IN THE UNITED STATES DISTRICT COURT

IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF CONNECTICUT

CONNECTICUT ASSOCIATION OF THE DEAF,et al., Plaintiffs,
and
THE UNITED STATES OF AMERICA, Plaintiff-Intervenor
v.
MIDDLESEX MEMORIAL HOSPITAL, et al.,Defendants.
No. 395-CV-02408 (AHN)

CONSENT DECREE

REGARDING HEALTH CARE

SERVICES TO PEOPLE WHO ARE DEAF OR HARD OF HEARING

WHEREAS, the Connecticut Association of the Deaf (ACAD@) is a nonprofit association with more than 200 members organized to serve the needs of people who are deaf or hard of hearing;

WHEREAS, Karen Avena, Linda Basehore, June Freeman, Janice M. Stiffler, Jane Does I-VI, Michael E. Fiorino and Doris Simons as executrix of the estate of Joseph Simons are persons who are deaf or hard of hearing and thus are individuals with disabilities within the meaning of the Americans with Disabilities Act (AADA@), 42 U.S.C. '' 12101 et seq., and the implementing regulations at 28 C.F.R. pts. 35 and 36, Section 504 of the Rehabilitation Act of 1973, as amended, 29 U.S.C. § 794 (the "Rehabilitation Act") and the implementing regulation at 45 C.F.R. pt. 84, and Conn. Gen. Stat. '' 46a-64 et seq., and Allen Freeman is an individual associated with a person who is deaf or hard of hearing within the meaning of the ADA and the implementing regulations (together, the "Named Plaintiffs");

WHEREAS, Middlesex Hospital, Day Kimball Hospital, The Waterbury Hospital, Yale-New Haven Hospital, The William W. Backus Hospital, Hartford Hospital, Connecticut Children's Medical Center, Norwalk Hospital, Saint Francis Hospital and Medical Center and John Dempsey Hospital (the "Defendant Hospitals") are acute care hospitals in Connecticut and are subject to the ADA and the Rehabilitation Act;

WHEREAS, individually with respect to damages and, with respect to prospective injunctive relief on behalf of themselves and a class of similarly situated people who are deaf or hard of hearing, CAD and the Named Plaintiffs filed an action (the "CAD Complaint") alleging that the Defendant Hospitals violated the ADA, the Rehabilitation Act, and Conn. Gen. Stat. '' 46a-64 et seq., by failing to provide auxiliary aids and services as necessary for effective communication with persons who are deaf or hard of hearing;

WHEREAS, to address the interests of the public and of certain individual complainants (the "United States Complainants"), the United States, acting through the Attorney General, who has statutory authority to enforce titles II and III of the ADA, 42 U.S.C. '' 12101 et seq., filed a Complaint in Intervention against the Defendant Hospitals alleging that they discriminated against persons who are deaf or hard of hearing as well as others associated with them by failing to provide them with the full and equal enjoyment of the Hospitals' goods, services, programs, and activities, and by failing to provide appropriate auxiliary aids and services when necessary for effective communication;

WHEREAS, the United States, acting through the Department of Justice ("DOJ" or the "United States"), investigated additional allegations of discrimination against Lawrence & Memorial Hospital, St. Mary's Hospital, New Britain General Hospital, and Bridgeport Hospital (the "Investigated Hospitals");

WHEREAS, the Investigated Hospitals, in lieu of being sued by the United States, agreed to file and have filed Rule 24(b) Motions to Intervene as Defendants under the Federal Rules of Civil Procedure;

WHEREAS, in lieu of submitting to compliance reviews by the United States and in the absence of any allegations of discrimination, certain hospitals⁽¹⁾ have voluntarily agreed to become Parties to this Consent Decree by filing Rule 24(b) Motions to Intervene as defendants (the "Voluntarily Participating Hospitals") (the Defendant Hospitals, the Investigated Hospitals and the Voluntarily Participating Hospitals being referred to together as the "Hospitals" and individually as a "Hospital");

WHEREAS, one or more Plaintiffs alleged that he or she was subject to retaliation by one or more Defendant Hospitals in violation of the ADA;

WHEREAS, the Defendant Hospitals deny the material allegations in the complaints;

WHEREAS, the Parties stipulate that a class be certified;

WHEREAS, the Parties stipulate that the settlement class shall be defined as all persons in the following groups ("Class Members"):⁽²⁾

(A) persons who are deaf or hard of hearing and are (i) patients of a Hospital ("Patients") or (ii) persons who will be consulted or would otherwise reasonably be expected to communicate with Hospital Personnel regarding health care issues of Patients ("Companions"), and

(B) persons who are not deaf or hard of hearing and are (i) Patients with Companions who are deaf or hard of hearing, (ii) Companions of Patients who are deaf or hard of hearing, or (iii) associated with Companions who are deaf or hard of hearing.

WHEREAS, the class is so numerous that joinder of all Class Members is impracticable;

WHEREAS, the claims of the Named Plaintiffs and the United States Complainants are typical of those of the class;

WHEREAS, there are questions of law and fact common to the class;

WHEREAS, the Hospitals have acted or refused to act on grounds generally applicable to the claims of the class, thereby making appropriate final injunctive relief with respect to the class as a whole;

WHEREAS, the Parties have engaged in arm's-length negotiations regarding the settlement of this matter;

WHEREAS, without conceding the allegations of CAD, the Named Plaintiffs, the United States Complainants or the United States (together with the Class Members, the "Plaintiffs"), or the defenses of the Defendant Hospitals, all Parties agreed that it is in their best interests and that of the class to resolve this matter promptly and without protracted litigation; and

WHEREAS IT WAS AGREED by and among the Parties hereto, acting through their undersigned counsel, that, subject to the approval of the Court, this Action shall be resolved on the terms and conditions set forth below,

THEREFORE, THE FOLLOWING IS HEREBY AGREED AND ORDERED:

JURISDICTION AND VENUE

This Court has jurisdiction over this action pursuant to 42 U.S.C. '' 12132 and 12188(b)(1)(B), and 28 U.S.C. '' 1331 and 1345. Venue is proper in the District of Connecticut pursuant to 28 U.S.C. ' 1391 in that all claims alleged herein arose within this District. The Court has authority to grant declaratory relief pursuant to 28 U.S.C. '' 2201 and 2202.

CERTAIN DEFINITIONS

The term "appropriate auxiliary aids and services" shall mean: qualified sign language or oral interpreters, notetakers, computer-assisted real time transcription services, written materials, telephone handset amplifiers, assistive listening devices, assistive listening systems, telephones compatible with hearing aids, closed caption decoders, open and closed captioning, and TTY's. 28 C.F.R. § 35.104; 28 C.F.R. §36.303.⁽³⁾
The term "Hospital Personnel" shall mean: all employees and independent contractors with contracts to work on a substantially full-time basis for a Hospital (or on a part-time basis exclusively for a Hospital), including, without limitation, nurses, physicians, social workers, technicians, admitting personnel, security staff and therapists, and all volunteers, who have or are likely to have direct contact with Patients or Companions.
The term "Parties" shall mean: the Named Plaintiffs, CAD, the Connecticut Office of Protection and Advocacy for Persons with Disabilities ("P&A"), the United States Complainants, the United States, acting by and through the Department of Justice, the Class Members, and the Hospitals.
The term "qualified sign language interpreter," "oral interpreter," or "interpreter" shall mean: an interpreter who is able to interpret competently, accurately, and impartially, both receptively and expressively, using any specialized terminology necessary for effective communication in a Hospital setting to a Patient or a Companion who is deaf or hard of hearing. Someone who has only a rudimentary familiarity with sign language or finger spelling is not a "qualified sign language interpreter" under this Decree. Likewise, someone who is fluent in sign language but who does not possess the ability to process spoken communication into the proper signs or to observe someone else signing and change their signed or fingerspelled communication into spoken words is not a qualified sign language interpreter. 28 C.F.R. § 35.104, 28 C.F.R. § 36.104.
The term "Standards" shall mean: the ADA Standards for Accessible Design, as set forth at 28 C.F.R. pt. 36, App. A.
The term "TTY's" or "TDD's" shall mean: devices that are used with a telephone to communicate with persons who are deaf or hard of hearing by typing and reading communications.
The term "undue burden" shall mean: significant difficulty or expense. In determining whether an action would result in an undue burden, factors to be considered include:
1. The nature and cost of the action needed;
2. The overall financial resources of the site or sites involved in the action; the number of persons employed at the site; the effect on expenses and resources; legitimate safety requirements that are necessary for safe operation, including crime prevention measures; or the impact otherwise of the action upon the operation of the site;
3. The geographic separateness, and the administrative or fiscal relationship of the site or sites in question to any parent corporation or entity;
4. If applicable, the overall financial resources of any parent corporation or entity; the overall size of the parent corporation or entity with respect to the number of its employees; the number, type, and location of its facilities; and
5. If applicable, the type of operation or operations of any parent corporation or entity, including the composition, structure, and functions of the workforce of the parent corporation or entity. 28 C.F.R. § 36.104; 28 C.F.R. § 35.164.

EFFECTIVE COMMUNICATION

I. GENERAL OBLIGATIONS

A. Establishment of Program to Provide Appropriate Auxiliary Aids and Services. As soon as practicable after the entry of this Decree, each Hospital will design and institute a program (the "Program") that will effectively implement the provisions of this Decree, including without limitation:

developing, coordinating, and overseeing the development of specific procedures to implement fully this Decree;
scheduling, announcing, and promoting all training required by this Decree;
coordinating the community outreach required by this Decree; and
drafting, maintaining, and providing all reports required by this Decree.

The Program shall include, among other things:

The designation of an individual or office at the Hospital that will maintain full information about access to and the operation of the Program (the "Information Office"). The Information Office shall maintain a combination voice/TTY telephone line or a dedicated TTY telephone line, shall publicize its purpose and telephone number broadly within the Hospital and to the public, shall respond to telephone inquiries during normal business hours, and shall maintain a recording system for inquiries received after normal business hours. The Information Office shall be established within sixty (60) days after the entry of this Decree.
The designation of one or more individuals ("Program Administrators"), within sixty (60) days after the entry of this Decree, who shall be available twenty-four (24) hours a day, seven (7) days a week, to answer questions and provide appropriate assistance regarding immediate access to and proper use of the appropriate auxiliary aids and services available under the Program (as described below). Such Program Administrators shall know where the appropriate auxiliary aids are stored and how to operate them, and will be responsible for their maintenance, repair, replacement, and distribution. Each Hospital will circulate broadly within the Hospital the names, telephone numbers, functions, and office locations of such Program Administrators, including a TTY telephone number that may be called by deaf or hard of hearing Patients and Companions in order to obtain the assistance of such Program Administrators.

