least one such employee or his or her designee(s) (typically the nursing supervisors) will always be on duty and available to Hospital staff, Patients, and Companions twenty-four (24) hours a day, seven (7) days a week, to answer questions and provide appropriate assistance regarding immediate access to, and proper use of, the appropriate auxiliary aids and services, including qualified interpreters. The ADA Administrator, ADA Co-Administrators, or his or her designee(s) 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. Dominion Hospital will continue to include in the on-duty nursing supervisor’s binder located in the Nursing Supervisor’s Office the name, telephone number and office number through which the on-duty ADA Administrator, Co-Administrator, or designee can be contacted twenty-four (24) hours a day seven days a week by Hospital Personnel providing services to individuals who are deaf or hard-of-hearing. The ADA Administrator or Co-Administrators 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 AUSA Steven Gordon or, if he is unavailable, another attorney designated by the United States Attorney’s Office.
26. Auxiliary Aid and Service Log. Dominion 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(s) for the entire duration of the Agreement, and will be incorporated into the semi-annual Compliance Reports as described in paragraph 47 of this Agreement. The Hospital will implement the Auxiliary Aid and Service Log no later than thirty (30) days following execution of this Agreement.
27. Complaint Resolution. Dominion Hospital will continue to utilize its established grievance resolution mechanism for the investigation of disputes regarding effective communication with deaf and hard-of-hearing Patients and Companions. Dominion Hospital will maintain records of all grievances regarding effective communication, whether oral or written, made to the Hospital and actions taken with respect thereto. At the time Dominion Hospital completes its assessment described in paragraphs 23-24 and advises the Patient and/or Companion of its determination of which appropriate auxiliary aids and services are necessary, the 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(s) 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. Record of Need for Auxiliary Aid or Service. Dominion Hospital will take appropriate steps to ensure that Hospital Personnel involved in providing care to hearing-impaired Patients and their Companions are made aware of the disability and the auxiliary aid(s) and service(s) needed so that effective communication with such person will be achieved. These steps will include designating this information in the electronic medical record.

C. Qualified Interpreters

30. Circumstances Under Which Interpreters May be Required. Depending on the complexity and nature of the communication, a qualified interpreter may be necessary to ensure effective means of communication for patients and visitors. When an interpreter is needed, 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, Dominion Hospital will provide the name(s) of the interpreter services currently used by the Hospital for securing qualified on-site interpreters as well as VRI services.
32. 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 deaf or hard-of-hearing Patient or Companion less than two (2) 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 paragraphs 23-24 above. A qualified interpreter (via VRI) will be provided as soon as practicable, but no more than 30 minutes 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 on-site qualified interpreter is required, an interpreter will be provided as soon as practicable, but no more than two (2) hours from the time it becomes clear that VRI will not provide effective communication. As described below in section (c) of this paragraph, the Hospital will document the on-site interpreter service’s response time. Deviations from this response time will be addressed with the interpreting service provider. If no interpreter can be located, Hospital Personnel will take the following additional steps:
       1. Hospital Personnel will exert reasonable efforts (which shall be deemed to require no fewer than five (5) telephone inquiries and/or emails and/or text messages unless exceptional circumstances intervene) to contact any interpreters or interpreting agencies already known to the Hospital and request their services;
       2. Inform the ADA Coordinator of the efforts made to locate an interpreter and solicit assistance in locating an interpreter;
       3. Inform the Patient or Companion (or a family member or friend, if the Patient or Companion is unavailable) of the efforts taken to secure a qualified interpreter and that the efforts have failed, and follow up on reasonable suggestions for alternate sources of qualified interpreters, such as contacting a qualified interpreter known to that person; and
       4. Document all of the above efforts.
    2. Scheduled Interpreter Requests. A “scheduled interpreter request” is a request for an interpreter made two (2) or more hours before the services of the interpreter are required. For scheduled interpreter requests, Dominion Hospital Personnel will complete the assessment described in paragraphs 23-24 above in advance, and, when a qualified interpreter is appropriate, Dominion Hospital will make a qualified interpreter available at the time of the scheduled appointment. If a qualified interpreter fails to arrive for the scheduled appointment, upon notice that the interpreter failed to arrive, the Hospital will immediately call the interpreter service for another qualified interpreter.
    3. Data Collection on Interpreter Response Time. The Hospital will monitor and document in the Auxiliary Aid and Service Log, described in paragraph 26, the response time of each qualified interpreter service it uses to provide communication to deaf or hard-of-hearing Patients or Companions through its established process of monitoring outside vendors. The Hospital will document and investigate, per the grievance process identified in paragraphs 27, any complaints by the deaf or hard-of-hearing Patients or Companions regarding the quality and/or effectiveness of services provided by the interpreter service.
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, 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 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. Dominion Hospital shall continue offering its established VRI services. 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 requested in accordance with the timetable set forth above and provided in a reasonable and timely manner.
34. Notice to Deaf or Hard-of-Hearing Patients and Companions. As soon as Dominion Hospital Personnel have determined that a qualified interpreter is necessary for effective communication with a deaf or hard-of-hearing 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. Dominion 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 Dominion Hospital’s obligation to provide qualified interpreters in a timely manner as required by paragraph 32 of this Agreement.
35. Other Means of Communication. Dominion 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 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, for example, using sign language pictographs. This provision in no way lessens Dominion Hospital’s obligation to provide qualified interpreters in a timely manner as required by paragraph 32 of this Agreement.
36. Restricted Use of Certain Persons to Facilitate Communication. In accordance with its policy, Dominion Hospital will not rely on an adult friend or family member of the individual with a disability to interpret except in an emergency involving an imminent threat to the safety of an individual or the public where there is no interpreter available; or where the individual with a disability specifically requests that the adult friend or family member interpret, the accompanying adult agrees to provide such assistance, and reliance on that adult for such assistance is appropriate under the circumstances. Dominion Hospital will not rely on a minor child or a patient to interpret except in an emergency involving an imminent threat to the safety of an individual or the public where there is no interpreter available.

