Voluntary Resolution Agreement Between The United States Department Of Justice, United States Department Of Health And Human Services, Office For Civil Rights And Dearborn Obstetrics And Gynecology, P.C.

I.  Parties to Agreement

  1. The parties to this Voluntary Resolution Agreement (“Agreement”) are: 
    1. the U.S. Department of Justice, U.S. Attorney’s Office for the Eastern District of Michigan (“DOJ”), pursuant to its jurisdictional authority under Title III of the Americans with Disabilities Act of 1990, 42 U.S.C. §§12181-12189, and its implementing regulation, 28 C.F.R. Part 36, (“the ADA”), and the U.S. Department of Health and Human Services (“HHS”), Office for Civil Rights (“OCR”) pursuant to its jurisdictional authority under Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. § 794 et seq., and its implementing regulation, 45 C.F.R. Part 84 (“Section 504”) and Section 1557 of the Patient Protection and Affordable Care Act, 42 U.S.C. § 18116 and its implementing regulation, 45 C.F.R. Part 92 (“Section 1557”) (collectively, “the Departments”); and
    2. Dearborn Obstetrics and Gynecology P.C. (“Dearborn Obstetrics”).

II.  Background

  1. This matter was initiated by a complaint filed with DOJ alleging that Dearborn Obstetrics discriminated against a patient (“Complainant”) on the basis of her disability in violation of the ADA, and a parallel complaint filed with HHS, alleging that Dearborn Obstetrics discriminated against Complainant of the basis of her disability in violation of Section 504 and Section 1557.
  2. Complainant, who is deaf and utilizes American Sign Language (“ASL”) as her primary means of communication, specifically alleged that Dearborn Obstetrics, on more than one occasion, failed to provide her with qualified sign language interpreter services necessary for effective communication during her medical appointments and informed her that the medical practice would no longer treat her as a patient due to the costs of providing a sign language interpreter.

