MEMORANDUM OF UNDERSTANDING MASSACHUSETTS GENERAL HOSPITAL AND BOSTON CENTER FOR INDEPENDENT LIVING, THERESA BAINO, STACY BERLOFF, KELLYANN BINARI AND PAMELA DALY WHEREAS, the parties are engaged in negotiations to resolve claims concerning disability access at MGH, including potential claims regarding injunctive relief. WHEREAS, negotiations have entailed discussions about the following: the process for identifying architectural barriers at facilities and developing proposed remediation plans; installation of accessible medical equipment; adoption of policies and procedures to improve access to health care for persons with disabilities; training for medical professionals, staff and volunteers in (a) use of accessible medical equipment, (b) provision of auxiliary aids and services, and (c) compliance with policies and procedures and training, implementation of existing or modified policies for providing access to health care for persons with disabilities, and provision of auxiliary aids and services for persons with disabilities. AGREEMENT NOW THEREFORE, Claimants and MGH agree as follows: I. DEFINITIONS 1. “ADA” means and refers to the Americans with Disabilities Act as codified at 42 U.S.C. §12101 et seq, as amended by the ADA Amendments Act of 2008, P.L. 110-335, 122 Stat. 3553 (2008). 2. “ADAAG” means and refers to the ADA Standards for Accessible Design, commonly referred to as the Americans with Disabilities Act Access Guidelines, as codified at Appendix A to 28 C.F.R. Part 36. The Guidelines to be followed under this Agreement are the Guidelines in effect at the time the Architectural Consultant completes his survey, except that if amendments to or a different version of the Guidelines are adopted by the Department of Justice, MGH will comply with the amended or revised Guidelines. MGH shall not be required to make alterations to any work it has done pursuant to this Agreement prior to the effective date of the amended or revised Guidelines. 3. “Access” and “Accessible” mean and refer to conditions that comply with the relevant and applicable standards set forth in the Disability Rights Laws. 4. “Accessible Medical Equipment” means and refers to medical equipment that is accessible to and useable by patients with disabilities, including, but not limited to, examination tables, examination chairs, lift equipment, scales, radiologic and diagnostic equipment, dental chairs, ophthalmology equipment, and any other medical equipment used in the medical context for the provision of health care services. 5. “Agreement” shall mean this Memorandum of Understanding. 6. “Architectural Barrier” means and refers to a physical impediment to accessibility of patient-care services or other visitor services at an MGH facility, including, but not limited to, parking facilities, entrances, paths of travel, restrooms, patient bedrooms, examination rooms, waiting areas, treatment rooms, laboratories, counters, public telephones, drinking fountains, pharmacies, cafeterias, gift shops and any other fixed features within MGH facilities that are regulated by Disability Rights Laws. 7. “Auxiliary Aids and Services” means and refers to services and devices necessary for ensuring that no individual with a disability is excluded, denied services, segregated or otherwise discriminated against and includes those services and devices necessary for ensuring effective communication with Individuals with Sensory Disabilities, including, but not limited to, qualified sign language interpreters, TTY/TDD machines, qualified readers, taped texts, audio recordings, Braille materials, large print materials, Accessible websites, and audible prescription labels. 8. “Claimants” means and refers to the Boston Center for Independent Living, Theresa Baino, Stacy Berloff, Kellyann Binari, and Pam Daly. 9. “Claimants’ Counsel” means and refers to the law offices of Greater Boston Legal Services (“GBLS”) and Disability Rights Advocates (“DRA”) and the attorneys and other employees therein. 10. “Days” means calendar days. 11. “Disability” means and refers to the definition of disability in the ADA and implementing regulations. 12. “Disability Rights Laws” means and refers to the ADA and implementing regulations, the Rehabilitation Act of 1973, 29 U.S.C. § 701, et seq, and implementing regulations, and the Rules and Regulations of the Massachusetts Architectural Access Board (“MAAB”), 521 Code of Massachusetts Regulations §1.00 et seq. 13. “Effective Date” shall mean the date set out in Section III of this Agreement as the Effective Date. 14. “Expiration Date” shall mean the date set out in Section III of this Agreement as the Expiration Date. 15. “Facilities” means and refers to all portions of MGH premises where health care services are provided and to which the public is invited, including but not limited to: (a) the physical structures, such as hospital buildings, (b) exam rooms, patient bedrooms, public restrooms, waiting areas, treatment rooms, laboratories (to the extent they are utilized by patients), pharmacies (in areas utilized by the public), gift shops and cafeterias within hospital buildings, (c) paths of travel and entrances serving these physical structures and (d) parking facilities under the control of MGH. Attachment A to this Agreement sets out the specific facilities which will be surveyed pursuant to Section V.A. Attachment A also includes a clarifying statement which describes the parts of such facilities which will be surveyed and which will not. 16. “Individual with a Disability” means and refers to an individual with a mobility disability and/or sensory disability. “Disability” means and refers to mobility disability and/or sensory disability. 