United States of America v. Washington Hospital Center - Settlement Agreement

IV. ACCESSIBLE MEDICAL EQUIPMENT

A. Definitions.

1. Accessible Equipment. For purposes of this Agreement, accessible equipment means equipment that is accessible to and usable by persons with disabilities.

2. Accessible Equipment Requiring Transfer. For purposes of this Agreement, in order to be deemed accessible, any piece of medical equipment to which patients must transfer for examination or treatment purposes, including, but not limited to, examination tables and chairs, tables used for radiologic exams, and gurneys, shall lower to a point no greater than 17 - 19 inches from the floor, shall be capable of being locked or otherwise fixed into position so as to permit a safe transfer from a wheelchair or other mobility device without slipping, and shall have a protective padded surface (unless such a surface is inconsistent with the table’s intended use). Tables and gurneys that can be lowered closest to the floor (i.e., to 17 inches) are preferred because they will provide better access for more individuals with disabilities, and WHC is encouraged to select such tables. Accessible patient beds are separately addressed in Paragraph IV.B.3. below.

B. Purchase and Distribution of Accessible Examination Tables, Chairs, and Patient Beds.

1. Initial Purchase of Examination Tables and Chairs.

(a) Initial Purchase of Accessible Examination Tables/Chairs. WHC hereby agrees to purchase and place one accessible examination table or examination chair, as defined in Paragraph IV.A. above, as appropriate to the Department, in each Department that utilizes examination tables or chairs and which does not already have such an examination table or chair. Each table and/or chair purchased pursuant to this purchase obligation shall be equipped with all necessary ancillary equipment, as described in Paragraph IV.B.1.(e) below. This initial obligation does not apply to Departments where the examination tables are physically integrated with medical technologies (e.g., radiology or other imaging equipment); the need for such tables shall be evaluated during the equipment survey, to be conducted pursuant to Paragraph IV.C. below.

(b) Department and Clinic List. In order to assist the parties in understanding the location of existing accessible medical equipment and the possibility and feasibility of sharing equipment, within 60 days of the Effective Date of this Agreement, WHC will provide to DOJ a list of: (i) all WHC departments and clinics where patients (whether inpatients or outpatients) are examined, treated, or otherwise receive services; and (ii) the subset of those departments and clinics that treat or examine patients on an examination table or chair to which a patient must transfer. This list shall be certified by the ADA Officer as true, complete, and correct. Hereinafter, all WHC’s departments, clinics, and similar specialized treatment areas shall be referred to as “Departments.”

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

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

(e) Ancillary Equipment. All ancillary equipment used with the examination table or chair shall be adapted or adjustable for use by individuals with disabilities. Ancillary equipment includes items such as leg supports for gynecological examinations, protective padding, positioning straps, and additional supports or rails needed to ensure the safety and comfort of patients with disabilities.

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

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

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

(i) Continence Center. Within 120 days of the Effective Date of this Agreement, the Continence Center in the POB shall have an accessible urological exam chair.

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

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

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

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

WHC further agrees that, by the conclusion of the initial five-year term of this Agreement, all Accessible Patient Rooms planned to be in service as of that date, including all Accessible Patient Rooms required to be completed hereunder, shall be equipped with an Accessible Bed or Beds. If WHC receives final approval to construct the Tower described in Paragraph III.B.4. above, WHC will purchase, at the time WHC purchases the patient beds needed to equip the Tower, sufficient Accessible Beds such that every Accessible Patient Room contains an Accessible Bed or Beds.

C. Survey of Existing Equipment and Acquisition of Additional Equipment

1. Equipment Survey Tool. Within 60 days of the appointment and DOJ approval of the ADA Equipment Expert as set forth in Paragraph II.D. above, the Equipment Expert shall develop a survey tool on which to capture the information of a survey of existing equipment (as defined in Paragraph IV.C.2. below), and a list of equipment to be surveyed. WHC shall submit the survey tool and list of equipment to DOJ for approval, which approval shall not be unreasonably withheld. DOJ shall approve or make recommendations for revisions within 30 days of receiving the survey tool. If DOJ recommends any revisions, WHC shall consider the proposed revisions and make appropriate changes in good faith. If the parties cannot agree on the survey tool, they shall follow the procedure set out in Paragraph VIII.D. below.

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

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