D. Telephones and Related Equipment

37. Public-Access Courtesy Telephones. Dominion Hospital will continue to provide Patients and their Companions with the following:
    1. TTYs in public areas. The Hospital will continue to provide access to portable TTYs in common areas including the lobby and individual patient units to the same extent public access phones are available for use by non-disabled Patients and Companions at the Hospital.
    2. Portable access technology – defined. Dominion Hospital will make available portable access technology. Such technology, as referred to in this section, shall include TTYs, other electronic devices, visual notification devices for incoming telephone calls, volume control telephones, and telephones that are hearing aid compatible. The Hospital will ensure that each volume control telephone and each visual notification device for incoming telephone calls complies fully with § 704.3 of the 2010 Standards.
    3. Notice of availability of TTYs. Dominion will provide notice of the availability of portable TTYs in the patient handbooks and in the Notice of Services for Deaf and Hard-of-Hearing Persons at Dominion Hospital.
    4. Volume control telephones. Dominion Hospital will ensure that portable equipment equipped with volume control mechanisms are readily available for use by Patients and their Companions in public access areas.
    5. Storage and availability of equipment. Portable equipment required by this section for use in public areas shall be stored in a place or places that are readily accessible to all Hospital Personnel who have client contact at all times of the day and night. All Hospital Personnel will be notified of the storage location that is closest to their work area(s). The equipment is to be stored at the appropriate supervised location. Such equipment shall be made available to individuals who are deaf or hard-of-hearing to same extent they would be made available to non-disabled individuals as soon as practicable consistent with good medical care and/or the safety of other patients at the Hospital. The ADA Administrator (as discussed in paragraph 25) will be responsible for ensuring that this equipment remains readily accessible.
    6. Timeliness. Dominion Hospital will continue making the portable equipment required by this section available in the patient units to the same extent non-TTY/TDD or other assistive equipment is made available for use within units. The Hospital will notify all relevant Hospital Personnel of the availability and location of this equipment.
38. Televisions. Dominion Hospital will continue to ensure that Patients with hearing impairments have access to televisions with closed captioning capabilities. 28 C.F.R. § 36.303(e). It is the Hospital’s general practice that Hospital staff and not the Patients control the televisions. Hospital Personnel will be familiar with the directions for operating the closed caption function.

E. Notice to Community

39. Policy Statement. Within ninety (90) days of the entry of this Agreement, Dominion 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. A sample posting is included as Exhibit B. 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.”

40. Website. Dominion Hospital will include on its website the policy statement described above.
41. Patient Handbook. Dominion 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, 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.

F. Notice to Dominion Hospital Personnel and Physicians

42. Dominion Hospital shall continue to publish on its intranet a policy statement regarding the Hospital’s policy for effective communication with persons who are deaf or hard-of-hearing. This policy statement includes, but is not limited to, language to the following effect:

    If you recognize or have any reason to believe that a Patient or a relative, close friend, or Companion of a Patient is deaf or hard-of-hearing, you must advise the person that appropriate auxiliary aids and services, such as sign language and oral interpreters, video remote interpreting services, TTYs, written materials, telephone handset amplifiers, assistive listening devices and systems, telephones compatible with hearing aids, televisions with captioning or closed caption decoders, and open and closed captioning of most hospital programs, will be provided free of charge when appropriate. If you are the responsible health care provider, you must ensure that such aids and services are provided when appropriate. All other personnel should direct that person to the appropriate ADA Administrator(s) at _____________ and reachable at ________________.

