The Facts
Home Up The Complaiint ADA Auxiliary Terms Kaiser Agreed To The Facts

 

A.  Pre-Litigation Facts: The Metzler Agreement

     On July 9, 2001, Plaintiffs retained Pinnock & Wakefield to file a civil action against Kaiser for failing to provide auxiliary aids and services to Kaiser members. Through news reports, lead counsel Theodore A. Pinnock, had notice that Kaiser entered into a broad based ADA Title III Settlement with Disability Rights Advocates (DRA) with regards to architectural barriers.  On January 27, 2002, Mr. Pinnock wrote an email to Larry Paradis, a DRA attorney, to determine if the settlement covered auxiliary aids specifically, and if it was a class action settlement. 

      In July 2002, Mr. Pinnock received a settlement agreement entitled “SETTLEMENT AGREEMENT Metzler et al. v. Kaiser Foundation Health Plan, Inc. et al” attached as Exhibit A to the Decl. Of Theodore A. Pinnock.  First, Mr. Pinnock surmised the Metzler Agreement was not a class agreement.  Second, he determined the agreement focused on removing architectural barriers at Kaiser facilities. Third, the agreement did not cover auxiliary aids and services.  Fourth, Mr. Pinnock found a catchall provision, which stated:

“25. With the assistance of the parties, the Access Policy Consultant(s) and/or the Access Policy Work Group will review Kaiser’s policies and procedures (or the absence thereof) for addressing the communication needs of people with vision, speech, hearing, and cognitive disabilities and, where appropriate, will recommend reasonable modifications that Kaiser will adopt and implement. With respect to the model facilities, this review, recommendation, and implementation process shall be completed within one year from the effective date of this Agreement. The review, recommendation, and implementation process for all Kaiser facilities in California shall be completed within three years from the effective date of this Agreement.”

            Plaintiffs desired specific auxiliary aids and services definitions and guidelines.  The Metzler Agreement was not intended to provide such definitions and guidelines. Thus, this civil action was filed on July 19, 2002 after reviewing evidence showing Kaiser’s failure to provide auxiliary aids and reviewing auxiliary aids statutory law.

     B.  The Complaint

     In the Complaint Plaintiffs LISA IRVING-RAMIREZ, AN INDIVIDUAL and MARIA DEER, AN INDIVIDUAL allege they have sight impairments which substantially limit their ability to see or read standard print.  Specifically, LISA IRVING-RAMIREZ is partially visually impaired and requires written material to be in 14-point large print.  MARIA DEER cannot see at all and requires written material be delivered on audiocassette. 

     Between 2001 to present, at all times Plaintiffs were/are a client or customer of Defendants.  Defendants operate several medical facilities, including, inpatient and outpatient medical facilities throughout San Diego County.  Plaintiffs received medical services at one or more Kaiser facilities in San Diego.  Plaintiffs, on numerous occasions, received pharmacy written instructions, written medical instructions, printed media delivered in person to patients or clients and printed media delivered by other means to patients or clients from Kaiser.  Plaintiff Irving-Ramirez repeatedly requested this information be delivered to her in large print timely.  Plaintiff Deer repeatedly requested this information be delivered to her in audiocassette form timely.  Defendants continued to deliver Plaintiffs pharmacy written instructions, written medical instructions, printed media delivered in person to patients or clients and printed media delivered by other means to patients or clients in standard print, or Defendants delivered to Plaintiffs pharmacy written instructions, written medical instructions, printed media delivered in person to patients or clients and printed media delivered by other means to patients or clients which failed to provide meaningful access to the words contained therein. 

C.      November 15, 2002 Private Settlement Meeting: Plaintiffs’ November 16, 2002 Demand

     In early August 2002, Malcolm Trifon, Kaiser Corporate Counsel, contacted Mr. Pinnock about an extension of time to file a responsive pleading and about pursuing settlement.  Mr. Trifon and Mr. Pinnock agreed to meet.  In preparation for the meeting, in early August, 2002, Mr. Pinnock decided to update his case research to determine if a court interpreted “auxiliary aids and services” and if a court defined the meaning of “large print,” “Braille,” “audio recordings,” “taped text,” and “qualified readers” as used in the ADA.   On November 15, 2002, Mr. Trifon and Mr. Pinnock had an in person private settlement conference where Mr. Pinnock made an oral settlement demand. 

            On November 16, 2002, Mr. Pinnock made a written settlement demand.  The demand stated, in relevant part:

  1. Kaiser shall furnish appropriate auxiliary aids and services where necessary to

ensure effective communication with individuals with disabilities. The Appendix to 28 CFR Sec.36.303 states effective communication means relaying information ``effectively, accurately, and impartially”.