III.  Jurisdiction

  1. DOJ is authorized to investigate alleged violations of, and undertake periodic reviews of compliance with, the ADA.  42 U.S.C. § 12188(b); 28 C.F.R. §36.502.  Moreover, DOJ is authorized, where appropriate, to use alternative means of dispute resolution, including settlement negotiations to resolve disputes. 42 U.S.C. § 12212; 28 C.F.R. §36.506. If resolution is not achieved, DOJ may bring a civil action in federal court in any case where the Attorney General has reasonable cause to believe that a pattern or practice of discrimination exists or where the case raises an issue of general public importance.  42 U.S.C. § 12188(b); 28 C.F.R. § 36.503. Ensuring that medical care providers do not discriminate against patients on the basis of disability is an issue of general public importance.
  2. HHS is responsible for investigating complaints and conducting compliance reviews to determine if recipients of HHS funding operate their programs and activities in compliance with Section 504 and Section 1557, and, where appropriate, negotiate and secure voluntary compliance agreements.  If noncompliance cannot be corrected by informal means, HHS may take any action authorized by law.  45 C.F.R. §§ 84.61, 92.5 (incorporating 45 C.F.R. §§ 80.6-80.10).
  3. Dr. Peter L. Stevenson is a licensed physician specializing in obstetrics and gynecology. He owns and operates Dearborn Obstetrics, a professional corporation located at 2100 Monroe, Dearborn, Michigan.  The office is a place of public accommodation covered by the ADA. 42 U.S.C. § 12181(7)(F); 28 C.F.R. § 36.104.  Accordingly, Dearborn Obstetrics is a public accommodation, and is obligated to comply with the requirements of the ADA.  28 C.F.R. § 36.104.
  4. Dearborn Obstetrics receives financial assistance from HHS, including through its participation in Medicare, Title XVIII of the Social Security Act, 42 U.S.C. § 1396 et seq., and Medicaid, Title XIX of the Social Security Act, 42 U.S.C. § 1396 et seq., and is therefore subject to the requirements of Section 504.  45 C.F.R. § 84.2.  As a health program or activity receiving financial assistance from HHS, Dearborn is also subject to the requirements of Section 1557.  45 C.F.R. § 92.3(a)(1).
  5. The ADA prohibits discrimination on the basis of disability in the full and equal enjoyment of the goods, services, facilities, privileges, advantages, or accommodations by a public accommodation.  42 U.S.C. § 12182(a); 28 C.F.R. § 36.201(a). Specifically, a public accommodation shall take those steps that may be necessary to ensure that no individual with a disability is excluded, denied services, segregated, or otherwise treated differently than other individuals because of the absence of auxiliary aids and services, unless the public accommodation can demonstrate that taking those steps would fundamentally alter the nature of the goods, services, facilities, privileges, advantages, or accommodations being offered or would result in an undue burden.  28 C.F.R. § 36.303(a).
  6. Sections 504 and 1557 provide that no qualified individual with a disability shall be excluded from participation in, be denied the benefits of, or be subjected to discrimination by reason of disability in any health program or activity receiving financial assistance from HHS.  29 U.S.C. § 794; 42 U.S.C. § 18116; 45 C.F.R. §§ 84.4(a), 84.52(a)(1); 92.2.  Specifically, a recipient of HHS financial assistance shall provide appropriate auxiliary aids to persons with impaired sensory, manual, or speaking skills, where necessary to afford such persons an equal opportunity to benefit from the service in question.  45 C.F.R. § 84.52(d); § 92.102(b).  Furthermore, a covered health program or activity shall take appropriate steps to ensure that communications with individuals with disabilities are as effective as communications with others in health programs and activities, in accordance with the standards found at 28 C.F.R. §§ 35.160 through 35.164 (regulation implementing Title II of the ADA).  45 C.F.R. § 92.102(a) (incorporating 28 C.F.R. §§ 35.160 – 164). 
  7. Complainant has a physical impairment (deafness) that substantially limits one or more major life activities, including hearing.  Accordingly, Complainant has a disability within the meaning of the ADA, 42 U.S.C. § 12102 and 28 C.F.R. § 36.105.  The definition of "disability" under the ADA is incorporated by reference into the definitions of disability under Section 504 and Section 1557. See 29 U.S.C. § 705(9)(B); 42 U.S.C. § 18116.
  8. DOJ conducted an investigation of Complainant’s allegations.  Dearborn Obstetrics has fully cooperated in the DOJ investigation.  As a result of its investigation, DOJ determined that by denying Complainant’s request for a qualified sign language interpreter and dismissing her as a patient, Dearborn Obstetrics denied the complainant a full and equal opportunity to participate in and benefit from the goods, services, facilities, privileges, advantages, or accommodations of Dearborn Obstetrics’ medical practice within the meaning of 42 U.S.C. §§ 12182(a), 12182(b)(1)(A)(ii), 12182(b)(2)(A)(iii) and 28 C.F.R. §§ 36.202; 36.303.
  9. HHS coordinated its investigation with DOJ in accordance with the enforcement requirements under 45 C.F.R. §80.7(c).  When an investigation by HHS indicates a failure to comply with applicable nondiscrimination requirements, HHS attempts to resolve the matter by informal means whenever possible.  See 45 C.F.R. § 80.7(d) (incorporated by reference at 45 C.F.R. §§ 84.61, 92.5).

IV.  Purpose of Agreement

  1. The Parties agree that it is in the Parties’ best interest, and the Departments believe that it is in the public interest, to resolve this complaint on mutually agreeable terms without further investigation, enforcement action or litigation and therefore have agreed to the terms of this Agreement. 
  2. This Agreement is neither an admission of liability by Dearborn Obstetrics nor a concession by the Departments that their claims are not well founded.  By entering into this Agreement, Dearborn Obstetrics is not admitting that any action taken with respect to Complainant was wrongful, unlawful, or in violation of any local, state or federal act or statute. 
  3. In consideration of the terms of this Agreement, the Departments agree to refrain from undertaking further investigation of DJ # 202-37-312 or OCR # 21-432317, or filing a civil suit in this matter, except as provided in Paragraph 47of this Agreement.  DOJ or HHS, however, may review Dearborn Obstetrics’ compliance with this Agreement and/or the ADA, Section 504, and Section 1557 at any time.  Except as related to the facts alleged in the above-mentioned complaint(s), nothing in this agreement shall be construed as a waiver by DOJ or HHS of any right to institute enforcement proceedings against Dearborn Obstetrics for violations of any statutes, regulations, or rules administered by DOJ and HHS or to prevent or limit the right of DOJ and HHS to obtain relief under the ADA, Section 504, or Section 1557.