Dominion Hospital’s policy will continue to be accessible to all Hospital Personnel and both employed and Active Members of the Hospital Medical Staff, and to all new Hospital Personnel and newly employed or Active Members of the Hospital Medical Staff upon their affiliation or employment with the Hospital.

G. Training

43. Training of ADA Administrator. Dominion Hospital will continue to provide mandatory training for the ADA Administrator(s) as designated in paragraph 25 of this Agreement. Such training will occur within sixty (60) days of designation of the ADA Administrator(s) unless such training has been provided in accordance with Dominion Hospital’s training schedule within the same calendar year of the Effective Date of this Settlement. Such training will be sufficient in duration and content to train the ADA Administrator(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. to encourage Active Members of the Hospital Medical Staff to notify the Hospital of deaf and hard-of-hearing Patients and Companions as soon as Patients schedule admissions or other health care services at the Hospital;
    4. to use, when appropriate and available, flash cards and/or 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 27 of this Agreement.
44. Training of Hospital Personnel. Except for Active Members of the Hospital Medical Staff, who are governed by paragraph 46 of this Agreement, Dominion Hospital will provide mandatory in-service training to all Hospital 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. 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/or pictographs (in conjunction with any other available means of communication that will augment the effectiveness of the communication).
    2. Such training must be provided within ninety (90) days of the Effective Date of this Agreement, unless such training has been provided within the same calendar year of the Effective Date of this Settlement in accordance to Dominion Hospital’s training schedule.
    3. New employees must be trained within thirty (30) days of their hire. Self-study through the provision of the study material used during Hospital Personnel training and a screening of a video of the proper use of VRI equipment will suffice to meet this obligation.
45. Training Attendance Records. Dominion Hospital will maintain for the duration of this Agreement, confirmation of training conducted pursuant to paragraphs 43-44 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.
46. Training of Active Members of the Hospital Medical Staff. Dominion Hospital will provide Active Members of the Hospital Medical Staff a copy of its policy on the communication needs of Patients or Companions who are deaf or hard-of-hearing and will invite all Active Members of the Hospital Medical Staff to reach out to the ADA Administrator(s) if they have questions about the policy. A cover letter provided with the policy, and delivered to each Active Members of the Hospital Medical Staff’s physical on-site mailbox will reference its availability on the intranet and will request Active Members of the Hospital Medical Staff to notify Dominion Hospital of deaf and hard-of-hearing Patients and Companions as soon as they schedule admissions or other health care services offered at the Hospital, in the unlikely event that they become aware of such needs prior to the Hospital.

H. Reporting, Monitoring, and Violations

47. Compliance Reports. Beginning six months after the Effective Date of this Agreement and every six (6) months thereafter for the entire duration of the Agreement, Dominion 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 Dominion Hospital 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.

    Dominion 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.

48. Complaints. During the term of this Agreement, Dominion 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 Dominion 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 Dominion 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 of the allegation provided by the complainant. Dominion Hospital will reference this provision of the Agreement in the notification to the U.S. Attorney’s Office.

I. Compensatory Relief for Complainants and Release

49. Within ten (10) days after receiving the executed Agreement, the complainants’ signed releases (a blank release form is at Exhibit C), and complainants’ executed IRS Form W-9, Dominion Hospital will send by FedEx, three checks as follows: (1) in the amount of twenty-five thousand ($25,000) dollars made out to Complainant V.L.; (2) in the amount of twenty-five thousand ($25,000) dollars made out to Complainant N.C.; and (3) in the amount of five thousand ($5,000) dollars made out to Complainant D.L. These check are 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 checks shall be mailed to:

    Steven Gordon
    Assistant United States Attorney
    2100 Jamieson Avenue
    Alexandria, VA 22314

J. Enforcement and Miscellaneous

50. Duration of the Agreement. This Agreement will be in effect for three (3) years from the Effective Date.
51. 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 or Section 504 of the Rehabilitation Act of 1973 in this matter, except as provided in paragraph 52. 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 Dominion 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.
52. 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 Dominion Hospital, and the parties will attempt to resolve the concern(s) in good faith. The United States will allow Dominion Hospital thirty (30) days from the date it notifies the 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.
53. 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.
54. 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.
55. 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.
56. The effective date of this Settlement Agreement is the date of the last signature below.
57. This Agreement may be executed in counterparts, each of which constitutes an original and all of which constitute one and the same Agreement. Electronically transmitted signatures shall constitute acceptable, binding signatures for purposes of this Agreement.