U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
OFFICE FOR CIVIL RIGHTS
MEE MEMORIAL HOSPITAL
Transaction Numbers: 12-143846, 13-151016 & 13-153378
TABLE OF CONTENTS
- Parties to the Agreement
- Purpose of the Agreement
- Title VI Coordinator
- Language Assistance
- Limited-English Proficient (LEP) Individual
- Primary Language
- Vital Documents
- Telephone Interpretive Service
- Video Interpretive Service
- Staff Interpreter
- Community-Based Interpreter
- Qualified Interpreter
- Facilities Covered By Agreement
- Effective Date and Duration of Agreement
- State Agency’s Continuing Obligation
- Effect on Other Compliance Matters
- Prohibition Against Retaliation and Intimidation
- OCR’s Review of MMH’s Compliance with this Agreement
- Failure to Comply with the Terms of this Agreement
- Non-Waiver Provision
- Entire Agreement
- Modification of Agreement
- Effect of MMH Program Changes
- Publication or Release of this Agreement
- Authority of Signer
- Third Party Rights
- Central Coordinating Office
- Community Advisory Board
- Use of Family and Friends as Interpreters
- Reporting Requirements to OCR
This Resolution Agreement (Agreement) is entered into by the United States Department of Health and Human Services (USDHHS), Office for Civil Rights (OCR) and Mee Memorial Hospital (MMH). This Agreement resolves OCR Transaction Numbers 12-143846, 13-1551016, and 13-153378, three complaints, which were filed with OCR on May 21, 2012, October 30, 2012, and December 3, 2012, respectively. The complaints were filed on behalf of three Mexican national origin individuals whose primary language is Triqui-Bajo. The complaints contend that MMH failed to provide the affected parties, who are limited English Proficient (LEP), with effective interpreter services and thereby discriminated against them on the basis of national origin, in violation of Title VI of the Civil Rights Act of 1964.
Upon receipt of the subject complaints, OCR initiated investigations of the same. However, prior to the consummation of OCR’s formal investigations, MMH and OCR mutually agreed to pursue an expeditious, informal resolution of these matters by entering into this voluntary resolution agreement.
A. Parties to the Agreement:
- United States Department of Health and Human Services (“HHS”), Office for Civil Rights (“OCR”);
- Mee Memorial Hospital (MMH).
MMH receives Federal financial assistance (FFA) from the USDHHS, and is subject to Title VI of the Civil Rights Act of 1964, 42 U.S.C. 2000d et. seq. (Title VI), and its implementing regulations, 45 C.F.R. Part 80. Title VI prohibits discrimination on the basis of race, color, or national origin in any program or activity receiving FFA. The implementing regulations prohibit both intentional discrimination and policies and practices that appear neutral but have a discriminatory effect. Failure of a recipient of FFA to undertake reasonable steps to ensure that program participants, including national origin minorities who are LEP, have meaningful access to available programs and services, may constitute a violation of Title VI. Communication assistance policies and procedures that are implemented in a manner that adversely impact the meaningful access by persons with LEP of a particular national origin may result in a violation of Title VI.
C. Purpose of the Agreement
- MMH agrees to the terms stipulated in this Agreement and affirms its assurance of compliance with all provisions of Title VI and its implementing regulations. The promises, obligations or other terms and conditions set forth in this Agreement constitute the exchange of valuable consideration between MMH and OCR.
- This Agreement shall not be construed as an admission or as evidence that MMH has not complied with Title VI or its implementing regulations with respect to any particular complaint or investigation.
- For purposes of this Agreement, “Title VI” shall refer only to those provisions of Title VI that address, in part, MMH’s obligations to undertake reasonable steps to ensure meaningful access to available services to all program participants, including national origin minorities who are LEP.
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For the purpose of this Agreement, the terms listed below shall have the following meaning:
- Title VI Coordinator means the MMH workforce member who, pursuant to Title VI, MMH has selected to coordinate and manage its language services program.
- Language Assistance means all oral and written language services needed to assist LEP individuals to communicate effectively with MMH staff and to provide LEP individuals with meaningful access to, and an equal opportunity to participate fully in, the services, activities, programs, or other benefits provided by MMH.