V.  Definitions

  1. For the purposes of this Agreement, the terms listed below shall have the following meaning:
    1. The term “Patient” shall be broadly construed to include any individual who is seeking or receiving health care services from Dearborn Obstetrics’ medical practice. 
    2. The term “Companion” is defined by 28 C.F.R. § 36.303(c)(1)(i) as “a family member, friend, or associate of an individual seeking access to, or participating in, the goods, services, facilities, privileges, advantages, or accommodations of a public accommodation, who, along with such individual, is an appropriate person with whom the public accommodation should communicate.” As applied to Dearborn Obstetrics, this means either (a) a person whom the patient, consistent with privacy regulations, indicates should communicate with Dearborn Obstetrics about the patient, participate in any treatment decision, play a role in communicating the patient’s needs, condition, history or symptoms to Dearborn Obstetrics, or help the patient act on the information, advice or instructions provided by Dearborn Obstetrics; (b) a person legally authorized to make health care decisions on behalf of a patient; or (c) such other person with whom Dearborn Obstetrics would ordinarily and regularly communicate with concerning the patient’s medical condition including, but not limited to, the patient’s next of kin or health care surrogate.
    3. The term “auxiliary aids and services” includes, but is not limited to, qualified interpreters on-site or through video remote interpreting (VRI) services; note takers; real-time computer-aided transcription services; written materials; exchange of written notes; telephone handset amplifiers; assistive listening devices; assistive listening systems; telephones compatible with hearing aids; closed caption decoders; open and closed captioning, including real-time captioning; voice, text, and video-based telecommunications products and systems, including text telephones (TTYs), videophones, and captioned telephones, or equally effective telecommunications devices; videotext displays; accessible electronic and information technology; or other effective methods of making aurally delivered information available to individuals who are deaf or hard of hearing. 28 C.F.R. § 36.303.
    4. The term “qualified interpreter” means an interpreter who, via a VRI service or an on-site appearance, is able to interpret effectively, accurately, and impartially, both receptively and expressively, using any necessary specialized vocabulary.  Qualified interpreters include, for example, sign language interpreters, oral transliterators, and cued-language transliterators. 28 C.F.R. § 36.104.  Not all interpreters are qualified for all situations.  For example, an interpreter who is qualified to interpret using American Sign Language (ASL) is not necessarily qualified to interpret orally.  Someone who has only a rudimentary familiarity with sign language or finger spelling is not a qualified interpreter under this Agreement.  Likewise, someone who is fluent in ASL but unable to translate spoken communication into ASL or to translate signed communication into spoken words is not a qualified interpreter.

VI.  Remedial Actions

  1. General Nondiscrimination Obligations
  1. Nondiscrimination.  Dearborn Obstetrics (with respect to any individual who has a disability, any individual who has a record of a disability, or any individual regarded as having a disability) agrees to comply with the requirements of Title III of the ADA, Section 504, Section 1557, and their implementing regulations. Dearborn Obstetrics will take the steps necessary to ensure that no individual with a disability is excluded, denied services, segregated or otherwise treated differently than other individuals because of the absence of auxiliary aids and services. 28 C.F.R. § 36.303(a).
  2. Retaliation and Coercion.  Dearborn Obstetrics shall not retaliate against or coerce any person who made, or is making, a complaint or exercised, or is exercising, his or her rights under Title III of the ADA, Section 504, or Section 1557, or who has assisted or participated in the investigation of any matter covered by this Agreement.  42 U.S.C. § 12203; 45 C.F.R. §§ 84.6, 92.5 (incorporating 45 C.F.R. §§ 80.6-80.10). 
  1. Policies and Procedures
  1. Nondiscrimination Policies and Procedures.  Within forty-five (45) calendar days of the Effective Date of this Agreement, Dearborn Obstetrics shall modify its policies and procedures regarding the treatment of all disabled individuals, including Patients and Companions.  The modified policies shall clearly state that Dearborn Obstetrics shall not discriminate against any individual with a disability in the full and equal enjoyment of the goods, services, facilities, privileges, advantages, or accommodations it provides.  The modified policies and procedures shall also include, but shall not be limited to, the following:      
    1. Dearborn Obstetrics shall provide auxiliary aids and services, including qualified interpreters, free of charge to Patients and Companions who are deaf or hard of hearing;
    2. No advance or supervisory approval is needed before obtaining an on-site
      interpreter for a Patient or Companion who needs one;
    3. The name(s) of one or more interpreter services that Dearborn Obstetrics has retained to provide qualified interpreters to fully implement the terms of this Agreement;
    4. Information about how to make and receive relay service calls; and
    5. A statement that individuals requesting auxiliary aids and services will not be retaliated against or coerced for exercising the individual’s rights under the ADA, Section 504 or Section 1557, or for making a complaint, participating in or assisting in the investigation of a complaint regarding any right thereunder.
  1. Approval by the Department  Within forty-five (45) calendar days of the Effective Date of this Agreement, Dearborn Obstetrics will submit copies of all policies and procedures that are created and/or modified in order to comply with this Agreement for review and approval to the Departments prior to their implementation.  HHS shall review policies and procedures for consistency with Section 504 and Section 1557, and DOJ shall review policies and procedures for consistency with the ADA.  The Departments will make their best efforts to review the proposed policies and procedures within thirty (30) calendar days of receipt.  Dearborn Obstetrics will adjust its proposed policies and procedures to reflect any reasonable comments or concerns identified by the Departments.  The Departments will not unreasonably withhold their approval of proposed policies and procedures.

