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SETTLEMENT AGREEMENT

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SETTLEMENT AGREEMENT Powered By Docstoc
					                          SETTLEMENT AGREEMENT

                                        AMONG

                     THE UNITED STATES OF AMERICA

              PLAINTIFFS EQUAL RIGHTS CENTER,
        DENNIS CHRISTOPHER BUTLER, ROSEMARY CIOTTI,
         GEORGE AGUEHOUNDE, AND MARSHA JOHNSON

                                          AND

                     WASHINGTON HOSPITAL CENTER

Department of Justice Complaint Number 202-16-120


I. BACKGROUND
     A. On November 25, 2003, Dennis Christopher Butler, Rosemary Ciotti, George
     Aguehounde, Marsha Johnson (the “Individual Plaintiffs”), and The Disability
     Rights Council of Greater Washington commenced an action in the United States
     District Court for the District of Columbia against Washington Hospital Center,
     captioned Disability Rights Council et al. v. Washington Hospital Center, Case
     Number 1:03CV02434 (the “DRC/ERC Litigation”). The Plaintiffs in the
     DRC/ERC Litigation allege that Washington Hospital Center (“WHC”)
     discriminated against the Individual Plaintiffs by denying each of them the full
     and equal enjoyment of and access to its health care services and health care
     facilities, on the basis of their disabilities, in violation of Title III of the
     Americans with Disabilities Act, 42 U.S.C. §§12181 et seq. (the “ADA”), Section
     504 of the Rehabilitation Act of 1973, 29 U.S.C.§ 794 (“Section 504”), and the
     District of Columbia Human Rights Act, D.C. Code §§ 1-2501 et seq., and that
     WHC’s alleged violations of law caused injuries to the Plaintiffs. WHC has
     denied all material allegations in the DRC/ERC Litigation.

     B. WHC is a subsidiary of MedStar Health, Inc. (“MedStar”), a nonprofit
     corporation located at 5565 Sterrett Place, Columbia, MD 21044. WHC owns and
     operates a hospital and adjacent facilities at 110 Irving Street, NW, Washington,
     DC 20010; and operates services within the Washington Hospital Center
     Physicians Office Building (the “POB”), at 106 Irving Street, NW, Washington,
     DC 20010; however, WHC does not currently own the POB. As a private entity
     that owns and operates medical service establishments, WHC is a public
     accommodation covered by Title III of the ADA, 42 U.S.C. § 12181(6); 28 C.F.R.
     § 36.104.
C. Dennis Christopher Butler, Rosemary Ciotti, George Aguehounde, and Marsha
Johnson are individuals with mobility disabilities, each of whom uses a
wheelchair. Mr. Butler is an individual with quadriplegia and uses a power
wheelchair that is operated by a sip and puff system. Ms. Ciotti has lupus and
related neurological complications that require her to use a power wheelchair for
mobility. Mr. Aguehounde has a spinal cord injury and uses a power wheelchair.
Ms. Johnson uses a power wheelchair for mobility due to polio and post-polio
symptoms. Each of these individuals is an individual with a disability within the
meaning of the ADA.

D. The Disability Rights Council of Greater Washington (the “DRC”) was a
nonprofit advocacy group with a direct interest in protecting the rights of
individuals with disabilities, including those with mobility impairments. The
Equal Rights Center (the “ERC”) is the DRC’s successor in interest, and is a
nonprofit advocacy group organized to promote fair housing, fair employment,
and equal access to public accommodations for all members of society without
regard to race, color, religion, sex, disability, family status, national origin, or any
federal, state, or local civil rights protected class, and equal opportunities for
persons with disabilities, with respect to the use of public accommodations,
transportation, and telecommunications facilities and services. On June 30, 2005,
the DRC submitted Articles of Merger to the District of Columbia Department of
Consumer and Regulatory Affairs, memorializing a merger of the DRC with
ERC, a District of Columbia nonprofit corporation. On July 18, 2005, a Consent
Motion for Substitution, pursuant to Federal Rule of Civil Procedure 25, was filed
with the United States District Court for the District of Columbia, substituting
ERC for the DRC in the DRC/ERC Litigation. An Order Granting Substitution
was issued on July 19, 2005. The ERC and the Individual Plaintiffs are hereinafter
collectively referred to as the “Plaintiffs.”

E. Title III of the ADA requires that a medical services entity provide individuals
with disabilities, among other things, full and equal enjoyment of and access to its
health care services and health care facilities; reasonable modifications to its
policies, practices, and procedures when necessary to make health care services
fully available to individuals with disabilities; and auxiliary aids and services.
Title III also requires that the entity remove architectural barriers where such
removal is readily achievable and comply with the architectural requirements for
new construction and alterations.

F. The Plaintiffs’ allegations in the DRC/ERC Litigation include, among other
things, not being placed in an accessible inpatient room; being examined on
inaccessible equipment which required them to be lifted onto an examination
table; having such lifting performed in an improper manner; having to wait
significantly longer than other patients for an outpatient exam because the
examination room with an accessible table was occupied; not receiving adequate
inpatient services required as a result of a disability, such as assistance with
eating, drinking and having bowel movements; and not timely receiving
accessible equipment needed as an inpatient, such as an accessible call button and
telephone. There is no allegation in the DRC/ERC Litigation of any medical
malpractice on the part of WHC, but rather the above allegations relate solely to
claims that WHC violated Title III of the ADA, Section 504 of the Rehabilitation
Act, and the District of Columbia Human Rights Act.

G. In addition to the DRC/ERC Litigation, the Plaintiffs filed an administrative
complaint with the United States Department of Justice (“DOJ”) making the same
allegations (the “DOJ Complaint”). DOJ, which is not a party to the DRC/ERC
Litigation, conducted an investigation of the complaint it received against WHC
under the authority granted under Section 308(b)(1) of the ADA, 42 U.S.C. §
12188(b)(1). The Attorney General of the United States is authorized, pursuant to
42 U.S.C. § 12188(b)(1)(B) of the ADA, to bring a civil action under Title III to
enforce the ADA in any situation where a pattern or practice of discrimination is
believed to exist or a matter of general public importance is raised.

H. After investigating, DOJ concluded that WHC had violated certain provisions
of the ADA by denying equal access to medical services for individuals with
disabilities. WHC has denied, and continues to deny, that it has violated the ADA.

I. The parties to the DRC/ERC Litigation, after good-faith negotiation, have
determined that the DRC/ERC Litigation should be resolved through a
comprehensive Settlement Agreement (“Agreement”), the terms of which are set
forth fully herein.

J. DOJ, having participated in the negotiations among the parties to the DRC/ERC
Litigation, and having conducted its own investigation of the matters addressed by
this Agreement, believes that the public interest will be served by entering into
this Agreement, the terms of which are set forth fully herein.

K. In order to avoid unnecessary and costly litigation, and not as an admission of
liability, the parties have agreed to resolve the DRC/ERC Litigation and the DOJ
Complaint as set forth below.

L. The Plaintiffs and DOJ recognize that WHC has cooperated fully in resolving
alleged disputes and has demonstrated a strong commitment to providing equal
access to its services and facilities for persons with disabilities, including the
goals of ensuring that inpatients with mobility disabilities will be placed in
accessible rooms; that patients with mobility disabilities undergoing examinations
will be examined in an appropriate manner by trained personnel; that accessible
equipment (such as adjustable exam tables, Hoyer lifts, wheelchair scales, and
accessible call buttons) will be available to patients who need it; and that
additional policies and training will be implemented to ensure that individuals
with disabilities are not discriminated against on the basis of disability in the full
and equal enjoyment of the services, facilities, and other accommodations
  provided by WHC and have an opportunity to benefit from the medical services
  provided by WHC that is equal to the opportunity afforded other individuals. The
  parties recognize and agree that this statement of the goals of this Agreement is
  not intended to enlarge or otherwise modify the specific obligations set forth in
  this Agreement.


II. COORDINATION AND OVERSIGHT
  A. ADA Officer.
     1. Appointment. Within 30 days of the Effective Date of this Agreement,
     as such term is defined in Paragraph VIII.N. below, in order to oversee the
     implementation of this Agreement and to perform the additional functions
     described below, WHC shall appoint an ADA Officer. The ADA Officer
     position shall be maintained throughout the Term of this Agreement, as
     defined in Paragraph VIII.R. below. The individual selected to be the
     ADA Officer and his or her successors shall be subject to approval by
     DOJ, which approval shall not be unreasonably withheld. DOJ shall
     approve or reject the proposed individual within 15 days of its receipt of
     the proposed individual’s qualifications. Any person appointed under this
     paragraph shall be a regular employee of WHC and shall have experience
     in hospital administration and a background or training in disability issues.
     The ADA Officer must have authority within WHC to implement changes
     and effectuate this Agreement. WHC has appointed and DOJ has approved
     Ms. Renee P. Landry as the ADA Officer for WHC. Ms. Landry currently
     serves as Vice President of Support Services and has experience in
     hospital administration. She will attend training on Title III of the ADA as
     it applies to medical facilities and disability awareness within 60 days of
     the Effective Date of this Agreement. Such training and the person(s) or
     organization(s) who will conduct the training shall be selected by WHC
     and approved by DOJ, which approval shall not be unreasonably withheld.