17. “Individual with a Mobility Disability” means and refers to any individual who meets the general definition of “disability” and has any impairment or condition that limits or makes difficult the major life activity of moving his or her body or a portion of his or her body. “Mobility disability” includes, but is not limited to, orthopedic and neuro-motor disabilities and any other impairment or condition that limits an individual’s ability to walk, maneuver around objects, ascend or descend steps or slopes, and/or operate controls. An individual with a mobility disability may use a wheelchair or other assistive device for mobility or may be semi-ambulatory. 18. “Individual with a Sensory Disability” means and refers to any individual who meets the general definition of “disability” and has any visual disability that limits or makes difficult the major life activity of seeing, and/or any hearing disability that limits or makes difficult the major life activity of hearing, and/or any speech disability that limits or makes difficult the major life activity of speaking. “Sensory disability” means and refers to visual disability, and/or hearing disability, and/or speech disability. 19. “MGH” means and refers to the General Hospital Corporation, d/b/a the Massachusetts General Hospital, a Massachusetts nonprofit corporation. 20. “Parties” means and refers to MGH, BCIL and the Claimants. 21. “Removal of Barriers,” “Alteration,” “Readily Achievable Barrier Removal,” “Maximum Extent Feasible,” and “Undue Burden” mean and refer to those terms as defined in the ADA and its regulations. It is understood that among the considerations as to whether a particular barrier removal is readily achievable will be, but is not limited to, expense and patient care considerations, and that among the considerations as to whether a particular recommendation for a particular piece of Accessible Medical Equipment would result in an Undue Burden will be, but is not limited to, expense and patient care considerations. II. TIMEFRAMES AND DEADLINES It is understood by both parties that the completion of particular assessments or actions contemplated in this agreement may be delayed due to circumstances beyond either parties’ control, and therefore both parties agree to consider requests to extend such timelines and deadlines in a reasonable manner, and to not withhold any agreement to so extend unreasonably. If either party believes that the other party is being unreasonable in either its request for an extension or its refusal to agree to such extension, such a dispute will be subject to the Dispute Resolution procedure set out in Section VIII of this Agreement. If any stage of this Agreement is completed early, any time saved due to such early completion will be added onto the next related obligation as set out in this Agreement.1 1 For example, Task A must be completed within 120 days; Task B must be completed within 180 days of Task A’s completion. If Task A is completed within 90 days, then Task B must be completed within 210 days of Task A’s completion. III. EFFECTIVE DATE AND DURATION OF THE MEMORANDUM OF UNDERSTANDING The provisions of this MOU and the agreements contained herein are effective as of July 1, 2009 (the “effective date”) and shall remain in effect through June 30, 2015 (the “expiration date”). If MGH does not fully satisfy its obligations under this agreement, the expiration date shall be extended solely as to any particular obligation that has not been satisfied until such obligation has been satisfied. Determinations as to whether MGH has fully satisfied any obligations with respect to any section shall be subject to the Dispute Resolution procedure set out in Section VIII of this Agreement. IV. REPRESENTATION OF INTEREST, CONFIDENTIALITY AND NONDISPARAGEMENT 1. BCIL and its counsel are authorized to represent the interests of the Claimants with respect to the MOU. 2. The parties acknowledge and agree that certain documents provided by MGH to the parties prior to the execution of this Agreement may contain confidential business information of MGH and that such documents, in whatever form, shall be maintained as confidential and used solely for purposes of administering and enforcing the provisions of this Agreement. The parties further acknowledge that MGH, its agents, or its consultants shall provide documents subsequent to the execution of this Agreement that may contain confidential business information of MGH and that MGH shall mark such documents as confidential or otherwise indicate to the parties