B. Provision of Appropriate Auxiliary Aids and Services Under the Program.

Immediate Aids and Services. Within sixty (60) days after the entry of this Decree, each Hospital shall provide, to Patients and Companions who are deaf or hard of hearing, any of the following appropriate auxiliary aids and services that may be necessary for effective communication, as soon as practicable after making such determination: written materials, note takers, assistive listening devices, assistive listening systems, and computer-assisted real time transcription services.
Pictographs. After the entry of this Decree, DOJ will develop or obtain, with the assistance of the Hospitals, pictograph forms and flash cards to assist in providing effective communication. The Hospitals shall utilize such pictograph forms and flash cards within sixty (60) days after receipt in full from DOJ. The Hospitals shall have the right to modify said pictograph forms and flash cards from time to time when deemed necessary for effective communication with Patients and Companions.
Additional Appropriate Aids and Services. Each Hospital shall provide the sign language and oral interpreters and the technology when and as specified in Sections II and III below.
Assessment. The determination of which appropriate auxiliary aids and services are necessary, and the timing, duration and frequency with which they will be provided, shall be made by the Hospital Personnel who are otherwise primarily responsible for coordinating and/or providing patient care services, in consultation with the person with a disability where possible.⁽⁴⁾ The assessment will take into account all relevant facts and circumstances, including without limitation the nature, length, and importance of the communication at issue, as well as the individual's communication skills, knowledge, the Patient's health status or changes thereto, the reasonably foreseeable health care activities of the Patient (e.g., group therapy sessions, medical tests or procedures, rehabilitation services, meetings with health care professionals or social workers, or discussions concerning billing, insurance, self-care, prognoses, diagnoses, history and discharge), and the availability at the required times, day or night, of appropriate auxiliary aids and services.
1. Initial assessment. The initial assessment will be made at the time an appointment is scheduled or on the arrival of the Patient or Companion at the Hospital, whichever is earlier. Hospital Personnel will perform and document a communication assessment as part of each initial inpatient assessment which is required by the Joint Commission On Accreditation of Healthcare Organizations ("JCAHO"). Completion of communication assessments will be documented in the Patient's record.
2. Ongoing assessments. If a Patient or a Companion who is deaf or hard of hearing has an ongoing relationship with the Hospital, the provision of appropriate auxiliary aids or services will be reconsidered as part of each routine assessment of an inpatient, or on a regular basis with respect to other Patients and Companions. Hospital Personnel shall keep appropriate records that reflect the ongoing assessments, such as notations in Patients' records.
Medical Concerns. Nothing in this Decree shall require that an electronic device or equipment constituting an appropriate auxiliary aid be used when or where its use may interfere with medical or monitoring equipment or may otherwise constitute a threat to a Patient's medical condition.

C. Complaint Resolution. Each Hospital will maintain an effective complaint resolution mechanism regarding use of the Program by Patients and Companions and will maintain records of all complaints filed and actions taken with respect thereto.

D. Prohibition of Surcharges. All appropriate auxiliary aids and services required by this Decree will be provided free of charge to the Patient or Companion who is deaf or hard of hearing.

E. Individual Notice In Absence of Request. If a Patient or a Companion who is deaf or hard of hearing does not request appropriate auxiliary aids or services but Hospital Personnel have reason to believe that such person would benefit from appropriate auxiliary aids or services for effective communication, the Hospital will specifically inform the person that appropriate auxiliary aids and services are available free of charge.

F. Communication with Inpatients and Companions. Each Hospital will take appropriate steps to ensure that all Hospital Personnel having contact with an inpatient or Companion who is deaf or hard of hearing are made aware of such person's disability so that effective communication with such person will be achieved.

II. SIGN LANGUAGE AND ORAL INTERPRETERS

A. Circumstances Under Which Interpreters Will Be Provided. Each Hospital shall provide qualified sign language interpreters to Patients and Companions who are deaf or hard of hearing and whose primary means of communication is sign language, and qualified oral interpreters to such Patients and Companions who rely primarily on lip reading, as necessary for effective communication. The determination of when such interpreters shall be provided to Patients or Companions shall be made as set forth in Section I.B.4. (Assessment) above. The following are examples of circumstances when it may be necessary to provide interpreters:

determination of a Patient's medical history or description of ailment or injury;
provision of Patients' rights, informed consent or permission for treatment;
religious services and spiritual counseling;
explanation of living wills or powers of attorney (or their availability;
diagnosis or prognosis of ailments or injuries;
explanation of procedures, tests, treatment, treatment options, or surgery;
explanation of medications prescribed (such as dosage, instructions for how and when the medication is to be taken, and side effects or food or drug interactions);
explanation regarding follow-up treatments, therapies, test results or recovery
blood donations or apheresis;
discharge instructions;
provision of mental health evaluations, group and individual therapy,⁽⁵⁾ counseling, and other therapeutic activities, including grief counseling and crisis intervention;
explanation of complex billing or insurance issues that may arise; and
educational presentations, such as classes concerning birthing, nutrition, CPR, and weight management.

The foregoing list of circumstances is neither exhaustive nor mandatory, and shall not imply that there are not other circumstances when it may be appropriate to provide interpreters for effective communication nor that an interpreter must always be provided in these circumstances.

B. Chosen Method for Obtaining Interpreters. Each Hospital has authorized The Connecticut Hospital Association ("CHA"), immediately upon entry of this Decree, to enter into a contract with Family Services Woodfield ("FSW")⁽⁶⁾ to establish and operate a program (the "FSW Program") to provide qualified sign language and oral interpreters at the request of the Hospital. The contract will be substantially in the form of Exhibit II.B., attached hereto (the "FSW Contract").

C. Provision of FSW Interpreters in a Timely Manner. Each Hospital shall require FSW to maintain the following response times in at least eighty (80) percent of non-scheduled incidents within any six (6) month period (excluding any incident when the assessment calls for an interpreter to be provided at a later time), measured from the time beginning fifteen (15) minutes after it is determined that an interpreter is necessary for effective communication with a Patient or Companion who is deaf or hard of hearing (or, if earlier, when the request for an interpreter is communicated to FSW):

Hospitals located in the counties of Fairfield, Middlesex, Hartford, and New Haven, one (1) hour.
All other Hospitals, one hour, with a fifteen (15) minute grace period when needed.

In 100% of non-scheduled incidents, FSW's response time shall be two (2) hours or less.

The foregoing response times shall be subject to "force majeure" events, i.e., any response time that is delayed because of a force majeure event shall be excluded from the determination whether the prescribed response criteria have been met. Force majeure events shall be events outside the reasonable control of the Hospital, FSW or the interpreter called to respond, such as weather problems and other Acts of God, unanticipated illness or injury of the interpreter, and unanticipated transportation problems (including without limitation mechanical failure of the interpreter's automobile, automobile accidents, and roadway obstructions).

Furthermore, the foregoing response times have been formulated based on FSW's predictions of the availability of qualified interpreters statewide. During the first six (6) months after the FSW Program begins in each of New London, Tolland, Windham, and Litchfield Counties, FSW shall exert its best efforts to comply with the standard set forth in clause 2 above containing a fifteen (15) minute grace period, but shall not be deemed in breach thereof if it fails to meet such standard provided that it would have met such standard if it included a thirty (30) minute grace period. At the end of said six (6) month period, the Hospitals, CAD (through its attorneys, P&A), and DOJ shall negotiate reasonably and in good faith, based on the facts then known, whether the grace period provided in said clause 2 above should be eliminated, shortened or extended, and this Decree shall be amended accordingly. In the event thereafter that the response time performance standards set forth in clause 1 or clause 2 above cannot be maintained despite the Hospitals' good faith efforts, the Hospitals shall be entitled to request the consent of DOJ and P&A to such modifications of such performance standards as may be reasonable under the circumstances. DOJ and P&A shall consider any such request reasonably and in good faith, and any such modification that is agreed to shall be presented to the Court

for approval and deemed an amendment to this Decree, notice of which shall be given by the Hospitals to all Parties hereto.

D. Phase-In of FSW Program. The FSW Program is to be phased in throughout Connecticut according to the following schedule:

	Service	Implementation Period (Months After Entry of Decree)
1.	Organization, start-up, and initial training	0-3
2.	Hospitals in Hartford, Fairfield, and New Haven Counties	3-6
3.	Hospitals in New London and Middlesex Counties	6-9
4.	Hospitals in Tolland and Windham Counties	9-11
5.	Hospitals in Litchfield County	11-13

E. Notice to Patients and Companions Who Are Deaf or Hard of Hearing. As soon as Hospital Personnel have determined that an interpreter is necessary for effective communication with a Patient or a Companion who is deaf or hard of hearing, and one hour later, the Hospital will inform such person (or a family member or friend, if such person is not available) of the current status of efforts being taken to secure a qualified interpreter on his or her behalf. Additional updates shall be provided thereafter as necessary until an interpreter is secured.

F. Other Means of Communication. Each Hospital agrees that between the time an interpreter is requested and when an interpreter arrives, Hospital Personnel will continue to try to communicate with the Patient or Companion who is deaf or hard of hearing for such purposes and to the same extent as they would have communicated with the person but for the hearing impairment, using all available methods of communication. This provision in no way lessens the Hospitals' obligation to provide qualified interpreters in a timely manner as required by this Decree.

G. Restricted Use of Certain Persons to Facilitate Communication. Due to confidentiality, potential emotional involvement, and other factors that may

adversely affect the ability to facilitate communication, Hospitals shall never require or coerce a family member, companion, case manager, advocate, or friend of a Patient or Companion who is deaf or hard of hearing to interpret or facilitate communications between Hospital Personnel and such Patient or Companion. In any case, such person shall be used to interpret or facilitate communication only if the Patient or Companion who is deaf or hard of hearing does not object, if such person wishes to provide such assistance, and if such use is necessary or appropriate under

the circumstances, giving appropriate consideration to any privacy issues that may arise.

H. Interim and Alternate Procedures.

Initial Period (first 60 days)

Beginning on the date of entry of this Decree and for sixty (60) days thereafter, each Hospital shall take the following steps, in order, when it receives notice that a Patient or Companion requires sign language or oral interpreters for effective communication, until an interpreter is secured or the steps have been exhausted:
1. request an interpreter from FSW;⁽⁷⁾
2. request an interpreter from CDHI (Connecticut Commission for the Deaf and Hearing Impaired);
3. exert reasonable efforts (which shall be deemed to require no fewer than five (5) telephone inquiries) to contact any free-lance interpreters or interpreting agencies already known to the Hospital and request their services; and
4. inform the Patient or Companion who is deaf or hard of hearing (or, if unavailable, the person's companions) of the efforts taken to secure an interpreter and that the efforts have failed, and follow up on reasonable suggestions for alternate sources of interpreters, such as contacting an interpreter known to that person.
Interim Period (Day 61 to onset of FSW Program)

Beginning sixty-one (61) days from the entry of this Decree, and until such time as the FSW Program is available at a Hospital according to the table in Section II.D.1. ("Interim Period"), such Hospital shall develop and maintain, through regular consultation with CAD and RID (Registry of Interpreters for the Deaf), a list of a reasonable number of qualified interpreters residing within 75 miles of the Hospital ("Interpreter List"). This list will include the names of all interpreters and interpreting agencies already known to and deemed satisfactory by the Hospital.