VII.  Notice of Nondiscrimination

  1. Interim Notice of Nondiscrimination  Within ten (10) calendar days of the Effective Date of this Agreement, Dearborn Obstetrics shall adopt and implement an Interim Notice of Nondiscrimination. The Interim Notice of Nondiscrimination shall be posted in the reception or waiting area, examination rooms, and wherever a Patient’s Bill of Rights is required by law to be posted, on signs of conspicuous size and print. The Interim Notice of Nondiscrimination shall include the following provisions:
    1. Dearborn Obstetrics shall not discriminate against any individual with a disability in the full and equal enjoyment of the goods, services, facilities, privileges, advantages, or accommodations it provides;
    2. Dearborn Obstetrics shall provide auxiliary aids and services, including qualified interpreters, free of charge to Patients and Companions who are deaf or hard of hearing;
    3. No advance or supervisory approval is needed before obtaining an on-site
      interpreter for a Patient or Companion who needs one; and
    4. Individuals requesting auxiliary aids and services will not be retaliated against or coerced for exercising the individual’s rights under the ADA, Section 504 or Section 1557, or for making a complaint, participating in or assisting in the investigation of a complaint regarding any right thereunder.
  1. Permanent Notice of Nondiscrimination. After the Departments have approved and Dearborn Obstetrics has implemented appropriate nondiscrimination policies and procedures referenced in Paragraph 19, Dearborn Obstetrics shall take appropriate and continuing steps to notify Patients, Dearborn Obstetrics personnel, and the public of the rights and protections afforded by the ADA, Section 504, and the following:
    1. That it does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs or activities (Nondiscrimination Statement);
    2. The availability of the grievance procedure and how to file a grievance;
    3. How to file a discrimination of disability-based complaint with HHS and DOJ; and
    4. The terms of Dearborn Obstetrics’ approved nondiscrimination policies and procedures referenced in Paragraph 19.

Within thirty (30) calendar days of the Departments’ approval of the policies referenced in Paragraph 19, Dearborn Obstetrics shall provide photographic evidence that it has prominently displayed this Permanent Notice of Nondiscrimination in visible locations within all patient waiting areas, and to all interested persons by posting the Permanent Notice of Nondiscrimination prominently on the Dearborn Obstetrics website. The Permanent Notice of Nondiscrimination shall replace the Interim Notice of Nondiscrimination in all formats and locations. 

Dearborn Obstetrics is also obligated to comply with federal civil rights laws enforced by HHS, that require it to take reasonable steps to provide limited English proficient (LEP) individuals meaningful access to its health programs and activities.  45 C.F.R. §§ 80.3(b)(2), 92.201.  Accordingly, Dearborn Obstetrics should provide the Permanent Notice of Nondiscrimination in appropriate languages to LEP persons in its surrounding community to allow for accessibility in its programs, activities and services.