receiving such information that the information is confidential. In designating a document as ‘confidential’, MGH will exercise good faith judgment, and the Dispute Resolution procedure set out in Section VIII will be available to Claimants if they deem a designation not to have been made in good faith. Neither Claimants nor Claimants’ Counsel shall disclose such information to any third party except as is reasonably necessary to administer or enforce the provisions of this Agreement or with the express consent of MGH. The parties acknowledge that among other things, “reasonably necessary,” as provided above, does not include disclosures of MGH information to the press or to the general public in the form or a press release. In the event that Claimants or Claimants’ Counsel receives a court-issued subpoena seeking production of any documents or information deemed confidential under this provision, the recipient of such subpoena shall provide MGH notice and a copy of such subpoena and shall make its best efforts to do so within three (3) business days of such receipt, and provide MGH an opportunity to protect its interests in court with regard to such subpoena. Beginning 60 days prior to the expiration of this Agreement, as set forth in Section III, above, MGH may request that Claimants and Claimants’ Counsel destroy or return to MGH (at MGH’s option) all documents and information remaining in their possession marked confidential pursuant to this provision, and all copies of same, and Claimants and Claimants’ Counsel shall comply. 3. The parties recognize the importance of maintaining a constructive working relationship which serves the interests of the parties and MGH patients. Accordingly, as to any matter which could be addressed through the Dispute Resolution Procedure set forth in Section VIII, neither Claimants nor Claimants’ Counsel which, for purposes of this paragraph, shall be deemed to include their respective Boards of Trustees and employees, will communicate to any outside person or entity, whether through press release or otherwise, anything which could reasonably be perceived as disparaging to MGH in any way. As to any matter which could not be addressed through said Procedure, Claimants and their Counsel will notify MGH if they intend to communicate anything which could be considered disparaging to MGH and meet with MGH at its request to resolve the matter and avoid making any such statement. Nothing in this paragraph limits Claimants or Claimants’ Counsel in communicating factual information regarding matters related to healthcare received by persons with disabilities at MGH to any outside person or entity, whether through press release or otherwise. 4. MGH shall appoint, or otherwise assign responsibility to represent its interest to an individual(s) to oversee implementation of this Agreement and to be principal liaison(s) and point(s) of contact for the Claimants. Such individual(s) shall report directly to senior management at MGH. 5. While not a contractual obligation, it is in the spirit of this Agreement that the representatives of the parties will endeavor to build an effective working relationship with each other in the interest of providing high quality health care services to persons with disabilities. 6. There shall be Claimant representation on a Council at MGH that has responsibility for improving services to individuals with disabilities. V. ASSESSMENT OF ACCESS BARRIERS AND CORRECTIVE ACTION PLANS A. Architectural Barrier Removal 1. MGH will engage Evan Terry Associates, P.C. [“ETA”] as an Architectural Consultant to provide an architectural barrier assessment for the MGH facilities specified in Attachment A. The scope of the assessment is set forth in Attachment B. If at any time MGH determines that ETA’s contract with MGH should be terminated or if ETA becomes unavailable, MGH will engage a substitute Architectural Consultant satisfactory to BCIL. BCIL will not unreasonably withhold its approval of such consultant. All references to the Architectural Consultant in this Agreement shall then be deemed to apply to the substitute expert. 2. The parties will identify specific MGH facilities and areas within those facilities for a pilot survey to be conducted within 120 days of the effective date of this agreement. 3. Within 180 days following completion of the pilot survey, MGH shall prepare and submit to BCIL a pilot survey report and barrier removal plan. The survey report will include: (a) a description of each major element that deviates from the ADA Standards for Accessible Design, 28 C.F.R. Part 36, App. A and the Rules and Regulations of the Massachusetts Architectural Access Board (“MAAB”), 521 Code of Massachusetts Regulations §1.00 et seq.; and (b) the Architectural Consultant’s rating of the severity of the identified barrier. 