Voluntary Resolution Agreement Between the United States Department of Justice, the U.S. Department of Health and Human Services Office for Civil Rights & Multicare Health System

SETTLEMENT AGREEMENT BETWEEN
THE UNITED STATES DEPARTMENT OF JUSTICE,

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

AND MULTICARE HEALTH SYSTEM
USAO #2021v00312; DJ #202-82-191; OCR #23-525615

TABLE OF CONTENTS

BACKGROUND
INVESTIGATION AND DETERMINATIONS
PURPOSE OF AGREEMENT
DEFINITIONS
EQUITABLE RELIEF
MONETARY RELIEF
ENFORCEMENT AND MISCELLANEOUS PROVISIONS

I. BACKGROUND

The parties (“Parties”) to this Settlement Agreement (“Agreement”) are:
1. The U.S. Department of Justice (“DOJ”) and the U.S. Department of Health and Human Services (“HHS”), Office for Civil Rights (“OCR”) (collectively, “the Departments”); and
2. MultiCare Health System, a not-for-profit healthcare system headquartered in Tacoma, Washington. “MultiCare” as used herein is defined as those health care facilities and hospitals wholly owned and controlled by MultiCare Health System through September 1, 2024, and located in the Western District of Washington.¹
This matter was initiated by the U.S. Attorney’s Office for the Western District of Washington (“U.S. Attorney’s Office”), a component of the Department of Justice, after receiving complaints in 2020 from a married couple, V.F., who is deaf and visually impaired, and K.F., who is deaf-blind. Complainants alleged that MultiCare violated Title III of the Americans with Disabilities Act of 1990 (“ADA”) by failing to provide them effective communication, including sign language or tactile interpreters during medical appointments or care, surgical consultations, surgery, and/or pre- and post-operative surgical portions of their medical care. This matter includes a complaint received in 2024 from C.L., who is deaf-blind, and alleged that MultiCare violated Title III of the ADA by failing to provide him with a qualified tactile interpreter as necessary for effective communication on several occasions in 2024, including pre-surgical consultation, surgery, and post-surgical care, and that C.L.’s son, M.L., was placed in a position where he felt obligated to provide tactile interpreter services for his dad during his medical care, a position for which he is neither qualified nor obligated to fulfill.
In March 2023, the U.S. Attorney’s Office notified HHS OCR of its investigation of MultiCare, DOJ #202-82-191, and advised HHS OCR of its initial investigation findings. In May 2023, HHS OCR initiated a parallel compliance review of MultiCare 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”).

II. INVESTIGATION AND DETERMINATIONS

The U.S. Attorney’s Office is authorized to investigate alleged violations of Title III of the ADA. 42 U.S.C. § 12188(b)(1)(A); 28 C.F.R. § 36.502. It also has the authority to, where appropriate, negotiate voluntary settlements, and to bring civil actions enforcing Title III of the ADA should the terms of the settlement be breached. 42 U.S.C. § 12188(b)(1)(B); 28 C.F.R. § 36.503.
HHS OCR 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 OCR may take any action authorized by law. 45 C.F.R. §§ 84.61, 92.5 (incorporating 45 C.F.R. §§ 80.6-80.10).
Complainant V.F. is deaf with limited vision, and Complainants K.F. and C.L. are deaf-blind. The Complainants are individuals with a “disability” within the meaning of the ADA. 42 U.S.C. § 12102; 28 C.F.R. § 36.104. 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.
MultiCare is a “public accommodation” within the meaning of Title III of the ADA, 42 U.S.C. § 12181(7)(F) and its implementing regulations, 28 C.F.R. § 36.104, as it is a hospital and professional office of health care providers. The ADA prohibits public accommodations, including hospitals, from discriminating on the basis of disability in the full and equal enjoyment of their goods, services, facilities, privileges, advantages or accommodations. 42 U.S.C. § 12182(a); 28 C.F.R. § 36.201(a). Discrimination includes failing to take such steps as necessary to ensure that no individual with a disability is excluded, denied services, segregated, or otherwise treated differently than any other individual because of the absence of Auxiliary Aids and Services. 42 U.S.C. § 12182(b)(2)(A)(iii); 28 C.F.R. § 36.303.
MultiCare 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, MultiCare is also subject to the requirements of Section 1557. 45 C.F.R. § 92.3(a)(1).
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). In determining what types of Auxiliary Aids and Services are necessary, the covered health program must give primary consideration to the requests of individuals with disabilities. 45 C.F.R. § 84.77(b)(2).
MultiCare fully cooperated with the United States’ investigations DJ #202-82-191 and OCR #23-525615. Based on its investigation, DOJ contends that MultiCare failed to provide K.F. with a qualified tactile interpreter necessary for effective communication on several occasions throughout 2018-2022, including pre-surgical consultation, surgery, and post-surgical care. DOJ contends that K.F. suffered harm from these recurring experiences. DOJ further contends that K.F.’s spouse, V.F., was placed in a position where she felt obligated to provide tactile interpreter services for her husband during his medical care. F. was in the difficult position of serving as both a supportive Companion and medical interpreter, a position for which she is neither qualified nor obligated to fulfill. Further, DOJ contends MultiCare failed to provide V.F. with her own interpreter when she was accompanying her husband at his appointments and on one occasion when she was seeking emergency care for herself. DOJ also contends that MultiCare failed to provide C.L. with a qualified tactile interpreter as necessary for effective communication on several occasions in 2024, including pre-surgical consultation, surgery, and post-surgical care. DOJ contends that C.L. suffered harm from these recurring experiences. DOJ further contends that C.L.’s son, M.L., was placed in a position where he felt obligated to provide tactile interpreter services for his dad during his medical care. M.L. was in the difficult position of serving as both a supportive Companion and medical interpreter, a position for which he is neither qualified nor obligated to fulfill. DOJ reviewed MultiCare’s training materials, responses to DOJ requests, vendor data showing interpreter fulfillment rates, and other complaints regarding patients who have low-vision, are deaf, deaf-blind, or hard of hearing during the investigation, and contends that MultiCare lacked an adequate system to provide Auxiliary Aids and Services necessary to ensure effective communication with all patients and their Companions. DOJ contends that MultiCare denied Complainants K.F., V.F., C.L. and M.L. and other individuals Auxiliary Aids and Services necessary for effective communication in violation of 42 U.S.C. § 12182(b)(2)(A)(iii) and 28 C.F.R. § 36.303. The DOJ also contends that MultiCare engaged in associational discrimination against V.F and M.L. in putting them in a position where they felt compelled to serve as medical interpreters. See 42 U.S.C. § 12182(b)(1)(E). Finally, the DOJ contends MultiCare engaged in similar discriminatory conduct with respect to other patients who are deaf, deaf-blind, hard of hearing, or low-vision and their Companions during the Relevant Time Period (from January 1, 2018, through the execution of this Agreement by all Parties is the “Relevant Time Period”), who, like C.L., M.L., K.F. and V.F., suffered harm as a result.
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).

III. PURPOSE OF AGREEMENT

The Parties agree that it is in the Parties’ best interest, and the Departments believe that it is in the public interest, to resolve complaints DJ #202-82-191 and OCR #23-525615 and all potential claims arising under those investigations during the Relevant Time Period (the “Covered Claims”) on mutually agreeable terms without further investigation, enforcement action or litigation and therefore have agreed to the terms of this Agreement.
This Agreement is neither an admission of liability by MultiCare nor a concession by the Departments that their claims are not well founded. By entering into this Agreement, MultiCare is not admitting that any action taken with respect to the Complainants or any Eligible Person was wrongful, unlawful, or in violation of any local, state or federal act or statute.
In consideration of the terms of this Agreement, the Departments agree to refrain from undertaking further investigation of any Covered Claim, including DJ #202-82-191 or OCR #23-525615, or filing a civil suit relating to any Covered Claim, including the conduct investigated under DJ #202-82-191 or OCR #23-525615. DOJ or HHS, however, may review MultiCare’s compliance with this Agreement and/or the ADA, Section 504, and Section 1557 at any time. Nothing in this Agreement shall be construed as a waiver by DOJ or HHS of any right to institute enforcement proceedings against MultiCare 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 for conduct or actions other than the Covered Claims, including those investigated under DJ #202-82-191 or OCR #23-525615 and incorporated into the Agreement.