     2. Responsibilities. The ADA Officer shall serve as WHC’s primary
     administrative contact on disability issues for the public and for the parties
     to this Agreement. The ADA Officer will be responsible for WHC’s
     compliance with Title III of the ADA and Section 504, and for
     implementing and administering WHC’s obligations under this
     Agreement, including compliance with all reporting requirements herein.
     The ADA Officer, jointly with the designated consultant or expert, shall
     carry out the obligations set forth in Sections III - VI below. The ADA
     Officer shall be responsible for ensuring that disability-related issues and
     complaints raised by patients and others are addressed and for supervising
     the Environment of Care Committee with respect to resolving disability-
     related matters, as set forth in Paragraph II.C. below. The ADA Officer
     will consult with the Advisory Resource Group established pursuant to
     Paragraph II.G. below, as needed, in carrying out his or her
     responsibilities.
B. Patient Complaint Process. WHC will use its existing Patient Complaint
Process for patients with disabilities or their family members to submit
complaints, comments, and questions regarding accommodation or treatment
issues. The Patient Complaint Process provides a phone number for patients, their
friends, family, and other guests to use to lodge a complaint with the Patient and
Guest Services Department ("PGSD"). This phone number is currently designated
the Customer Care Number and, as of the Effective Date of this Agreement, will
also be designated the ADA Disability Assistance Number. While the process for
raising an ADA concern will be the same as for other patient complaints, the
ADA Disability Assistance Number and ADA Disability Assistance Process shall
be separately designated as such on all materials describing these services. When
a PGSD representative receives a disability-related complaint, s/he will
investigate and try to resolve the complaint. If s/he is unable to do so, s/he will
consult with either the Clinical Specialist or Non-Clinical Specialist designated
for this process, depending on the nature of the complaint. The Clinical and Non-
Clinical Specialists are management-level employees with an expertise in an area
relevant to the resolution of disability-related issues (e.g., background in facilities,
equipment, lifting mechanics, etc. for Non-Clinical Specialist; and patient care
education/training for Clinical Specialist), selected by WHC to participate in the
ADA Complaint review process. If the Specialist is unable to resolve the
complaint, the Specialist will notify the ADA Officer, who will assist in resolving
the complaint. All reasonable efforts must be made to resolve the complaint in a
timely way; what is timely will depend on the nature of the complaint. The PGSD
will maintain regular Occurrence Reports documenting each complaint received
and its resolution. A chart illustrating the Patient ADA Disability Assistance
Process is attached as Exhibit A hereto and hereby made a part of this Agreement.
    1. Within 60 days of the Effective Date of this Agreement, the Clinical
    and Non-Clinical Specialists designated for the ADA Disability Assistance
    Process will attend training on Title III of the ADA as it applies to medical
    facilities and interacting with individuals with disabilities.

    2. Within 30 days of the Effective Date of this Agreement, WHC shall
    place a sticker on each inpatient room telephone that depicts the
    International Symbol of Accessibility, the phone number for the ADA
    Disability Assistance Number, and to the extent space allows, the words
    “ADA Disability Assistance Number.” The sticker shall also be added to
    all telephones available for patients that have special adaptive features,
    such as voice-activated telephones and TTY telephones. TTY telephones
    shall also have a sticker on them with the local Relay number (711).

    3. Within the next scheduled publication cycle of WHC’s Patient
    Information Guide, but no later than 120 days from WHC’s receipt of
    DOJ’s approval of the language for the ADA Brochure, WHC shall revise
    its Patient Information Guide to incorporate the information developed
    jointly with DOJ for WHC’s ADA Brochure, as set forth in more detail in
    Paragraph V.G. below. This information shall include an explanation of
   patients’ rights and remedies under the ADA and Section 504 in a hospital
   setting, and shall contain WHC’s ADA Disability Assistance Number and
   an explanation of WHC’s ADA Disability Assistance Process. The Patient
   Information Guide shall be made available to individuals with vision
   impairments in compliance with the policy on effective communication to
   be developed under Section V below.
C. Environment of Care Committee. The Environment of Care Committee
("EOCC") is a multi-disciplinary standing committee that meets at least quarterly.
Within 30 days of the Effective Date of this Agreement, the members of the
Committee will include the Clinical and Non-Clinical Specialists described in
Paragraph II.B. above, and representatives from other disciplines needed to
address compliance with this Agreement as determined by WHC. The EOCC will
be used to ensure that the Patient Complaint Process is effectively addressing
requests for ADA assistance from patients with disabilities or their families or
guests. The EOCC will receive regular reports from the PGSD containing
summaries of ADA complaints sufficient to ensure that any institutional issues
that are leading to recurring problems are addressed and resolved. If necessary,
the EOCC will also be available to consider disability-related policy issues that
arise through other channels, such as the review and development of WHC’s
disability-related policies and procedures as set forth in Section V below. The
EOCC will report to the ADA Officer.

D. ADA Consultant on Policies and Training. Within 30 days of the Effective
Date of this Agreement, WHC shall appoint an ADA Consultant on Policies and
Training (“ADA Consultant”). The individual selected to be the ADA Consultant
and his/her successors shall be subject to approval by DOJ and ERC, which
approval shall not be unreasonably withheld. DOJ and ERC shall approve or
reject the proposed individual within 15 days of receiving the proposed
individual’s qualifications. The ADA Consultant shall have experience in policy
and training development and a background or training in disability issues in the
health care field. The ADA Consultant shall serve in a consulting capacity, not as
a regular employee, and shall serve as long as needed to fulfill WHC’s obligations
under this Agreement. The ADA Consultant shall be paid by WHC. WHC has
appointed and DOJ and ERC have approved Paul R. Rao, Ph.D, to be the ADA
Consultant. Dr. Rao is currently the Vice President of Clinical Services, Quality
Improvement and Corporate Compliance at National Rehabilitation Hospital in
Washington D.C., and an expert on policy development, rehabilitation facilities
and stroke rehabilitation.

The ADA Consultant on Policies and Training, jointly with the ADA Officer, will
review, revise, and create policies and procedures relating to the treatment and
care of individuals with disabilities, and will develop and coordinate the training
program, as set forth in Sections V and VI below. The ADA Consultant may
consult with the Advisory Resource Group, as necessary to obtain feedback and
insight, as set forth in Paragraph II.G. below.
E. ADA Equipment Expert. Within 60 days of the Effective Date of this
Agreement, WHC shall appoint an ADA Equipment Expert. The individual
selected to be the ADA Equipment Expert and his/her successors shall be subject
to approval by DOJ, which approval shall not be unreasonably withheld. DOJ
shall approve or reject the proposed individual within 15 days of its receipt of the
proposed individual’s qualifications. The Equipment Expert shall have knowledge
of the ADA and the needs of individuals with disabilities relating to using medical
equipment, and shall have or be able to acquire knowledge of medical equipment
currently available on the market and under development, especially with regard
to adaptive equipment, and of the medical equipment needed to provide equal
access to medical services for individuals with disabilities (e.g., padded leg
supports on a gynecological exam table). The Equipment Expert shall survey
certain equipment and determine necessary acquisitions and modifications, jointly
with the ADA Officer, as set forth in Paragraph IV.C. below. The Equipment
Expert shall consult with the Advisory Resource Group, as needed, regarding the
survey of equipment, as set forth in Paragraph II.G. below.

F. ADA Architectural Expert. Within 60 days of the Effective Date of this
Agreement, WHC shall appoint an ADA Architectural Expert. The individual
selected to be the ADA Architectural Expert and his/her successors shall be
subject to approval by DOJ, which approval shall not be unreasonably withheld.
DOJ shall approve or reject the proposed individual within 15 days of its receipt
of the proposed individual’s qualifications. The Architectural Expert shall be
responsible for surveying the WHC facility for architectural barriers, and for
determining, jointly with the ADA Officer, appropriate barrier removal, as set
forth in Section III below. The Architectural Expert shall have expertise in
conducting ADA architectural compliance surveys, preferably in a medical
setting.

G. Advisory Resource Group of Persons with Disabilities (“Advisory Resource
Group”). Within 60 days of the Effective Date of this Agreement, WHC shall
appoint a resource group comprised of individuals with disabilities, who also have
specific professional knowledge regarding the provision of health care to people
with disabilities, to serve in an advisory capacity to the ADA Officer, ADA
Consultant, and ADA Equipment Expert, as set forth in Paragraphs II.A., II.D.,
and II.E. above. The individuals appointed to the Advisory Resource Group and
their individual successors shall be subject to approval by DOJ, which approval
shall not be unreasonably withheld. The Advisory Resource Group or individual
members of the Advisory Resource Group with the appropriate knowledge and
experience shall be consulted with regard to the development of policies, the
development of the training program, equipment purchases, and any other issues
for which the input of the Advisory Resource Group will be helpful. The group
members may be employees of WHC, MedStar, or its affiliates.
III. STRUCTURAL MODIFICATIONS TO WHC BUILDINGS AND FACILITIES
  A. Accessible Patient Room. For purposes of this Agreement, an “Accessible
  Patient Room” must comply in all respects with the ADA Accessibility Standards
  (the “ADA Standards”) for new construction in effect at the time the room is
  renovated or constructed. The current ADA Standards are at 28 CFR §36.406 and
  Part 36, App. A. All Accessible Patient Rooms must: (i) contain an accessible
  toilet room; (ii) contain or have access to an accessible shower, consistent with
  the amenities provided in adjacent patient rooms; and (iii) contain and/or have
  access to all other amenities provided in or available to patients occupying
  adjacent rooms. All references to Accessible Patient Rooms herein shall be
  understood to refer to Accessible Patient Rooms as defined in this paragraph. DOJ
  may approve certain rooms as Accessible Patient Rooms that do not fully comply
  with the ADA Accessibility Standards.