VIII.  Grievance Procedures

  1. Interim Grievance Procedure.  Within ten (10) calendar days of the Effective Date of this Agreement, Dearborn Obstetrics shall adopt and implement an Interim Grievance Procedure requiring that all complaints alleging discrimination on the basis of disability are internally investigated within fourteen (14) calendar days, and that any necessary remedial action is taken within fourteen (14) calendar days following the completion of the investigation.
  2. Permanent Grievance Procedure  After the Departments have approved and Dearborn Obstetrics has implemented appropriate nondiscrimination policies and procedures referenced in Paragraph 19, within forty-five (45) calendar days of the Effective Date of this Agreement, Dearborn Obstetrics shall adopt and provide to the Departments a Grievance Procedure that incorporates appropriate due process standards and that provides for the prompt and equitable resolution of any complaints alleging discrimination on the basis of disability to ensure it addresses any complaints alleging any action that would be prohibited by Section 504 or the ADA. The Permanent Grievance Procedure shall replace the Interim Grievance Procedures in all formats and locations. 
  3. Publication of Grievance Procedure.  No more than thirty (30) calendar days after the Departments’ approval of the Grievance Procedure, Dearborn Obstetrics shall publish on its website the Grievance Procedure and provide that link to HHS and DOJ.  Also, no more than thirty (30) calendar days after the Departments’ approval of the Grievance Procedure, Dearborn Obstetrics shall have each employee sign a form or other document indicating they have received, read, and understand the Grievance Procedure, which shall be produced to HHS and DOJ.

IX.  Program for Effective Communication

  1. Immediately as of the effective date of this Agreement, Dearborn Obstetrics will provide, free of charge, appropriate auxiliary aids and services, including qualified interpreters, to individuals who are deaf or hard of hearing whenever it is necessary to ensure effective communication for those individuals, unless it can be demonstrated that an undue burden or a fundamental alteration would result.
  2. If VRI services are used, Dearborn Obstetrics will ensure that the service provides (1) real-time, full motion video and audio over a dedicated high-speed, wide-bandwidth video connection or wireless connection that delivers high-quality video images that do not produce lags, choppy, blurry, or grainy images, or irregular pauses in communication; (2) a sharply delineated image that is large enough to display the interpreter´s face, arms, hands, and fingers, and the participating individual´s face, arms, hands, and fingers, regardless of his or her body position; (3) a clear, audible transmission of voices; and (4) adequate training to users of the technology and other involved individuals so that they may quickly and efficiently set up and operate the VRI. 28 C.F.R. § 36.303(f); 45 C.F.R. § 92.102(a) (incorporating 28 C.F.R. § 35.160(d)).
  3. The determination of appropriate auxiliary aids or services, and the timing, duration, and frequency with which they will be provided, will be made by Dearborn Obstetrics in consultation with the person with a disability.  In making these determinations, Dearborn Obstetrics staff will take into account all relevant facts and circumstances, including, but not limited to, the following:
    1. The nature, length, complexity, and importance of the communication at issue;
    2. The individual’s communication skills and knowledge;
    3. The Patients’ health status or changes thereto; and
    4. The Patients’ and/or Companions’ request for, or statement of need for, an interpreter.
  4. Examples of circumstances when it may be necessary to provide an interpreter include, but are not limited to, obtaining a Patient’s medical history or description of ailment; explaining or discussing a patient’s diagnosis or prognosis; explaining or discussing follow-up care, including a Patient’s or Companion’s questions regarding the patient’s condition and/or previous or future procedures, tests, and/or treatment; discussing proper regiment of medications prescribed; discussing a Patient’s birth plan; providing information regarding high risk pregnancies and prenatal care; and answering a Patient’s or Companion’s questions regarding infertility tests and treatment options.
  5. The determination of appropriate auxiliary aids and services, and the timing, duration, and frequency with which they will be provided, must be made at the time a patient schedules an appointment, or upon the arrival of the Patient or Companion at Dearborn Obstetrics’ medical practice, whichever is earlier.  Dearborn Obstetrics staff will perform a communication assessment as part of each initial Patient assessment, consulting with the patient, and documenting the results in the Patient’s medical chart.  In the event that communication is not effective, Dearborn Obstetrics staff will reassess, in consultation with the Patient or Companion, as applicable, which auxiliary aids and services are needed to ensure effective communication and will document the results accordingly.
  6. If a Patient or Companion has an ongoing relationship with Dearborn Obstetrics, with respect to subsequent visits, Dearborn Obstetrics will continue to provide the appropriate auxiliary aids or services to the Patient or Companion without requiring a request for the appropriate auxiliary aids or services by the Patient or Companion for each visit.  Dearborn Obstetrics will keep appropriate records that reflect the ongoing provision of auxiliary aids and services to Patients and Companions, such as notations in a Patient’s medical charts.
  7. Obstetric care, while limited in time, requires multiple visits with varying degrees of complexity. Accordingly, any particular auxiliary aids or services may be effective for one visit, but ineffective at another. If a Patient and/or Companion has an ongoing relationship with Dearborn Obstetrics for obstetric care, Dearborn Obstetrics will reassess, in consultation with the Patient or Companion, as applicable, which auxiliary aids and services are needed to ensure effective communication given the complexity of each individual appointment, without requiring any discrete or additional requests by the Patient or Companion, and will document the results accordingly.
  8. If a Patient and/or Companion does not request auxiliary aids or services, but Dearborn Obstetrics has reason to believe that such person would benefit from auxiliary aids or services, Dearborn Obstetrics will specifically inform the Patient and/or Companion that auxiliary aids and services are available free of charge.
  9. Within thirty (30) calendar days of the Effective Date of this Agreement, Dearborn Obstetrics shall post in the reception or waiting area, examination rooms, and wherever a Patient’s Bill of Rights is required by law to be posted, signs of conspicuous size and print stating:

In compliance with the Americans with Disabilities Act (ADA), Section 504 of the Rehabilitation Act, and Section 1557 of the Patient Protection and Affordable Care Act, qualified interpreters and other auxiliary aids and services are available free of charge to people who are deaf or hard-of-hearing.

  1. These signs will include the international symbols for “interpreters,” and list the name and contact information for the person(s) to whom a Patient or Companion should speak in order to request auxiliary aids or services. The signs shall also contain the following statement: “For more information about the Americans with Disabilities Act (ADA), call the Department of Justice’s toll-free ADA Information Line at 1-800-514-0301 (voice), 1-800-514-0383 (TTY), or visit the ADA Home Page at www.ada.gov.  For information about Section 504 of the Rehabilitation Act or Section 1557 of the Patient Protection and Affordable Care Act, call the Department of Health and Human Services, Office for Civil Rights at 1-800-368-1019 (voice), 1-800-537-7697 (TTD), or visit www.hhs.gov/ocr.”
  2. Within thirty (30) calendar days of the Effective Date of this Agreement, Dearborn Obstetrics shall post the same content described in Paragraphs 34 and 35 on its website (currently https://www.dearbornobgyn.com/), and unless previously and permanently removed, its Facebook page (currently https://www.facebook.com/people/Dearborn-Obstetrics-Gynecology-PC/10006…), and, unless previously and permanently removed, its Instagram Account (currently https://www.instagram.com/dearbornobgyn_/).

X.  Recordkeeping

  1. Immediately, as of the effective date of this Agreement, Dearborn Obstetrics’ medical practice will maintain a log of each request for an auxiliary aid or service.  The log will record the time and date of the request, the name of the individual who made the request, the name of the individual for whom the auxiliary aid or service is being requested (if different than the requestor), the specific auxiliary aid or service requested, the time and date of the scheduled appointment (if a scheduled appointment was made), the time and date the auxiliary service was provided, the type of auxiliary aid or service provided, if different than what was requested, and, if applicable, a statement that the requested auxiliary aid or service was not provided, along with the reason it was not provided.

XI. Training

  1. Within sixty (60) calendar days of the approval of policies referenced in Paragraph 19 or within 60 calendar days of hiring, and annually thereafter, Dearborn Obstetrics will provide mandatory ADA, Section 504 and Section 1557 training for all doctors, employees, staff members, and other individuals who might interact with Patients and/or Companions.  The trainer and training materials must be approved by both DOJ and HHS prior to Dearborn Obstetrics administering the training.  Such training, which can be provided by a third-party, will be sufficient in duration and content to train the individual in:
    1. The various degrees of hearing impairment, language, and cultural diversity in the deaf community;
    2. Identification of communication needs of persons who are deaf or hard of hearing;
    3. The office’s auxiliary aids and services policy;
    4. Recommended and required charting procedures governing requests for auxiliary aids and services;
    5. Types of auxiliary aids and services available;
    6. The proper use and role of qualified interpreters;
    7. The proper use and role of VRI services;
    8. Making and receiving calls through TTYs and the relay service;
    9. The nonretaliation provisions of the ADA, Section 504 and Section 1557; and
    10. Any other applicable requirements of this Agreement.