IV. DEFINITIONS

The term “Auxiliary Aids and Services” includes, but is not limited to, Qualified Interpreters provided either on-site or through 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, 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, deaf-blind, hard of hearing, or low-vision. 28 C.F.R. § 36.303; 45 C.F.R. § 84.10, 92.4.
The term “MultiCare Personnel” means individuals, full-time and part-time, that are directly employed as W-2 employees of MultiCare and who routinely have direct contact with Patients or Companions as defined herein. MultiCare Personnel does not include independent and third-party contractors or employees whose job responsibilities do not involve direct interactions with Patients or Companions in connection with medical care.
The term “Active Members of the Medical Staff” means all persons who are credentialed and privileged and provide medical services involving direct contact with Patients or Companions at MultiCare, whether or not they are direct employees of MultiCare.
The term “Qualified Interpreter” means an interpreter who, via VRI service or an on-site appearance, is able to interpret effectively, accurately, and impartially, both receptively and expressively, using any necessary specialized vocabulary. 28 C.F.R. § 36.104. Qualified Interpreters include, for example, sign language interpreters, tactile interpreters, oral transliterators, and cued-language transliterators. For purposes of this Agreement, a Qualified Interpreter must be knowledgeable with medical terminology.
The term “Patient” shall be broadly construed to include any individual who is seeking access to, or participating in, the healthcare related goods, services, facilities, privileges, advantages, or accommodations of MultiCare, including emergency room care, inpatient and outpatient services, surgery, clinics, and educational classes.
The term “Companion” means a person who is a family member, friend, or associate of a Patient, who, along with such individual, is an appropriate person with whom the public accommodation should communicate. 28 C.F.R. § 36.303(c)(1)(i); 45 C.F.R. § 84.77(a)(2), 92.4.

V. EQUITABLE RELIEF

A. Prohibition of Discrimination

Nondiscrimination. MultiCare shall provide appropriate Auxiliary Aids and Services, including Qualified Interpreters, where such aids and services are necessary to ensure effective communication with Patients and Companions who have low-vision, are deaf, deaf-blind, or hard-of-hearing. Pursuant to 42 U.S.C. § 12182(a), MultiCare shall also provide Patients and Companions who have low-vision, are deaf, deaf-blind, or hard of hearing with the full and equal enjoyment of the services, privileges, facilities, advantages, and accommodations of MultiCare as required by this Agreement and the ADA, Section 504, Section 1557, and their implementing regulations.
Discrimination by Association. MultiCare shall not deny equal services, accommodations, or other opportunities to any individual because of the known relationship of that person with someone who is deaf, deaf-blind, hard of hearing, or low-vision. 42 U.S.C. § 12182(b)(1)(E).
Retaliation and Coercion. MultiCare shall not retaliate, interfere with, or coerce any person who made, or is making, a complaint according to the provisions of this Agreement or exercised, or is exercising, his or her rights under this Agreement or the ADA, 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).

B. Effective Communication

Appropriate Auxiliary Aids and Services. Consistent with 42 U.S.C. § 12182(b)(2)(A)(iii), MultiCare will provide to Patients and Companions who have low-vision, are deaf, deaf-blind, or hard-of-hearing any appropriate Auxiliary Aids and Services necessary for effective communication after making the assessment described in Paragraphs 25-26 of this Agreement. Appropriate Auxiliary Aids and Services will be provided as soon as practicable (without compromising patient care), except that the provision of on-site interpreters must be within the period described in Paragraph 34 of this Agreement.
Method of Assessment for Effective Communication.
1. Standard. The determination of appropriate Auxiliary Aids and Services, and the timing, duration, and frequency with which they will be provided, will be made by MultiCare in consultation with the Patient or Companion who is deaf, deaf-blind, hard of hearing, or low-vision. The determination will take into account all relevant facts and circumstances, including, for example, the individual’s preference, communication skills and knowledge, and the nature and complexity of the communication at issue. If lip-reading is requested, MultiCare will take steps to ensure that the Patient or Companion can see and readily understand what is being said, including use of clear or windowed face masks approved by the Food and Drug Administration (“FDA”).
2. Initial Assessment. Within sixty (60) days following the Effective Date of this Agreement, MultiCare will provide all Patients or Companions who have low-vision, are deaf, deaf-blind, or hard of hearing with a notice of services and conduct the model communication assessment substantially similar to the Model Communication Assessment Form attached to this Agreement as Exhibit A. MultiCare may provide the assessment form or ask the questions included on the form as part of its intake process and may document the questions and responses in its electronic health record (“EHR”). MultiCare will provide the form in Unified English Braille (contracted/Grade 2) and large print (at least 20-point font) to Patients or Companions where necessary for effective communication and will provide appropriate assistive technology to facilitate completion of the form. The information provided on the completed hard-copy communication assessment form will be incorporated into the Patient’s electronic medical record.
3. On-Going Relationship. For a Patient or Companion who is deaf, deaf-blind, hard of hearing, or low-vision and has an ongoing relationship with MultiCare, MultiCare will continue to provide appropriate Auxiliary Aids or Services to the Patient or his or her Companion necessary for effective communication. MultiCare Personnel will continue to assess the communications needs of the Patient or Companion and will amend the provision of an auxiliary aid or service, as appropriate. MultiCare will keep records that reflect the ongoing provision of Auxiliary Aids and Services to Patients and Companions who are deaf, deaf-blind, hard of hearing, or low-vision, including notations in Patients’ records.
Timing of Assessment for Effective Communication.
1. Initial Assessment. Within sixty (60) days following the Effective Date of this Agreement, MultiCare will determine which appropriate Auxiliary Aids and Services are necessary, and the timing, duration, and frequency with which they will be provided to the individual either: (i) at the time an appointment is scheduled for the Patient who is deaf, deaf-blind, hard of hearing, or low-vision, or (ii) on the arrival of the Patient or Companion who is deaf, deaf-blind, hard of hearing, or low-vision at MultiCare, whichever is earlier.
2. Ongoing Relationships/Re-Assessment. Within sixty (60) days following the Effective Date of this Agreement, MultiCare will implement policies and procedures to expedite arrangements for the provision of Auxiliary Aids and Services for Patients or Companions with on-going relationships with MultiCare. These policies and procedures should include, but are not limited to, a requirement that when a Patient who is deaf, deaf-blind, hard of hearing, or low-vision (or who has a known Companion who is deaf, deaf-blind, hard of hearing, or low-vision) makes an appointment at MultiCare, MultiCare Personnel will confirm, as part of the appointment process, what Auxiliary Aid or Services are necessary for effective communication. Further, MultiCare Personnel will arrange for the provision of the appropriate auxiliary aid or service as soon as is practicable after the appointment is scheduled.
3. As part of their scheduling obligations, MultiCare Personnel will take steps necessary to ensure Auxiliary Aids or Services necessary for effective communication throughout the expected period of necessity, including, where appropriate, scheduling multiple interpreters over several days.
4. When a Patient or Companion who is deaf, deaf-blind, hard of hearing, or low-vision provides notice to MultiCare that they are en route to a MultiCare Emergency Department, MultiCare Personnel will make reasonable efforts to conduct a communication assessment and take steps so that Auxiliary Aids and Services are available as soon as practicable after the Patient or Companion’s arrival at a MultiCare Emergency Department.
Assistive Device Point Persons. MultiCare will designate an Assistive Device Point Person (“ADPP”). This ADPP or his or her designee(s) will always be on duty and available to MultiCare staff, Patients, and Companions during the same hours of operation and days of week in which MultiCare is open to the public. The ADPP’s responsibilities include, but are not limited to:
1. Answering questions from staff regarding how to provide appropriate assistance to Patients and Companions who are deaf or hard of hearing, including how to obtain immediate access to, and proper use of, the appropriate Auxiliary Aids and Services;
2. Knowing where the appropriate auxiliary aids are stored and how to operate them;
3. Distributing and replacing Auxiliary Aids and Services as appropriate;
4. Maintaining Auxiliary Aids in good working order; and
5. Knowing when Qualified Interpreters are necessary for effective communication and how to obtain a Qualified Interpreter for a Patient or Companion. The Assistive Device Point Person must also know how to obtain a Qualified Interpreter upon short notice for walk-in, urgent care, emergency services, and/or appointments upon short notice.
MultiCare will include in its intranet under the name “Assistive Device Point Person” and its “Quick List” phone directory the telephone number through which the on-duty ADPP can be contacted by MultiCare Personnel providing services to individuals who have low-vision, are deaf, deaf-blind, or hard of hearing. The ADPP and his or her designees will be designated by MultiCare no later than sixty (60) days following Effective Date of this Agreement and notice of such designation for MultiCare will be provided to the Departments.
Auxiliary Aid and Service Log. MultiCare will maintain logs in which requests for Qualified Interpreters on-site or through video remote services for persons who have low-vision, are deaf, deaf-blind, or hard of hearing will be documented. The log will indicate:
1. The name of the Patient or Companion who is deaf, deaf-blind, hard of hearing or low-vision;
2. The nature of the Auxiliary Aid or Service requested;
3. The time and date the request was made by the Patient (if applicable);
4. The time and date the request was made by staff after assessing the needs of the Patient (if applicable);
5. The name of the staff member making the request;
6. The time and date the request was made for, i.e., for immediate use (emergent need) or for a scheduled appointment (stating the date and time of the appointment);
7. The time and date the request was fulfilled; and
8. The nature of the Auxiliary Aid or Service
9. If the Auxiliary Aid or Service determined necessary and requested by the staff member was not provided, was not provided in the type requested, or was provided outside of the timeliness provisions contained in Paragraph 34 of this Agreement, the log shall indicate the request was unfulfilled and contain a statement explaining the circumstances, including whether the appointment was cancelled or if not how effective communication was provided, and specify whether the interpreter failed to show, cancelled, or declined the request.
Such logs will be maintained by the ADPP and/or the designee at MultiCare for the duration of the Agreement and will be incorporated into the semi-annual Compliance Reports as described in Paragraph 49 of this Agreement. MultiCare will implement the Auxiliary Aid and Service Logs no later than sixty (60) days following the Effective Date of this Agreement.
Grievance Procedure. MultiCare will maintain a complaint resolution mechanism for the investigation of disputes regarding effective communication with Patients and Companions who have low-vision, are deaf, deaf-blind, or hard of hearing. In particular:
1. MultiCare will maintain records of all complaints regarding effective communication, whether oral or written, made to MultiCare and actions taken with respect thereto for the duration of this Agreement.
2. At the time MultiCare completes its assessment described in Paragraphs 25-26 and advises the Patient and/or Companion of its determination of which Auxiliary Aids and Services are appropriate, MultiCare will notify persons who have low-vision, are deaf, deaf-blind, or hard of hearing of its complaint resolution mechanism, to whom complaints should be made, and of the right to receive a written response to the complaint as well as informing the individual of their right to file a complaint via ada.gov and www.hhs.gov/ocr as is required under Paragraph 39.
3. A written response to any complaint filed shall be provided to the complainant as soon as is practicable, but in no event longer than thirty (30) days after receipt of the complaint.
Prohibition of Surcharges. All appropriate Auxiliary Aids and Services required by this Agreement will be provided free of charge to the Patient and/or Companion who is deaf, deaf-blind, hard of hearing, or low-vision.