During the Interim Period, each Hospital shall take the following steps, in order, when it receives notice that a Patient or Companion requires sign language or oral interpreters for effective communication, until an interpreter is secured or the steps have been exhausted:
1. request an interpreter from FSW;
2. request an interpreter from CDHI;
3. exert reasonable efforts (which shall be deemed to require no fewer than five (5) telephone inquiries) to obtain an interpreter from the Interpreter List; and
4. inform the Patient or Companion who is deaf or hard of hearing (or, if unavailable, the person's companions), of the efforts taken to secure an interpreter and that those efforts have failed, and follow up on reasonable suggestions for alternate sources of interpreters, such as contacting an interpreter known to that person.
Back-Up Procedures (during use of FSW Program)

During a Hospital's participation in the FSW Program, as soon as it is notified that no qualified interpreter will be available on a timely basis through the FSW Program, whether for reasons set forth in Section II.C. or otherwise, the Hospital shall take the following steps until an interpreter is secured or the steps have been exhausted:
1. request an interpreter from CDHI;
2. exert reasonable efforts (which shall be deemed to require no fewer than five (5) telephone inquiries) to obtain an interpreter from the Interpreter List; and
3. inform the Patient or Companion who is deaf or hard of hearing (or, if unavailable, the person's companions) of the steps taken to secure an interpreter and that those steps have failed, and follow up on all reasonable suggestions for alternate sources of interpreters, such as contacting an interpreter known to that person.
Alternate Procedures (if FSW Program ends)

In the event for any reason that FSW terminates its performance of services to one or more Hospitals, CHA terminates the FSW Contract or FSW materially breaches its obligations under the FSW Contract with respect to one or more Hospitals to such a degree as to raise a substantial question regarding its ability thereafter to perform such obligations consistently and competently with respect to such Hospital(s), the Hospital(s) shall promptly notify the United States and P&A of their intent to replace or supplement the FSW Program with another program designed to achieve the same objectives (the "New Program"). The Hospital(s) shall within ninety (90) days thereafter provide the United States and P&A with a written plan regarding the New Program and shall, as soon as practicable but no later than eight (8) months after the date of notification, fully implement the New Program. Until the New Program is in effect, the obligations of the Hospital(s) will be those described above as "Back-Up Procedures." Upon full implementation of the New Program, the obligations of the Hospital(s) shall be to provide coverage and response times equal to those set forth in Sections II.C. and II.E. through II.H. of this Decree.
Staff Interpreters. A Hospital may, but shall have no obligation to, satisfy its obligations under this Decree (including without limitation regarding the Initial and Interim Periods and the Backup and Alternate Procedures) by hiring or otherwise contracting with qualified staff interpreters. Staff interpreters must meet the definition of "qualified interpreters." Patients and Companions who are provided with staff interpreters must have the same level of coverage (for both duration and frequency) as the Hospital is otherwise obligated to provide under this Decree. Hospitals may assign other duties to staff interpreters. To the extent that a Hospital does not have staff interpreters or a staff interpreter is not available when needed, the Hospital will follow the Interim or Back-Up Procedures described above in Section II.H.2. or II.H.3., as the case may be.

I. Quality Control. Each Hospital shall cause FSW to design and implement, as part of the FSW Program, a system for querying a reasonable and representative sampling of Patients and Companions to whom the Hospital has provided sign language interpreters (using whatever means) regarding whether the interpreters were actually able to effectuate effective communication, given the context of the communications at issue and the communication skills, knowledge, and history of the persons who are deaf or hard of hearing. The Hospital shall cause FSW to maintain appropriate records and take appropriate action with respect to any interpreter who does not provide effective communication. In the event that FSW fails to perform the duties set forth in this Section I, the Hospital shall perform, or shall cause a third party to perform, such duties.

III. TECHNOLOGY

A. Telephones and Related Equipment.

Public Telephones. As soon as practicable but no later than ninety (90) days after the entry of this Decree, each Hospital will provide the following:
1. TTY's in public areas. Each Hospital will make a TTY device available wherever a telephone is made available to the public. There will be at least one TTY available for each bank of four public telephones, but never less than one. To satisfy this provision, a Hospital can permanently install the required TTY's or make available a sufficient number of portable TTY's. Standards §§ 4.1, 4.31.9. Each such TTY, whether permanently installed or portable, shall comply with the Standards set forth in Schedule III.A.1. hereto.
2. TTY's required in specific locations. Each Hospital will provide a TTY at each public telephone location in or adjacent to an emergency department, recovery room, or waiting room. Standards §§ 4.1, 4.31.9. To satisfy this provision, a Hospital can permanently install the required TTY's or make available a sufficient number of portable TTY's. Each such TTY, whether permanently installed or portable, shall comply with the Standards set forth in Schedule III.A.1. hereto.
3. Shelves and outlets. Wherever portable TTY's are made available as an alternative to installed TTY's (at emergency departments, recovery rooms, and waiting rooms, and where there are banks of four or more public telephones), and wherever there is a bank of three or more public telephones, each Hospital will provide shelves and electrical outlets that comply with the Standards set forth in Schedule III.A.1. hereto.
4. Signs indicating the location of TTY's.
  1. Wherever public telephones are available but TTY's are not permanently installed, each Hospital will post signs complying with the Standards set forth in Schedule III.A.1. hereto. Such signs will indicate the location of the nearest portable or permanently installed TTY's; and
  2. Wherever TTY's are permanently installed, each Hospital will post signs complying with the Standards set forth in Schedule III.A.1. hereto to indicate their location.
5. Volume control telephones. Each Hospital will ensure that no less than twenty-five (25) percent of all of its public telephones are equipped with volume control mechanisms, plus at least one public telephone at each of the following locations: in or adjacent to emergency departments, recovery rooms, or waiting rooms. Each volume control telephone shall comply with the Standards set forth in Schedule III.A.1. hereto. Each Hospital will ensure that volume control phones are dispersed among all public telephones throughout the Hospital. Each Hospital will ensure that signs complying with the Standards set forth in Schedule III.A.1. hereto are displayed at each volume control telephone.
6. Hearing aid compatible telephones. Each Hospital will ensure that no less than twenty-five (25) percent of all of its public telephones are hearing aid compatible, plus at least one public telephone at each of the following locations: in or adjacent to emergency departments, recovery rooms, or waiting rooms. Each Hospital will ensure that hearing aid compatible telephones are dispersed among all public telephones throughout the Hospital. Standards § 4.1, 4.31.5.
7. Storage and availability of equipment. Portable equipment for use in public areas shall be stored in places that are readily accessible to all Hospital Personnel who have client contact at all times of the day and night. All Hospital Personnel will be notified of the storage location that is closest to their work area(s). The equipment is to be stored at the appropriate supervised location (e.g., nurses' station, admission desk, etc.) closest to the public phone for which the equipment is to be made available. Such equipment shall be made available to Patients or Companions who are deaf or hard of hearing as soon as practicable but no more than ten (10) minutes from the time of the person's request.
8. Telephones in Patient Rooms. Within ninety (90) days of the entry of this Decree:
  1. Portable access technology - defined. Each Hospital will make available portable access technology. Such technology, as referred to in this section, shall include TTY's with printout capability, visual notification devices for incoming telephone calls, volume control telephones, and telephones that are hearing aid compatible. Each Hospital shall ensure that each volume control telephone and each visual notification device for incoming telephone calls complies with the Standards set forth in Schedule III.A.1. hereto.
  2. Portable access technology - general obligation. Each Hospital will make portable access technology available to Patients and Companions who are deaf or hard of hearing and who are admitted to (or are accompanying Patients who are admitted to) rooms equipped with a telephone. In units of a Hospital where patients normally do not have telephones in their rooms, if hearing patients are given access to common area telephones other than the public phones identified in this Decree, such Hospital will maintain in each such unit appropriate portable access technology that can be used by Patients and Companions who are deaf or hard of hearing so that such persons have equal access to make outgoing calls and receive incoming calls as do hearing persons.
  3. Electrical outlets. Each Patient room with a telephone shall have an electrical outlet within four feet of the telephone connection to facilitate the use of a TTY device, or the Hospital will provide when needed a heavy-duty extension cord for patient rooms that are not so equipped.
  4. Timeliness. Within ninety (90) days of the entry of this Decree, each Hospital will make the equipment required by this section available within thirty (30) minutes of a Patient's arrival in a patient room, regardless of the hour of the day or night. Each Hospital will notify all relevant Hospital Personnel of the availability and location of this equipment.

B. Visual Alarms.

Areas of Common Use. Within ninety (90) days of the entry of this Decree, each Hospital that has audible alarms in public areas will add visual alarms complying with the Standards set forth in Schedule III.B.1. hereto. Public areas include restrooms and any other general usage areas (e.g., meeting rooms, teaching amphitheaters, hallways, lobbies, cafeterias, and any other area for common use).
1. Exception. To the extent that the present capabilities of an existing audible alarm system are not sufficient to handle an electrical load that would allow a retrofit to include visual alarms without extensive re-wiring, such visual alarms will be added within two (2) years of the entry of this Decree.
2. This exception does not apply to any Hospital or area of a Hospital that is subject to the new construction or alterations provisions of the ADA (for John Dempsey, which is subject to title II of the ADA: 42 U.S.C. §§ 12146, 47; 28 C.F.R. § 35.151) (for Hospitals which are subject to title III of the ADA: 42 U.S.C. § 12183(a)(1), (2); 28 C.F.R. §§ 36.401 (new construction), 36.402 (alterations)). Such Hospitals or areas of Hospitals that should already comply with such Standards and which presently do not comply with such Standards (or, to the extent that John Dempsey has chosen the Uniform Federal Accessibility Standards, or "UFAS," as its governing design standards, UFAS § 4.28.3), will be retrofitted within one hundred eighty (180) days of the entry of this Decree, without regard to the expense or difficulty of such retrofit.
Patient Rooms. Within ninety (90) days of the entry of this Decree, each Hospital will make portable visual alarms available for patient rooms when a Patient or Companion who is deaf or hard of hearing is residing in or is anticipated to spend significant periods of time in such a room. This requirement only applies to those patient rooms in which hearing Patients are reasonably able to hear an audible alarm, whether the audible alarm speaker is located in the room itself, in the hallway, or in another relatively close location. Each Hospital shall ensure that each patient room into which a visual alarm is to be placed complies with the Standards set forth in Schedule III.B.1. hereto.
Exceptions.
1. Standard health care alarm design practices. Placement of visual alarms may be modified to suit any standard health care alarm design practices employed by the Hospital. Hospitals shall not be required to provide visual alarms in areas where Patients would not normally be expected to evacuate themselves in the event of an emergency, such as a neo-natal intensive care unit.
2. Health considerations. Hospitals shall not be required to provide portable visual alarms in a patient room if a person who may suffer from seizures that may be triggered by a visual alarm is reasonably expected to spend significant amounts of time in the room.

C. Captioning and Decoders.

Televisions and Caption Decoders. Within ninety (90) days of the entry of this Decree, each Hospital will make closed captioning decoders available to Patients or Companions who are deaf or hard of hearing as part of available television services at no additional cost, except for televisions that have the built-in capability to display captions. 28 C.F.R. § 36.303(e).
1. Clearly stated directions for use of the closed caption capability shall be in the Patient Handbook (or equivalent publication) or otherwise available in each patient room or public area containing a television with captioning capability. The directions for operating the closed caption function shall also accompany all closed caption decoders for standard television sets.
Duty to Provide Programs in a Manner That is Accessible to Persons With Hearing Impairments.
1. It is expressly agreed that no Hospital has an obligation to provide captions on any program broadcast over the public airways or commercial cable television services, where such captions are not already integrated into the program.
2. Beginning no later than ninety (90) days from the entry of this Decree, each Hospital that solicits a third party, parent company, or affiliated health care provider to produce or provide video programs that may be broadcast within the Hospital to Patients or Companions who are deaf or hard of hearing will ensure that the program is captioned, unless, under the circumstances, doing so would impose an undue burden. 28 C.F.R. § 35.164, 28 C.F.R. § 36.303. Commercial videos available to the general public shall not be subject to this requirement.
3. Beginning no later that ninety (90) days from the entry of this Decree, each Hospital that produces internally a pre-recorded program for broadcast within the Hospital will ensure that the program is made accessible to Patients and Companions who are deaf or hard of hearing, whether by captioning such program or by providing a transcript or sign language interpreter whenever it is viewed by a Patient or Companion who is deaf or hard of hearing. If the program is not captioned, the method of access delivery must be tailored to the needs of the Patient or Companion who is deaf or hard of hearing. For instance, if the person does not know sign language, the Hospital may provide effective communication through a transcript. In most circumstances, captioning will be regarded as providing effective communication with all persons who are deaf or hard of hearing, regardless of the communication skills and history of such persons (though repeated screenings may be necessary, if the person who is deaf or hard of hearing cannot read English at the rate required to keep pace with the audible portion of the program). If, however, the contents of a program are sufficiently important to require precise communication of its contents, the Hospital will take additional measures to ensure effective communication.
4. Beginning no later than ninety (90) days from the entry of this Decree, each Hospital that produces its own live broadcasts will make most such programs as accessible to Patients and Companions who are deaf or hard of hearing as they are to others. Captioning is one way, but not the only way, to make such programs accessible to Patients and Companions who are deaf or hard of hearing. Hospitals can also choose to provide sign language interpreters (if the person who is deaf or hard of hearing uses sign language) or written scripts prepared in advance of the live broadcast. In order to determine which programs should be captioned, a Hospital may prioritize and consider such factors as the importance and length of the program, as well as any significant difficulty or expense in captioning the program or displaying the captions, given the location of its filming or viewing.