4. The barrier removal plan will identify all barriers which MGH proposes to remove under the readily achievable barrier removal standard or otherwise. For any barriers for which MGH determines removal is not readily achievable, it shall propose a readily achievable alternative solution, or provide an explanation as to why it concludes that there is no such readily achievable alternative. The barrier removal plan will include MGH’s proposed timeline for completing barrier removal and/or implementation of alternative solutions. The survey report and barrier removal plan may be produced as a single document at MGH’s discretion. Each year during the term of this Agreement, MGH will provide to BCIL a schedule of specific Barrier Removal projects scheduled to be undertaken during such year, which BCIL understands will be based upon capital budgets and other priorities and obligations of MGH, as well as its ultimate obligations under this Agreement. Each year’s schedule will include a reasonable percentage of the total barrier removal projects that will be undertaken that year. 5. Within 90 days of receiving the barrier removal plan BCIL may provide a report to MGH which identifies any barriers not scheduled for removal in the Barrier Removal Plan and which BCIL reasonably believes should be removed based upon BCIL’s good faith assessment that such removal (a) is readily achievable or (b) is subject to the Alteration standard. BCIL shall identify in any such report whether it is challenging MGH’s determination based upon “a” or “b”, above. For any such determination that BCIL is challenging based upon “b”, above, MGH shall, within 30 days, provide all information within its possession and control which shows what, if any, Alterations, have been undertaken in the portion of the facility where the barrier is located. If, after receiving the information, BCIL concludes that the barrier should be removed, the Parties shall follow the Dispute Resolution procedure in Section VIII. In the event there is a determination that the relevant portion of the facility has undergone an Alteration, removal of the barrier shall be undertaken as required by the Disability Rights Laws. Notwithstanding the foregoing, nothing in this Agreement shall obligate MGH to make more inpatient rooms, inpatient bathrooms and inpatient toilet rooms accessible than would be required under Section 6.1(4) of the ADAAG and/or 521 CMR 13.3.1. Further, nothing in this Agreement shall obligate MGH to make more patient examination and diagnostic rooms accessible than are required to provide equal access and equal benefits to individuals with disabilities. 6. Following completion of the pilot survey the parties will meet and confer within 30 days to determine whether the scope of the assessments as set forth in Attachment B should be modified to ensure a full identification of architectural barriers. If the parties cannot agree on modifications to the scope of the assessment, they will treat their failure to reach agreement as a dispute to be resolved in accordance with Section VIII. 7. Upon determination of the scope of the survey, MGH shall cause a survey to be taken of whatever portion of MGH existing facilities is necessary to identify barriers in all facilities identified in Attachment A, other than those areas covered by the pilot survey. The survey shall be completed by December 31, 2010. 8. Within 180 days of the completion of the survey a survey report and a barrier removal plan will be provided to BCIL. The survey report will include the following: (a) a description of each major element that deviates from the ADA Standards for Accessible Design, 28 C.F.R. Part 36, App. A and the Rules and Regulations of the Massachusetts Architectural Access Board (“MAAB”), 521 Code of Massachusetts Regulations §1.00 et seq.; and (b) the Architectural Consultant’s rating of the severity of the identified barrier. 9. The Barrier Removal Plan, which shall incorporate the Pilot Barrier Removal Plan, will identify all barriers which MGH proposes to remove under the readily achievable barrier removal standard or otherwise. For any barriers for which MGH determines removal is not readily achievable, it shall propose a readily achievable alternative solution, or provide an explanation as to why it concludes that there is no such readily achievable alternative. The barrier removal plan will include MGH’s proposed timeline for completing barrier removal and/or implementation of alternative solutions. The survey report and barrier removal plan may be produced as a single document at MGH’s discretion. Each year during the term of this Agreement, MGH will provide to BCIL a schedule of Barrier Removal projects scheduled to be undertaken during such year, which BCIL understands will be based upon capital budgets and other priorities and obligations of MGH, as well as its ultimate obligations under this Agreement. Each year’s schedule will include a reasonable percentage of the total barrier removal projects that will be undertaken that year. 10. Within 90 days of receiving the Barrier Removal Plan, BCIL may provide a report to MGH which identifies any barriers not scheduled for removal in the Barrier Removal Plan and which BCIL reasonably believes should be removed based upon BCIL’s good faith assessment that such removal (a) is readily achievable or (b) is subject to the Alteration standard. BCIL shall identify in any such