United States of America v. The Beth Israel Deaconess Medical Center - Settlement Agreement

A. DEFINITIONS AND BACKGROUND

1. This matter is based upon a compliance review of physical accessibility for individuals with disabilities at the Beth Israel Deaconess Medical Center ("BIDMC") facilities under title III of the Americans with Disabilities Act, 42 U.S.C. §§ 12181 - 12189 (the "ADA"), and the Department of Justice's implementing regulation, 28 C.F.R. Part 36, including the ADA Standards for Accessible Design, 28 C.F.R. Part 36, Appendix A (the "Standards").

2. Title III of the ADA requires BIDMC to ensure that no individual with a disability is discriminated against on the basis of a disability in the full and equal enjoyment of BIDMC's services and facilities. 42 U.S.C. §§ 12182 - 12183. Title III of the ADA requires, among other things, that BIDMC remove barriers to access in existing facilities where it is readily achievable to do so, and that it construct or alter any buildings or facilities in such a manner that those buildings or facilities meet the requirements of title III of the ADA, including the Standards.

3. BIDMC is the product of the 1996 merger of two and separate historic hospitals. The Deaconess Hospital was founded in 1896 by Methodist deaconesses as part of their missionary charter to care for city residents, and the Beth Israel Hospital was founded in 1916 by the Boston Jewish community to meet the needs of the growing immigrant population. Today, BIDMC is a non-profit health care institution, and operates as a quaternary acute care academic medical center and a level one trauma center. BIDMC is recognized for its excellent patient care, medical research, teaching and community service.

BIDMC's facilities consist of multiple connecting and non-connecting buildings in the East and West clinical campuses in the Longwood Medical Area of Boston, Massachusetts. Its facilities also include three community health clinics located in Dorchester, Lexington, and Chelsea, Massachusetts. At the time this review began in 2006, BIDMC owned approximately 30 buildings. Five buildings were constructed after the ADA was implemented, and are subject to the new construction standards. These facilities are Shapiro on the East Campus, West Clinical Center on the West Campus, The Lexington Center in Lexington, Massachusetts, Chelsea Community Care Center in Chelsea, Massachusetts, and Bowdoin Street Community Health Center in Dorchester, Massachusetts.

Many of BIDMC's existing buildings, or parts thereof, have been altered or renovated after the implementation of the ADA and are subject to the alterations requirements of the ADA. These facilities include Ansin, Dana, East, Feldberg, Finard, Gryzmish, Kirstein, Rabb, Reisman, Research North, Research West, Rose, Service, Sherman, Slosberg, Stoneman and Yamins on the East Campus; and Baker, Deaconess, Dooley Chapel, Farr, Libby-Maintenance, Lowry, and Palmer on the West Campus.

4. Although the United States found that BIDMC had made significant efforts to make its facilities accessible, the United States' compliance review identified various aspects of BIDMC's facilities that were not in compliance with title III of the ADA and its regulations, including the provisions referenced in Paragraph 2 above.

5. The United States contends that those violations include, but are not limited to:

-inaccessible (round) door knobs;
-inadequate wheelchair maneuvering space at doors;
-incorrect placement of grab bars at toilets;
-inadequate maneuvering clearance at toilet room doors;
-hand sanitizer dispensers that protrude into the circulation path;
-steep (greater than 8.3%) ramps and curb ramps;
-inaccessible patient rooms and toilet rooms;
-inaccessible showers;
-toilet seats that are mounted too high;
-toilets not centered at 18" from the side wall;
-drinking fountain spouts that are too high;
-lack of accessible examination tables and accessible equipment, and
-a lack of accessible routes to some clinical areas.

6. On July 1, 2008, the United States provided copies of reports to BIDMC identifying representative violations of the ADA Standards at its facilities and pedestrian routes on the East and West Campuses, as well as at three BIDMC community clinical centers. These reports document alleged violations of the Standards discovered during site surveys of selected portions of BIDMC facilities conducted by the United States in late 2006 and early 2007. BIDMC disputes some of the alleged violations and contends that others have been remedied during the course of the Department's investigation.

7. BIDMC contends that it has taken various steps over the last eighteen years to complete accessibility improvements at its facilities. BIDMC states that, as part of its efforts to comply with title III of the ADA, it:

• a. has engaged in readily achievable barrier removal and is establishing an ADA advisory group (which seeks guidance from architects, designers and disability organizations) to provide recommendations on barrier removal projects;

• b. is establishing a process to review all plans for new construction and alterations for compliance with title III, including the Standards; and

• c. is implementing policies and procedures to ensure that individuals with disabilities will have access to BIDMC's services.

8. The parties to this Settlement Agreement ("Agreement") are the United States and BIDMC. In order to avoid the burden and expense of further investigation and possible litigation, the parties have entered into this Agreement.

9. For the purposes of this Agreement, "Accessible Beds" means height-adjustable hospital beds that are accessible to and usable by persons with disabilities. In order to be deemed accessible, a bed must (i) lower to a point no greater than 17-19 inches from the floor, and (ii) 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.

10. For the purposes of this Agreement, "Accessible Equipment" means equipment that is accessible to and usable by persons with disabilities. In order to be deemed accessible, any piece of medical equipment to which a patient must transfer for examination or treatment purposes, including, but not limited to, examination tables and chairs, tables used for radiologic or other exams, gurneys, and accessible patient beds, must (i) lower to a point no greater than 17-19 inches from the floor, (ii) 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 (iii) have a protective padded surface, unless such a surface is inconsistent with the equipment's intended use.

11. For the purposes of this Agreement, "Accessible Patient Room" means a patient room that complies with the alteration requirements (unless in a newly constructed facility) of the ADA Standards for Accessible Design, 28 C.F.R. Part 36, Appendix A. In addition, all accessible patient rooms must (i) contain an accessible toilet room; (ii) contain or have access to an accessible shower (consistent with the amenities provided in adjacent patient rooms); (iii) contain or have access to height-adjustable, medical-surgical beds ("med-surg beds") that lower to a point no greater than 17-19 inches from the floor ("Accessible Beds"); and (iv) contain or have access to all other amenities provided in, or available to, patients in rooms in the same clinical service category.

12. For the purposes of this Agreement, "Ancillary Equipment" means equipment used with examination tables or chairs, and adapted to 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.