D. Client Education. Each Hospital shall ensure that each Patient and Companion who is deaf or hard of hearing who is provided with portable access technology is appropriately directed as to the proper use of such equipment.

E. Acquisition of Additional Equipment. In addition to the equipment required above, each Hospital shall purchase and/or rent such additional equipment as is reasonably needed to replace defective units. Each Hospital shall also monitor developments in technology and shall upgrade such equipment when and if it deems it reasonable and appropriate to do so.

IV. NOTICE TO COMMUNITY

A. Policy Statement. Within ninety (90) days of the entry of this Decree, each Hospital shall post and maintain signs of conspicuous size and print at all Hospital admitting stations, the emergency department, and wherever a Patient's Bill of Rights is required by law to be posted. Such signs shall be to the following effect:

Sign language and oral interpreters, TTY's, and other auxiliary aids and services are available free of charge to people who are deaf or hard of hearing. For assistance, please contact any Hospital personnel or the Information Office at ____________ (voice/TTY), room ____________.

These signs will include the international symbols for "interpreters" and "TTY's." An example is attached hereto as Exhibit IV A.

B. Advertisements. Within ninety (90) days of the entry of this Decree, each Hospital will take appropriate steps to publicize in the community the Hospital's commitment to provide all of its services to Patients and Companions who are deaf or hard of hearing. Such publicity shall be deemed satisfied by the purchase of reasonable advertising space at least twice in newspapers of general circulation serving the same community as is served by the Hospital, which advertisements include a statement that all appropriate auxiliary aids and services, including qualified sign language interpreters and TTY's, will be provided free of charge upon request, and include appropriate instructions regarding access to the Information Office at each Hospital. Annually thereafter, the Hospitals shall take reasonable steps to publicize the existence of the Program to the deaf and hard of hearing community. Hospitals are specifically permitted to share resources to satisfy the provisions of this Section, including the publication of advertisements in newspapers of statewide circulation.

C. Patient Handbook. Each Hospital will include in all future printings of its Patient Handbook (or equivalent) and all similar publications a statement to the following effect:

"To ensure effective communication with Patients and their companions who are deaf or hard of hearing, we provide appropriate auxiliary aids and services free of charge, such as: sign language and oral interpreters, TTY's, notetakers, computer-assisted real time transcription services, written materials, telephone handset amplifiers, assistive listening devices and systems, telephones compatible with hearing aids, closed caption decoders, and open and closed captioning of most Hospital programs.

Please ask your nurse or other Hospital personnel for assistance, or contact the Information Office at _________________ (voice or TTY), room ___________________."

V. NOTICE TO HOSPITAL PERSONNEL AND PHYSICIANS

Each Hospital shall publish, in an appropriate form, a written policy statement regarding the Hospital's policy for effective communication with persons who are deaf or hard of hearing. The policy statement shall include, but is not limited to, language to the following effect:

"If you recognize or have any reason to believe that a patient, relative, or a close friend or companion of a patient is deaf or hard of hearing, you must advise the person that appropriate auxiliary aids and services will be provided free of charge. 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 Program Administrator. This offer and advice must likewise be made in response to any overt request for appropriate auxiliary aids or services."

Each Hospital will distribute this document within sixty (60) days of the entry of this Decree to all Hospital Personnel and affiliated physicians (physicians with practicing or admitting privileges), and to all new Hospital Personnel and newly affiliated physicians upon their affiliation or employment with the Hospital.

VI. TRAINING OF HOSPITAL PERSONNEL

A. Comprehensive Training. Pursuant to the FSW Contract, each Hospital will require FSW to provide one or more one-day training sessions for the Hospital (which can be held at CHA headquarters or the Hospital, and which can also service other Hospitals) prior to the date on which the Hospital is scheduled to join the FSW Program and annually thereafter. If FSW fails to provide the training as required under its contract with CHA, the Hospitals will substitute substantially similar training provided by another entity as soon as practicable, but within four (4) months.

Content. Such training shall be sufficient in duration and content to train a reasonable number of Hospital Personnel in access to the Program, use of the Program, and sensitivity to the needs of the deaf community. Such training shall include topics relevant to the health care needs of the deaf and hard of hearing, such as the various degrees of hearing impairment, language and cultural diversity in the deaf community, dispelling myths and misconceptions about persons who are deaf, identification of communication needs of persons who are deaf, the unique needs and problems encountered by late-deafened individuals, psychological implications of deafness and its relationship to interaction with hearing health care professionals, recommended and required charting procedures, types of auxiliary aids and services as required under this Decree,⁽⁸⁾ the proper use and role of qualified sign language interpreters, procedures and methods for accessing the FSW Program for providing sign language interpreters, as well as use of CDHI and free-lance interpreters, the existence in each Hospital of an Information Office and Program Administrators, making and receiving calls through TTY's and the Connecticut Relay or other relay service providers, third party resources which can provide additional information about people who are deaf or hard of hearing, the existence of the Hospital's complaint resolution process, and any other requirements of this Decree applicable to such Hospital Personnel.
Mandatory Nature of Training for Certain Personnel. Each Hospital will make this training mandatory for the following categories of Hospital Personnel:
1. All personnel who work or volunteer in the Information Office;
2. All Program Administrators; and
3. All persons who will be responsible for training other Hospital Personnel concerning the Program.
Training Sources Other than FSW. Each Hospital may choose an entity other than FSW to provide the required initial training, so long as the entity is approved by the United States or P&A to provide this training (which approval will not be unreasonably withheld). A Hospital may choose to discharge its training obligation by requiring appropriate personnel to view a videotape that covers the training topics required by this Decree for that audience.

B. Emergency Department Personnel. In addition to the subjects specified in Section A above, each Hospital will provide special mandatory in-service⁽⁹⁾ training to Hospital Personnel with patient responsibility who work or volunteer in the Emergency Department that addresses the special needs of deaf and hard of hearing Patients and Companions utilizing that department. This training will include the following objectives: to promptly identify communication needs and preferences of persons who are deaf or hard of hearing; to secure qualified interpreter services as quickly as possible when necessary; and to use, when appropriate, flash cards and pictographs (in conjunction with any other available means of communication that will augment the effectiveness of the communication). Such training shall be provided prior to the date on which the Hospital is scheduled to join the FSW Program and annually thereafter.

C. Psychiatric Personnel and Social Workers. In addition to the subjects specified in Section A above, each Hospital will provide specialized mandatory in-service training to Hospital Personnel with patient responsibility who work in the Department of Psychiatry (or its equivalent, if any) or are members of the Social Work Department (or its equivalent). This training will include the following objectives: to promptly identify communication needs and preferences of Patients and Companions who are deaf or hard of hearing; to secure qualified interpreter services as quickly as possible when necessary; and to facilitate appropriate interaction between Patients who are deaf or hard of hearing and other Patients, when appropriate (e.g., group therapy sessions and other times when interaction with persons other than Hospital Personnel is encouraged). Such training shall be provided prior to the date on which the Hospital is scheduled to join the FSW Program and annually thereafter.

D. Other Key Personnel. Special training will be given to the following Hospital Personnel not otherwise trained as provided above: all clinical directors and nursing supervisors; personnel who staff the Admission desk (or its equivalent for in-patient registration), the Central Registry desk (or its equivalent for out-patient registration), and the General Information desk; all triage nurses and other triage professionals; and all heads of each department in which communication with Patients occurs. Such training will cover all of the subject matters listed above in Section A. Such training shall be provided prior to the date on which the Hospital is scheduled to join the FSW Program and annually thereafter.

E. Operators. All Hospital Personnel who receive incoming telephone calls from the public will receive special instructions on using TTY's and the Connecticut Relay or similar services to make and receive telephone calls.

F. Affiliated Physicians.

Training Sessions. Each Hospital will annually conduct one or more training sessions on the communication and psychological needs of persons who are deaf or hard of hearing, and will invite all physicians who are affiliated in any way with the Hospital (admitting or surgical privileges, etc.) to attend. Training videotapes that contain substantially similar information shall also be provided to any affiliated physician upon request.
Written materials. Within ninety (90) days of the entry of this Decree, each Hospital will distribute a set of materials to all affiliated physicians. These materials will contain at least the following: the Hospital's policy statement and any relevant forms; a description of the Program; and a request that physicians' staff members notify the Hospital of those Patients and Companions who are deaf or hard of hearing as soon as they schedule admissions, tests, surgeries, or other health care services at the Hospital.

G. Others. Each Hospital will develop and implement an internal program that will provide appropriate training to all Hospital Personnel not trained under the preceding sections. This training will take place at such times as may be necessary to permit the Hospital to meet all of its obligations under this Decree.

H. General Provisions. Each Hospital will provide the training specified above to new Hospital Personnel (including without limitation Emergency Department, Psychiatric and Social Work personnel) within a reasonable time after the commencement of their services for the Hospital. Such training shall be comparable to training provided to specific departments as necessary. A screening of a video of the original training will suffice to meet this obligation.

VII. REPORTING, MONITORING AND VIOLATIONS

FSW Reports. Each Hospital will require FSW, under the FSW Contract, to keep appropriate records to document response times for each request for interpreters, and to provide such documentation to the Hospital upon request. Each Hospital shall provide such documentation to DOJ and P&A upon reasonable written notice. In the event FSW is unable to meet its obligations under this Section, the Hospitals shall without delay comply with the remaining terms of this Section.
Hospital Compliance Reports. Three (3), nine (9), fifteen (15) and twenty-one (21) months following the entry of this Decree, and annually thereafter, each Hospital shall provide a written report (a "Report") to DOJ and P&A regarding its efforts to comply with this Decree. Each Report shall take the form of, or provide similar information to, the sample report attached hereto as Exhibit VII. B. Each Hospital shall make the most recent three Reports available for public inspection in the Information Office. Each Hospital shall maintain appropriate records to document the information contained in the Report.
Right of Compliance Review. During the term of this Decree, the United States may, upon reasonable advance notice to a Hospital's Information Office from time to time, inspect the Hospital premises and review the Hospital's compliance with this Decree. As a part of such review, the United States may, with reasonable notice and in a reasonable manner that protects patient confidentiality rights and avoids interfering with patient care and other hospital services, require the Hospital to permit the United States to interview Hospital Personnel, Class Members, and other persons with knowledge relating to implementation of this Decree, to the extent reasonably necessary to determine whether the Hospital is complying with the provisions of this Decree. Each Hospital will retain (or cause FSW to retain) during the life of this Decree all records required to be maintained by this Decree. Each Hospital will produce such records for the purpose of photocopying if and when requested by the United States, unless doing so would unduly burden or disrupt the Hospital's normal business operations, in which case the Hospital will identify the burdens or disruptions and make a good faith effort to cooperate with the United States to ameliorate those disruptions or burdens while allowing the United States appropriate access to the records. No such records shall be produced in violation of applicable law or without any legally required consents, and any records containing confidential information that are produced shall be kept confidential by the United States. Anything to the contrary in this Section VII.C. notwithstanding, nothing herein is intended to, nor shall, limit, extend or expand the investigatory or compliance review powers of the United States otherwise provided by law.
Violation of Decree.
1. If any Hospital violates this Decree or any subpart of this Decree, the Parties shall have such remedies as are allowed by law, provided that the first such violation by a Hospital shall be deemed a first violation of the ADA for the purpose of calculating civil penalties, if any.
2. Notwithstanding the provisions of Section 1 above, in the event that any Party believes that a Hospital has violated any provision of this Decree, such Party shall give notice (including reasonable particulars) of such violation to such Hospital's chief executive officer, and such Hospital shall then respond to such notice and/or cure such non-compliance as soon as practicable but no later than 30 days thereafter. Any event of non-compliance that prevents or restricts a Patient from receiving urgent health care services shall be cured without delay. The Parties shall negotiate in good faith in an attempt to resolve any dispute relating thereto before seeking relief under Section 1 above.