C. Qualified Interpreters

Circumstances Under Which Interpreters May be Required. Although the determination of whether and what Auxiliary Aids and Services are appropriate to a given situation is generally to be made on a case-by-case basis (as informed by its assessment pursuant to Paragraphs 25-26), some circumstances typically require that MultiCare provide a Qualified Interpreter to Patients or Companions who rely upon such types of communications and who request an in-person Qualified Interpreter. Such circumstances generally arise when the communication is particularly complex or lengthy or there is a particular disability or need requiring in-person communication. Examples of circumstances when it may be necessary to provide an interpreter on request include, but are not limited to:
1. Discussing a Patient’s symptoms for diagnostic purposes, and discussing medical condition, medications, and medical history;
2. Explaining medical conditions, treatment options, tests, medications, surgery, and other procedures;
3. Providing a diagnosis or recommendation for treatment;
4. Communications immediately preceding, during, and immediately after surgery or other procedures and during physician’s rounds;
5. Obtaining informed consent for treatment;
6. Providing instructions for medications, post-treatment activities, and follow-up treatments;
7. Providing mental health services, including group or individual counseling for patients and family members;
8. Providing information about blood or organ donations;
9. Discussing powers of attorney, living wills and/or complex billing, and insurance matters; or
10. During educational presentations, such as birthing or new parent classes, nutrition and weight management programs, and CPR and first-aid training.

In such circumstances, MultiCare will presume that a Qualified Interpreter is necessary for effective communication with the Patient or Companion and will provide one unless otherwise directed by the Patient or Companion.

Chosen Method for Obtaining Interpreters. Throughout the duration of this Agreement, MultiCare will maintain separate contracts with at least three (3) in-person sign language interpreter services or contract with an entity that maintains subcontracts with at least three (3) in-person sign language interpreter services, including at least one (1) that is capable of providing interpretation to individuals who are deaf-blind, during all hours of MultiCare’s operations and on an emergency or short-notice (less than 24 hours’ notice) basis. MultiCare will offer provisions to incentivize maximum acceptance and fulfillment rates, including provisions to minimize cancellations, declinations or no shows in new contracts or contracts subject to renewal. MultiCare will provide copies of its in-person sign language interpreter services contracts to the Departments. If MultiCare ends or substantively alters its contracts with any of these entities or adds additional contracts during the term of this Agreement, MultiCare will notify the Departments of the change within thirty (30) days.
Video Remote Interpreting (“VRI”). When using VRI services, MultiCare shall ensure that it provides:
1. Real-time, full-motion video and audio over a dedicated high-speed, wide-bandwidth video connection or wireless connection that delivers high-quality video images that do not produce lags, choppy, blurry, or grainy images, or irregular pauses in communication;
2. A sharply delineated image that is large enough to display the interpreter’s face, arms, hands, and fingers, and the participating individual’s face, arms, hands, and fingers, regardless of his or her body position;
3. A clear, audible transmission of voices; and
4. Adequate training to users of the technology and other involved individuals so that they may quickly and efficiently set up and operate the VRI. 28 C.F.R. § 36.303(f).
MultiCare will use other Auxiliary Aids when there are any indicators that VRI is not providing effective communication, including but not limited to: (1) a Patient’s limited ability to move his or her head, hands or arms; vision or cognitive issues; or significant pain; (2) space limitations in the room; or (3) the complexity of the medical issue. Whenever, based on the circumstances, VRI does not provide effective communication with a Patient or Companion who is deaf or hard of hearing, an on-site Qualified Interpreter shall be requested and provided in a timely manner as required by Paragraph 34 of this Agreement. In such instance, the two (2) hours begins when it becomes evident that VRI cannot provide effective communication for that interaction.
Provision of Interpreters in a Timely Manner. MultiCare will take reasonable steps in its control to provide an on-site Qualified Interpreter whenever requested by a Patient or Companion or when a determination is made that an on-site Qualified Interpreter is necessary for effective communication.
1. Non-scheduled Interpreter Requests: A “non-scheduled interpreter request” means a request for an interpreter made by a Patient or Companion who is deaf, deaf-blind, or hard of hearing less than twenty-four (24) hours before the Patient’s appearance at MultiCare for examination or treatment. For non-scheduled interpreter requests, MultiCare Personnel will complete the assessment described in Paragraphs 25-26.
  - A Qualified Interpreter (via VRI) will be provided as soon as practicable, unless VRI is likely ineffective, and it is expected that an interpreter will be provided by VRI no more than thirty (30) minutes from the time MultiCare completes the assessment (absent exigent circumstances affecting patient care which may extend the time for providing such service).
  - In the event that an on-site Qualified Interpreter is required, an interpreter will be provided as soon as practicable, and it is expected that an interpreter will be provided no more than two (2) hours from the time it becomes clear that a live interpreter is necessary for effective communication.
    As described below in Section (c) of this Paragraph, MultiCare will document the on-site interpreter service’s response time, including the time of contact and the time of arrival. Deviations from this response time will be addressed with the interpreting service provider, and performance goals will be reviewed with the Departments every six (6) months, pursuant to Paragraph 49. If no Qualified Interpreter can be located to provide services within two (2) hours from the time the need is evident, MultiCare Personnel will:
    1. Exert reasonable efforts (which shall be deemed to require no fewer than five (5) telephone inquiries and/or emails and/or text messages unless exceptional circumstances intervene) to contact any Qualified Interpreters or interpreting agencies contracted with MultiCare and request their services;
    2. Inform the Assistive Device Point Person of the efforts made to locate an interpreter and solicit assistance in locating an interpreter;
    3. Use other necessary and available Auxiliary Aids and Services required under Paragraph 36 to inform the Patient or Companion (or a family member or friend, if the Patient or Companion is unavailable) of the efforts taken to secure a Qualified Interpreter and that the efforts have failed, and follow up on reasonable suggestions for alternate sources of Qualified Interpreters, such as contacting a Qualified Interpreter known to that person; and
    4. Document all of the above efforts.
2. Scheduled Interpreter Requests. A “scheduled interpreter request” is a request for an interpreter made twenty-four (24) or more hours before the services of the interpreter are required. For scheduled interpreter requests, MultiCare Personnel will complete the assessment described in Paragraphs 25-26 in advance, and, when a Qualified Interpreter is appropriate, MultiCare will make a Qualified Interpreter available at the time of the scheduled appointment. If a Qualified Interpreter fails to arrive for the scheduled appointment, upon notice that the Qualified Interpreter failed to arrive, MultiCare will immediately call the interpreter service for another Qualified Interpreter and comply with the timeframes set forth in Paragraph 34(a).
3. Data Collection and Quality Improvement on Interpreter Response Time. MultiCare will establish a quality improvement process to monitor vendor performance. The quality improvement process will include at minimum:
  1. Review of documentation in the Auxiliary Aid and Service Log, described in Paragraph 28, of the fulfillment rate and response time of each Qualified Interpreter service it uses to provide communication to Patients or Companions who have low-vision, are deaf, deaf-blind, or hard of hearing;
  2. Review of documentation and investigation, per the complaint resolution process identified in Paragraph 29, of any complaints by the Patients or Companions who have low-vision, are deaf, deaf-blind, or hard of hearing regarding the quality and/or effectiveness of services provided by the interpreter service; and
  3. Active and affirmative quality improvement efforts including, but not limited to expanding vendors, amending vendor contract terms, and providing additional training.
Notice to Patients and Companions Who Are Deaf, Deaf-Blind, or Hard of Hearing. As soon as MultiCare Personnel have determined that a Qualified Interpreter is necessary for effective communication with a Patient or Companion who is deaf, deaf-blind, or hard of hearing, MultiCare will inform the Patient or Companion (or a family member or friend, if the Patient or Companion is not available) of the current status of efforts being taken to secure a Qualified Interpreter on his or her behalf. MultiCare will provide additional updates to the Patient or Companion as necessary until an interpreter is secured. Notification of efforts to secure a Qualified Interpreter does not lessen MultiCare’s obligation to provide Qualified Interpreters in a timely manner as required by Paragraph 34 of this Agreement.
Other Means of Communication. MultiCare agrees that between the time an interpreter is requested and the interpreter is provided, MultiCare Personnel will continue to try to communicate with the Patient or Companion who is deaf, deaf-blind, or hard of hearing for such purposes and to the same extent as they would have communicated with the person but for the disability, using all available methods of communication, for example, using sign language pictographs or other assistive technologies for deaf-blind individuals. This provision in no way lessens MultiCare’s obligation to provide Qualified Interpreters in a timely manner as required by Paragraph 34 of this Agreement.
Restricted Use of Certain Persons to Facilitate Communication. MultiCare will not rely on an adult friend or family member of the Patient or Companion who is deaf, deaf-blind, or hard of hearing to interpret except:
1. In an emergency involving an imminent threat to the safety of an individual or the public where there is no interpreter available; or
2. Where the Patient or Companion who is deaf, deaf-blind, hard of hearing specifically requests that the adult friend or adult family member interpret, the accompanying adult agrees to provide such assistance, and reliance on that adult for such assistance is appropriate under the circumstances. A Qualified Interpreter is required for the situations listed in Paragraph 31.
MultiCare will not rely on a minor child of Patient to interpret except in the limited circumstances described in (a) above.