XII.  Monetary Relief

  1. Compensatory Relief for Complainant. Within twenty (20) calendar days of DOJ providing Dearborn Obstetrics with a signed Release (fully releasing all claims against it, its employees and agents, including but not necessarily limited to all personnel) from the complainant and anyone legally permitted to bring a claim on complainant’s behalf, Dearborn Obstetrics shall pay damages to the complainant or someone legally authorized to receive funds on complainant’s behalf in the amount of the negotiated settlement between Dearborn Obstetrics and DOJ in the sum of Seven Thousand Five Hundred ($7,500.00) Dollars.  Said payment is to be sent to complainant c/o the United States Attorney’s Office, and it shall be considered made on the date of its mailing.  Dearborn Obstetrics will not withhold taxes from the monetary award, and Complainant through the signed release, will accept full responsibility for taxes due and owing, if any, on such funds.  Dearborn Obstetrics will issue to Complainant an IRS Form 1099 reflecting the amount paid.  Nothing in this Paragraph or any other provision of this agreement constitutes an agreement by DOJ concerning the characterization of the Compensatory Relief for purposes of the Internal Revenue laws, Title 26 of the United States Code.    

XIII.  Reporting and Monitoring

  1. Notices to the Departments.  Unless otherwise provided, all payments, notices, reports or other such documents required by this agreement shall be submitted to DOJ by email to Assistant United States Attorney Michael El-Zein at Michael.El-Zein@usdoj.gov:

Unless otherwise provided, all notices, reports or other such documents required by this Agreement shall be submitted to HHS by email to the Office for Civil Rights, Rocky Mountain Region, Regional Manager, Andrea.Oliver@hhs.gov.

  1. Records.  Dearborn Obstetrics shall maintain appropriate records to document the information required by this Agreement, and shall make them available, upon request, to HHS and DOJ, throughout the duration of this Agreement.
  2. Complaints.  During the term of this Agreement, Dearborn Obstetrics will immediately notify the Departments if any individual submits a complaint, charge, grievance, or files a lawsuit, alleging that Dearborn Obstetrics failed to provide any auxiliary aids or services to any individual with a disability.  Such notification must be provided in writing within fifteen (15) calendar days of receipt and will include, at a minimum, the nature of the allegation, the name of the individual making the allegation, and any documentation possessed by Dearborn Obstetrics or any of its agents or representatives relevant to the allegation.
  3. Compliance Report.  Dearborn Obstetrics shall provide an initial written report (“Compliance Report”) to HHS and DOJ regarding the status of its compliance with this Agreement within six months of the Effective Date of this Agreement and a new Compliance Report at each subsequent six-month interval for the Duration of this Agreement (i.e., a second Compliance Report within 12 months of the Effective Date of this Agreement (covering the preceding six-month period); a third Compliance Report 18 months after the Effective Date of this Agreement (covering the preceding six-month period), etc.).
  4. Required Content for Compliance Reports.  Each Compliance Report shall include appropriate documentation of the steps Dearborn Obstetrics has taken to comply with each term of this Agreement, including:
    1. Any revised policies and procedures;
    2. The distribution of policies and procedures;
    3. The adoption and implementation of a Grievance Procedure;
    4. The distribution of the materials;
    5. The training required by this Agreement, including the training materials and attendance records; and
    6. The list of any grievance and/or complaints filed by Patients or those acting on their behalf regarding allegations of discrimination on the basis of disability, including a description of the allegations, the date filed, the status and/or outcome of each grievance or complaint and a copy of the grievance itself.