VIII. COMPENSATORY AND INJUNCTIVE RELIEF FOR NAMED
PLAINTIFFS AND UNITED STATES COMPLAINANTS

The Hospitals will jointly deliver a check in the amount of $136,000 payable to the Office of Protection and Advocacy, Trustee.

Within ten (10) days of the entry of this Decree, the Hospitals will send by certified mail, return receipt requested, checks totalling $217,000 to the individuals and in the amounts shown on Exhibit VIII-1 hereto (to be filed under seal). These checks are compensation for alleged discrimination against United States Complainants who are deaf or hard of hearing or non-disabled persons associated with persons who are deaf or hard of hearing, and for one person on the basis of retaliation. Simultaneous with the mailing of the checks, the Hospitals will provide to the Department of Justice copies of the checks for its records.

Within thirty (30) days of the entry of this Decree, New Britain General Hospital and Bridgeport Hospital shall provide certain United States Complainants and Named Plaintiffs with the information set forth in Exhibit VIII-2 hereto.

IX. RELEASES

Within five (5) days of the entry of this Decree, the Attorney General will deliver a release, substantially in the form of Exhibit IX.A. hereto, releasing the claims against each of the Hospitals as more fully set forth therein.
Within five (5) days of the entry of this Decree, the United States will deliver appropriate releases to counsel for each of the Hospitals on behalf of its complainants or, in the case of minors, by their parents or guardians. The releases will be substantially in the form of Exhibit IX.B. hereto.
Within five (5) days of the entry of this Decree, CAD and the Named Plaintiffs will each execute and deliver appropriate releases to counsel for each of the Hospitals. The releases will be substantially in the form of Exhibit IX.C. hereto.
DOJ, P&A, and CAD each warrants that: (1) as of the date on which it signed this Consent Decree, it is not aware of any Class Member who may have a basis for a claim against any Hospital subject to this Decree based on an alleged failure to provide effective communication to a Patient or Companion, except for those identified in Exhibits VIII-1 and IX.D.; and (2) it will not seek additional damages on behalf of any Class Member who has, or who may have, the basis for a claim against any Hospital subject to this Decree, which is based on an alleged failure to provide effective communication to a Patient or Companion, if the discrimination is alleged to have taken place prior to the date of entry of this Consent Decree, or thereafter with respect to acts or omissions of a Hospital that conform to its obligations hereunder. Except as otherwise provided in this Decree, these warranties do not extend to future acts of discrimination or retaliation, or subjects not covered by this Decree.
Any and all claims, proceedings, and causes of action for damages, penalties, attorneys fees, interest, costs, declaratory, injunctive or other relief arising out of the transaction or series of transactions that gave rise to this action and not expressly provided for by this Decree, except for those expressly reserved in the releases to be executed under Sections A, B and C above, are dismissed with prejudice.

X. MISCELLANEOUS

Disclaimer of Liability. Nothing in this Decree shall be construed as an admission by the Hospitals of any liability or fault, that they engaged in any wrongful or illegal activity, that any of the facts and allegations contained in the CAD Complaint or the United States' Complaint in Intervention are true, or that any person suffered any injury as a result of the events described in Plaintiffs' allegations. This Decree shall not be offered or received in evidence in any action or proceeding in any court or other tribunal as an admission or concession of liability or wrongdoing of any nature on the part of the Hospitals, except in an action challenging a Hospital's compliance with this Decree.
Term of the Decree. The United States District Court for the District of Connecticut shall retain jurisdiction over this action for the purpose of ensuring compliance and enforcing the provisions of this Decree for five (5) years from the date hereof, after which time its provisions shall be terminated unless the Court determines, based on findings of non-compliance of any or all of the Hospitals, that it is necessary to extend any of its requirements, in which case those requirements, after hearing, may be extended subject to the requirements of equity.
Execution of Decree. The undersigned counsel represent that they have been fully authorized by their clients to enter into and execute this Consent Decree, under the terms and conditions contained herein.
Public Agreement. This Consent Decree, along with its exhibits (except those filed under seal), constitutes a public agreement and a copy of the Consent Decree, or any information concerning its contents (except where sealed), may be made available to any person.
Changing Circumstances. During the five (5) years in which this Decree will be in effect, there may be a change in circumstances such as, for example and without limitation, an increased or decreased availability of qualified sign language or oral interpreters or developments in technology to assist or improve communications with persons who are deaf or hard of hearing. If a Hospital determines that such changes create opportunities for communicating with Patients and Companions who are deaf or hard of hearing more efficiently or effectively than is required under this Decree, or create difficulties not presently contemplated in the provision of appropriate auxiliary aids and services, it may propose changes to this Decree by presenting written notice to DOJ and P&A. Such changes will then only be presented to the Court for incorporation in this Decree if DOJ and P&A, upon review, grant their approval, which approval will not be unreasonably withheld. All Parties shall negotiate in good faith prior to proposing any changes to the Court.
Binding. This Decree is final and binding on the Parties, including all principals, agents, executors, administrators, representatives, successors in interest, beneficiaries, assigns, heirs and legal representatives thereof. Each Party has a duty to so inform any such successor in interest.
Non-Waiver. Failure by any Party to seek enforcement of this Decree 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.
Counterparts. This Consent Decree may be executed in one or more counterparts, each of which shall be deemed to be an original but all of which together shall constitute one and the same instrument.
Compliance. A Hospital that performs its obligations under this Decree shall be deemed by all Parties to have fulfilled its obligations under the ADA, the Rehabilitation Act, and Connecticut General Statutes §§ 46a-64 et seq. regarding communication with Patients and Companions who are deaf or hard of hearing, for purposes of any remedy that may be available to the Parties for any alleged violation of such obligations by such Hospital.
Discrimination by Association. No Hospital will deny equal services, accommodations, or other opportunities to any individual because of the known relationship of the person with someone who is deaf or hard of hearing.
Retaliation and Coercion. Each Hospital agrees not to retaliate against or coerce in any way any person who is trying to exercise his or her rights under this Decree or the ADA.
Non-Discrimination. No Hospital shall deny its goods or services to any prospective or actual Class Member based on the fact that the person is deaf or hard of hearing or is associated with someone known to be deaf or hard of hearing.
Severability. In the event that the Court shall determine that any provision of this Decree is unenforceable, such provision shall be severed from this Decree and all other provisions shall remain valid and enforceable, provided, however, that if the severance of any such provision shall materially alter the rights or obligations of the Parties hereunder, they shall, through reasonable, good faith negotiations, agree upon such other amendments hereto as may be necessary to restore the Parties as closely as possible to the relative rights and obligations initially intended by them hereunder.

IN WITNESS WHEREOF, the undersigned counsel of record, AGREE and CONSENT to the form, content, and entry of this Consent Decree on this ______ day of _____________, 1998:

PLAINTIFFS
CONNECTICUT ASSOCIATION OF THE DEAF,
KAREN AVENA, LINDA BASEHORE, JANE DOES
I-VI INCLUSIVE, MICHAEL E. FIORINO, JUNE
FREEMAN, JANICE M. STIFFLER, DORIS
SIMONS AS EXECUTRIX OF THE ESTATE OF
JOSEPH SIMONS

By: ______________________________________
    Aileen M. Bell, Esq.
    Catherine E. Cushman, Esq.
    Elam Lantz, Esq.
    Gwendolyn K. McDonald, Esq.
    Office of Protection and Advocacy for
    Persons with Disabilities
    60B Weston Street
    Hartford, CT 06120-1551
    (860) 297-4330

PLAINTIFF - INTERVENOR

By: ______________________
     Stephen C. Robinson,
     U.S. Attorney
     John B. Hughes
     Assistant U.S. Attorney
     Chief, Civil Division
     Lauren M. Nash
     Assistant U.S. Attorney
     Connecticut Financial Center
     157 Church Street
     New Haven, CT 06510

THE UNITED STATES OF AMERICA

By: ______________________________________
     Bill Lann Lee, Acting Assistant Attorney General
     John L. Wodatch, Section Chief
     Renee M. Wohlenhaus, Acting Deputy Chief
     Mary Lou Mobley, Trial Attorney
     Robert J. Mather, Trial Attorney
     Bruce Friedman, Trial Attorney
     Katherine Nicholson, Trial Attorney
     Robin C. Deykes, Investigator
     United States Department of Justice
     Civil Rights Division
     Disability Rights Section
     P.O. Box 66738
     Washington, DC 20035-6738
     (202) 307-0663

DEFENDANTS
MIDDLESEX HOSPITAL

By: ________________________________
Name: Gregory B. Nokes, Esq.
Name of Firm: Cummings & Lockwood

DAY KIMBALL HOSPITAL

By: ______________________________
Name: Penny Q. Seaman, Esq.
Name of Firm: Wiggin & Dana

JOHN DEMPSEY HOSPITAL

By: ______________________________

     Name: William N. Kleinman, Esq.
     Name of Firm: Assistant Attorney General
     University of Connecticut
     Health Center

THE WATERBURY HOSPITAL

By: ________________________________
Name: Paul S. Tagatac, Esq.
Name of Firm: Carmody & Torrance

YALE-NEW HAVEN HOSPITAL

By: ________________________________
Name: Penny Q. Seaman, Esq.
< Name of Firm: Wiggin & Dana

THE WILLIAM W. BACKUS HOSPITAL

By: ________________________________
Name: Penny Q. Seaman, Esq.
Name of Firm: Wiggin & Dana

HARTFORD HOSPITAL

By: ________________________________
Name: Robert L. Wyld, Esq.

Name of Firm: Shipman & Goodwin

CONNECTICUT CHILDREN'S
MEDICAL CENTER

By: ________________________________
Name: Theodore J. Tucci, Esq.
Name of Firm: Robinson & Cole

NORWALK HOSPITAL

By: ________________________________
Name: Frank W. Murphy, Esq.
Name of Firm: Tierney, Zullo, et al.

SAINT FRANCIS HOSPITAL
AND MEDICAL CENTER

By: ________________________________
Name: Penny Q. Seaman, Esq.
Name of Firm: Wiggin & Dana

BRIDGEPORT HOSPITAL

By: ________________________________
Name: Penny Q. Seaman, Esq.
Name of Firm: Wiggin & Dana

LAWRENCE & MEMORIAL HOSPITAL

By: ________________________________
Name: Penny Q. Seaman, Esq.
Name of Firm: Wiggin & Dana

NEW BRITAIN GENERAL HOSPITAL

By: ________________________________
Name: Penny Q. Seaman, Esq.
Name of Firm: Wiggin & Dana

ST. MARY'S HOSPITAL

By: ________________________________
Name: Penny Q. Seaman, Esq.
Name of Firm: Wiggin & Dana

BRADLEY MEMORIAL HOSPITAL & HEALTH CENTER

By: ________________________________
Name: Penny Q. Seaman, Esq.
Name of Firm: Wiggin & Dana

BRISTOL HOSPITAL, INC.