  B. Modifications to Patient Rooms and Restrooms.
     1. Group 1. During the first 24 months following the Effective Date of this
     Agreement, WHC will modify the 23 existing patient rooms listed
     immediately below to create 23 fully compliant Accessible Patient Rooms.
     These rooms will be: 2E: 1, 5, 9, 11, 15, IMC1, IMC3; 4D: 27, 31; 5C: 7,
     11, 19, 28; 5F 2; 2NE 10; 2NW 10; 3NE 10 (lead lined); 3NW 10; 4NE
     10; 4NW 10; 5NW: 5, 8; 5NE 11. Notwithstanding the foregoing, because
     of space limitations in Rooms 5C 7, 11, and 19, these rooms will not be
     fully compliant with the ADA Standards because a patient will be able to
     transfer to the bed in each such room from one side of the bed only. The
     schedule for modifying these 23 rooms shall be as follows:
         (a) During the first 12 months following the Effective Date of this
         Agreement, modifications to 12 of the Group 1 rooms will be
         completed, including, but not limited to, 2NE 10; 2NW 10; 3NE
         10; 3NW 10; 4NE 10; and 4NW 10.

         (b) During months 13 through 24 following the Effective Date of
         this Agreement, modifications to the remaining 11 rooms in Group
         1 will be completed.

         (c) Based on site visits to WHC, the parties to this Agreement
         believe that fully compliant patient rooms can be created within the
         existing footprints of the patient rooms listed in Paragraph III.B.1
         above (except for Rooms 5C 7, 11, and 19). However,
         notwithstanding the language in Paragraph III.B.1. above, if WHC
         cannot create a fully compliant Accessible Patient Room, as
         defined in Paragraph III.A. above, within the existing footprint of
         the patient room because of space constraints, then WHC shall be
         obligated only to make the room as accessible as possible within
         the existing footprint. If WHC believes it cannot make a room
   specified in Paragraph III.B.1. above a fully compliant Accessible
   Patient Room because of such space constraints, WHC must
   provide drawings demonstrating why ADA compliance is not
   possible and seek approval from DOJ for its alternate design plan.
2. Group 2. During the 3rd, 4th and 5th years following the Effective Date
of this Agreement, WHC will modify 12 additional existing patient rooms,
at least 6 of which shall be located in WHC’s North Addition, to create 12
additional fully compliant Accessible Patient Rooms, regardless of cost. If
WHC decides to locate any of the 6 remaining patient rooms in Group 2 in
areas other than the North Addition, WHC agrees to use its best efforts to
locate these rooms in medical specialty units that do not, at that time, have
Accessible Patient Rooms. None of these 12 additional Accessible Patient
Rooms shall be located in any of WHC’s maternity units. WHC shall
complete the modifications for at least one Accessible Patient Room
required by this paragraph within the 3rd year following the Effective
Date of this Agreement.

3. Group 3. During the 4th and 5th years following the Effective Date of
this Agreement, WHC shall expend at least $100,000 per year on direct
construction and renovation costs for upgrading additional patient rooms
(other than those rooms addressed in Paragraphs III.B.1. and 2., above)
toward achieving the goal of having 10% of the total number of WHC’s
inpatient hospital rooms (excluding ICU facilities) be Accessible Patient
Rooms. At the beginning of each of these years, WHC will review with
DOJ its plans for the expenditure of these funds during the year toward
achieving additional patient room accessibility. If the expenditure of these
funds is insufficient to achieve full ADA accessibility of additional patient
rooms, WHC shall use its best efforts, in consultation with DOJ, to
maximize patient room accessibility to the greatest extent possible by
utilizing such funds.

4. New Tower Rooms. WHC has informed the parties that it is considering
the construction of a new hospital tower at WHC, which will contain
additional medical facilities including, inter alia, inpatient hospital rooms.
If, within 5 years of the Effective Date of this Agreement, WHC receives
notice from MedStar that funds have been committed and all necessary
approvals have been obtained from MedStar to construct a hospital tower
that will include any non-ICU patient rooms (the “Tower”), as evidenced
by a MedStar Board Resolution or its equivalent, it shall immediately so
notify DOJ and ERC in writing. Such notice shall be accompanied by
evidence of MedStar’s approval in the form of a Board Resolution or
similar corporate document, and the following terms shall apply:
   (a) The Term of this Agreement, as more particularly set forth in
   Paragraph VIII.R. below, shall be extended to the date that the
   Tower construction is complete, with respect to matters concerning
   construction of the Tower only;
   (b) WHC shall make twenty-five percent (25%) of the non-ICU
   patient rooms in the new Tower, or 25 non-ICU patient rooms,
   whichever is greater, Accessible Patient Rooms;

   (c) In the event that more than one medical specialty unit is
   constructed within the Tower, WHC shall disperse the Accessible
   Patient Rooms constructed in the Tower among the various
   medical specialty units within the Tower;

   (d) Before commencing construction of the Tower, WHC will
   provide DOJ a copy of the architectural plans for the Accessible
   Patient Rooms in the Tower prior to such plans becoming final.
   Within 15 business days of its receipt of such plans, DOJ shall
   identify any elements of the architectural plans for the patient
   rooms that do not comply with the ADA Standards. Any violations
   identified by DOJ must be limited to issues of design compliance
   with the ADA Standards for patient rooms. DOJ’s review of the
   plans, as described above, shall not be construed to be an approval
   of WHC’s design for the Tower with respect to other standards or
   elements of the building, other than the patient rooms. WHC will
   consider any proposed revisions and make appropriate changes in
   good faith. If the parties cannot agree on the recommendations,
   they shall follow the procedure set out in Paragraph VIII.D. below;

   (e) Upon completion and final inspection of the Tower, WHC shall
   provide DOJ with a copy of the Certificate of Occupancy for the
   Tower or its equivalent, and copies of all documents required to
   demonstrate that the Tower has been completed and received all
   approvals needed to begin admitting and treating patients. WHC
   shall also provide the written certification of the project architect
   that the Accessible Patient Rooms in the Tower comply with the
   ADA Standards and have been constructed in a manner consistent
   with the plans previously approved by DOJ. The certification shall
   include “as built” drawings of the non-ICU patient rooms in the
   Tower. The drawings shall be certified by WHC’s architect as true,
   complete, and correct.
5. Relief from Group 3 Room Obligation. If WHC provides DOJ with the
notice required by Paragraph III.B.4. above within 36 months following
the Effective Date of this Agreement, WHC shall be relieved of its
obligations with respect to the Group 3 Rooms; provided, however, that if
construction on the Tower fails to commence within the earlier of: (i) 36
months of such notice; or (ii) two months prior to the expiration of the
Term of the Agreement, WHC’s obligations with respect to the Group 3
Rooms shall be immediately reinstated and WHC shall be obligated to
spend $100,000 per year on direct construction costs for renovations to
   patient rooms for the next two years, commencing on the date that the
   earlier of events (i) or (ii) above occurs. In such event, the Term of this
   Agreement, in its entirety, shall be extended until the date WHC fulfils its
   obligations under Paragraph III.B.3. above.
C. Survey of WHC.
   1. Architectural Survey Tool. Within 30 days of the appointment and DOJ
   approval of the ADA Architectural Expert, as set forth in Paragraph II.E.
   above, WHC shall submit a survey tool prepared by the ADA
   Architectural Expert on which to collect the information to be gathered
   during the architectural survey, as described in further detail in Paragraph
   III.C.2. below, to DOJ for approval, which approval shall not be
   unreasonably withheld. The survey tool shall be designed to identify, in
   reasonable detail, elements that do not conform with the ADA Standards.
   DOJ shall approve or make recommendations for revisions to the survey
   tool within 15 days of receiving the survey tool. If DOJ recommends any
   revisions, WHC shall consider the proposed revisions and make
   appropriate changes in good faith. If the parties cannot agree on the survey
   tool, they shall follow the procedure set out in Paragraph VIII.D. below.

   2. Completion of Architectural Survey. The ADA Architectural Expert
   shall complete a survey of all areas in which WHC provides services to
   the public (whether in the main hospital, POB, or other buildings),
   including: (i) all areas where WHC patients, whether inpatients or
   outpatients, are treated or receive medical services of any nature including
   diagnostic services (excluding inpatient bedrooms); (ii) all areas where
   WHC patients and their guests or other visitors transact business with
   WHC, including patient registration and financial transactions; and (iii) all
   other areas open to patients and the public, including, but not limited to,
   common areas, cafeterias, gift shops, chapels, counseling rooms,
   classrooms, parking garages, and public toilet rooms. The requirements of
   this paragraph apply to the POB and other buildings to the extent that
   WHC owns or has ownership interest in such structures, or is a tenant
   therein. WHC shall ensure that all original survey instruments completed
   while conducting the survey are retained during the Term of this
   Settlement Agreement, to be made available to DOJ, upon request.