- Limited-English Proficient (LEP) Individual means an individual who does not speak English as his or her primary language and who has a limited ability to read, write, speak, or understand English in a manner that permits him or her to communicate effectively with MMH and have meaningful access to, and an equal opportunity to participate fully in, the services, activities, programs, or other benefits administered by MMH.
- Primary Language means the language that an LEP individual identifies as the language that he or she uses to communicate effectively, and is the language which the individual has indicated the individual would prefer to use to communicate with MMH.
- Vital Documents shall include, but are not limited to: applications; consent forms; complaint forms; letters or notices pertaining to eligibility for benefits; letters or notices pertaining to the reduction, denial or termination of services or benefits or that require a response from the LEP person; written tests that test competency for a particular license, job, or skill for which knowing English is not required; documents that must be provided by law; and notices regarding the availability of free language assistance services for LEP individuals.
- Telephone Interpretive Service means a telecommunication service that provides Language Assistance over a telephone.
- Video Interpretive Service means a video-telecommunication service that uses devices such as web cameras or videophones to provide Language Assistance.
- Staff Interpreter means an MMH workforce member whose job is to provide interpretation and/or translation services.
- Community-Based Interpreter means an individual who is not a member of the MMH workforce, who is qualified to provide Language Assistance.
- Qualified Interpreter means an individual who is able to interpret effectively, accurately, and impartially, both receptively and expressively, using any specialized vocabulary required by the circumstances.
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III. General Provisions
- Facilities Covered by Agreement. MMH is a non-profit, community hospital. It consists of a main hospital and five clinics that offer services to a population of about 50,000 throughout 2,500 square miles in the towns of King City, Greenfield, Soledad, Lockwood, San Ardo, and San Lucas, California. MMH’s main facility is located in King City, California. Adjacent to this facility are four of MMH’s five clinics: the King City Clinic, the Women’s Center, the Family Medical Center, and the Specialty Clinic. MMH also maintains a fifth clinic, the Greenfield Clinic, in Greenville, California, and operates a Mobile Health Unit which provides prevention programs and medical care across Southern Monterey and Northern San Luis Obispo Counties.
- Effective Date and Duration of Agreement. This Agreement shall become effective on the date it is executed by OCR (Effective Date) and shall remain in effect for two (2) years or until OCR’s written acceptance of the final progress report, whichever date is later. At such time, the Agreement will terminate, provided MMH is in substantial compliance with the Agreement. Notwithstanding the aforementioned time limitation, MMH acknowledges that it will comply with Title VI for so long as it continues to receive Federal financial assistance.
- MMH’s Continuing Obligation. Nothing in this Agreement is intended to relieve MMH of its obligation to comply with other applicable non-discrimination statutes and their implementing regulations.
- Effect on Other Compliance Matters. The terms of this Agreement do not apply to any other issues, investigations, reviews, or complaints of discrimination that are unrelated to the subject matter of this Agreement and that may be pending before OCR or any other Federal Agency. Any compliance matters arising from other reviews or investigations of specific complaints will be addressed and resolved separately from this Agreement. OCR may review complaints against MMH that are received on or after the Effective Date of this Agreement that concern the laws, regulations, issues and subject matter covered by this Agreement. Nothing in this Agreement shall be construed to limit or restrict OCR’s statutory and regulatory authority to conduct complaint investigations and compliance reviews.
- Prohibition Against Retaliation and Intimidation. MMH shall not retaliate, intimidate, threaten, coerce, or discriminate against any person who has filed a complaint, assisted, or participated in any manner in the investigation of matters addressed in this Agreement.
- OCR’s Review of MMH’s Compliance with Agreement. OCR may, at any time, review MMH’s compliance with this Agreement. As part of such review, OCR may require MMH to provide written reports, permit inspection of offices, interview staff members, and allow OCR to examine and copy documents. MMH agrees to retain records required by OCR to assess its compliance with the Agreement and to submit the requested reports to OCR, pursuant to Section IV.E.
- Failure to Comply with the Terms of the Agreement. If at any time OCR determines that MMH has failed to comply with any provision of this Agreement, OCR shall notify MMH in writing. On notice to MMH, OCR may shorten the time frame outlined below, if it determines that a delay would result in injury to a complainant or to other affected persons.