XIV.  Enforcement

  1. Duration of this Agreement.  This Agreement shall terminate Eighteen (18) Months from its Effective Date, provided DOJ and OCR determine that Dearborn Obstetrics demonstrated compliance with this Agreement, at which point DOJ and OCR’s review and monitoring of this Agreement shall terminate.
  2. Compliance within Eighteen Month. Notwithstanding Paragraph 45, this Agreement will terminate earlier than eighteen months from the Effective Date if both HHS and DOJ determine that Dearborn Obstetrics has demonstrated compliance with the terms of this Agreement, the ADA, Section 504, Section 1557 and their implementing regulations with respect to individuals with disabilities and their participation in and benefit from Dearborn Obstetrics’ services, programs, and activities, and maintained that compliance for one year.
  3. Compliance Review and Enforcement.  HHS or DOJ may review compliance with this Agreement or the ADA, Section 504 and/or Section 1557 at any time. If the Departments believe that Dearborn Obstetrics has failed to comply in a timely manner with any requirement of this Agreement without obtaining sufficient advance written agreement with the Departments for a modification of the relevant terms, the Departments will so notify Dearborn Obstetrics in writing and will attempt to resolve the issue or issues in good faith. If the Departments are unable to reach a satisfactory resolution of the issue or issues raised within thirty (30) calendar days of the date it provides notice to Dearborn Obstetrics, DOJ may institute a civil action in federal district court to enforce the terms of this Agreement or the ADA, Section 504 and Section 1557, and their implementing regulations, or administrative proceedings to suspend, terminate, or refuse to grant or continue HHS financial assistance. The Departments may, in such actions, seek any relief available under law.

XV.  Miscellaneous

  1. Non-Waiver.  Failure by the Departments to initiate any provision of this Agreement is not a waiver of its right to enforce other provisions of this Agreement.
  2. Binding. This Agreement is binding on Dearborn Obstetrics and its agents, employees, shareholders, partners, and associates as long as those agents, employees, shareholders, partners, and associates are serving in that capacity. In the event Dearborn Obstetrics seeks to transfer or assign all or part of this interest in any entity covered by this Agreement, and the successor or assignee intends to carry on the same or similar use of the entity, as a condition of sale, Dearborn Obstetrics shall obtain the written accession of the successor or assign to any obligations remaining under this Agreement for the remaining term of this Agreement.
  3. Entire Agreement.  This Agreement constitutes the entire agreement between the Departments and Dearborn Obstetrics on the matter raised herein, and no other statement, promise, or agreement, either written or oral, made by either party or agents of either party, that is not contained in this written Agreement shall be enforceable. This Agreement does not purport to remedy any other potential violations of the ADA, Section 504, Section 1557 or any other federal law. This Agreement does not affect the continuing responsibility of Dearborn Obstetrics to comply with all aspects of the ADA, Section 504 and Section 1557.
  4. Effective Date. The effective date of this Agreement is the date of the last signature. 
  5. Headings.  The headings in this Agreement are for convenience only and shall not affect in any way the language of the provisions to which they refer.
  6. Execution of Agreement.  The undersigned agents of the parties represent that they have been fully authorized by their clients to enter into and execute this Agreement under the terms and conditions contained herein.
  7. Publication or Disclosure of Agreement.  The Departments place no restriction on the publication of the Agreement.  In addition, the Departments may be required to disclose material related to this Agreement to any person upon request, consistent with the requirements of the Freedom of Information Act, 5 U.S.C. § 522, and its implementing regulation, 45 C.F.R. Part 5

Agreed and Consented to:

For the UNITED STATES DEPARTMENT OF JUSTICE

DAWN N. ISON
United States Attorney
Eastern District of Michigan

/s/                                                                              

MICHAEL H. EL-ZEIN
Assistant United States Attorney
United States Attorney's Office
Eastern District of Michigan
Civil Rights Unit
211 W. Fort St., Suite 2001
Detroit, MI 48226

Dated:  3/7/2023

For the UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES, OFFICE FOR CIVIL RIGHTS

/s/                                                                              

ANDREA OLIVER
Regional Manager, Rocky Mountain Region
Office for Civil Rights
1961 Stout Street, Room 08-148
Denver, Colorado 80294

Dated:  3/7/2023

For DEARBORN OBSTETRICS AND GYNECOLOGY, P.C.

/s/                                                                              

PETER STEVENSON, MD
2100 Monroe Street
Dearborn, Michigan 48124

Dated:  2/27/2023

Content created by Office for Civil Rights (OCR)
Content last reviewed