  1.  [Plaintiffs] made the following injunctive relief demand:

a.       Alternative Formats

i.         Printed Material

1.      All material must be in 18 point;

2.      All materials offered to members must in large print which include but are not limited to appointment notices, Questionnaires, health history forms, brochures, pamphlets, newsletters, membership magazines, healthcare provider directories, in class hand outs, prescription directions, medication inserts, medication information sheets, All maps, directories and in house phone numbers, signs, all Kaiser classes, written correspondence on behalf of membership services and any other Kaiser entity or representative;

3.      Each department shall have large print devices;

4.      Personnel in each department shall be trained to use said devices;

  ii.  Audiocassette

    1.  Kaiser shall prohibit abridging any printed text and there shall be no omission of any printed text;

            2.  Each department shall                  have recording devices;

    3.  Personnel in each department shall be trained to use said devices;

  iii.  Braille

   1.   Must be in grade two which shall be condensed text content or  an omission of any text which appears in standard print materials furnished by the Kaiser Healthcare Network;

  2.  Provide inserts, handouts, prescription directions, etc. in  Braille, grade two.

  iv.  Online

    Online within one year of the settlement date all printed health are provider directories, newsletter and pamphlets shall be fully accessible to member who use screen readers in place of viewing graphics and text on computer screen.  In order to achieve 100% accesses to online resources it is essential to consult with specialists who design and evaluate online and Internet services for user-friendly interfacing of screen reader program and online goods and services.

            v.  Automation

     Automated access for prescription information, handouts about side effects, etc. With one-year print impaired Kaiser members shall be able to “read” third prescriptions, directions landside effects through automated phone service.

            vi.    Shopping

     Assistance with “shopping” for goods within the pharmacy.  Members who are unable to read standard print or who are unable to see goods stocked on shelves or behind the counter need pharmacy assistance.  This assistance shall be available to Members who identify themselves as being unable to read standard print. 

            vii.   Screens

     Scrolling screens and numbers posted above pharmacy windows limit or exclude persons highly unreliable.  For this reason these members shall drop off pickup prescription from the same line.  If other members are expected to wait 30 minutes then the member with vision loss shall be given the same waiting period and will re-enter the designated line to obtain his or her medication.

           viii.  Tiling

     Kaiser must demonstrate it has thoroughly investigated the installation of tiling signs, which can only be heard by the member who has a receiver.  Such technology has existed for more than a decade and is available in some airports, rehabilitation centers and some transit services within the United States.

             ix.    Directories

     Facility directories, which often appear in entrance and rear elevators and exist to inform members where a service or physician is located, must be in alternate format.  Members shall contact membership services to obtain these hospital and city directories in 18 point print or grade two Braille. No advanced notice of the members shall be required however; advanced notice can be stated as preferred.  Phone directories posted on wall or in-house phones must be available in 18-point print and grade two Braille.  It is strongly recommended that these lists automatically be posted in 18-point print.  A Braille directory shall be available at Membership Services as well as in tee cosset check in are to the phone.

 x.  Full Inclusion into all Kaiser        Classes

      Members who participate in nutrition, stress management, support groups, etc., shall offer alternative formats.  Upon verbal request from the member with a vision disability the instructor will read (instead of pointing or referencing to the overhead etc). Instructors reading out loud what they are writing or presenting in the mom college campuses.  Members who register for any class shall identify one are self as being a member with a vision disability.  The purpose of identifying one’s self as having a vision disability is to enable Kaiser staff to offer handouts and resources prior to class.  At that time the member wall be offered options of 18 point print, Braille, grade two, audio cassette information at least 72 hours prior to the first lecture or one can pick up the materials in alternative format at the start of the class when had outs are typically distributed. If the class us geared to hands-on illustrations then the members with vision disability should be offered the opportunity to be directly involved in the demonstration.  This works well in First Aid and PR courses.  It shall not be the responsibility of other sighted class participant to read materials on imparts visual information the member with the vision disability.

xi.  Representation by an Advisory  Committee

     At every regional level an Advisor Committee shall be established to ensure members each vision loss are continuously and fully included into every service and all goods provided by any Kaiser Healthcare Network.  The advisory committee shall be equally comprised of members and professionals not employed by or for Kaiser.  Both sighted and visually literate adults shall recommend, vote and oversee the committee’s recommendations and determinations. The committee shall report to Kaiser regional representatives, a designated entity such as Department of Health and Human Services and for the first two years shall annually appraise  law firm.  This committee may be a sub-committee of the committee created by section I1 of the Metzler Agreement.

  xii.     Kaiser shall appoint an Auxiliary Aid Specialis

     Mr. Trifon wanted Plaintiffs to agree to the Metzler Agreement with some compensation, thus, he rejected Mr. Pinnock’s demand.  Mr. Trifon filed an Answer. 

     D.   Early Neutral Evaluation: Kaiser’s ADA Policy Consultant

On February 12, 2003, an Early Neutral Evaluation was held, however, the case did not settle.  On April 14, 2003, a telephone conference was held with Mr. Pinnock, Mr. Trifon, Shari Samuels who is Kaiser’s ADA Policy Consultant and Ms. Nicole Duckett who is Kaiser’s Litigation Counsel to discuss Kaiser’s progress in providing auxiliary aids.  On July 14, 2003, Mr. Pinnock drafted an e-mail to Ms. Duckett stating a willingness to settle by entering a consent decree[1] adopting Samuels' Kaiser plan with compliance within 1 year with an offer to settle for $60,000.00.  Ms. Duckett sent an email making a counter proposal to Mr. Pinnock as follows: relying on Samuels' plan, agree that Kaiser is making efforts to comply, agree on a monetary amount and dismiss suit.  Plaintiffs did not accept this counter proposal.