By: ________________________________
Name: Penny Q. Seaman, Esq.
Name of Firm: Wiggin & Dana

THE DANBURY HOSPITAL

By: ________________________________
Name: Penny Q. Seaman, Esq.
Name of Firm: Wiggin & Dana

GREENWICH HOSPITAL

By: ________________________________
Name: Penny Q. Seaman, Esq.
Name of Firm: Wiggin & Dana

GRIFFIN HOSPITAL

By: ________________________________
Name: Penny Q. Seaman, Esq.
Name of Firm: Wiggin & Dana

THE CHARLOTTE HUNGERFORD HOSPITAL

By: ________________________________
Name: Penny Q. Seaman, Esq.
Name of Firm: Wiggin & Dana

JOHNSON MEMORIAL HOSPITAL

By: ________________________________
Name: Penny Q. Seaman, Esq.
Name of Firm: Wiggin & Dana

MANCHESTER MEMORIAL HOSPITAL

By: ________________________________
Name: Penny Q. Seaman, Esq.
Name of Firm: Wiggin & Dana

MILFORD HOSPITAL

By: ________________________________
Name: Penny Q. Seaman, Esq.
Name of Firm: Wiggin & Dana

NEW MILFORD HOSPITAL

By: ________________________________
Name: Penny Q. Seaman, Esq.
Name of Firm: Wiggin & Dana

ROCKVILLE GENERAL HOSPITAL

By: ________________________________
Name: Penny Q. Seaman, Esq.
Name of Firm: Wiggin & Dana

ST. JOSEPH MEDICAL CENTER

By: ________________________________
Name: Penny Q. Seaman, Esq.
Name of Firm: Wiggin & Dana

THE HOSPITAL OF SAINT RAPHAEL

By: ________________________________
Name: Penny Q. Seaman, Esq.
Name of Firm: Wiggin & Dana

ST. VINCENT'S MEDICAL CENTER

By: ________________________________
Name: Penny Q. Seaman, Esq.
Name of Firm: Wiggin & Dana

SHARON HOSPITAL, INC.

By: ________________________________
Name: Penny Q. Seaman, Esq.
Name of Firm: Wiggin & Dana

THE STAMFORD HOSPITAL

By: ________________________________
Name: Penny Q. Seaman, Esq.
Name of Firm: Wiggin & Dana

VETERANS MEMORIAL MEDICAL CENTER

By: ________________________________
Name: Penny Q. Seaman, Esq.
Name of Firm: Wiggin & Dana

WINDHAM HOSPITAL

By: ________________________________
Name: Penny Q. Seaman, Esq.
Name of Firm: Wiggin & Dana

Having read and considered the foregoing, and good cause appearing, IT IS ORDERED that this Motion be GRANTED and the Consent Decree ADOPTED and ENTERED by this Court as final disposition of this case.

So ordered,

____________________________ ____________
The Honorable Thomas Smith, Date
United States Magistrate Judge
for the District of Connecticut

____________________________ ____________
The Honorable Allan H. Nevas Date
United States District Judge
for the District of Connecticut

INDEX OF SCHEDULES and EXHIBITS

Schedules

III.A.1. Certain TTY and Telephone Standards

III.B.1. Certain Visual Alarm Standards

Exhibits

II.B. FSW Contract

IV.A. Example of Sign

VII.B. Hospital Compliance Report

VIII-1 Certain Information

VIII-2 Certain Information

IX.A. United States Release

IX.B. United States Complainants Release

IX.C. CAD and Named Plaintiffs Release

IX.D. Certain Known Class Members

SCHEDULE III.A.1

I. TTY's in Public Areas and Specific Locations

If an acoustic coupler is used for a permanently affixed TTY, the telephone cord shall be sufficiently long to allow connection of the TTY and the telephone receiver.
& If an acoustic coupler is used for a portable TTY, the telephone handset cord shall be sufficiently long so as to allow connection of the TTY and the telephone receiver.

II. Shelves and Outlets

Telephones designed to accommodate a portable TTY shall be equipped with a shelf and an electrical outlet within or adjacent to the telephone enclosure. The telephone handset shall be capable of being placed flush on the surface of the shelf. The shelf shall be capable of accommodating a TTY and shall have 6 in (152 mm) minimum vertical clearance in the area where the TTY is to be placed.

III. Signs Indicating Location of TTY's

TTYs shall be identified by the international TTY/TDD symbol:

(Symbols not Available on Computer version of purposed Consent
At all public telephone locations, signs posted to indicate the availability of permanently affixed TTYs and signs which provide direction to or information about the location of TTYs shall satisfy the following requirements:
1. Character Proportion. Letters and numbers on signs shall have a width-to-height ratio between 3:5 and 1:1 and a stroke-width-to-height ratio between 1:5 and 1:10.
2. Character Height. Characters and numbers on signs shall be sized according to the viewing distance from which they are to be read.If a sign is to be suspended overhead, the minimum height shall be 3 inches (or 75 mm), as measured using an upper case X. Lower case characters are permitted.
3. Raised and Brailled Characters and Pictorial Symbol Signs (Pictograms). Letters and numerals shall be raised 1/32 in., uppercase, sans serif or simple serif type and shall be accompanied withGrade 2 Braille. Raised characters shall be at least 5/8 in (16 mm)high, but no higher than 2 in (50 mm). Pictograms shall be accompanied by the equivalent verbal description placed below the pictogram. The border dimension of the pictogram shall be 6 in (152 mm) minimum in height.
4. Finish and Contrast. The characters and background of signs shall be eggshell, matte, or other non-glare finish. Characters and symbols shall contrast with their background - either light characters on a dark background or dark characters on a light background.
5. Mounting Height and Location. Mounting height shall be 60 in (1525 mm) above the finish floor to the centerline of the sign. Mounting location for such signage shall be so that a person may approach within 3 in (76 mm) of signage without encountering protruding objects or standing within the swing of a door.

IV. Volume Control

Telephones required to have a volume control shall be identified by a sign containing a depiction of a telephone handset with radiating sound waves. These signs shall comply with the requirements set forth in Section III.B. above.
Public area and patient room telephones required to have a volume control shall be capable of a minimum of 12 dbA and a maximum of 18 dbA above normal volume. If an automatic reset is provided then 18 dbA. may be exceeded.

SCHEDULE III.B.1

I. Visual Alarms

Emergency warning systems in medical facilities may be modified to suit standard health care alarm design practice.
Visual alarm signal appliances shall be integrated into the building or facility alarm system. If single station audible alarms are provided then single station visual alarm signals shall be provided. Visual alarm signals shall have the following minimum photometric and location features:
1. The lamp shall be a xenon strobe type or equivalent.
2. The color shall be clear or nominal white (i.e., unfiltered or clear filtered white light).
3. The maximum pulse duration shall be two-tenths of one second (0.2 sec) with a maximum duty cycle of 40 percent. The pulse duration is defined as the time interval between initial and final points of 10 percent of maximum signal.
4. The intensity shall be a minimum of 75 candela.
5. The flash rate shall be a minimum of 1 Hz and a maximum of 3 Hz.
6. The appliance shall be placed 80 in (2030 mm) above the highest floor level within the space or 6 in (152 mm) below the ceiling, whichever is lower.
7. In general, no place in any room or space required to have a visual signal appliance shall be more than 50 ft (15 m) from the signal (in the horizontal plane). In large rooms and spaces exceeding 100 ft (30m) across, without obstructions 6 ft (2m) above the finish floor, such as auditoriums, devices may be placed around the perimeter, spaced a maximum 100 ft (30 m) apart, in lieu of suspending appliances from the ceiling
8. No place in common corridors or hallways in which visual alarm signaling appliances are required shall be more than 50 ft (15 m) from the signal.
Patient rooms into which portable visual alarms are to be placed shall have a standard 110-volt electrical receptacle into which such alarm can be connected and a means by which a signal from the building emergency alarm system can trigger such a portable alarm. When visual alarms are in place the signal shall be visible in all areas of the unit or room. Instructions for use of the auxiliary alarm or receptacle shall be provided.
Visual notification devices for incoming telephone calls shall not be connected to auxiliary visual alarm signal appliances.

EXHIBIT II.B.
AGREEMENT

This Agreement (the "Agreement") is made as of May 26, 1998 (the "Effective Date") by and among The Connecticut Hospital Association, Incorporated, a Connecticut non-stock corporation with its principal place of business at 110 Barnes Road, Wallingford, Connecticut 06492-0090 ("CHA"), and Family Services Woodfield, a Connecticut non-stock corporation with its principal place of business at 475 Clinton Avenue, Bridgeport, Connecticut 06605 ("FSW").

RECITALS:

CHA is a non-profit membership organization whose members include acute-care hospitals ("Hospitals") and other institutional health care providers (together with Hospitals, "Members") located throughout the State of Connecticut.
FSW is a non-profit family services agency accredited by the National Council on Accreditation of Services for Families and Children, Inc., providing, among other services, communication services for deaf and hearing-impaired persons ("Interpreter Services").
CHA is desirous of making Interpreter Services available for patients and other persons being served by its Hospitals and other Members, and FSW is willing to provide such services on the terms and conditions set forth in this Agreement.

Therefore, in consideration of the foregoing and of the mutual covenants contained in this Agreement, CHA and FSW hereby agree as follows:

Program Design.

1.1 FSW shall design a program (the "Program") for the provision of Interpreter Services to deaf patients and other persons in need of such services at each Member's location in Connecticut. The Hospitals and other Members who elect to participate in the Program, as provided in Section 1.3 below, are referred to herein as "Participants." Upon final approval of CHA of the Program design, FSW shall commence the provision of services on a phased basis as set forth below:

	Service	Implementation Period (Months After Effective Date)
a.	Organization, start-up, and initial training	0-3
b.	Hartford, fairfield and New Haven Counties	3-6
c.	New London and Middlesex Counties	6-9
d.	Tolland and Windham Counties	9-11
e.	Litchfield County	11-13

(Each of the foregoing counties or group of counties is referred to herein as a "Region.")

1.2 The basic elements of the Program shall be the following:

FSW shall employ or contract with a sufficient number of interpreters, available throughout the State of Connecticut, to satisfactorily perform its obligations hereunder. Each interpreter engaged by FSW to provide services for the Program shall have an Associates Degree in interpreting for the deaf or equivalent training and/or experience, and shall be (i) certified by the Registry of Interpreters for the Deaf ("RID") or the National Association for the Deaf ("NAD"), (ii) in the process of certification by such organization as an interpreter for the deaf, or (iii) have equivalent training and/or experience. Each interpreter shall also hold such licenses or certifications as may be required from time to time by any governmental body of competent jurisdiction. FSW shall ensure that each interpreter is at all times fully qualified to interpret effectively, accurately and impartially both receptively and expressively, using any necessary specialized vocabulary, including without limitation in a medical setting. FSW shall provide each interpreter with any additional training, specific to interpreting in a medical setting, that may be necessary or appropriate. At FSW's request, CHA shall provide reasonable assistance with such training. Interpreters shall specifically be qualified in American Sign Language, and shall also be skilled in signed English and visual, gestural, and tactile communication.
FSW shall make Interpreter Services available to Participants 24 hours a day, 365 days a year, for such purposes and periods as the Participants may request. Interpreter Services shall be provided on both emergency and non-emergency bases. "Emergency Services" shall be defined as Interpreter Services needed (i) during weekends or state or federal holidays, or during the hours of 11:00 p.m. to 7:00 a.m. daily, or (ii) at any time on advance notice of less than 24 hours or one business day. "Routine Services" shall be defined as all Interpreter Services that are not Emergency Services. Except for Interpreter Services needed on an urgent basis (i.e., the interpreter is requested to arrive as soon as possible for a nonscheduled incident), FSW shall provide interpreters (whether for Emergency Services or Routine Services) at the times requested by Participants. Participants shall provide as much advance notice to FSW as feasible, i.e., promptly upon learning of the need for such services.