   3. Architectural Survey Report. Within 120 days of DOJ’s approval of the
   survey tool, the ADA Officer, in consultation with the ADA Architectural
   Expert, shall write and submit to DOJ a report of the survey providing, for
   each element: (a) a description of each element that deviates from the
   ADA Standards for Accessible Design, 28 CFR Part 36, App. A; (b) a
   description of what, if any, readily achievable barrier removal is necessary
   to make the element accessible to individuals with disabilities, including
   mobility disabilities (e.g., the modification of counter heights, signage,
   door width, accessible routes); and (c) a plan for removing each barrier
   identified or a proposed readily achievable alternative to barrier removal,
   as described immediately below (the “Barrier Removal Plan”). The Barrier
   Removal Plan shall provide a description of the remedial action to be
   taken to remove each barrier and set forth a proposed schedule. For any
   barrier whose removal WHC determines is not readily achievable and/or
   will not make WHC’s services more usable for individuals with
   disabilities, WHC shall determine which readily achievable alternative to
   barrier removal would be appropriate to ensure access to the services and
   explain the reason for its determination. Any such alternatives to barrier
   removal shall be included in the written policies and procedures required
   to be provided to DOJ pursuant to Section V. DOJ shall approve or offer
   revisions to the Barrier Removal Plan within 30 days of receiving the
   report. If the parties cannot agree on the list of barriers to be removed or
   the schedule for barrier removal, they shall follow the procedure set out in
   Paragraph VIII.D. below. Upon agreement, WHC shall immediately
   implement the Barrier Removal Plan in accordance with the schedule set
   forth therein.

   4. Readily Achievable Barrier Removal Standard. For purposes of this
   Agreement, the readily achievable barrier removal standard, 28 CFR §
   36.304, will define what architectural changes are required by WHC as a
   result of the survey set forth in Paragraph III.C. The readily achievable
   barrier removal standard applies for purposes of this Agreement only, and
   does not reflect a determination by DOJ or the Plaintiffs that it is the
   correct standard, in contrast to the new construction or alterations
   standard, to apply in any other legal context for any particular area of
   WHC.
D. Reporting Requirements.
   1. Updates. DOJ may, from time to time, request WHC to provide updates
   on the progress of its modifications, and/or copies of architectural plans,
   until such time as WHC notifies DOJ that such modifications have been
   completed. Any such requests for updates shall be made in writing by DOJ
   to the ADA Officer and DOJ shall provide WHC with a reasonable time
   period, not to exceed 30 days, in which to respond to such requests.

   2. Final Barrier Removal Report. Within 30 days of the last date on which
   barrier removal is required to be completed in accordance with the Barrier
   Removal Plan, WHC shall deliver to DOJ a Final Barrier Removal Report
   in which it shall certify to DOJ, in writing, that it has fulfilled all of its
   obligations under the Barrier Removal Plan (the "Final Report"). The
   Final Report shall set forth each of the barriers required to be removed
   pursuant to the Barrier Removal Plan and shall describe the steps WHC
   has taken to remove each barrier. The Final Report shall include “as built”
   drawings depicting the architectural changes required by the Barrier
   Removal Plan, to the extent they exist or are required for the particlar
   modification contemplated. The drawings shall be certified by WHC’s
   architect as true, complete, and correct. Upon its receipt of the certified
     Final Report, DOJ may request a site visit to verify that the required
     modifications have been made, as agreed. If the parties have agreed upon
     certain readily achievable alternatives to barrier removal, the Final Report
     shall include copies of all written policies and procedures setting forth
     such alternatives to barrier removal, which shall be certified as true,
     complete, and correct by WHC.


IV. ACCESSIBLE MEDICAL EQUIPMENT
  A. Definitions.
     1. Accessible Equipment. For purposes of this Agreement, accessible
     equipment means equipment that is accessible to and usable by persons
     with disabilities.

     2. Accessible Equipment Requiring Transfer. For purposes of this
     Agreement, in order to be deemed accessible, any piece of medical
     equipment to which patients must transfer for examination or treatment
     purposes, including, but not limited to, examination tables and chairs,
     tables used for radiologic exams, and gurneys, shall lower to a point no
     greater than 17 - 19 inches from the floor, shall be capable of being locked
     or otherwise fixed into position so as to permit a safe transfer from a
     wheelchair or other mobility device without slipping, and shall have a
     protective padded surface (unless such a surface is inconsistent with the
     table’s intended use). Tables and gurneys that can be lowered closest to
     the floor (i.e., to 17 inches) are preferred because they will provide better
     access for more individuals with disabilities, and WHC is encouraged to
     select such tables. Accessible patient beds are separately addressed in
     Paragraph IV.B.3. below.
  B. Purchase and Distribution of Accessible Examination Tables, Chairs, and
  Patient Beds.
     1. Initial Purchase of Examination Tables and Chairs.
         (a) Initial Purchase of Accessible Examination Tables/Chairs.
         WHC hereby agrees to purchase and place one accessible
         examination table or examination chair, as defined in Paragraph
         IV.A. above, as appropriate to the Department, in each Department
         that utilizes examination tables or chairs and which does not
         already have such an examination table or chair. Each table and/or
         chair purchased pursuant to this purchase obligation shall be
         equipped with all necessary ancillary equipment, as described in
         Paragraph IV.B.1.(e) below. This initial obligation does not apply
         to Departments where the examination tables are physically
         integrated with medical technologies (e.g., radiology or other
         imaging equipment); the need for such tables shall be evaluated
         during the equipment survey, to be conducted pursuant to
         Paragraph IV.C. below.
(b) Department and Clinic List. In order to assist the parties in
understanding the location of existing accessible medical
equipment and the possibility and feasibility of sharing equipment,
within 60 days of the Effective Date of this Agreement, WHC will
provide to DOJ a list of: (i) all WHC departments and clinics
where patients (whether inpatients or outpatients) are examined,
treated, or otherwise receive services; and (ii) the subset of those
departments and clinics that treat or examine patients on an
examination table or chair to which a patient must transfer. This
list shall be certified by the ADA Officer as true, complete, and
correct. Hereinafter, all WHC’s departments, clinics, and similar
specialized treatment areas shall be referred to as “Departments.”

(c) Examination Equipment List. The ADA Officer, with the
assistance of the Equipment Expert, will determine which make
and model of accessible examination table and/or chair, including
ancillary equipment, is appropriate for each Department. Within
105 days of the Effective Date of this Agreement, WHC shall
submit a list of this equipment, with the make and model specified,
to DOJ for its review. This list shall identify all equipment to be
included in WHC’s initial purchase order. DOJ shall approve or
make recommendations for revisions within 15 days of receiving
the equipment list and proposed purchase order. If DOJ
recommends any revisions, WHC shall consider the proposed
revisions and make appropriate changes in good faith. If the parties
cannot agree on the equipment to be purchased, they shall follow
the procedure set out in Paragraph VIII.D. below. Tables and
gurneys that can be lowered closest to the floor (i.e., to 17 inches)
are preferred because they will provide better access for more
individuals with disabilities, and WHC is encouraged to select such
tables.

(d) Examination Table and Chair Purchase Schedule. Within 30
days of WHC's receipt of approval from DOJ pursuant to
Paragraph IV.B.1(c) above, WHC shall place the initial purchase
order for accessible tables and/or examination chairs, as approved
by DOJ. When such equipment is received by WHC, it shall
immediately be placed in the appropriate Department.

(e) Ancillary Equipment. All ancillary equipment used with the
examination table or chair shall be adapted or adjustable for use by
individuals with disabilities. Ancillary equipment includes items
such as leg supports for gynecological examinations, protective
padding, positioning straps, and additional supports or rails needed
to ensure the safety and comfort of patients with disabilities.
   (f) Limited Exception. While the parties anticipate that every
   Department will receive an accessible exam table or chair, if WHC
   believes that an accessible examination table or chair is not needed
   in a particular Department, then, within 60 days of the Effective
   Date of this Agreement, WHC shall provide documentation of such
   to DOJ and ERC and shall propose a process by which patient
   needs for an accessible examination table/chair in that location can
   be met. For any procedure routinely performed on an examination
   table/chair, WHC may not justify failing to provide an accessible
   examination table/chair on the grounds that the procedure can be
   performed in a patient’s wheelchair or personal mobility device.
   Further, any proposed process must ensure that the facilities,
   equipment, and services provided to patients with disabilities are
   the equivalent of, and are not inferior to, those provided to patients
   without disabilities. Within 30 days of receiving the
   documentation, DOJ and ERC will determine whether an
   accessible table/chair is needed in a given location and/or whether
   patient needs can be met by the process proposed by WHC. If
   DOJ, ERC and WHC cannot agree on the need for a table/chair,
   they will utilize the procedure set forth in Paragraph VIII.D. or
   VIII.E. below. Any alternative process for providing access to
   examination tables/chairs shall be included in the written policies
   and procedures required to be developed pursuant to Section V.
   This paragraph is intended to apply only in limited, unique
   circumstances (e.g., where two departments already share
   examination table equipment).

   (g) Radiology Department and Clinic. Within 120 days of the
   Effective Date of this Agreement, the Radiology Department in the
   hospital building and the outpatient Radiology Clinic in the POB
   shall each have an accessible gurney and a lifting device (e.g.,
   Hoyer lift) to assist patients in transferring to radiologic exam
   surfaces that are not accessible.

   (h) Breast Health Center. Within 120 days of the Effective Date of
   this Agreement, the Breast Health Center in the POB shall have an
   accessible gurney or other appropriate lifting device (e.g., Hoyer
   lift) to assist patients in transferring to exam surfaces that are not
   accessible.