- The notice shall include a statement of the basis for OCR’s determination and will allow MMH thirty (30) working days from receipt of the notice to either:
- Explain in writing the reasons for its actions and describe the remedial actions that have been or will be taken to achieve compliance with this Agreement; or
- Provide information that may cause OCR to review or change its determination.
- If MMH does not respond to the notice or, if upon review of MMH’s response, OCR finds that MMH has not substantially complied with the terms of this Agreement, OCR may, upon notice to MMH, initiate any applicable proceedings under Federal law. Specifically, OCR may:
- Re-open the investigation of the compliance review;
- Issue a Letter of Findings documenting the area of non-compliance;
- Initiate administrative enforcement proceedings to suspend or terminate Federal financial assistance;
- Refer the matter to the U.S. Department of Justice with a recommendation that appropriate proceedings be brought for enforcement; or
- Initiate any other applicable proceedings under Federal law.
- Non-Waiver Provision. Failure by OCR to enforce this entire Agreement or any provision thereof with respect to any deadline or any other provision shall not be construed as a waiver of OCR’s right to enforce other deadlines or any provisions of this Agreement.
- Entire Agreement. This Agreement constitutes the entire understanding between MMH and OCR in resolution of Transaction Numbers 12-143846, 13-151016 and 13-153378. Any statement, promise, or agreement not contained herein shall not be enforceable through this Agreement
- Modification of Agreement. This Agreement may be modified by mutual agreement of the parties in writing.
- Effect of MMH Program Changes. MMH reserves the right to change or modify its programs, so long as MMH ensures compliance with Title VI and its implementing regulations, other applicable state and federal laws, and the provisions of this Agreement. Significant program changes that may affect compliance with this Agreement or any applicable statutes and regulations within OCR’s jurisdiction must be reported to OCR promptly.
- Publication or Release of Agreement. OCR places no restrictions on the publication of the terms of this Agreement. In addition, OCR may be required to release the Agreement and all related materials to any person upon request consistent with the requirements of the Freedom of Information Act, 5 U.S.C. 552, and its implementing regulations, 45 C.F.R. Part 5.
- Authority of Signer. The individual who signs this document on behalf of MMH represents that he or she is authorized to bind MMH to this Agreement.
- Third Party Rights. This Agreement can only be enforced by the parties specified in this Agreement, their legal representatives and assigns. This Agreement shall be unenforceable by third parties and shall not be construed to create third party beneficiary rights.
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IV. Specific Provisions
- Recognition. MMH recognizes that LEP individuals need language assistance services to access and fully participate in programs and activities operated by MMH. Pursuant to MMH’s policy, MMH is committed to providing competent language assistance at no cost and in a timely manner to LEP individuals to ensure meaningful access to, and an equal opportunity to participate fully in, the services, activities, programs, or other benefits administered by MMH. This includes ensuring effective communication with LEP individuals by MMH staff members.
- Title VI Coordinator and Central Coordinating Office
- MMH shall establish a Central Coordinating Office (CCO) that will operate under the direction of the Title VI Coordinator, and will be responsible for ensuring that appropriate Language Assistance is provided to LEP persons who seek access to services at MMH. The CCO shall be responsible for monitoring Title VI compliance and compliance with the terms of this Agreement. The CCO shall also serve as a liaison concerning Title VI policy issues between MMH, the Community Advisory Board, other community organizations, and advocates serving LEP persons.
- MMH shall staff the CCO in a manner that permits it to adequately perform the functions set forth below, including providing a sufficient number of dedicated staff. The Title VI Coordinator will be staffed, at a minimum, with a senior level employee in accordance with the recommendations set forth in the Title VI LEP Policy Guidance issued by OCR. The CCO, under the direction of the Title VI Coordinator, shall have wide latitude throughout the entire department in the creation and enforcement of MMH policies and procedures for ensuring timely and effective services to LEP Participants.
- The CCO's functions shall include, but are not limited to, the following:
- Assessment: Ensuring that MMH conducts an assessment of the language needs of the population to be served, including:
- Identifying the non-English languages that MMH is likely to encounter in its service area;
- Estimating the number of LEP persons that are eligible to receive services from MMH in its service area;
- Ensuring that the primary language of each LEP patient is clearly identified in the patient's medical record;
- Identifying the location and availability of Language Assistance resources, and arrangements that must be made to access these resources in a timely fashion.