     E.    Kaiser’s $24,000 as a potential global monetary amount

     On October 9, 2003, Mr. Pinnock received an email from Ms. Duckett about $24,000 as a potential global monetary amount.  Mr. Pinnock replied, on October 9, 2003, stating $24,000 did not include fees and indicated a willingness to submit fees to this Court.  On October 27, 2003, a settlement conference was held in which Mr. Pinnock stated that auxiliary aids must be defined in a settlement agreement, fees can be decided by this Court, and this case must be settled as a class action.  The case did not settle.

     F.  The Kaiser Draft

     On November 1, 2003, Mr. Pinnock wrote a proposed settlement and release agreement called the Kaiser Draft where he made a detailed outline governing the auxiliary aids and related services.  On February 19, 2004, Defendants responded to the Kaiser Draft with a revised agreement  in which Defendants deleted all of Mr. Pinnock's detailed auxiliary aids and related services, and it did not provide for any definition for auxiliary aids.  Also, the revised draft agreement did not state when the plaintiffs would be provided with the auxiliary aids, the agreement contained a confidentiality clause which would inhibit other Kaiser members from learning of the availability of auxiliary aids, and the agreement did not specify the amount of payment.

     G.  Mr. Pierce Stepping In For Ms. Duckett

     On March 15, 2004, Mr. Pinnock received an email from Mr. Pierce stepping in for Ms. Duckett.  Mr. Pierce emphasized common settlement ground and stated auxiliary aids regulations are not precise.  On March 16, 2004, Mr. Pinnock drafted an e-mail to Mr. Pierce stating the parties needed the court to define auxiliary aids.  Also, Mr. Pinnock analyzed the Auxiliary Aid regulation in reply to an email sent by Pierce. 

     H.   Plaintiffs’ Terms

      On March 16, 2004, Mr. Pinnock, in an effort to gain consensus on the definitions of auxiliary aids, drafted an e-mail to Jeff Thom, President of the California Council of the Blind, asking for definitions for Braille, large print, and audiocassette. Mr. Pinnock received an email from Gene Lozano of the California Council of the Blind about definitions for large print, Braille, and audiocassette on March 19, 2004.  From March 19, 2004 to March 20, 2004, Mr. Pinnock conducted detailed research on the NSL website, Library of Congress website, the Braille Institute website, and other websites to ascertain secondary authority for defining large print, Braille, audio recording, taped text and qualified readers.   Mr. Pinnock also researched the Federal Rules of Evidence and the Federal Rules of Civil Procedure for authority defining large print, Braille, audio recording, taped text and qualified readers.  Beginning on March 20, 2004, Mr. Pinnock wrote the detailed Plaintiffs’ Terms attached as Exhibit D of the Decl. Of Theodore A. Pinnock based upon his detailed research.  Mr. Pinnock, Mr. Trifon and Mr. Pierce agreed, in principal, on Plaintiffs’ Terms at a settlement conference on March 26, 2004.  On April 19, 2004 the parties agreed on the final version of Plaintiffs’ Terms and Defendants started drafting another settlement agreement incorporating Plaintiffs’ Terms. On May 31, 2004, a draft agreement prepared by defendants incorporating the final version of Plaintiffs’ Terms was completed. 

     I.  Plaintiffs Are The Prevailing Party: On June 4, 2004, The Parties Appeared At A Settlement Conference

     On June 4, 2004, the parties appeared at a settlement conference.  At the conference the parties agreed on the record: 1. Plaintiffs would receive $28,000 in 30 days, 2. Plaintiffs would receive auxiliary aids in 30 days, 3. Plaintiffs are the prevailing party, 4. Plaintiffs’ counsel will file a motion for fees and costs, 5. Defendants will revise the draft agreement prepared by defendants incorporating the final version of Plaintiffs’ Terms to reflect the provisions placed on the record.  On June 14, 2004, Mr. Pinnock wrote an e-mail to Mr. Pierce asking him to revised the last draft release to state $28,000 for damages due 30 days from June 4, 2004, to state 30 days to provide auxiliary aids, and reminding him of Mr. Pinnock's $60,000 fee demand expired on June 14.[2]  Due to the fact Mr. Pierce did not revised the agreement, on June 21, 2004, Mr. Pinnock modified the agreement prepared by the defendant by adding the payment of 28,000 dollars for damages, by indicating to whom the payment should be made to, by indicating the payment shall not include the attorney fees and costs, by indicating that the attorney fees and costs shall be determined by a motion and by adding within 30 days of June 4, 2004, defendants will provide the auxiliary aids and related services to the plaintiff, and deleted the confidentiality clause.  Subsequently, Defendants modified the Agreement that became the Final Version.  

J.       The Final Release and Agreement contains an Exhibit A. Exhibit A contains the 

      ADA compliance terms

     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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