   (i) Continence Center. Within 120 days of the Effective Date of
   this Agreement, the Continence Center in the POB shall have an
   accessible urological exam chair.
2. Subsequent Height-Adjustable Equipment Purchases. All height-
adjustable equipment that patients must transfer to for examination or
treatment purposes (excluding operating tables and hospital beds) that
WHC purchases after the Effective Date of this Agreement shall be
accessible, as defined in Paragraph IV.A.2. above, to individuals with
disabilities. If equipment fully meeting the height requirements set forth in
Paragraph IV.A.2 is not readily commercially available, WHC shall
purchase equipment that comes closest to meeting the height requirements.
If WHC determines, in its judgment, that an accessible model of a
particular piece of equipment is available, but that the overall functionality
of the accessible model is substantially less, or its cost substantially
greater, than non-accessible alternatives, WHC may present its
justification to DOJ and request approval to purchase the non-accessible
alternative. DOJ shall respond within 30 days, or 3 business days for
emergency situations as designated by WHC, and shall not unreasonably
withhold approval.

If ancillary equipment is associated with the use of height-adjustable
equipment (e.g., leg supports for gynecological exam tables), WHC will
ensure that a reasonable percentage of accessible equipment (at least 25%
and no less than 1) it purchases for each Department has ancillary
equipment that is adapted or adjustable for use by individuals with
disabilities. This paragraph does not apply to equipment identified in
Paragraph IV.B.1 above.

3. Accessible Beds. Upon execution of this Agreement, WHC shall
acquire a minimum of three height-adjustable, medical-surgical patient
beds (“med-surg beds”) that lower to a point no greater than 17 - 19 inches
from the floor (“Accessible Beds”). Until such time as WHC is able to
develop and implement a barcode tracking system for tracking the location
of its Accessible Beds electronically, WHC shall develop a procedure for
holding a reserve supply of no fewer than three Accessible Beds to be
available to meet requests from patients who use wheelchairs or similar
mobility devices and who need an Accessible Bed to facilitate transfers
between the patient’s wheelchair and hospital bed.

Within six months of the Effective Date of this Agreement, WHC agrees
to purchase a sufficient number of Accessible Beds to ensure that all
Accessible Patient Rooms existing as of that date are equipped with an
Accessible Bed or Beds. This purchase shall include no fewer than ten
Accessible Beds. Within the subsequent 18-month period thereafter, WHC
agrees to purchase a sufficient number of additional Accessible Beds to
ensure that all Group 1 Accessible Patient Rooms, as defined above in
Paragraph III.B.1 above, contain an Accessible Bed or Beds. Thereafter,
during the remaining term of this Agreement, whenever WHC places an
order to purchase med-surg beds, it shall order a sufficient number of
Accessible Beds to ensure that all Accessible Patient Rooms required or
planned to be in service as of the date that the order of med-surg beds is
   reasonably anticipated to be delivered, contain an Accessible Bed or Beds.

   WHC further agrees that, by the conclusion of the initial five-year term of
   this Agreement, all Accessible Patient Rooms planned to be in service as
   of that date, including all Accessible Patient Rooms required to be
   completed hereunder, shall be equipped with an Accessible Bed or Beds.
   If WHC receives final approval to construct the Tower described in
   Paragraph III.B.4. above, WHC will purchase, at the time WHC purchases
   the patient beds needed to equip the Tower, sufficient Accessible Beds
   such that every Accessible Patient Room contains an Accessible Bed or
   Beds.
C. Survey of Existing Equipment and Acquisition of Additional Equipment
   1. Equipment Survey Tool. Within 60 days of the appointment and DOJ
   approval of the ADA Equipment Expert as set forth in Paragraph II.D.
   above, the Equipment Expert shall develop a survey tool on which to
   capture the information of a survey of existing equipment (as defined in
   Paragraph IV.C.2. below), and a list of equipment to be surveyed. WHC
   shall submit the survey tool and list of equipment to DOJ for approval,
   which approval shall not be unreasonably withheld. DOJ shall approve or
   make recommendations for revisions within 30 days of receiving the
   survey tool. If DOJ recommends any revisions, WHC shall consider the
   proposed revisions and make appropriate changes in good faith. If the
   parties cannot agree on the survey tool, they shall follow the procedure set
   out in Paragraph VIII.D. below.

   2. Completion of Equipment Survey. Within 90 days of receiving DOJ’s
   approval of the survey tool, as set forth in Paragraph IV.C.1. above, the
   ADA Equipment Expert, with the assistance of the ADA Officer, shall
   complete a survey, in WHC and those areas of the POB that are under
   WHC’s control as a lessee, of equipment that is utilized in the care of
   patients and that can be potentially modified, supplemented or replaced to
   improve equal access to care for patients with disabilities in a meaningful
   way, including all equipment to which a patient is required to transfer
   (e.g., examination tables and ophthalmology equipment); operating tables
   and medical-surgical patient beds are excluded. The Equipment Expert,
   jointly with the ADA Officer, shall determine: (a) what, if any, additional
   equipment (e.g., examination tables and chairs, lifts, radiologic equipment,
   wheelchair scales, positioning equipment, specialized air mattresses, or
   other adaptive technology for patients with disabilities, such as an
   accessible call buttons and accessible water sources) should be purchased
   or modified to ensure that individuals with disabilities receive equal access
   to medical services; or (b) if no new equipment or modifications to
   existing equipment would overcome a barrier posed by the existing
   equipment, what alternatives should be utilized to ensure that individuals
   with disabilities receive equal access to medical services. The survey shall
   result in a definitive inventory of equipment. For the survey, the
     Equipment Expert, with the assistance of the ADA Officer, shall review
     and be familiar with the nature of the services provided in each
     Department; identify barriers to providing such services to individuals
     with disabilities of all kinds including, but not limited to, mobility
     impairments, visual impairments, hearing impairments, and cognitive and
     intellectual impairments; and identify the equipment or other methods
     needed to overcome barriers to providing service. The Equipment Expert
     shall interact with health care providers to gain an understanding of the
     services provided and the nature of the patient population served in each
     Department.

     3. Equipment Survey Report. Within 120 days of receiving DOJ’s
     approval of the survey tool, WHC shall submit a report that describes the
     results of the survey to DOJ and ERC. The report shall include, for each
     Department, the nature of the services provided, the current equipment
     used in that Department, barriers to providing equal access to medical
     services, including, but not limited to, barriers posed by the equipment,
     recommendations for the purchase of additional equipment, the
     modification of existing equipment, and other methods to eliminate
     barriers, and a schedule for the recommended purchase and modification
     of the equipment and the implementation of other barrier removal. Within
     45 days of receiving WHC’s report, DOJ and ERC shall either approve
     WHC’s recommendations or propose revisions. WHC shall consider any
     proposed revisions and make appropriate changes in good faith. If the
     parties cannot agree on the recommendations, they shall follow the
     procedure set out in Paragraph VIII.D. and/or VIII.E. below. Upon
     agreement, WHC shall immediately begin purchasing equipment in
     accordance with the schedule.


V. DEVELOPMENT OF DISABILITY-RELATED POLICIES AND
PROCEDURES
  A. Review and Submission of Policies and Procedures. Within 120 days of the
  Effective Date of this Agreement, the ADA Officer, with the assistance of the
  ADA Consultant, shall: (1) review all existing policies and procedures relating to
  the services, treatment and care provided to individuals with disabilities
  (including, but not limited to, patients, their guests, and other visitors) for
  consistency with the ADA and this Agreement; (2) determine whether any
  additional policies or procedures, or changes to existing policies and procedures,
  are necessary to comply with the ADA or to effectuate the purposes of this
  Agreement and, if so, shall develop such policies and/or procedures; and (3)
  submit all of such policies and procedures, including revised policies and new
  policies, to DOJ and ERC.

  B. Implementation of Policies and Procedures. Within 45 days of receiving
  WHC’s revised or proposed policies, DOJ and ERC will either approve WHC’s
policies or propose revisions. WHC shall consider any proposed revisions and
make appropriate changes in good faith. If the parties cannot agree on the
policies, they shall follow the procedure set out in Paragraph VIII.D. or VIII.E.
below. Within 45 days of reaching agreement with DOJ and ERC on the policies,
WHC shall finalize its policies and procedures, disseminate them to the
appropriate personnel, implement them, and provide copies of each to DOJ and
ERC.

C. Advisory Resource Group and EOCC Review. The ADA Officer and ADA
Consultant shall consult with the Advisory Resource Group and EOCC and solicit
their comments on revised and newly created policies before the policies are
submitted to DOJ and ERC, and at other points in the policy review process, as
needed.

