The Final Release and Agreement contains an Exhibit A. Exhibit A contains the ADA compliance terms as follows:

The parties agree that Kaiser is required to take such steps as may be necessary to ensure that no Kaiser member with a visual impairment is excluded, denied services, segregated or otherwise treated differently than other individuals because of the absence of auxiliary aids and services. The parties define auxiliary aids and services as those aids and services designed to provide effective communications, I. e., making aurally and visually delivered information available to persons with vision impairments. This definition is the same definition found in the United State Department of Justice interpretative Appendix to the ADA Title III Regulations. Implicit in this duty to provide auxiliary aids and services is the underlying obligation of Kaiser to communicate effectively with its customers, clients, patients, or participants who have disabilities affecting vision. 

The parties agree that providing effective communication in the health care context is crucial as Kaiser members must make informed decisions related to health care. Kaiser shall ensure in each critical patient care situation as defined herein a Kaiser member will receive effective communication regardless of the form of the auxiliary aid upon the signing of this Agreement. Plaintiffs understand that Kaiser is conducting a study and designing a plan as to the provision of auxiliary aids and related services. 

Plaintiffs understand that Kaiser may need to acquire or modify equipment or devices to provide auxiliary aids and related services. Plaintiffs understand that Kaiser may need to conduct personnel training to provide auxiliary aids and related services. The parties agree that conducting a study and designing a plan, acquiring or modifying equipment or devices and conducting personnel training to provide auxiliary aids and related services may take extended time as specified herein or as stated in the Metzler v. Kaiser Foundation Health Plan, Inc., (Metzler) Agreement. However, Kaiser must effectively communicate, by a method determined by Kaiser, with Kaiser members with visual impairments upon the signing of this Agreement irrespective of future intentions to conduct a study and design a plan, acquire or modify equipment or devices and conduct personnel training to provide of auxiliary aids and related services.

The parties agree that the auxiliary aid requirement is a flexible one. Kaiser can choose among various alternatives as long as the result is effective communication.

The parties agree that based upon a careful review of the ADA legislative history, Congress did not intend under title III to impose upon Kaiser the requirement that it give primary consideration to the request of the individual with a disability. The parties agree the legislative history demonstrates congressional intent to strongly encourage consulting with persons with disabilities.

For the purposes of this agreement the term "auxiliary aids and services" includes qualified readers, taped texts, audio recordings, Braille materials, large print materials, or other effective methods of making visually delivered materials available to individuals with visual impairments, acquisition or modification of equipment or devices, and other similar services and actions. Individuals with visual impairments can perceive, receive and process external information by their five senses: 1. Taste; 2. Touch; 3. Sight; 4. Sound; 5. Smell. The Title III regulations, as to the visually impaired and auxiliary aids and related services, are intended to give people with visual impairments equal access to information communicated by Kaiser.

In general, Kaiser members can receive information by one or more Core Senses: 1. Touch 2. Sight 3. Sound.

By way of example, the regulations lists Five Core Methods of Auxiliary Aids that provide information to the Core Senses: 1. Qualified readers; 2. Taped texts; 3. Audio recordings; 4. Braille; 5. Large print. However, the focus must be on providing information effectively to the Core Senses. Hence, the regulations allow for other effective methods and similar services and actions other than the Five Core Methods to provide information effectively to the Core Senses.

1.    Qualified readers

Based upon the Federal Rules of Evidence, when Qualified Readers are utilized, they must accurately reflect the original written material without abridgement when reading. However, within a reasonable time frame, not to exceed two weeks, after providing the information through a qualified reader, the information must be provided in a fixed format depending upon the needs of the patient. Qualified reader, in the Kaiser context, means a Kaiser employee who possesses the skills to read and pronounce accurately standard American English or the language of the patient, to read and pronounce medical terms and to read and pronounce medical-legal terms.

2. Taped Texts

Based upon the Federal Rules of Evidence Taped Texts must accurately reflect the original written text without abridgement. Taped texts may be used by Kaiser as an alternative format.

