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

V. DEVELOPMENT OF DISABILITY-RELATED POLICIES AND PROCEDURES

A. Review and Submission of Policies and Procedures.

Within 120 days of the Effective Date of this Agreement, the ADA Officer, with the assistance of the ADA Consultant, shall: (1) review all existing policies and procedures relating to the services, treatment and care provided to individuals with disabilities (including, but not limited to, patients, their guests, and other visitors) for consistency with the ADA and this Agreement; (2) determine whether any additional policies or procedures, or changes to existing policies and procedures, are necessary to comply with the ADA or to effectuate the purposes of this Agreement and, if so, shall develop such policies and/or procedures; and (3) submit all of such policies and procedures, including revised policies and new policies, to DOJ and ERC.

B. Implementation of Policies and Procedures.

Within 45 days of receiving WHC’s revised or proposed policies, DOJ and ERC will either approve WHC’s policies or propose revisions. WHC shall consider any proposed revisions and make appropriate changes in good faith. If the parties cannot agree on the policies, they shall follow the procedure set out in Paragraph VIII.D. or VIII.E. below. Within 45 days of reaching agreement with DOJ and ERC on the policies, WHC shall finalize its policies and procedures, disseminate them to the appropriate personnel, implement them, and provide copies of each to DOJ and ERC.

C. Advisory Resource Group and EOCC Review.

The ADA Officer and ADA Consultant shall consult with the Advisory Resource Group and EOCC and solicit their comments on revised and newly created policies before the policies are submitted to DOJ and ERC, and at other points in the policy review process, as needed.

D. Content of Policies and Procedures.

The policies and procedures to be reviewed, revised, and/or developed by the ADA Consultant and the ADA Officer shall include, but not be limited to, policies and procedures for:

1. A statement of compliance with Title III of the ADA and Section 504 generally;

2. The acquisition, provision, and use of all equipment with regard to accessibility (including location, maintenance and updating of equipment, sharing among Departments, and dissemination of information regarding accessible equipment);

3. The use of appropriate techniques for safely transferring and positioning patients with disabilities (especially for gynecological and radiological exams) including, if practicable within the organizational structure of WHC, the establishment and maintenance of a lift team of individuals with advanced training in lifting, whose responsibility will be to transfer patients throughout the hospital;

4. The maintenance of accessible features and accessibility within WHC, including, but not limited to, ensuring that accessible restrooms, patient rooms, hallways, elevator buttons, etc., are kept free from all obstacles, such as boxes, medical supplies, furniture, trash receptacles, and newspaper racks;

5. The provision of auxiliary aids and services for individuals who are deaf or hard of hearing, including, but not limited to, the provision of communication-related equipment and sign language interpreters, and closed caption televisions in waiting areas and patient bedrooms;

6. The use of service animals;

7. The effective communication of written materials to individuals with visual impairments;

8. Planning for inpatient hospital care, including, but not limited to:

(a) A policy to include an individualized assessment for every patient with a disability to determine any specialized needs, including, but not limited to, diet, bowel program, communication, and mobility-related needs, and a program to implement the services identified as needed in the assessment;

(b) Procedures for determining the inpatient placement of a patient who needs an accessible room, since accessible rooms are not available in every Nursing Unit. When the hospital is not operating at full inpatient capacity, WHC shall use its best efforts to reserve Accessible Patient Rooms for persons with disabilities and hold them open until all other rooms in the Nursing Unit are filled. When a patient with a disability who needs an accessible room is admitted, WHC shall use its best efforts to arrange for an accessible room for that patient, consistent with medical standards of care. If there is an accessible room in the Nursing Unit to which the patient would ordinarily be assigned, but it is occupied by a non-disabled patient, WHC shall use its best efforts, consistent with medical standards of care, to reassign patient rooms so that the accessible room can be utilized by the patient with the disability. If no Accessible Patient Room consistent with the patient’s medical needs is available when a patient with a disability who needs an accessible room is admitted, WHC shall continue to use its best efforts, for the duration of the patient’s stay, to arrange for an Accessible Patient Room for the patient as soon as possible, if so desired by the patient. Staff from the Admissions Department shall be responsible for seeking an accessible room for the patient, and shall do so at least once in every 24 hour period after the patient’s admission;

(c) Procedures for ensuring that an Accessible Bed is made available to individuals with mobility impairments who use wheelchairs or similar mobility devices and who need an Accessible Bed to facilitate transfer.