D. Content of Policies and Procedures. The policies and procedures to be
reviewed, revised, and/or developed by the ADA Consultant and the ADA Officer
shall include, but not be limited to, policies and procedures for:
   1. A statement of compliance with Title III of the ADA and Section 504
   generally;

   2. The acquisition, provision, and use of all equipment with regard to
   accessibility (including location, maintenance and updating of equipment,
   sharing among Departments, and dissemination of information regarding
   accessible equipment);

   3. The use of appropriate techniques for safely transferring and positioning
   patients with disabilities (especially for gynecological and radiological
   exams) including, if practicable within the organizational structure of
   WHC, the establishment and maintenance of a lift team of individuals with
   advanced training in lifting, whose responsibility will be to transfer
   patients throughout the hospital;

   4. The maintenance of accessible features and accessibility within WHC,
   including, but not limited to, ensuring that accessible restrooms, patient
   rooms, hallways, elevator buttons, etc., are kept free from all obstacles,
   such as boxes, medical supplies, furniture, trash receptacles, and
   newspaper racks;

   5. The provision of auxiliary aids and services for individuals who are
   deaf or hard of hearing, including, but not limited to, the provision of
   communication-related equipment and sign language interpreters, and
   closed caption televisions in waiting areas and patient bedrooms;

   6. The use of service animals;

   7. The effective communication of written materials to individuals with
visual impairments;

8. Planning for inpatient hospital care, including, but not limited to:
   (a) A policy to include an individualized assessment for every
   patient with a disability to determine any specialized needs,
   including, but not limited to, diet, bowel program, communication,
   and mobility-related needs, and a program to implement the
   services identified as needed in the assessment;

   (b) Procedures for determining the inpatient placement of a patient
   who needs an accessible room, since accessible rooms are not
   available in every Nursing Unit. When the hospital is not operating
   at full inpatient capacity, WHC shall use its best efforts to reserve
   Accessible Patient Rooms for persons with disabilities and hold
   them open until all other rooms in the Nursing Unit are filled.
   When a patient with a disability who needs an accessible room is
   admitted, WHC shall use its best efforts to arrange for an
   accessible room for that patient, consistent with medical standards
   of care. If there is an accessible room in the Nursing Unit to which
   the patient would ordinarily be assigned, but it is occupied by a
   non-disabled patient, WHC shall use its best efforts, consistent
   with medical standards of care, to reassign patient rooms so that
   the accessible room can be utilized by the patient with the
   disability. If no Accessible Patient Room consistent with the
   patient’s medical needs is available when a patient with a disability
   who needs an accessible room is admitted, WHC shall continue to
   use its best efforts, for the duration of the patient’s stay, to arrange
   for an Accessible Patient Room for the patient as soon as possible,
   if so desired by the patient. Staff from the Admissions Department
   shall be responsible for seeking an accessible room for the patient,
   and shall do so at least once in every 24 hour period after the
   patient’s admission;

   (c) Procedures for ensuring that an Accessible Bed is made
   available to individuals with mobility impairments who use
   wheelchairs or similar mobility devices and who need an
   Accessible Bed to facilitate transfer.
9. Planning for outpatient care. The policy will include a provision that the
individual responsible for scheduling outpatient appointments in each of
WHC's outpatient areas will exercise his or her best efforts to inquire,
while scheduling the appointment, whether the patient will need a
modification of policies or procedures or auxiliary aids and services in
order to receive equal medical services. These modifications or auxiliary
aids and services may include an adjustable exam table, Hoyer lift, sign
language interpreter or other assistance. WHC will ensure that such
assistance is provided to the patient at the time of the appointment. The
   patient Sign-In Sheet for each outpatient clinic will include a statement,
   along with the international symbol of accessibility, directing patients to
   inform the staff if they will need assistance at the exam due to a disability;

   10. Assisting patients in resolving disability-based difficulties encountered
   during the course of their care. The policy should set out a process for
   registering complaints and identify the ADA Officer who is ultimately
   responsible for resolving complaints, and shall be consistent with Exhibit
   A hereto;

   11. Methods and materials for communicating with individuals who have
   cognitive and/or intellectual impairments, including methods for
   communicating information concerning both medical procedures and post-
   procedure patient care information;

   12. Readily achievable alternatives to barrier removal, if any;

   13. Review of policies to ensure that existing policies are not inconsistent
   with federal disability law, including the ADA and Section 504;

   14. Ensuring that WHC does not charge a patient with a disability who is
   in need of an Accessible Patient Room more for the accessible patient
   room than it would charge for a non-accessible patient room in which the
   patient would otherwise have been placed; and

   15. Ensuring that WHC, in providing shuttle bus service between WHC
   and other locations, such as the Metro (either directly or through
   agreement with third parties), shall: use only wheelchair accessible shuttle
   buses, maintain the lifts and other accessibility features of such vehicles so
   they are usable by individuals who use wheelchairs; train shuttle drivers
   and maintenance personnel in the maintenance and safe operation of the
   lifts, restraints, and other accessibility features; and provide a phone
   number for riders to confirm that all accessible vehicles are in service.
E. Procedure for admitting inpatients with spinal cord injuries and similar
conditions. When an individual who has an existing spinal cord injury or similar
condition is admitted as an inpatient, WHC shall, in the initial nursing intake
process, discuss particular concerns relating to that individual’s spinal cord injury
or similar condition with the patient, including, but not limited to, concerns
regarding bowel or bladder program, diet, eating/drinking assistance, turning, and
communication needs (e.g., call buttons, telephones). This discussion shall be
documented on the initial intake form, Interdisciplinary Patient Data Base Form
1236 (“Form 1236"), which shall be revised within 60 days of the Effective date
of this Agreement to prompt the nurse to discuss these specific matters with the
patient.

Within 60 days of the Effective Date of this Agreement, the rehabilitation risk
screening portion of Form 1236 will be expanded to ask whether the patient has a
spinal cord injury or other long-term condition that results in paraplegia,
quadriplegia, or otherwise substantially limits the use of one’s limbs. A positive
answer will trigger a Physical Therapy/Occupational Therapy (“PT/OT”)
screening assessment by a team member from the Rehabilitation Department
(e.g., a physical therapist), which will occur as soon as possible based on
prioritization of needs by the rehabilitation department, but no later than 48 hours
after the patient’s admission to the nursing unit. The assessment shall involve a
more detailed discussion with the patient of particular needs, such as pressure
sores, bowel programs, and autonomic dysreflexia, and will evaluate whether the
patient needs an additional physiatry consultation. The PT/OT consultant shall be
available to consult with the patient throughout his or her hospital stay, if
necessary, and shall leave his or her telephone number with the patient. In
addition, the PT/OT consultant shall discuss with the patient’s medical and
nursing staff any additional needs of the patient relating to his or her disability,
including, but not limited to, reviewing the patient’s bowel program, required
frequency of turning, modifications to communication equipment, and assistance
with eating and drinking, if necessary.

F. ADA Poster. A poster outlining patients’ rights and remedies under the ADA
and Section 504 in a hospital setting, along with the ADA Disability Assistance
Number, shall be posted and maintained in each outpatient reception area and in
the common area associated with each inpatient unit. The poster shall include the
ADA Disability Assistance telephone number. DOJ shall create the ADA Poster,
with input from the ADA Officer, within 60 days of the Effective Date of this
Agreement, and it shall be reproduced and posted by WHC within 90 days of its
receipt of the text of the final poster.

G. ADA Brochure. Within 30 days of the Effective Date of this Agreement,
WHC, with input from DOJ, shall submit a draft ADA brochure to DOJ. The draft
brochure shall depict the international symbol of accessibility on its front cover
and shall contain (i) a description of the equipment and services available to
WHC’s patients with disabilities and an explanation the process for obtaining
them; (ii) WHC’s ADA Disability Assistance Number; and (iii) an explanation of
WHC’s ADA Disability Assistance Process. The ADA Brochure will also include
an explanation of patients’ rights and remedies under the ADA and Section 504 in
a hospital setting, to be provided by DOJ within 15 days of the Effective Date of
this Agreement. DOJ shall approve or suggest revisions to the language within 10
days of its receipt of the draft brochure. WHC shall consider any proposed
revisions and make appropriate changes in good faith. If the parties cannot agree
on the recommendations, they shall follow the procedure set out in Paragraph
VIII.D. below.

WHC shall make the ADA Brochure available for distribution within 30 days of
its receipt of final approval from DOJ. The ADA Brochure shall be distributed to
each inpatient upon admission and to each outpatient upon his or her initial
   registration at an outpatient clinic. The ADA Brochure shall also be available in
   places throughout the hospital where other patient education materials are located.
   The information and language developed for the ADA Brochure will be
   incorporated within the Patient Information Guide, as set forth Paragraph II.B.3.
   above.


VI. TRAINING
   A. Training Participants. The ADA Consultant, in consultation with the ADA
   Officer, shall establish a training program for all employees involved in direct
   patient assistance on the policies identified in Section V above, on disability
   awareness, and on providing equal access to medical services for patients with
   disabilities, including, among other things, the particular needs and concerns of
   patients with mobility impairments (“disability training”). Employees involved in
   direct patient assistance include, but are not limited to: doctors, nurses, nurses
   aides, admissions staff, receptionists in outpatient facilities, and patient services
   assistants (orderlies). Doctors and nurse practitioners who practice at WHC but
   who are not employees of WHC shall also receive training in accordance with this
   paragraph. It is anticipated that the training program may vary for different
   categories of employees.

   B. Training Schedule. Disability training shall occur as soon as practicable, but no
   later than one year after the date the policies are approved pursuant to Paragraph
   V.B. above. Disability training may be offered in conjunction with other training
   provided by WHC. Thereafter, training for newly-hired employees involved in
   direct patient assistance shall occur within 3 months of hire. Disability training
   shall be repeated for existing employees periodically, as appropriate.

   C. Selection of Trainer and Curriculum. The ADA Consultant shall, in
   consultation with the Advisory Resource Group, select the trainer(s) (if used) and
   develop the training curriculum. Within 60 days after the policies identified in
   Section V above are approved, WHC shall develop and submit the training
   curriculum to DOJ for approval, which approval shall not be unreasonably
   withheld. Within 30 days of receiving the training curriculum, DOJ shall approve
   it or recommend revisions. If the parties cannot agree on the curriculum, they
   shall follow the procedure set out in Paragraph VIII.D. below.