D. Notice to the Community

Policy Statement. Within ninety (90) days following the Effective Date of this Agreement, MultiCare shall post and maintain Unified English Braille (contracted/Grade 2) and printed signs at all MultiCare admitting stations and wherever a Patient’s Bill of Rights is required by law to be posted, with substantially similar language to that provided in the Sample Posting attached as Exhibit B notifying the public of the availability of Auxiliary Aids and Services and their related rights. These signs will include the international symbol for “interpreter” in raised print. Printed signs must be at least 27 inches by 41 inches in size with at least 20-point font.
Website. Within ninety (90) days following the Effective Date of this Agreement, MultiCare will include on its website the same or substantially similar policy statement and information regarding how to request Auxiliary Aids or Services and information regarding how to file a complaint with the hospital, through its complaint process, and through www.adgov and www.hhs.gov/ocr. Further, all new and redesigned web pages, web applications, and web content (“Web Pages”) published by MultiCare must act in accordance with the Web Content Accessibility Guidelines 2.1 AA.
Patient Handbook. MultiCare will include in all future publications of its Patient Handbook (or equivalent) and all similar publications a statement the same or substantially similar to:
To ensure effective communication with Patients and their Companions who have low vision, are deaf, deaf-blind, hard of hearing, we provide appropriate Auxiliary Aids and Services free of charge to the Patient or Companion, including sign language and oral interpreters, video remote interpreting services, written materials, telephone handset amplifiers, assistive listening devices and systems, telephones compatible with hearing aids, televisions with caption capability or closed caption decoders, and open and closed captioning of most Hospital programs.
Please ask your nurse or another medical provider for assistance or contact Interpreter Services at (telephone number).
MultiCare will also include in its Patient Handbook a description of its complaint resolution mechanism. The notice in the Patient Handbook will be available in large print (at least 20-point font) and Unified English Braille (contracted/Grade 2) for individuals with visual impairments.

E. Policy Revisions

Policy Revisions. MultiCare will revise its policies to be consistent with Section 504, Section 1557, and ADA requirements regarding effective communication and the terms of this Agreement. Such revisions must be provided to the Departments within thirty (30) days following the Effective Date of this Agreement for review. Once approved by the Departments, the policy will be distributed to MultiCare Personnel and all Active Members of the Medical Staff in accordance with the timelines set forth in the Notice and Training sections that follow.

F. Notice to Multicare Personnell

Intranet. Within sixty (60) days following the Effective Date of this Agreement, MultiCare will publish on its intranet a policy statement regarding MultiCare’s policy for effective communication with persons who have low-vision, are deaf, deaf-blind, or hard of hearing This policy statement includes, but is not limited to, language to the same or substantially similar to:
If you recognize or have any reason to believe that a Patient or a relative, close friend, or Companion of a Patient is deaf, deaf-blind, hard of hearing, or low-vision you must advise the person that appropriate Auxiliary Aids and Services will be provided free of charge to the Patient or Companion. Examples of Auxiliary Aids and Services include, but are not limited to, qualified sign language interpreters, notetakers, real-time computer-aided transcription services, written materials, exchange of written notes, assistive listening devices, assistive listening systems, closed caption decoders, 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, Unified English Braille (contracted/Grade 2) materials and displays; and large print materials. The type of auxiliary aid or service necessary to ensure effective communication will vary in accordance with the method of communication used by the individual; the nature, length, and complexity of the communication involved; and the context in which the communication is taking place. If you are the responsible health care provider, you must ensure that such aids and services are provided when appropriate. All other personnel should direct that person to the appropriate ADA Administrator(s) at President, Florence S. Chang and reachable at (253) 403-7355.
Notice to Personnel. Within thirty (30) days of the approval of policy revisions referenced in Paragraph 41, MultiCare will distribute its policy/policies relating to effective communication with individuals who have low-vision, are deaf, deaf-blind, or hard of hearing to all MultiCare Personnel and Active Members of the Medical Staff. The policy will also be provided to all newly hired MultiCare Personnel and all Active Members of the Medical Staff upon their affiliation or employment with MultiCare.