9. Planning for outpatient care. The policy will include a provision that the individual responsible for scheduling outpatient appointments in each of WHC's outpatient areas will exercise his or her best efforts to inquire, while scheduling the appointment, whether the patient will need a modification of policies or procedures or auxiliary aids and services in order to receive equal medical services. These modifications or auxiliary aids and services may include an adjustable exam table, Hoyer lift, sign language interpreter or other assistance. WHC will ensure that such assistance is provided to the patient at the time of the appointment. The patient Sign-In Sheet for each outpatient clinic will include a statement, along with the international symbol of accessibility, directing patients to inform the staff if they will need assistance at the exam due to a disability;

10. Assisting patients in resolving disability-based difficulties encountered during the course of their care. The policy should set out a process for registering complaints and identify the ADA Officer who is ultimately responsible for resolving complaints, and shall be consistent with Exhibit A hereto;

11. Methods and materials for communicating with individuals who have cognitive and/or intellectual impairments, including methods for communicating information concerning both medical procedures and post-procedure patient care information;

12. Readily achievable alternatives to barrier removal, if any;

13. Review of policies to ensure that existing policies are not inconsistent with federal disability law, including the ADA and Section 504;

14. Ensuring that WHC does not charge a patient with a disability who is in need of an Accessible Patient Room more for the accessible patient room than it would charge for a non-accessible patient room in which the patient would otherwise have been placed; and

15. Ensuring that WHC, in providing shuttle bus service between WHC and other locations, such as the Metro (either directly or through agreement with third parties), shall: use only wheelchair accessible shuttle buses, maintain the lifts and other accessibility features of such vehicles so they are usable by individuals who use wheelchairs; train shuttle drivers and maintenance personnel in the maintenance and safe operation of the lifts, restraints, and other accessibility features; and provide a phone number for riders to confirm that all accessible vehicles are in service.

E. Procedure for admitting inpatients with spinal cord injuries and similar conditions.

When an individual who has an existing spinal cord injury or similar condition is admitted as an inpatient, WHC shall, in the initial nursing intake process, discuss particular concerns relating to that individual’s spinal cord injury or similar condition with the patient, including, but not limited to, concerns regarding bowel or bladder program, diet, eating/drinking assistance, turning, and communication needs (e.g., call buttons, telephones). This discussion shall be documented on the initial intake form, Interdisciplinary Patient Data Base Form 1236 (“Form 1236"), which shall be revised within 60 days of the Effective date of this Agreement to prompt the nurse to discuss these specific matters with the patient.

Within 60 days of the Effective Date of this Agreement, the rehabilitation risk screening portion of Form 1236 will be expanded to ask whether the patient has a spinal cord injury or other long-term condition that results in paraplegia, quadriplegia, or otherwise substantially limits the use of one’s limbs. A positive answer will trigger a Physical Therapy/Occupational Therapy (“PT/OT”) screening assessment by a team member from the Rehabilitation Department (e.g., a physical therapist), which will occur as soon as possible based on prioritization of needs by the rehabilitation department, but no later than 48 hours after the patient’s admission to the nursing unit. The assessment shall involve a more detailed discussion with the patient of particular needs, such as pressure sores, bowel programs, and autonomic dysreflexia, and will evaluate whether the patient needs an additional physiatry consultation. The PT/OT consultant shall be available to consult with the patient throughout his or her hospital stay, if necessary, and shall leave his or her telephone number with the patient. In addition, the PT/OT consultant shall discuss with the patient’s medical and nursing staff any additional needs of the patient relating to his or her disability, including, but not limited to, reviewing the patient’s bowel program, required frequency of turning, modifications to communication equipment, and assistance with eating and drinking, if necessary.

F. ADA Poster.

A poster outlining patients’ rights and remedies under the ADA and Section 504 in a hospital setting, along with the ADA Disability Assistance Number, shall be posted and maintained in each outpatient reception area and in the common area associated with each inpatient unit. The poster shall include the ADA Disability Assistance telephone number. DOJ shall create the ADA Poster, with input from the ADA Officer, within 60 days of the Effective Date of this Agreement, and it shall be reproduced and posted by WHC within 90 days of its receipt of the text of the final poster.

G. ADA Brochure.

Within 30 days of the Effective Date of this Agreement, WHC, with input from DOJ, shall submit a draft ADA brochure to DOJ. The draft brochure shall depict the international symbol of accessibility on its front cover and shall contain (i) a description of the equipment and services available to WHC’s patients with disabilities and an explanation the process for obtaining them; (ii) WHC’s ADA Disability Assistance Number; and (iii) an explanation of WHC’s ADA Disability Assistance Process. The ADA Brochure will also include an explanation of patients’ rights and remedies under the ADA and Section 504 in a hospital setting, to be provided by DOJ within 15 days of the Effective Date of this Agreement. DOJ shall approve or suggest revisions to the language within 10 days of its receipt of the draft brochure. 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. below.

WHC shall make the ADA Brochure available for distribution within 30 days of its receipt of final approval from DOJ. The ADA Brochure shall be distributed to each inpatient upon admission and to each outpatient upon his or her initial registration at an outpatient clinic. The ADA Brochure shall also be available in places throughout the hospital where other patient education materials are located. The information and language developed for the ADA Brochure will be incorporated within the Patient Information Guide, as set forth Paragraph II.B.3. above.