VII. PAYMENTS TO THE PLAINTIFFS IN THE DRC/ERC LITIGATION
Pursuant to the terms of a Supplemental Settlement Agreement between the Plaintiffs and
WHC, WHC shall pay damages to the Plaintiffs in an amount specified therein (the
“Settlement Payment”).
VIII. IMPLEMENTATION AND ENFORCEMENT
  A. ERC Release. As a condition of WHC’s willingness to enter into this
  Agreement, and in consideration for the agreements of the parties contained in
  this Agreement, including the Settlement Payment, the Plaintiffs, with the
  intention of binding themselves, their respective heirs, beneficiaries, trustees,
  administrators, executors, assigns and legal representatives (collectively, the
  “Plaintiff Releasors”), hereby release, waive and forever discharge and hereby
  acknowledge full accord and satisfaction of, any and all claims, demands, causes
  of action, and liabilities of any kind whatsoever (upon any legal or equitable
  theory, whether contractual, common law or statutory, under federal, state or local
  law or otherwise), arising from facts or events that have taken place prior to or on
  the date of full and complete execution of this Agreement, whether known or
  unknown (with the exception of currently unknown claims unrelated to claims of
  disability discrimination), asserted or unasserted, by reason of any act, omission,
  transaction, agreement or occurrence that the Plaintiff Releasors ever had or now
  have against WHC or its successors, assigns, parents, subsidiaries, directors,
  officers, employees, or agents up to and including the date of the execution of this
  Agreement. Subject to and without limiting the generality of the foregoing, the
  Plaintiff Releasors hereby release and forever discharge WHC from:
     1. Any and all claims relating to or arising from the Individual Plaintiffs’
     treatment or any acts or omissions in connection herewith by WHC which
     form the subject of the Complaint filed by the Plaintiffs in the DRC/ERC
     Litigation, or which treatment, acts or omission could have been raised in
     the DRC/ERC Litigation;

     2. Violation of rights on the basis of disability under any federal, state or
     local statute or ordinance, public policy or the common law, including,
     without limitation, any and all claims under Title III of the Americans
     with Disabilities Act, 42 U.S.C. §§12181, et seq.; Section 504 of the
     Rehabilitation Act of 1973, 29 U.S.C. §794, and the District of Columbia
     Human Rights Act, D.C. Code §§1-2501 et seq., and as such laws have
     been or may be amended, which claims could have been raised in the
     DRC/ERC Litigation; and

     3. Any and all claims for monetary recovery for disability discrimination,
     as described in Paragraph VIII.A.2. above, including, without limitation,
     attorneys’ fees, experts’ fees, medical fees or expenses, costs and
     disbursements and the like, which could have been raised in the DRC/ERC
     Litigation.
  B. ERC and Future Actions. The Plaintiffs represent that they have not
  commenced or caused to be commenced, or participated, aided or cooperated in,
  any action, charge, complaint or proceeding of any kind (on their respective
  behalf and/or on behalf of any other person and/or on behalf of or as a member of
  any alleged class of persons) that is presently pending in any court or before any
administrative, regulatory or investigative body or agency (whether public, quasi-
public or private), against or involving WHC, other than this litigation and the
related DOJ investigation. The Plaintiffs further represent that they will not
participate, aid or cooperate in any such pending or future action, charge,
complaint or proceeding relating to the facts which form the subject of this
litigation, except pursuant to compulsory legal process or a court order, or except
as necessary to enforce this Agreement. The Plaintiffs further agree that during
the Term of DOJ’s Settlement Agreement, they will not commence, cause to be
commenced, or participate in any action, charge, complaint or proceeding (on
their respective behalf and/or on behalf of any other person and/or on behalf of or
as a member of any alleged class of persons) alleging violations of Title III of the
ADA by WHC, its parent, or any of its affiliates, subsidiaries or other related
MedStar Health entities (listed on Exhibit B, which is attached hereto and hereby
made a part of this Agreement) without first notifying such company, affiliate,
subsidiary or entity of such allegations and providing it with no less than 90 days
in which to respond to such notification. Additionally, Plaintiff ERC agrees that it
will use its best efforts to encourage members who approach it for counseling
and/or referral to legal counsel regarding any disability-related problems,
concerns or complaints with WHC or any of its affiliates, subsidiaries, or other
related MedStar Health entity, to provide no less than 90 days notice, as described
above.

C. Closing of DOJ Investigation. In consideration of, and consistent with, all the
terms of this Agreement, the Attorney General agrees to refrain from filing a civil
suit in this matter regarding all matters contained within this Agreement, except
as provided in Paragraph VIII.G. and closes Complaint #202-16-120.

D. Dispute Resolution Process with DOJ. If DOJ and WHC disagree about
specific modifications to be made to facilities, barrier removal, equipment
purchases, policies, or concerning any other topic about which the parties are
required to come to an agreement, after following the procedures set out in
Sections III, IV, V, and VI of this Agreement, as applicable, the parties shall meet
and confer in a good-faith effort to resolve the disagreement. If the parties are
unable to reach agreement after 90 days of good-faith negotiations they may,
upon mutual agreement, utilize mediation. In conjunction with such mediation,
only the provisions of this Agreement shall apply. If such negotiation and
mediation fail to produce a timely resolution of the matter, then DOJ may use the
procedure set out in Paragraph VIII.G. below.

E. Dispute Resolution Process with ERC. If ERC and WHC disagree about
specific modifications to be made to its facilities, policies, or any other topic
about which the parties are required to come to an agreement, after following the
procedures set out in Sections III, IV, and V of this Agreement, the parties shall
meet and confer in a good-faith effort to resolve the disagreement. If the parties
are unable to reach agreement after 60 days of good-faith negotiations they may
utilize mediation. If such negotiation and mediation fail to produce a timely
resolution of the matter, then ERC may use the procedure set out in Paragraph
VIII.H. below.

F. Time Extensions. With regard to any of the deadlines specified in this
Agreement, any party, if it cannot meet the deadline specified, shall notify all
other parties, at least 10 business days before the deadline, of the party’s inability
to meet the deadline and the reason(s) why, and shall request an extension of time
to a specific date. The other parties shall be reasonable in agreeing to extend
deadlines and agree to a reasonable amount of time for the extension. If any
deadline established by this Agreement falls on a weekend or a holiday, the
deadline shall be extended to the next business day.

G. DOJ Compliance Review and Enforcement Procedure. DOJ may review
compliance with this Agreement at any time. If DOJ believes that this Agreement
or any portion of it has been violated, it will so notify WHC in writing and it will
attempt to resolve the issue or issues raised in good faith. If DOJ is unable to
reach a satisfactory resolution of the issue or issues raised within 30 days of the
date it provides notice to WHC, except with respect to matters previously
negotiated and/or mediated pursuant to Paragraph VIII.D. above, for which no
additional negotiation period is required, it may institute a civil action in federal
district court to enforce the terms of this Agreement, or it may initiate appropriate
steps to enforce Title III and Section 504 of the Rehabilitation Act.

H. ERC Enforcement Procedure. If ERC believes that this Agreement or any
portion of it has been violated, it will so notify WHC in writing and it will attempt
to resolve the issue or issues raised in good faith. If ERC is unable to reach a
satisfactory resolution of the issue or issues raised within 30 days of the date it
provides notice to WHC, it may institute a civil action in federal district court
seeking to enforce the terms of this Settlement Agreement.

I. DOJ Notice to WHC of Possible Violation. If, during the Term of this
Agreement, DOJ becomes aware of an alleged violation of Title III or Section 504
of the Rehabilitation Act by WHC with respect to matters not specifically covered
by this Agreement, DOJ agrees to notify WHC of the alleged violation and permit
WHC 60 days to resolve the matter through its internal processes or to provide an
explanation as to why it believes the allegation is untrue. If WHC resolves the
matter to the satisfaction of DOJ, DOJ agrees to refrain from undertaking further
investigation against WHC on that matter.

J. Attorney Fees and Costs in Future Disputes between WHC and the ERC. In
disputes involving WHC and the ERC that are in the nature of an action that ERC
could otherwise have brought as a claim under Title III of the ADA, e.g., for
violation of new construction or alterations provisions or the failure to remove
barriers, then notwithstanding which party brings the action, attorneys’ fees and
costs will be awarded to the prevailing party in any such action as if 42 U.S.C. §
12205 applied and as if ERC were the plaintiff and WHC were the defendant. In
any other action to enforce contractual commitments involving WHC, such as
those involving reporting and record keeping, each side shall bear its own
attorneys’ fees.

K. WHC Annual Reporting Requirements. Twelve months after the Effective
Date of this Agreement, and every year on the anniversary of the Effective Date
thereafter until the expiration of this Agreement, WHC shall file a Compliance
Report with DOJ and ERC, reporting on its compliance with the actions described
in Sections II.B, III, IV, V, and VI above. The Compliance Report shall include: a
listing of the types of additional equipment purchased and their locations; copies
of new and revised policies; an outline of and the dates of the training provided
pursuant to Section VI above; a description of the barrier removal completed; a
current listing of Accessible Patient Rooms (including the medical specialty or
specialties associated with each room and the number of Accessible Beds in each
room); and copies of the PGSD Occurrence Reports, as described in Paragraph
II.B above (to be included in the DOJ version only). WHC need not resubmit
documents or reports previously provided to the parties. The Report shall be sent
by overnight mail to DOJ and to ERC, as set forth in Paragraph VIII.T. below.
The Compliance Report is in addition to specific reports required in other
Sections of this Agreement, such as the architectural survey report, the equipment
survey report, the certification concerning the completion of the Tower, and the
final barrier removal report. All reports submitted pursuant to this Agreement
must by certified by the ADA Officer as true, complete, and correct. The parties
expressly agree that providing these reports and certifications is essential to the
enforcement of this Agreement, and that a failure to provide the reports and
certifications required by this Agreement constitutes a breach of this Agreement.

