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

C. REMEDIAL ACTION

ADA Compliance Officer, Training and Web Site

16. By no later than thirty days after the effective date of this Agreement, BIDMC shall designate an ADA Compliance Officer who shall have the primary authority and responsibility for ensuring that all aspects of BIDMC meet the terms of this Agreement and of the ADA. In addition, the Compliance Officer shall be responsible for overseeing accessibility modification projects, including plans for barrier removal or alterations at BIDMC. The position of Compliance Officer shall be filled and maintained throughout the course of this Agreement. The ADA Compliance Officer shall have authority within BIDMC to implement changes and effectuate this Agreement and shall serve as BIDMC's primary administrative contact for the Agreement.

17. By no later than ninety days after the effective date of this Agreement, BIDMC shall select at least two employees to assist the Compliance Officer in fulfilling the obligations of this Agreement. The Compliance Officer - along with the selected employees who will assist him or her - shall undergo training on the ADA's accessibility requirements no later than one hundred and twenty days after the effective date of this Agreement. The training shall be of sufficient quality and duration to enable these individuals to become proficient in understanding the applicable accessibility requirements of title III of the ADA, including the ADA Standards.

18. By no later than one year after the effective date of this Agreement, BIDMC shall display on its website information to assist individuals with disabilities to identify accessible routes through the BIDMC campuses, accessible parking areas, accessible entrances to buildings, and accessible spaces within buildings. BIDMC's website shall also be updated regularly to reflect newly added or renovated accessible features of the hospital such as accessible patient rooms and accessible equipment.

Changes to Facilities and Routes

19. Except where an earlier deadline is set forth in this Agreement, BIDMC shall complete all work required under this Agreement by five years from the effective date.

20. NEW CONSTRUCTION. As of the effective date of this Agreement, BIDMC agrees to take steps to ensure that it shall design and construct all new facilities, and parts thereof, in compliance with the ADA. 42 U.S.C. § 12183(a)(1), 28 C.F.R. §§ 36.401 & 406. Where BIDMC has failed to comply with the ADA's new construction requirements (with respect to facilities constructed prior to the effective date of this Agreement but constructed for first occupancy after January 26, 1993), BIDMC agrees to correct aspects of those elements of newly constructed facilities that fail to comply with the ADA Standards by no later than three years from the effective date of this Agreement.

21. ALTERATIONS and BARRIER REMOVAL. BIDMC shall ensure that any alterations to BIDMC facilities shall comply with the requirements for alterations in the ADA Standards. 42 U.S.C. § 12183(a)(2), 28 C.F.R. §§ 36.402 - 36.406. BIDMC also agrees to ensure that any specific alterations or barrier removal efforts required by this Agreement shall comply with the requirements for alterations in the ADA Standards, except where, on a case-by-case basis, the parties may agree to different requirements for purposes of this Agreement. BIDMC may deviate from these requirements only after a detailed written request by BIDMC has been approved by the United States. The United States shall respond to a detailed written request within 60 days of receipt. If the parties are unable to agree, then the provisions of paragraph 35 will apply.

22. As noted in paragraph 6, the United States surveyed a representative selection of BIDMC's buildings, facilities, and equipment, and provided a report to BIDMC that noted representative violations of the ADA Standards. The manner that these violations will be addressed is identified in Appendix A. The work identified in Appendix A, as well as all other remedial work required by this Agreement, shall be completed pursuant to the Schedule set forth below, unless the parties otherwise agree in writing to modify this Schedule:

• a. By no later than three years from the effective date of this Agreement, BIDMC shall complete all remedial work required by this Agreement at the Bowdoin Street Health Center, Chelsea Health Center, Lexington Health Center, Shapiro Clinical Center and West Clinical Center;

• b. By no later than five years from the effective date of this Agreement, BIDMC shall complete all remedial work required by this Agreement at the remainder of BIDMC's facilities including, but not limited to, Farr, Feldberg, Lowry, Reisman, and Stoneman.

23. Within one year of the effective date of this Agreement, BIDMC shall survey those facilities and routes that were not surveyed by the United States and develop a plan to correct violations of the ADA Standards with respect to new construction and alterations, and to remove barriers to access where it is readily achievable to do so. That plan shall be provided to the Department upon its completion and the remedies required therein shall be implemented in accordance with paragraphs 19-21, and in accordance with the Schedule for Remedial Work set forth in paragraph 22 above. The parties shall negotiate in good faith any disputes regarding the survey conducted by BIDMC.

24. Within one year of the effective date of this Agreement, at those facility entrances and public and common use toilet rooms that are not accessible, BIDMC shall install directional signage that complies with Standards 4.1.2(7), 4.1.3(7)(d), 4.1.3(16), and 4.30 indicating the location of the nearest accessible entrance or public and common use toilet room. At accessible facility entrances and public and common use toilet rooms, BIDMC shall install the International Symbol of Accessibility and signage complying with the applicable requirements of Standards 4.1.2(7), 4.1.3(16), and 4.30.

25. Each building or facility subject to this Agreement currently has at least one accessible entrance. By no later than one year after the effective date of this Agreement, BIDMC shall provide at each facility, at least one accessible exterior route connecting at least one accessible building entrance to each of the following: public transportation stops located on the BIDMC campus, accessible parking spaces, passenger loading zones and public streets or sidewalks. Standards 4.1.2(1), (2) and 4.3.

Patient Rooms

26. BIDMC shall ensure that, at each of its facilities, at least 10% of its patient rooms are Accessible Patient Rooms (see Standards 6.1(1) and (2)), as defined in paragraph 11. In making modifications to ensure that it has provided the percentage of accessible patient rooms specified above, BIDMC shall also continue to ensure that these designated Accessible Patient Rooms are dispersed throughout BIDMC's facilities and clinical services to the greatest extent possible.

Medical Equipment

27. BIDMC shall provide Accessible Equipment, as defined in paragraph 10 above, as appropriate to each clinical service that utilizes examination tables or chairs and which does not already have such an Accessible Examination table or chair. Each table and/or chair shall be equipped with all necessary Ancillary Equipment, as defined in paragraph 12 above.

28. To ensure that it provides Accessible Medical Equipment, BIDMC will, within one year of the date of this Agreement, identify and maintain a data base 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, including all equipment to which a patient is required to transfer (e.g., examination tables and ophthalmology equipment). In this date base, BIDMC will also identify 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 accessible call buttons) should be purchased or modified to ensure that individuals with disabilities receive equal access to medical services. Where BIDMC is unable to identify equipment that would ensure that individuals with disabilities receive equal access to particular medical services, identify alternative measures that would ensure such access. This information shall be provided to the United States in BIDMC's annual report, as described in paragraph 32 of this Agreement.

29. BIDMC agrees that at least 10% of examination and treatment equipment purchased or leased after the effective date of this Agreement, but no fewer than one of each type in each clinical service, will be accessible to and usable by individuals with disabilities. BIDMC will maintain this percentage, and ensure that at least one of each type of its Accessible Equipment is of equivalent quality to similar non-Accessible Equipment used by BIDMC. The ADA Compliance Officer or one of his or her representatives will work with the BIDMC purchasing department to establish a protocol to review and coordinate proposed equipment purchases to comply with the height requirements of the ADA^1.

30. BIDMC agrees that with respect to ancillary equipment (as defined in paragraph 12), a reasonable percentage, at least 10%, and no less than one, of each type, will be adapted or adjustable for use by individuals with disabilities.