- Policies: Ensuring that MMH revises as necessary, and implements its language access policies and procedures. This will include, but is not limited to:
- identifying and assessing the language needs of its LEP patients;
- providing multiple Language Assistance services, which may include Telephone Interpretive Services, Video Interpreting Services, in-person Staff Interpreters and/or community based interpreters;
- giving notice of the right to free Language Assistance to LEP persons in a language they can understand;
- monitoring of program implementation; and
- translating documents where needed to meet Title VI requirements.
- Training Program: Developing a training program on MMH’s policies and procedures for the provision of language assistance.
- Training of Staff: Ensuring adequate training of MMH workforce members on MMH’s policies and procedures for the provision of language assistance.
- Monitoring: Monitoring MMH's Language Assistance program, in order to assess the current LEP makeup of MMH's service areas, the current communication needs of LEPs, and whether existing assistance is meeting the needs of such persons. In addition, MMH, through or with the assistance of the CCO, shall monitor staff knowledge and implementation of language access policies and procedures to determine whether sources of and arrangements for assistance are viable.
- Additional Duties: In conjunction with other MMH staff as appropriate, the CCO shall assume responsibility for the following:
- Providing language policies and procedures to the Community Advisory Board (CAB) described in Section IV. C. for advice and input, as policies are revised or developed;
- Coordinating written translations, ensuring the dissemination of translated materials and “I Speak…” Cards, and ensuring that multilingual signs and posters are posted.
- Centralizing all data and other reports required by this Agreement,
- Reviewing and responding to civil rights complaints by LEP persons in conjunction with other MMH staff, as appropriate;
- Ensuring corrective action is taken for LEP Applicants and Participants who have not received language appropriate services; and
- Outreach: MMH shall publicize the CCO in its newsletters and other materials distributed to the public. MMH shall also publicize the establishment and role of the CCO in internal MMH communications.
- Community Advisory Board. The Title VI Coordinator will appoint a committee, which meets at least quarterly, including members of the local community, and shall consult with other Monterey County hospitals to coordinate community needs and seek support for training and access to qualified interpreters.
- Use of Family or Friends as Interpreters. The parties recognize that LEP individuals may seek to use family members or friends as interpreters. Regardless, MMH shall not require an LEP individual to utilize family members or friends to provide interpretation or translation services, and must make the LEP individual aware that he or she has the option of MMH providing an interpreter at no cost. In addition:
- If, after the offer of free language assistance in his or her primary language, an LEP individual elects to use a family member or friend to provide interpretation, MMH shall take reasonable steps to determine whether the individual providing the interpretation is competent to provide this service. Further, MMH shall take reasonable steps to determine whether conflict of interest, confidentiality, or other concerns make use of the family member or friend inappropriate. These concerns are heightened and require the exercise of significant caution if the LEP individual asks to have a minor provide interpretation. If the family member or friend is not competent or appropriate under the circumstances, MMH shall provide interpreter services in place of or, if appropriate, in addition to the person selected by the LEP individual.
- For each LEP individual who declines the offer for MMH to provide an interpreter at no cost, MMH staff shall document in the LEP individual’s record:
- that an offer was made for MMH to provide an interpreter free of cost;
- that the offer was declined; and
- the name of the family member or friend who provided language assistance at the LEP individual’s request, if any.
- MMH shall inform an LEP individual who has declined the offer for MMH to provide an interpreter at no cost that the individual may reconsider and request an interpreter at any time.
- Reporting Requirements to OCR
- Six (6) months after the Effective Date of this Agreement, and every six months thereafter, for the duration of the Agreement, MMH shall provide to OCR a progress reports to show compliance with the Agreement.
- In addition to the semi-annual progress reports, MMH shall submit to OCR, within ninety (90) days of the Effective Date of this Agreement, a preliminary report on its plan for implementation of the terms of the Agreement.
- MMH, in consultation with OCR, shall determine the content and the form for the report submitted pursuant to this Section.
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The individuals signing represent that they are authorized to execute this Agreement and legally bind the parties to this Agreement.
Lex T. Smith Date
Chief Executive Officer
Mee Memorial Hospital
Michael Leoz Date
U.S. Department of Health and Human Services
Office for Civil Rights
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