G. Training

Training of the Assistive Device Point Person and His or Her Designees. MultiCare will provide mandatory training annually for the Assistive Device Point Person and his or her designees as set forth in Paragraph 27 of this Agreement during the term of this Agreement. Written materials, presentation slides, and outlines for such training must be provided to the Departments within sixty (60) days of the Effective Date of this Agreement for review. The Departments will review and comment on training materials within fourteen (14) days of receipt, with approval to occur as soon as possible. Once approved by the Departments, the training will occur within thirty (30) days. Such training will be sufficient in duration and content to train the Assistive Device Point Person and his or her designees in the following areas:
1. To promptly identify communication needs of Patients and Companions who have low-vision, are deaf, deaf-blind, or hard of hearing, including when an in-person Qualified Interpreter is necessary;
2. To secure Qualified Interpreter services or VRI services as quickly as possible when necessary and how to do so;
3. To use, when appropriate, flash cards and/or pictographs (in conjunction with any other available means of communication that will augment the effectiveness of the communication);
4. How, when, and when not to use VRI services;
5. To encourage Active Members of MultiCare’s Medical Staff to notify the Assistive Device Point Person or his or her designee of Patients and Companions who have low-vision, are deaf, deaf-blind, or hard of hearing as soon as Patients schedule admissions or other health care services at MultiCare; and
6. MultiCare’s complaint resolution procedure described in Paragraph 29 of this Agreement.
Training of MultiCare Personnel. Except for Active Members of the Medical Staff, who are governed by Paragraph 46 of this Agreement, MultiCare will provide annual mandatory in-service training to all MultiCare Personnel during the term of this Agreement.
1. The training will address the needs of Patients and Companions who are deaf, deaf-blind, hard of hearing, or low-vision and will include the following objectives:
  1. To promptly identify communication needs of Patients and Companions who have low-vision, are deaf, deaf-blind, or hard of hearing, including when an in-person Qualified Interpreter is necessary;
  2. To secure Qualified Interpreter services or VRI services as quickly as possible when necessary and how to do so;
  3. To use, when appropriate, flash cards and/or pictographs (in conjunction with any other available means of communication that will augment the effectiveness of the communication); and
  4. How, when, and when not to use VRI services.
2. Written materials, presentation slides, and outlines for such training must be provided to the Departments within sixty (60) days following the Effective Date of this Agreement for review. The Departments will review and comment on training materials within fourteen (14) days of receipt, with approval to occur as soon as possible. Once approved by the Departments, the training will occur within sixty (60) days for those individuals who have not already taken the training and within one-year for everyone else thereafter.
3. New employees hired after this training is approved, must receive this training within thirty (30) days of their hire.
Training of Active Members of the Medical Staff. Within thirty (30) days of the Departments’ approval of the policy revisions referenced in Paragraph 41 and annually following the Effective Date of this Agreement, MultiCare will provide electronically to Active Members of the Medical Staff a copy of its policy/policies relating to effective communication with Patients or Companions who have low-vision, are deaf, deaf-blind, or hard of hearing, along with a cover letter that:
1. Indicates the additional availability of the policy on the intranet;
2. Invites the recipient to reach out to the Assistive Device Point Person if they have questions about the policy and provides his or her contact information; and
3. Requests that if and when they become aware that a Patient or Companion who is deaf, deaf-blind, hard of hearing, or low-vision will be visiting MultiCare for health care services, that they promptly notify the Assistive Device Point Person of the expected visit, as well as the expected duration and purpose of the visit.
Training Attendance Records. MultiCare will maintain for the duration of this Agreement, confirmation of training conducted pursuant to Paragraph 45 of this Agreement, which will include the names and respective job titles of the attendees, as well as the date of the training session. MultiCare will also include in each of its Compliance Reports (Paragraph 49), an attestation that it has complied with the training and notice requirements of Paragraphs 42-46 of this Agreement or an explanation of how it has departed from such requirements, why, and what remedial measures to address the deficiency are being taken.

H. Reporting, Monitoring, and Violations

Contact Persons. MultiCare has identified the following individual as its authorized contact person regarding the implementation of this Agreement and for receipt and submission of notifications, reports, and other documents required by this Agreement: Tracy Lightfoot, Director, Privacy & Civil Rights, MultiCare Health System.
1. Unless otherwise provided, all payments, notices, reports or other such documents required by this Agreement shall be submitted to DOJ: Susan Kas, Assistant U.S. Attorney at Kas@usdoj.gov.
2. Unless otherwise provided, all notices, reports or other such documents required by this Agreement shall be submitted to OCR by email to Annette Tagliaferro, HHS OCR Investigator at Tagliaferro@hhs.gov.
Compliance Reports. Beginning six (6) months after the Effective Date of this Agreement and every four (4) months thereafter for the entire duration of the Agreement, MultiCare will provide a written report (“Compliance Report”) to the Departments regarding the status of its compliance with this Agreement. The Compliance Report will include data relevant to the Agreement, including but not limited to:
1. Information required in Auxiliary Aid and Service Log described in Paragraph 28;
2. Information maintained in the complaint records described in Paragraph 29, including the number of complaints received by MultiCare from Patients and Companions who have low-vision, are deaf, deaf-blind, or hard of hearing regarding Auxiliary Aids and Services and/or effective communication, and the resolution of such complaints including any supporting documents;
3. Information regarding training compliance as described in Paragraph 47; and
4. Information regarding quality improvement data efforts described in Paragraph 34(c).
MultiCare will maintain records to document the information contained in the Compliance Reports and will make them available, upon request, to the Departments.
Complaints. During the term of this Agreement, MultiCare will notify the Departments if any person files a lawsuit, complaint, or formal charge with a state or federal agency, alleging that MultiCare failed to provide Auxiliary Aids and Services to Patients or Companions who are deaf, deaf-blind, hard of hearing, or low-vision or otherwise failed to provide effective communication with such Patients or Companions. Such notification must be provided in writing via certified mail within twenty (20) days of the date MultiCare received notice of the allegation and will include, at a minimum, the nature of the allegation, the name of the person making the allegation, and any documentation of the allegation provided by the complainant. MultiCare will reference this provision of the Agreement in the notification to the Departments.