    FSW agrees to maintain the following response times in at least eighty (80) percent of urgent incidents within any six (6) month period, measured from the time FSW is notified that an interpreter is needed:

3.    Hospitals located in the counties of Fairfield, Middlesex, Hartford and New Haven, one (1) hour.

4.    All other Hospitals, one hour, with a fifteen (15) minute grace period when needed.

    In no event shall the response time exceed two (2) hours.

    The foregoing response times shall be subject to "force majeure" events, i.e., any response time that is delayed because of a force majeure event shall be excluded from the determination whether the prescribed response criteria have been met. Force majeure events shall be events outside the reasonable control of the Hospital, FSW or the interpreter called to respond, such as weather problems and other Acts of God, unanticipated illness or injury of the interpreter, and unanticipated transportation problems (including without limitation mechanical failure of the interpreter's automobile, automobile accidents, and roadway obstructions).

    Furthermore, the foregoing response times have been formulated based on FSW's predictions of the availability of qualified interpreters statewide. During the first six (6) months after the entry of this Decree, FSW shall exert its best efforts to comply with the standard set forth in clause 2 above containing a fifteen (15) minute grace period, but shall not be deemed in breach thereof if it fails to meet such standard provided that it would have met such standard if it included a thirty (30) minute grace period. At the end of said six (6) month period, FSW and CHA shall negotiate reasonably and in good faith, based on the facts then known, whether the grace period provided in said clause 2 above should be eliminated, shortened or extended, and this Agreement shall be amended accordingly, provided that such amendment is permissible under a certain consent decree entered in the United States

District Court for the District of Connecticut, case No. 395-CV-02408(AHN) (the "Consent Decree"). In the event thereafter that the response time performance standards set forth in clause 1 or clause 2 above cannot be maintained despite FSW's good faith efforts, FSW shall be entitled to request the consent of CHA to such modifications of such performance standards as may be reasonable under the circumstances. CHA shall consider any such request reasonably and in good faith, and any such modification that is agreed to by CHA

and is permissible under the Consent Decree shall be deemed an amendment to this Agreement.
Interpreters engaged by FSW are subject to RID Standards which, to the extent applicable, will be communicated by FSW to the Participants. For example, such standards may require that two interpreters be present for an overlapping time period, resulting in a charge for both interpreters during such period.
Requests for Interpreter Services shall be made on a state-wide 800 or 888 telephone line maintained by FSW at its sole expense, appropriately staffed on a 24-hour basis, with all dispatching being done by FSW.
FSW will consult by telephone with each Participant, upon request, to assess the needs of patients and other consumers for Routine Services (and will exert its best efforts to provide such consultation, if and when feasible, regarding Emergency Services), in order to determine the nature and schedule of such services that will most effectively and efficiently satisfy those needs.
FSW shall maintain accurate data, as mutually agreed with CHA from time to time, regarding the Program (including without limitation utilization by each Participant, overall Program revenues and expenses, adverse incidents, and complaints by Participants or consumers regarding the Program or the interpreters) and regarding usage of Program interpreters by Nonparticipants (as defined below). Such data shall be reported to CHA (and to other Participants) in such form and at such intervals (no less often than semi-annually) as CHA and FSW shall mutually agree.

1.3 CHA shall establish the criteria for participation in the Program by its Members from time to time and shall notify FSW of the names and addresses of the Participants, as well as the dates when such participation begins and terminates. CHA shall cause the Participants to execute documentation satisfactory to CHA evidencing their agreement to participate in the Program and to assume the obligations of Participants hereunder. FSW shall provide to each new Participant all of the rights and benefits of the Program after the Participant's personnel have completed the initial training program described below.

Training Services.

2.1 FSW shall provide training to CHA and the Participants as follows:
1. During the first year of the term of this Agreement, FSW shall provide, in conjunction with CHA, at least four (4) basic one-day training sessions at CHA's facilities for personnel of Participants designed to enable the Participants to effectively utilize the Program. Such training sessions shall be sufficient in duration and content (including at least the topics listed in Section VI.A.1. of the Consent Decree) to train a reasonable number of personnel from each Participant in access to the Program, use of the Program at the Participant, and sensitivity to the needs of the deaf community.
2. In each of the subsequent years of the term of this Agreement FSW shall provide, at CHA's facilities and with its cooperation and assistance, one (1) or more basic training sessions (as needed for new Participants or for new personnel of existing Participants) and at least two (2) follow-up and advanced training sessions for personnel who previously attended a basic training session. Such advanced sessions may address, among other things, problems encountered in the Program, updates in technology, and other services for the deaf available in the community. Participants shall also be entitled, during the first year of their participation in the Program, to one (1) on-site training session for personnel who have already received basic training and one (1) follow-up visit.
3. FSW shall offer training sessions at its standard rates to address special needs of particular Participants.
2.2 CHA shall provide suitable space for FSW to provide interpreter training either at CHA's facility or at Participants reasonably convenient to the trainees, at no cost to FSW.

2.3 FSW shall provide, with the cooperation and assistance of CHA and the Participants, consumer training as follows:
1. During the first year of the term hereof, at least two (2) sessions in each Region.
2. In each subsequent year, at least one (1) session in each Region. Upon reasonable advance from FSW, CHA shall provide suitable facilities either at CHA or at a Participant within the affected Region for consumer training. CHA and FSW shall cooperatively promote such consumer training sessions in each Region to solicit maximum participation therein.
  
  2.4 FSW will consult with CHA in the development and review of materials to be used within the Participants with regard to the Program.
Term. The term of this Agreement shall be ten (10) years commencing on the date hereof (unless earlier terminated pursuant to Section 14.13) and shall continue indefinitely thereafter unless and until either FSW or CHA terminates this Agreement upon advance notice of at least one (1) year to the other.
Compensation.

4.1 CHA shall compensate FSW for establishing the Program and for all services provided under this Agreement (unless expressly indicated to the contrary), other than Interpreter Services, as follows:
1. Upon execution of this Agreement, the sum of Three Hundred Seventy-five Thousand ($375,000.00) Dollars, less any amounts advanced prior to the date of execution and set forth on Schedule 4.1 hereto.
2. Upon substantial completion of the rollout of services in all five Regions as described in Section 1.1 above, the sum of Three Hundred Seventy-Five Thousand ($375,000.00) Dollars.
3. In the event that the number of Participants at any time exceeds thirty-two (32), then FSW shall be entitled to charge CHA, at its standard rates, for training services provided to the thirty-third and each additional Participant under Section 2.1(a) or (b), to the extent such training requires training sessions that would not otherwise be provided.
  
  4.2 FSW shall be compensated for Interpreter Services directly by the Participants requesting such services, at the rates set forth on Schedule 4.2 hereto, and CHA shall have no obligation with respect thereto. After the first three (3) years of the term of this Agreement, at the request of either CHA or FSW from time to time, the rates set forth on Schedule 4.2 shall be subject to good faith renegotiation based on all the facts and circumstances in effect at such time, provided that any increase in such rates shall be justified only to the extent necessary to cover FSW's reasonable expenses (direct and indirect) in operating the Program, plus a reasonable profit, and provided further that such rates shall not be subject to readjustment within one year after new rates have become effective.
Participant Responsibilities. CHA, in consultation with FSW, shall establish the responsibilities of each Participant (the "Participant Responsibilities"), including the following basic elements:
1. Each Participant will be responsible for sending the appropriate personnel for training prior to implementation of the Program at such Participant and from time to time thereafter as may be determined by the Participant or by CHA.
2. Each Participant shall appoint a principal contact person with responsibility under the Program, and at least one alternate.
3. Each Participant at all times shall assign such number of qualified personnel, and shall provide equipment and facilities of such nature and quantity, as may be necessary for FSW to properly perform its duties hereunder. Each Participant shall also maintain the insurance coverage required by Sections 11.3 and 11.4.
4. Each Participant shall pay when due all accurate invoices from FSW for Interpreter Services.
5. Each Participant shall at all times be a member in good standing of CHA.
6. Each Participant shall give CHA at least thirty (30) days' prior notice of the termination of its participation in the Program.
Quality Assurance. FSW and CHA will form a committee made up of consumers and representatives of FSW, CHA and Participants for the purpose of developing a quality assurance plan and thereafter monitoring the quality of services provided by FSW hereunder.
Grievance Procedure. Consumers shall have the right to pursue any complaints under FSW's standard grievance procedure, a copy of which is attached hereto as Exhibit 7.
Out of Program Services. Nothing in this Agreement shall prevent FSW from providing Interpreter Services to other organizations (whether or not Members of CHA) that are not Participants ("Nonparticipants"), subject to the following:
1. No comparable on call Interpreter Services shall be provided at rates more favorable than those charged to Participants. In the event that FSW wishes to charge lower rates to Nonparticipants, it shall so notify CHA and Schedule 4.2 shall be amended accordingly to reflect such lower rates.
2. FSW will not agree to provide Interpreter Services to health care provider Nonparticipants at response times shorter than those provided to Participants under Section 1.2(b).
3. In the event that a Participant's request for Interpreter Services conflicts (in terms of interpreter availability) with a request by a Nonparticipant, with the result that both requests cannot be filled when desired, the Participant's request shall be given priority unless the Nonparticipant's request involves an emergency situation and the Participant's request does not.
4. Training and consulting services (such as those provided under Section 2) shall not be provided to Nonparticipants without charge but shall be rendered only at FSW's standard hourly rates, which currently are $250.00 per hour, per trainer (minimum two hours), plus travel and related expenses.
Representations, Warranties and Covenants of FSW. FSW hereby represents, warrants and covenants to CHA that, at all times during the term of this Agreement:

9.1    FSW shall be a nonstock corporation (or other form of legal entity) duly organized and legally existing under the laws of the State of Connecticut with full power and authority to perform its obligations under this Agreement, and the execution, delivery and performance of this Agreement by FSW shall have been duly authorized by all necessary corporate action.

9.2    FSW and the interpreters: (i) shall comply with all applicable laws, ordinances, orders, rules, regulations and requirements of all federal, state and municipal governments, departments, commissions, boards and officers, and with all applicable rules, regulations, policies and procedures of the Participants, relating to the Interpreter Services, including without limitation those applicable to patient confidentiality; and (ii) shall hold any necessary licenses or authorizations from governmental or accrediting bodies having jurisdiction over the Interpreter Services.

9.3    FSW shall take reasonable measures on an ongoing basis to monitor the performance of its interpreters, and shall promptly take appropriate disciplinary action, up to and including exclusion from the Program, regarding any interpreter whose performance is unsatisfactory, giving due consideration to the opinions of the Participants and CHA.

9.4    The performance of this Agreement by FSW will not (i) violate or contravene any federal or Connecticut law or regulation applicable to FSW, (ii) result in a breach of, or cause a default under, the terms or conditions of any note, contract, agreement, lease, indenture or other instrument to which FSW is a party, or (iii) violate any order, writ, judgment, injunction or decree by which FSW is bound or to which it is subject.
Representations, Warranties and Covenants of CHA. CHA hereby represents, warrants and covenants to FSW that, at all times during the term of this Agreement:

10.1    CHA shall be a nonstock corporation (or other form of legal entity) duly organized and legally existing under the laws of the State of Connecticut with full power and authority to perform its obligations under this Agreement, and the execution, delivery and performance of this Agreement by CHA shall have been duly authorized by all necessary corporate action.