 3. Audio Recordings

Based upon the Federal Rules of Evidence Audio Recordings must accurately reflect the original written or oral material without abridgement. Audio recordings may be used by Kaiser as an alternative format.

 4. Braille Materials

 The Braille Authority of North America (BANA) and the National Library Service for the Blind and Physically Handicapped (NLS) defines Braille.  Literary Braille, as officially approved, comprises two grades. Grade 1 Braille is in full spelling and consists of the letters of the alphabet, punctuation, numbers, and a number of composition signs which are special to Braille. Grade 2 Braille consists of Grade 1 and 189 contractions and short-form words, and should be known as "English Braille." However, uncontracted Braille should be designated as "English Braille Code Grade I." The parties agree that if Kaiser uses Braille for written materials, it must be available in grade 1 or 2, or such material shall be available in alternative format immediately upon request in situations involving critical patient care. Critical patient care is defined as situations requiring the patient to read, understand and acknowledge critical written information related to that patient's immediate medical treatment. Immediate medical treatment means the administration of drugs, rehabilitation, dietary strategies or other medical techniques designed to treat an emergency medical condition.

5. Large Print Materials

Type is measured in points from the bottom of the lowest letter (for example, the tail of the letter "y") to the tallest capital; type one-inch high measures 72 points. Most adult print is set in 10- to 12-point type. The Library of Congress states the minimum size for large-print materials is 14-point type. The Library of Congress states that most large-print materials are commonly available in 16- to 18-point type. Based upon this information, the parties agree that Kaiser generated written materials will be available in at least 14-point upon request. If a Kaiser member requires written materials in 15 to 18 point, Kaiser shall deliver the requested material in 14-point and deliver the requested material in the requested higher point within a reasonable time period.

6. Other Effective Methods Of Making Visually Delivered Materials Available To Individuals With Visual Impairments And Other Similar Services And Actions.

If Kaiser, in the future, develops other effective methods and similar services and actions of providing information effectively to the Core Senses of Kaiser members with visual impairments that are equal to the Five Core Methods than Kaiser may use those methods. Other effective methods and similar services and actions may include signage or mapping, audio description services, secondary auditory programs (SAP), telebraillers, reading machines and other new assistive technology.

7. Acquisition Or Modification Of Equipment Or Devices

Kaiser agrees that equipment or devices are necessary to provide auxiliary aids and related services. The parties agree that Kaiser may use existing equipment or devices as long as such equipment or devices results in effective communication with Kaiser members with visual impairments. The parties agree that Kaiser may use modified existing equipment or devices as long as such equipment or devices results in effective communication with Kaiser members with visual impairments. The parties agree that Kaiser may use newly acquired equipment or devices as long as such equipment or devices results in effective communication with Kaiser members with visual impairments.

8. Minimum Standards

This Agreement sets minimum effective communication standards in light of the flexibility of the auxiliary and related services requirement. Also, this Agreement delineates Five Core Methods of providing auxiliary aids as minimum standards of effective communication with Kaiser members with vision impairments. It is understood that Kaiser's Communication Access Solutions Initiative for persons with vision impairments may modify, replace, and/or supplement the Five Core Methods.

9. Reporting

In light of the Metzler v. Kaiser                 Foundation Health Plan, Inc., (Metzler) Agreement this Agreement will not duplicate sections IV 20 and V 27 of Metzler as to the training programs as long as the training involves effective communication methods including the five Core Methods. Also, this Agreement will not duplicate sections V 22c and VI 33 of Metzler as to the written reports as long as the reports include an evaluation of effective communication methods, the five Core Methods, other similar services and actions and equipment and devices and forward said reports to Plaintiffs' Counsel within the same time periods specified in sections V 22c and VI 33 of Metzler. Kaiser agrees that Plaintiffs' Counsel's rate per hour shall be three hundred and fifty dollars ($350.00) for reviewing and responding to said reports and Kaiser agrees to pay said rate for the time spent for reviewing and responding to said reports.

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