VI. MONETARY RELIEF

Payment to the United States to Vindicate the Public Interest. Within thirty (30) days of the Effective Date of this Agreement, MultiCare will pay the United States NINETY-FIVE THOUSAND DOLLARS ($95,000) to vindicate the public interest pursuant to 42 U.S.C. § 12188(b)(2)(C). Full payment will be made by electronic funds transfer pursuant to instructions to be provided by the U.S. Attorney’s Office for the Western District of Washington.
Compensatory Relief for K.F. Within ten (10) days after receiving the executed Agreement and K.F.’s signed release (a Blank Release Form is at Exhibit B), MultiCare will pay Complainant K.F. ONE HUNDRED THOUSAND DOLLARS ($100,000.00). This payment is compensation to Complainant K.F. pursuant to 42 U.S.C. § 12188(b)(2)(B), for the effects of the alleged discrimination suffered as described in Paragraph 10. Full payment will be made by issuing a check in that amount to an address to be provided. In addition, MultiCare will send a copy of the check and a copy of the mailing envelope to the U.S. Attorney’s Office to the attention of the Assistant United States Attorney handling this matter.
Compensatory Relief for V.F. Within ten (10) days after receiving the executed Agreement and V.F.’s signed release (a Blank Release Form is at Exhibit B), MultiCare will pay Complainant V.F. FORTY THOUSAND DOLLARS ($40,000.00). This payment is compensation to Complainant V.F. pursuant to 42 U.S.C. § 12188(b)(2)(B), for the effects of the alleged discrimination suffered as described in Paragraphs 10. Full payment will be made by issuing a check in that amount to an address to be provided. In addition, MultiCare will send a copy of the check and a copy of the mailing envelope to the U.S. Attorney’s Office to the attention of the Assistant United States Attorney handling this matter.
Compensatory Relief for C.L. Within ten (10) days after receiving the executed Agreement and C.L.’s signed release (a Blank Release Form is at Exhibit B), MultiCare will pay Complainant C.L. ONE HUNDRED THOUSAND DOLLARS ($100,000.00). This payment is compensation to Complainant C.L. pursuant to 42 U.S.C. § 12188(b)(2)(B), for the effects of the alleged discrimination suffered as described in Paragraph 10. Full payment will be made by issuing a check in that amount to an address to be provided. In addition, MultiCare will send a copy of the check and a copy of the mailing envelope to the U.S. Attorney’s Office to the attention of the Assistant United States Attorney handling this matter.
Compensatory Relief for M.L. Within ten (10) days after receiving the executed Agreement and M.L.’s signed release (a Blank Release Form is at Exhibit B), MultiCare will pay Complainant M.L. FORTY THOUSAND DOLLARS ($40,000.00). This payment is compensation to Complainant M.L. pursuant to 42 U.S.C. § 12188(b)(2)(B), for the effects of the alleged discrimination suffered as described in Paragraph 10. Full payment will be made by issuing a check in that amount to an address to be provided. In addition, MultiCare will send a copy of the check and a copy of the mailing envelope to the U.S. Attorney’s Office to the attention of the Assistant United States Attorney handling this matter.
Compensation for Other Aggrieved Individuals/Victims’ Fund.
1. Compensation Fund. Within forty-five (45) days of the Effective Date of this Agreement, MultiCare shall deposit a sum of TWO MILLION DOLLARS ($2,000,000) in an interest-bearing settlement account for Eligible Persons under this Agreement (“Compensation Fund”) as compensatory damages to be apportioned as detailed herein. This account shall be established, maintained, and administered by the Claims Administrator (described in Paragraph 56(b)), and shall be identified on payment checks using the short-hand title, “MultiCare Compensation Fund.”
  1. Title to this account shall be in the name of “MultiCare for the benefit of aggrieved individuals pursuant to the DOJ investigation 202-82-191.” MultiCare shall submit written verification to the United States that the funds have been deposited.
  2. The original deposits, and all interest accrued on that amount, shall make up the Compensation Fund and be available solely for compensation of Eligible Persons under this Agreement with the limited exception of “residual amounts” addressed in Paragraph 56(o).
  3. MultiCare shall bear all costs of administering the Compensation Fund, including costs associated with establishing the account, maintaining it, and issuing payments. Copies of account statements shall be provided within seven (7) days of their issuance to the United States and the Claims Administrator.
2. Retention Of Claims Administrator. MultiCare will retain a third-party claims administrator within twenty (20) days of the Effective Date of this Agreement to serve as claims administrator for the purposes of compensating persons harmed through the conduct described above from the Compensation Fund (“Claims Administrator”).
  1. Within thirty (30) days of the Effective Date of this Agreement, MultiCare will contract to retain the Claims Administrator to conduct the activities set forth in this Agreement (“Retention Date”). MultiCare will obtain the United States’ consent to the contract prior to its execution. MultiCare will bear all costs associated with the claims administration. MultiCare’s contract with the Claims Administrator will require that the Claims Administrator comply with the provisions of this Agreement, as applicable to the Claims Administrator.
  2. The Claims Administrator will contract, at MultiCare’s expense, with a consultant who has expertise through lived or professional experience in communicating with individuals with hearing, visual, and/or speech disabilities to assist in conducting the claims administration process. The Claims Administrator must receive training from expert consultant necessary to acquire basic knowledge of Deaf culture and skills in communicating with persons who have a hearing, vision, or speech disability through sign language interpretation services or other Auxiliary Aids and Services. The Claims Administrator must commit to communicating in an accessible and culturally competent manner, using the preferred Auxiliary Aids and Services of Potential Eligible Persons and Eligible Persons, when appropriate, for all substantive communications with Potential Eligible Persons and Eligible Persons, as defined below.
  3. The Claims Administrator’s contract will require the Claims Administrator to work under the oversight of the United States in the conduct of the Claims Administrator’s activities, including reporting regularly to and providing all requested information to the United States. All information and data provided to the Claims Administrator pursuant to this Agreement shall be used by the Parties and the Claims Administrator only for the purposes of implementing this Agreement and shall be kept confidential.
3. Potential Eligible Persons. “Potential Eligible Persons” are individuals, other than the named Complainants K.F., V.F., C.L. and M.L., who either requested an accommodation for a hearing, vision, or speech disability, including but not limited to a Qualified Interpreter, or for whom an accommodation was requested but not fulfilled at any MultiCare location in the Western District of Washington (see Exhibit A) between July 19, 2018, and the Effective Date of this Agreement or who file grievances or complaints regarding ineffective communication.
  Within forty-five (45) days of the Effective Date of this Agreement, MultiCare shall deliver to the Claims Administrator and the United States a current “Potential Eligible Persons List” that includes the following information, if known to MultiCare, in a native spreadsheet format for each of the individuals associated with these documents and putative violations:
  1. Name;
  2. MultiCare identification number;
  3. MultiCare patient file;
  4. Description of interpreter requests made by or for the Potential Eligible Person during the Claims Period;
  5. Description of correspondence or complaints sent by the Potential Eligible Person to MultiCare (or on their behalf) for incidents or issues occurring during the Claims Period; and
  6. Contact information, including permanent address, last known addresses, phone numbers, and email addresses.
  MultiCare will provide the Claims Administrator with electronic copies of all records reflecting interpreter requests made by or for the listed Potential Eligible Persons and Correspondence or complaints sent by the Potential Eligible Person to MultiCare (or on their behalf) for incidents or issues occurring during the Claims Period. MultiCare will provide the United States copies of these documents upon request and will provide the Claims Administrator and the United States any additional information reasonably requested by the Administrator or the United States in furtherance of any aspect of the claims process pursuant to this Agreement.
4. Initial Notice to Potential Eligible Persons. Within ten (10) days after providing the Claims Administrator with the Potential Eligible Persons List, MultiCare shall provide notice to all Potential Eligible Persons about how to make a claim for compensation. The notice shall consist of the following:
  1. MultiCare shall send the Notice of Agreement and Claim Form (attached as Exhibit C) (amended with appropriate information and on MultiCare’s letterhead), via first-class (with a postage pre-paid return envelope) and via electronic mail, if possible, to each Potential Eligible Person listed. If the individual is known to have a visual impairment or is blind, MultiCare will send the form in large print (at least 20-point font) or Braille, as appropriate.
  2. MultiCare will prominently post on its website a copy of the Notice of Agreement and Claim Form along with a captioned video of an individual translating the Notice of Agreement and Claim Form into American Sign Language.
5. Locating Potential Eligible Persons. The Claims Administrator will work with the expert consultant retained pursuant to Paragraph 56(b)(ii) above and will utilize all reasonable methods routinely used by companies that administer litigation and government enforcement Compensation Funds, such as relying upon last known contacts, searches in public databases, and social media searches, to locate each Potential Eligible Person. For every individual on the Potential Eligible Person List whose Notice of Agreement and Claims Form is returned to the Claims Administrator as undeliverable, the Administrator will conduct a trace and search for additional contact information using reasonably available methods and technology. Within fifteen (15) days of receiving a returned Notice of Agreement and Claims Form as undeliverable, the Claims Administrator shall mail the Notice of Agreement and Claims Form via first class to all additional addresses generated for the individual from the Administrator’s database search, and also attempt to reach the individual by phone and electronic mail if possible. Further, for any person who has not responded to the Notice of Agreement and Claims Form within sixty (60) days of its mailing, the Claims Administrator shall follow up within fifteen (15) days by phone and electronic mail (if possible) to ascertain the individual’s interest in making a potential claim. The efforts described in this Paragraph shall be considered “Good Faith Efforts” for purposes of this Agreement.
6. Contact Reporting. After seventy-five (75) days have passed since the mailing of the Notice of Agreement and Claims Form, the Claims Administrator shall send the United States a list containing: (1) the names and contact information of all Potential Eligible Persons who responded affirmatively to the notice; (2) identification of all Eligible Persons (defined in Paragraph 56(g)); (3) if applicable, a brief description of why any Potential Eligible Person was deemed not eligible; and (4) the efforts the Claims Administrator took to reach Potential Eligible Persons who did not respond.
7. Eligible Persons. An Eligible Person shall be any person from the Potential Eligible Persons List who timely responds affirmatively, either through mail, e-mail, or phone, to the Claims Administrator confirming that they: (a) are interested in being considered for compensation under the Compensation Fund from this Agreement, and (b) have a hearing, vision, or speech disability. Timeliness shall be measured as a response received prior to one hundred twenty (120) days of the initial mailing of the Notice of Agreement and Claims Form. In all communications between the Claims Administrator and Potential Eligible Persons, the Claims Administrator shall advise the Potential Eligible Person regarding the deadline for response.
8. Harm Assessment. The Claims Administrator shall conduct a Harm Assessment in order to make a recommendation regarding the amount of compensation to be paid to each Eligible Person. The Harm Assessment must be conducted consistently with the guidance from the expert consultant and will include the following steps:
  1. The Claims Administrator shall review the Claims Form, all documents and information provided by each Eligible Person and by MultiCare pursuant to Paragraph 56(c), and any additional information provided by the U.S. Attorney’s Office. The Claims Administrator and shall compare the information regarding each Eligible Person against the Harm Criteria set forth in Paragraph 56(i).
  2. If the documentation provided by the individual, MultiCare, and U.S. Attorney’s Office does not have information necessary to assess any of the criteria set forth in Paragraph 56(i), the Claims Administrator shall contact each Eligible Person who responds to the Notice of Agreement and Claim Form (or who is on the Potential Eligible Persons list and otherwise contacts the Claims Administrator), using Good Faith Efforts, within forty-five (45) days of receiving their documentation and shall attempt to ascertain any further information necessary about the Eligible Person’s experience with MultiCare related to the Harm Criteria listed in Paragraph 56(i). The Claims Administrator may use either email, relay calls, or in-person interpreter meetings according to the preference of the Eligible Person at no expense to the Eligible Person. The Claims Administrator shall send a copy of all written communications to the United States. If the Claims Administrator is unable to obtain additional information from the Eligible Person, the Claims Administrator shall make the assessment purely on the basis of the information that is otherwise available.
9. Harm Criteria. The following criteria shall be considered in determining the amount of compensation paid to each Eligible Person for each instance in which the Eligible Person requested an accommodation, including a sign language interpreter, or had an accommodation requested for them but did not receive them (“Unfilled Request”):
  1. The degree of medical exigency, seriousness, complexity, or sensitivity involved in the Unfilled Requests which considers factors including but not limited to:
    1. Whether the request was for an appointment was for routine medical care with which the Patient was familiar or did not require explanation or exchange of information relating to the person’s health (e., vaccine, routine blood draw, etc.);
    2. Whether the request was for an appointment was for routine preventative care (e., non-essential consultations, yearly physicals, routine follow-ups);
    3. Whether the request was for pre- or post-operative, emergency, or mental health care involving critical communications;
    4. Whether the request was for the provision of acute inpatient care; or
    5. Whether the request for a surgical procedure.
  2. The additional consequences of the Unfilled Request that go beyond the inconvenience and harm resulting from having to rely upon family members, friends, or unqualified interpreters, facing a risk of miscommunication, or having to reschedule/cancel the appointment, including but not limited to:
    1. Missed work, school, or similar obligations;
    2. Prolonged pain or physical or mental health symptoms;
    3. Giving or withholding of consent for care based on misunderstanding;
    4. Misdiagnosis due to miscommunication;
    5. Additional health complications necessitating further medical interventions; or
    6. Other irreparable harm to physical or mental health.
  3. The degree to which the individual agrees other auxiliary aids or services were as effective as an interpreter.
10. Distribution Amounts. On the basis of the Harm Assessment described in Paragraph 56(h), the Claims Administrator shall make a written recommendation within sixty (60) days of the provision of the Eligible Persons List to the United States regarding the Eligible Persons who should receive compensation from the Compensation Fund and the recommended amounts of each Eligible Person’s compensation (“Proposed Fund Distribution”), provided that no single Eligible Person shall receive compensation from the Compensation Fund that exceeds one hundred thousand dollars ($100,000). The Proposed Fund Distribution shall include a brief description for each Eligible Person explaining which Harm Criteria qualified them for the amount proposed and why. The Proposed Fund Distribution should account for a full distribution of the amount in the Compensation Fund. The United States shall then have sixty (60) days after receiving the Proposed Fund Distribution from the Administrator to submit any changes, provided the changes do not result in a single Eligible Person receiving compensation from the Compensation Fund that exceeds one hundred thousand dollars ($100,000). The Claims Administrator shall make any changes submitted by the United States within ten (10) days and shall then issue to the United States and MultiCare the final list containing the names of Eligible Persons and amounts to be paid (“Final Distribution List”). The determination of Eligible Persons and the amount awarded as contained in the Final Distribution List are final and non-appealable. No individual or Party may request a review or modification of these determinations in any venue.
11. Distribution of the Compensation Fund. The Claims Administrator shall use the same Good Faith Efforts to notify Eligible Persons of the proposed amount of compensation they are to be paid under the Agreement within thirty (30) days of the Final Distribution List, along with a Release of Claims (Exhibit D). Within thirty (30) days of receiving an executed Release of Claims, the Claims Administrator shall issue a check from the Compensation Fund in the amount consistent with the Final Distribution List. All such payments shall be void if not cashed or deposited within ninety (90) days after the date of issue. If a check is returned as undeliverable and/or goes uncashed after ninety (90) days from the date of issue, the Claims Administrator shall make reasonable attempts to contact and reissue checks to such individuals for the next thirty (30) days.
12. Opt Out. Any Potential Eligible Person may decline all monetary benefits from this Agreement by not returning a signed Release. The Agreement does not limit the legal rights of any Potential Eligible Person who does not return a signed Release within the Claims Period or any individual who is not a Potential Eligible Person under this Agreement.
13. Payment. No Set-Off. MultiCare will not be entitled to a set-off, or any other reduction, of the number of payments to Eligible Persons, resulting from unpaid debts or otherwise, except as expressly provided herein.
14. Notification Of Final Payment. The Claims Administrator will notify MultiCare and the United States in writing on the day when all payments of monetary relief to Eligible Persons required by this Agreement have been sent.
15. Residual Amount In Compensation Fund. The Claims Administrator will distribute the Compensation Fund as set forth in Paragraphs 56(j) and 56(k). However, payments made to Eligible Persons that are returned or not cashed or deposited within the applicable ninety (90) day period (subject to the procedures set forth in Paragraph 56(k) for reissuing checks) will be considered the “Residual Amount,” as will any remaining interest accrued on the Compensation Fund. Within thirty (30) days after the mailing of the last payment to an individual on the Final Distribution List, the Claims Administrator shall notify the United States and MultiCare in writing of the balance of the total of the Residual Amount. The entire Residual Amount shall be returned to MultiCare to be used solely for purposes of implementing this Agreement.
16. Taxes. Eligible Persons shall be solely responsible for paying any taxes they owe resulting from payments they receive under this Agreement. MultiCare shall be solely responsible for paying any applicable federal, state, and/or local taxes owed by the Compensation Fund, if any (e., any such tax payments shall not be deducted from the Compensation Fund or from any monetary award to Eligible Persons).
17. Dispute Resolution. In the event the United States has reason to believe that the Claims Administrator is not materially complying with the terms of its contract with MultiCare, the United States and MultiCare will meet and confer for the purpose of agreeing on a course of action to affect the Claims Administrator’s material compliance with its contract. In the event that the United States and MultiCare are unable to so agree, the United States and MultiCare will present the matter to a mutually agreed upon mediator.