L. Enforcement in Part. Failure by DOJ or ERC to enforce this entire Agreement
or any of its provisions or deadlines shall not be construed as a waiver of DOJ’s
or ERC’s right to enforce other deadlines and provisions of this Agreement.

M. Agreement Binding on WHC Successor. This Agreement shall be binding on
WHC, its agents, employees, transfers, and assigns. In the event WHC seeks to
sell, transfer, or assign all or part of its interest in any facility covered by this
Agreement, and the successor or assign intends on carrying on the same or similar
use of the facility, as a condition of sale WHC shall obtain the written accession
of the successor or assign to any obligations remaining under this Agreement for
the remaining Term of this Agreement.

N. Effective Date. The Effective Date of this Agreement is the date of the last
signature below.

O. Entire Agreement. This Agreement constitutes the entire agreement between
DOJ and WHC 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 as between
DOJ and WHC. This Agreement and the Supplemental Settlement Agreement
constitute the entire agreement between ERC and WHC 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 these written
Agreements, shall be enforceable as between ERC and WHC. A default under the
Supplemental Settlement Agreement shall not constitute a default under this
Agreement. This Agreement does not purport to remedy any other potential
violations of the ADA or any other federal law. This Agreement does not affect
WHC’s continuing responsibility to comply with all aspects of the ADA.

P. Confidentiality of WHC Information. The parties acknowledge and agree that
certain documents and information provided by WHC to the parties prior to the
execution of this Agreement may contain confidential business information of
WHC and that such documents and information, in whatever form, shall be
maintained as confidential and used solely for purposes of administering and
enforcing the provisions of this Agreement, with the exception that, with respect
to documents provided to parties that comprise Individual Plaintiffs’ records of
their treatment at WHC (“WHC Medical Records”), each Individual Plaintiff
reserves the right to disclose his or her WHC Medical Records to third parties as
he or she sees fit. WHC, however, agrees to maintain such WHC Medical Records
as confidential. The parties further acknowledge that WHC, its agents, or its
consultants shall provide documents and information subsequent to the execution
of this Agreement that may contain confidential business information of WHC
and that WHC shall endeavor to mark such documents as confidential or
otherwise indicate to the parties receiving such information that the information is
confidential. Neither DOJ nor ERC shall disclose such information (including that
provided before the execution of this Agreement and after the execution of this
Agreement, whether or not marked confidential) to any third party except as is
reasonably necessary to administer or enforce the provisions of this Agreement or
with the express consent of WHC. The parties acknowledge that among other
things, “reasonably necessary,” as provided above, does not include disclosures of
WHC information to the press or to the general public in the form or a press
release. In the event DOJ or ERC receives a court-issued subpoena seeking the
production of any documents or information deemed confidential under this
provision, the recipient of such subpoena shall provide WHC notice and a copy of
such subpoena and shall make its best efforts to do so within 5 business days of
such receipt, and provide WHC an opportunity to protect its interests in court with
regard to such subpoena. Beginning 60 days prior to the expiration of this
Agreement, as set forth in Paragraph VIII.R.below, WHC may request that DOJ
and ERC destroy or return to WHC (at WHC’s option) all documents and
information remaining in their possession marked confidential pursuant to this
provision, and all copies of same, and DOJ and ERC shall comply.

Q. Confidentiality of Plaintiffs’ Information. The parties acknowledge and agree
that all documents and information provided by Plaintiffs to the parties prior to
the execution of this Agreement, including documents provided in discovery
during the Litigation, contain confidential business information of ERC,
confidential medical records of Individual Plaintiffs and/or other personal medical
information of Individual Plaintiffs and that such information, in whatever form,
shall be maintained as confidential. In the event WHC receives a court-issued
subpoena seeking the production of any documents or information deemed
confidential under this provision, the recipient of such subpoena shall provide
counsel for Plaintiffs notice and a copy of such subpoena within 5 business days
of such receipt, and provide Plaintiffs an opportunity to protect their interests in
court with regard to such subpoena. Within 60 days following the expiration of
this Agreement, WHC shall destroy or return to Plaintiffs (at Plaintiffs’ option) all
documents and information marked confidential pursuant to this provision, and all
copies of same, with the exception of WHC medical records for which WHC is
otherwise entitled to retain copies.

R. Term of Agreement. The Agreement shall remain in full force and effect for 5
years from the Effective Date of this Agreement; provided, however, that in the
event WHC receives the approval to construct a new Tower, as set forth in
Paragraph III.B.4 above, the Term of this Agreement shall be extended to the date
the Tower is completed and DOJ receives the documentation and certification
required by Paragraph III.B.4.(e) above (the “Completion Date”). If the Term of
this Agreement is so extended, this Settlement Agreement shall remain in full
force and effect until the Completion Date, except for the following paragraphs,
which shall terminate on the date which is 5 years from the Effective Date: II.B.,
II.C., II.D., II.E., II.F., II.G., III.B.1, III.B.2, III.C., IV.B.1., IV.C., V., VI., and
VII.

S. Section Titles and Headings. Section titles and other headings contained in this
Agreement are included only for ease of reference and shall have no substantive
effect.

T. Notices. All notices, demands, or other communications to be provided
pursuant to this Agreement shall be in writing and delivered by fax or overnight
mail to the following persons and addresses (or such other persons and addresses
as any party may designate in writing from time to time):
    1. For the Private Plaintiffs and ERC:
        Jennifer R. Bagosy
        Robert H. Cox
        Howrey Simon Arnold & White
        1299 Pennsylvania Ave., N.W.
        Washington, DC 20004
        Tel: 202.383.7182
        Fax: 202.383.6610

        Elaine Gardner
        Washington Lawyers’ Committee for Civil Rights and Urban
        Affairs
              11 Dupont Circle, N.W., Suite 400
              Washington, DC, 20036
              Tel: 202.319.1000 x131
              Fax: 202.319.1010

              Bruce K. Kahn
              Executive Director
              Equal Rights Center
              11 Dupont Circle, N.W.
              Washington, D.C. 20036
              Tel: 202.234.3062
              Fax: 202.234.3016
          2. For WHC
              James F. Caldas, President
              Renee P. Landry, Vice President Support Services
              110 Irving Street, N.W.
              Washington, D.C. 20010
              Tel: 202.877.3524
              Fax: 202.877.9184
          3. For the Department of Justice
              Anne M. Pecht, Esq.
              Amanda Maisels, Esq.
              Trial Attorneys
              Disability Rights Section
              Civil Rights Division
              U.S. Department of Justice
              950 Pennsylvania Ave., N.W.
              Washington, D.C. 20530-0001
              Tel: 202.307.0663
              Fax: 202.305.9775
                                             SO AGREED:




FOR WASHINGTON HOSPITAL CENTER                         FOR THE UNITED STATES




__________________________                             Bradley L. Schlozman
James F. Caldas, President                             Acting Assistant Attorney General
Renee P. Landry, Vice President for Support Services   Civil Rights Division
110 Irving Street, N.W.                                John Wodatch, Section Chief
Washington, D.C. 20010                                 L. Irene Bowen, Deputy Section Chief
                                       __________________________
                                       Anne Marie Pecht
Date 11/1/05                           Amanda Maisels
                                       Trial Attorneys

                                       Disability Rights Section
                                       Civil Rights Division
                                       U.S. Department of Justice
                                       950 Pennsylvania Ave., N.W.
                                       Washington, DC 20530



                                       Date 11/2/05




FOR THE EQUAL RIGHTS CENTER




_____________________________
Bruce K. Kahn
Executive Director
Equal Rights Center
11 Dupont Circle, N.W.
Washington, D.C. 20036



Date 10/28/05




INDIVIDUAL PLAINTIFFS




____________________________________   Date 8/3/05
Dennis Christopher Butler
____________________________________                Date 8/2/05
Rosemary Ciotti


____________________________________                Date 8/8/05
George Aguehounde


____________________________________                Date 8/4/05
Marsha Johnson




                                        Exhibit A

       Washington hospital Center Patient ADA Disability Assistance
                                 Process



     Patient Request/Complaint to Patient and Guest Services Department (PGSD)

     PGSD provides informational notice to Clinical or Non-Clinical Specialist via
       Occurrence Reporting System (ORS)

     PGSD responds to request/complaint, working (if necessary) with WHC staff member
       identified in ADA Resource Manual
        If satisfactory response, PGSD records in ORS

        If unsatisfactory response or additional assistance needed, PGSD contacts
            Clinical or Non-Clinical Specialist to revivew
            Clinical/Non-Clinical Specialist takes steps to respond to patient
                request/complaint
If satisfactorily resolved, Specialist notifies PGSD and ADA
    Officer; PGSD records in ORS

If unable to resolve, Specialist notifies PGSD & ADA Officer
   ADA Officer reviews to determine whether alternative
     is available to address patient need and
     communicates to Specialist

   Possible follow up communication to patient via
      Specialist

   Report to Environment of Care Committee (EOCC)
      pursuant to Paragraph II.B.5 of Settlement
      Agreement; PGSD records in ORS

				
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