10.2    CHA shall comply with all applicable laws, ordinances, orders, rules, regulations and requirements of all federal, state and municipal governments, departments, commissions, boards and officers, relating to its obligations hereunder, including without limitation those applicable to patient confidentiality.

10.3    The performance of this Agreement by CHA will not (i) violate or contravene any federal or Connecticut law or regulation applicable to CHA, (ii) result in a breach of, or cause a default under, the terms or conditions of any note, contract, agreement, lease, indenture or other instrument to which CHA is a party, or (iii) violate any order, writ, judgment, injunction or decree by which CHA is bound or to which it is subject.
Insurance.

11.1    During the term of this Agreement, FSW shall obtain and maintain general liability and professional liability (malpractice) or errors and omissions insurance coverage that shall insure FSW and shall name CHA and the Participants as additional insureds against liability for personal injury and damage arising out of or related to the provision of Interpreter Services hereunder. Such insurance coverage shall be in such amounts and with such companies as FSW and CHA may reasonably agree from time to time.

11.2    At all times during the term of this Agreement, FSW shall require its insurance carrier(s) to provide CHA with a current certificate of insurance evidencing the coverage required by Section 11.1 and to provide CHA with at least fifteen (15) days prior written notice of any cancellation, termination, modification or amendment to such insurance coverage. The obligations of FSW to be insured for acts and occurrences during the term of this Agreement shall survive the termination or expiration of this Agreement. In the event any such insurance is written on a "claims-made" rather than an "occurrence" basis, any necessary reporting endorsements ("tail insurance") shall be procured by FSW.

11.3    During the term of this Agreement, CHA and each Participant shall obtain and maintain general liability and professional liability (malpractice) or errors and omissions insurance coverage that shall insure it against liability for personal injury and damage arising out of or related to the performance of its obligations hereunder. Such insurance coverage shall be in such amounts and with such companies (or pursuant to such programs of self-insurance) as CHA may reasonably approve from time to time, subject to FSW's right to object for good cause thereto.

11.4    At all times during the term of this Agreement, at the request of FSW, CHA shall require its insurance carrier(s) to provide FSW with a current certificate of insurance evidencing the coverage required to be carried by it under Section 11.3 and to provide FSW with at least fifteen (15) days prior written notice of any cancellation, termination, modification or amendment to such insurance coverage. The obligations of CHA to be insured for acts and occurrences during the term of this Agreement shall survive the termination or expiration of this Agreement. In the event any such insurance is written on a "claims-made" rather than an "occurrence" basis, any necessary reporting endorsements ("tail insurance") shall be procured by CHA.
Termination

12.1    CHA or FSW may terminate this Agreement immediately upon the occurrence of any of the following events with regard to the other party: (i) the making of a general assignment for the benefit of creditors; (ii) the filing of a voluntary petition or the commencement of any proceeding by such party for relief under any bankruptcy or insolvency laws, or any laws relating to the relief of debtors, readjustment of indebtedness, reorganization, composition or extension; (iii) the filing of any involuntary petition or the commencement of any proceeding by or against such party for relief under any bankruptcy or insolvency laws, or any laws relating to the relief of debtors, readjustment of indebtedness, reorganization, composition or extension, which petition or proceeding is not dismissed within ninety (90) days of the date on which it is filed or commenced; or (iv) suspension of the transaction of the usual business of such party for a period in excess of thirty (30) days. In addition, CHA may terminate this Agreement in the event that FSW is excluded or suspended from the Medicare or Medicaid program for a period of more than sixty (60) days, provided that such exclusion or suspension could have a material adverse effect on the ability of FSW, CHA or any Participant to participate in the Program.

12.2    CHA or FSW may terminate this Agreement upon sixty (60) days prior written notice to the other party in the event of a material breach by such other party of any material term or condition of this Agreement, which breach is not cured to the reasonable satisfaction of the terminating party within such sixty (60) day period.

12.3    In the event that CHA terminates this Agreement under Section 12.2 within the first three and one-half years of the term, and in recognition of the fact that the damages thereby suffered by CHA and the Participants will be difficult or impossible to quantify, CHA shall be entitled to recover from FSW the amount then paid by CHA to FSW under Section 4.1. FSW and CHA agree that such amount represents a reasonable approximation of the actual damages that would be suffered by CHA and the Participants in the event of a termination of this Agreement, and that such amount constitutes negotiated liquidated damages and not a penalty.

12.4    CHA may (and shall if reasonably requested by FSW) terminate the participation of any Participant in the Program upon sixty (60) days prior written notice to the Participant in the event of a material failure by the Participant to fulfill any of its Participant Responsibilities (including without limitation the payment when due of all sums owed to FSW or CHA), which failure is not cured to the reasonable satisfaction of CHA within such sixty (60) day period. CHA shall take appropriate action with respect to any Participant whose material failure to fulfill its Participant Responsibilities has been reported to CHA by FSW.

12.5    In the event that FSW intends to terminate the Program for any reason, whether voluntarily or involuntarily, provided that it does not then have the right to terminate this Agreement under Section 12.2, it shall so notify CHA as soon as reasonable under the circumstances and shall offer to (i) sell to CHA all of its rights and assets with respect to the Program, including without limitation its contracts with Program interpreters and all know-how, policies, procedures and documentation related to the Program (the "Program Assets"), and (ii) assist and cooperate with CHA, in all reasonable ways but at CHA's expense, in CHA's assumption or continuation of the Program (or services similar thereto). Notwithstanding the foregoing, except to the extent FSW may otherwise agree at the time, the Program Assets shall not include any rights or assets that have continuing utility to FSW. The purchase price for the Program Assets shall be FSW's book value therefor, if any. CHA shall have sixty (60) days after receipt of the offer to sell to accept such offer and, if it does so accept, sixty (60) days thereafter to close the acquisition. This Section 12.5 (and CHA's actions hereunder) shall have no effect on any rights or remedies CHA or the Participants may have against FSW if such termination constitutes a breach of this Agreement, except to the extent that, if CHA exercises its right to purchase the Program Assets, the damages suffered by the Participants and CHA as the result of such breach are diminished.
Dispute Resolution.

13.1 Any controversy, claim, dispute or deadlocked decision arising out of or relating to this Agreement or the breach thereof (a "Dispute") may be submitted at any time by FSW or CHA to their chief executive officers for resolution. Such officers shall then exert their best efforts to resolve such dispute in a manner reasonably satisfactory to both parties within sixty (60) days after both have received notice of the request for resolution (or such longer time period as both such officers may agree). If and only if the Dispute is not resolved within such time period, then (A) if the Dispute consists of an inability to agree on a price renegotiation under Section 4.2 or a contract amendment under Section 14.1 (an "Arbitrable Dispute"), it shall be submitted to binding arbitration pursuant to Section 13.2, or (B) if the Dispute is not an Arbitrable Dispute, it shall be subject to any and all remedies that may then be available to the parties, at law or in equity.

13.2 Any Arbitrable Dispute shall be settled by binding arbitration in accordance with the Commercial Arbitration Rules of the American Arbitration Association. Arbitration under this Section 13.2 shall be held before one (1) arbitrator, appointed as set forth below, at a hearing in New Haven, Connecticut, and the decision of said arbitrator shall be final, binding, and enforceable in any court of competent jurisdiction. The arbitrator shall be a certified public accountant or an attorney licensed to practice in the State of Connecticut and mutually satisfactory to FSW and CHA. In the event they cannot agree within sixty (60) days after the matter has been submitted to arbitration, the arbitrator shall be selected by counsel for FSW and CHA from Boston or Connecticut Regional Panels of Distinguished Neutrals provided by the CPR Institute for Dispute Resolution, or from such other panel of arbitrators as such counsel may agree. The costs of the arbitration shall be borne equitably by the parties as the arbitrator may determine.
General Provisions

14.1    Subject to/Change in Law. The parties recognize that this Agreement is at all times to be subject to applicable local, state and federal statutory and common law, regulations of state and federal agencies, and state and federal judicial and administrative decisions, including without limitation, the Americans with Disabilities Act, the Rehabilitation Act, the Social Security Act and Rules and Regulations of the Department of Health and Human Services, all Public Health and Safety provisions of the Connecticut General Statutes and the Regulations of the Commissioners of Health Services, Children and Families, Social Services and Consumer Protection. The parties further recognize that this Agreement shall be subject to changes and amendments in these laws and regulations and to the provisions of any new legislation, regulations and case law affecting this Agreement. Any provisions of law or judicial or administrative decisions that invalidate, or are otherwise inconsistent with, the terms of this Agreement, or which would cause one of the parties to be in violation of law, shall automatically supersede the terms of this Agreement; provided, however, the parties shall exercise their best efforts to negotiate an appropriate modification to the terms and conditions of this Agreement to accommodate such provisions of law or judicial or administrative decisions and to effectuate the existing terms and intent of this Agreement to the greatest possible extent consistent with the requirements of such law or decision, including without limitation the fees to be charged by FSW to the Participants for Interpreter Services hereunder.

14.2    Independent Contractors. The relationship among FSW, CHA and the Participants is that of independent contractors, and none of the provisions of this Agreement is intended to create, nor shall be construed to create, an agency, partnership, joint venture or employment relationship among the parties. No party, nor any of its respective officers, members, employees or independent contractors, shall, except as otherwise expressly permitted in this Agreement, be deemed to be the agent, employee or representative of any party by virtue of this Agreement.

14.3    Notices. Any and all notices, designations, consents, offers, acceptances, or other communications required to be provided hereunder shall be in writing and delivered, either personally or by courier, or sent by certified mail, to CHA or FSW at the addresses first set forth above, Attention: Chief Executive Officer, or to such other address as either party may request by notice hereafter, and shall be deemed given upon such delivery. All communications by FSW to the Participants will be deemed duly given if so delivered to CHA.

14.4    Entire Agreement. This Agreement, together with the schedules attached hereto and hereby incorporated into this Agreement by reference, supersedes any and all other agreements, representations and understandings, either oral or in writing, between the parties with respect to the subject matter of this Agreement. This Agreement may not be changed orally, and may only be amended by an agreement in writing signed by FSW and CHA.

14.5    Rights in Third Parties. FSW and CHA acknowledge and agree that the Participants shall be third party beneficiaries of this Agreement and shall have standing to enforce their rights hereunder. In addition, CHA shall require that the Participants acknowledge and agree to fulfill the Participant Responsibilities applicable to them in this Agreement. This Agreement is not intended to, nor shall it be construed to, create any rights whatsoever in any other third parties, including without limitation in any consumer.

14.6    Governing Law. This Agreement shall be governed by, and construed and enforced in accordance with, the laws of the State of Connecticut.

14.7    Severability. If any provision of this Agreement shall be held by a court of competent jurisdiction to be contrary to law, that provision shall be enforced to the maximum extent permissible, and the remaining provisions of this Agreement shall remain in full force and effect, except as otherwise provided in this Agreement.

14.8    Waiver. The failure of a party to insist upon strict adherence to any term of this Agreement on any occasion shall not be considered a waiver of, or deprive that party of the right thereafter to enforce, that term or any other term of this Agreement.

14.9    Rights Unaffected. No amendment, supplement or termination of this Agreement shall affect or impair any rights or obligations that shall have theretofore matured hereunder.

14.10    Assignment. Neither CHA nor FSW may assign this Agreement or any of its rights or obligations hereunder without the prior written consent of the other party, which consent may be withheld in such party's sole and absolute discretion. Any sale, merger, assignment or transfer of FSW or substantially all of its assets to or with any person shall be deemed an assignment of this Agreement in material breach of this Section 14.10. Notwithstanding the foregoing, FSW may assign this Agreement (and be relieved of its obligations arising thereafter hereunder) with the prior written consent of CHA, which consent shall not unreasonably be withheld, to an entity affiliated with FSW, p