VII. ENFORCEMENT AND MISCELLANEOUS PROVISIONS

Duration of the Agreement. This Agreement will be in effect for three (3) years from the Effective Date. The “Effective Date” of the Agreement shall be the date upon which the last signature hereto was executed.
Enforcement. In consideration of the terms of this Agreement as set forth above, the Departments agree to refrain from undertaking further investigation or from filing a civil suit or other matter under Title III, Section 504, and/or Section 1557 related to the conduct and actions investigated under DJ #202-82-191 or OCR #23-525615, except as provided in Paragraphs 59-60. Nothing contained in this Agreement is intended or shall be construed as a waiver by the Departments of any right to institute proceedings against MultiCare for violations of any statutes, regulations, or rules administered by the Departments or to prevent or limit the right of the Departments to obtain relief under the ADA, Section 504, and/or Section 1557 for violations unrelated to the conduct or actions investigated under DJ #202-82-191 or OCR #23-525615.
Compliance Review and Enforcement. HHS OCR or DOJ may review compliance with this Agreement at any time and can enforce this Agreement if the Departments believe that it or any requirement thereof has been violated by instituting a civil action in U.S. District Court. If the Departments believe that this Agreement or any portion of it has been violated, it will raise its claim(s) in writing with MultiCare, and the Parties will attempt to resolve the concern(s) in good faith. The Departments will allow MultiCare thirty (30) days from the date it notifies MultiCare of any breach of this Agreement to cure said breach, prior to instituting any court action to enforce the terms of the 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.
Entire Agreement. This Agreement and the attachments hereto constitute the entire Agreement between the Parties on the conduct or actions investigated under DJ #202-82-191 or OCR #23-525615, and no other statement, promise, or agreement, either written or oral, made by either Party or agents of either Party, that is not contained in this written Agreement, shall be enforceable. This Agreement is limited to the conduct or actions investigated under DJ #202-82-191 or OCR #23-525615 and 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 MultiCare to comply with all aspects of the ADA, Section 504 and Section 1557.
This Agreement is final and binding on MultiCare, including all principals, agents, executors, administrators, representatives, successors in interest, beneficiaries, assigns, heirs, and legal representatives thereof. MultiCare has a duty to so inform any such successor in interest.
Non-Waiver. Failure by any Party to seek enforcement of this Agreement pursuant to its terms with respect to any instance or provision shall not be construed as a waiver to such enforcement with regard to other instances or provisions.
This Agreement may be executed in counterparts, each of which constitutes an original and all of which constitute one and the same Agreement. Electronically transmitted signatures shall constitute acceptable, binding signatures for purposes of this Agreement.

FOR THE UNITED STATES DEPARTMENT OF JUSTICE:

/s/

James Waldrop

Assistant United States Attorney

Dated: 11/21/2024

FOR THE UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES:

/s/

Melanie Fontes Rainer

Director

Office for Civil Rights, Pacific Region

Dated: 11/21/2024

FOR MULTICARE HEALTH SYSTEM:

/s/

Florence S. Chang

President

Dated: 11/19/2024

EXHIBIT A

MODEL COMMUNICATION ASSESSMENT FORM

Patient’s Name

Name of Person with Disability (if other than patient)

Date Time

Nature of Disability:

❏ Deaf

❏ Deaf-Blind

❏ Hard of Hearing

❏ Speech Disability

❏ Other: __________________

Relationship to Patient:

❏ Self

❏ Family Member

❏ Friend / Companion

❏ Other: ____________________

Do you want a professional sign language or oral interpreter for your visit?

❏ Yes. Choose one:

❏ American Sign Language (ASL) interpreter

❏ Tactile Interpreter

❏ Signed English interpreter

❏ Oral interpreter

❏ Other. Explain: ___________________________________________

❏ No. I do not use sign language.

❏ No. I do not feel an interpreter is necessary or do not want one for this visit.

Which of these would be helpful for you for effective communication?

❏ Assistive listening device (sound amplifier)

❏ Writing back and forth

❏ CART: Computer-Assisted Real Time Transcription Service

❏ TTY/TDD (text telephone)

❏ Other. Explain: _________________________________________

We ask this information so we can communicate with you effectively. All communication aids and services are provided FREE OF CHARGE. If you need further assistance, please ask a member of our office staff.

Any questions? Please call our office, , or visit during normal business hours.

EXHIBIT B

GENERAL RELEASE OF CLAIMS

I, [COMPLAINANT], execute this Release for the benefit of MultiCare Health System and its parent, subsidiary, and affiliate entities, if any (“MultiCare”).

WHEREAS, I originally claimed that personnel at MultiCare discriminated against me which resulted in a complaint filed with the United States Department of Justice (“DOJ”) and United States Department of Health and Human Services (“HHS”), Office for Civil Rights (“OCR”) (collectively, the “Departments”) because of MultiCare’s alleged failure to provide appropriate Auxiliary Aids and Services necessary for effective communication;

WHEREAS, I have raised all allegations of discrimination relating to Auxiliary Aids and Services necessary for effective communication at MultiCare with the DOJ, HHS and OCR that I am aware of through the date of signature;

WHEREAS, the Departments engaged in settlement negotiations on behalf of the public interest;

WHEREAS, the Departments and MultiCare have agreed to a settlement in this matter (the “Settlement”); and,

NOW THEREFORE, in consideration of the mutual promises and covenants contained herein and in consideration of the payment to me in the sum [AMOUNT] as set forth in the Settlement, I agree as follows:

I hereby release and forever discharge MultiCare, its parent, subsidiaries, affiliates, successors, assignees, shareholders, directors, officers, agents, heirs, and current and former employees from any and all causes, suits, reckonings, whether in law or equity, known or unknown, and claims for attorneys’ fees, costs, interest and claims for any other damages, whether that be compensatory, exemplary, punitive or any other form, and any other claim whatsoever, which I now have or have ever had through the date of signature, relating to or arising (or could have arisen) under Title III of the Americans with Disabilities Act, Section 504 of the Rehabilitation Act or Section 1557 of the Affordable Care Act against MultiCare.
This Release is a one-page document. By signing below, I agree to all terms contained in this Release. I further acknowledge that I have entered into this Release voluntarily and of my own free will.

NAME: [COMPLAINANT]

SIGNATURE: _________________________

DATE: ________________

EXHIBIT C

NOTICE OF AGREEMENT AND CLAIM FORM

You are receiving this notice because we have reason to believe that you did not receive accommodations you may have needed to communicate effectively at a MultiCare Health System (MultiCare) location between --- and ----. We have reason to believe that you requested a sign language interpreter or that a sign language interpreter was requested for you, but that an interpreter was not provider, or that you filed a complaint about not receiving the accommodations you needed.

The United States of America, through the Department of Justice, conducted an investigation of MultiCare for not providing sign language interpreters or other accommodations to help people with disabilities communicate. The parties agreed to resolve the issue through entry of a settlement agreement (“Agreement”), which includes a fund (“Compensation Fund”) to pay individuals who were harmed by this alleged practice. Under that Agreement, you may be entitled to receive money from the Compensation Fund.

In order to know whether you are entitled to compensation and how much you may receive, we would like to collect information from potentially eligible persons like yourself. We have hired – to help collect and analyze information. If you are interested in potentially receiving compensation, please fill out the following information and return it to the following address by [DATE – 60 DAYS FROM DATE OF MAILING]:

[CLAIMS ADMIN ADDRESS]

Alternatively, you may provide this information through email to the following address:

[INSERT] or by calling [INSERT].

Part I. Contact/Communication Information

Name:

Address:

Phone Number:

E-mail Address:

Please check the appropriate box regarding your hearing status:

I am deaf/Deaf

I am deaf-blind

I am hard of hearing

My preferred method of communicating with the Claims Administrator is:____________

________________________________________________________________________

Part II. OPTIONAL Narrative or other documentation

OPTIONAL: You are not required to provide any written explanation. However, if you would prefer to explain what happened in writing, you may use this section as a guide. Feel free to use this form as well as any additional sheets of paper as necessary. We will contact you via your preferred mode of communication if you leave this part blank or we need more information.

Type of visit(s) and date(s) when accommodation was not provided:_______________________

______________________________________________________________________________

Type of accommodation(s) needed (i.e. sign language interpreter, clear mask, etc.):

______________________________________________________________________________

When and how you found out the accommodation was not available:_______________________

______________________________________________________________________________

If other auxiliary aids or services were used, whether they were effective for you to understand and communicate as well as with your preferred accommodation:

______________________________________________________________________________

If other auxiliary aids or services were not used, what was the outcome (i.e. appointment was cancelled/rescheduled, used less effective communication method, relied on a companion, etc.):

______________________________________________________________________________

Whether you experienced any additional harm as a result:

___Missed work, school, or other obligation:___________________________________

________________________________________________________________________

___Prolonged pain, discomfort, or other untreated physical or mental health symptoms:

________________________________________________________________________

___ Gave or withheld consent for care without understanding: _____________________

________________________________________________________________________

___ Misdiagnosis due to misunderstanding or miscommunication: __________________

________________________________________________________________________

___ Additional health complications requiring additional medical care:_______________

________________________________________________________________________

_______________________________________________________________________

___Other:_______________________________________________________________

________________________________________________________________________

OPTIONAL: You are not required to provide any documentation at this time. However, if you have documents reflecting your requests for sign language interpreters from MultiCare between ---and ---, and you wish to provide them, that may be helpful in establishing your entitlement to compensation under the Compensation Fund. You can mail or email such documents to the address/email address listed above.

PART III: Change of Contact Information

Finally, please note that if you relocate or change your contact information during the next twelve (12) months you will need to notify us at the address, email address, or phone number listed above to provide the new contact information.Failure to provide current contact information may result in your inability to receive funds under this Agreement. If you already know that you will be at a different address from the one listed above, please provide it here:

Future Address:

Date of Expected Move:

If you have any other questions about this Agreement, the Compensation Fund, or the claims process, please feel free to email or call us at the following: [INSERT].

Thank you very much,

EXHIBIT D

GENERAL RELEASE OF CLAIMS

I, ___________, execute this Release for the benefit of MultiCare Health System and its parent, subsidiary, and affiliate entities, if any (“MultiCare”).

WHEREAS, I have raised all allegations of discrimination relating to Auxiliary Aids and Services necessary for effective communication at MultiCare that I am aware of through the date of signature through the Notice of Agreement and Claim Form and any other claim process;

wNOW THEREFORE, in consideration of the mutual promises and covenants contained herein and in consideration of the payment to me in the sum of $_____ as set forth in the Settlement, I agree as follows:

I hereby release and forever discharge MultiCare, its parent, subsidiaries, affiliates, successors, assignees, shareholders, directors, officers, agents, heirs, and current and former employees from any and all causes, suits, reckonings, whether in law or equity, known or unknown, and claims for attorneys’ fees, costs, interest and claims for any other damages, whether that be compensatory, exemplary, punitive or any other form, and any other claim whatsoever, which I now have or have ever had through the date of signature, relating to or arising (or could have arisen) under Title III of the Americans with Disabilities Act, Section 504 of the Rehabilitation Act or Section 1557 of the Affordable Care Act against MultiCare.
This Release is a one-page document. By signing below, I agree to all terms contained in this Release. I further acknowledge that I have entered into this Release voluntarily and of my own free will.

NAME: ___________________

SIGNATURE: _________________________

DATE: ________________

Endnotes

¹ This includes the following counties in Washington State: Island, King, San Juan, Skagit, Snohomish, Whatcom, Clallam, Clark, Cowlitz, Grays Harbor, Jefferson, Kitsap, Lewis, Mason, Pacific, Pierce, Skamania, Thurston, and Wahkiakum.

Voluntary Resolution Agreement Between the United States Department of Justice, the U.S. Department of Health and Human Services Office for Civil Rights & Multicare Health System

Endnotes

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