report whether it is challenging MGH’s determination based upon “a” or “b”, above. For any such determination that BCIL is challenging based upon “b”, above, MGH shall, within 30 days, provide all information within its possession and control which shows what, if any, Alterations, have been undertaken in the portion of the facility where the barrier is located. If, after receiving the information, BCIL concludes that the barrier should be removed, the Parties shall follow the Dispute Resolution procedure in Section VIII. In the event there is a determination that the relevant portion of the facility has undergone an Alteration, removal of the barrier shall be undertaken as required by Disability Rights Laws. Notwithstanding the foregoing, nothing in this Agreement shall obligate MGH to make more inpatient rooms, inpatient bathrooms and inpatient toilet rooms accessible than would be required under Section 6.1(4) of the ADAAG and 521 CMR 13.3.1. Further, nothing in this Agreement shall obligate MGH to make more patient examination and diagnostic rooms accessible than are required to provide equal access and equal benefits to individuals with disabilities. 11. The Yawkey Center for Outpatient Care shall be surveyed in either the pilot or follow-up survey and any barriers identified shall be removed under the new construction standard in the Disability Rights Laws. 12. MGH shall complete the architectural barrier remediation contemplated by this agreement by the expiration date of the agreement. 13. When the Building for the Third Century is completed the Architectural Consultant shall conduct an architectural barrier survey to identify each major element that deviates from the ADA Standards for Accessible Design, 28 C.F.R. Part 36, App. A and the Rules and Regulations of the Massachusetts Architectural Access Board (“MAAB”), 521 Code of Massachusetts Regulations §1.00 et seq. If any barriers are identified they shall be removed. 14. If at any time while this agreement is in effect, MGH plans to undertake a renovation, modification and/or improvement to any part of the Facilities or to undertake new building construction or renovation of existing or newly acquired or leased buildings, any of which exceeds Ten Million Dollars ($10,000,000) in construction costs and which affects the renovation, modification and/or improvement of inpatient rooms, inpatient bathrooms or toilet rooms, exam and treatment rooms or bathrooms associated with exam and treatment rooms, all relevant documents shall be submitted to the Architectural Consultant or some other architectural consultant acceptable to BCIL for a plan review sufficient to show compliance with Disability Rights Laws prior to commencement of any work and within an early enough timeframe for a meaningful review. Such architectural consultant shall complete the plan review within a reasonable period of time. MGH will review any recommendations for changes and will either accept them, reject them or propose alternative means for addressing the issues identified in the plan review. If MGH accepts the recommended changes they shall be put into effect forthwith. If MGH rejects them or proposes alternative solutions, the parties shall promptly meet and confer regarding such determination. If the parties cannot agree on a final plan, they will treat their failure to reach agreement as a dispute to be resolved in accordance with Section VIII below. Any renovation, modification and/or improvement project to any part of the Facilities that does not reach the threshold identified above shall be reviewed internally for compliance with the Disability Rights Laws and any variances from such laws will be addressed. The tool used for such internal review will be shared with BCIL when developed. B. Policies and procedures and ADA Training 1. MGH shall retain an Access Policy Consultant or consultants satisfactory to BCIL to assist it in its policy and procedure and ADA training review and development process. BCIL will not unreasonably withhold its approval of such consultant(s). 2. Within 60 days of the effective date of this Agreement, MGH will furnish to BCIL copies of any MGH policies which relate to the following subject matters and which apply to persons with disabilities: alternative formats; communication access; service access; scheduling exam rooms and patient room access; location, maintenance and use of accessible medical equipment; weight measurement; auxiliary aids and services; accessible websites; lifting and transferring patients with mobility disabilities; maintenance of accessible features, aids and services; and patient complaints. 3. Within 120 days of the effective date of this Agreement, MGH, in consultation with its Access Policy Consultant, shall 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 in order to 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. The subject matters to be considered in such review shall include, but not be limited to, the subject matters set forth in paragraph 2 above. 4. After MGH and its Access Policy Consultant have completed the necessary preliminary work in gathering and assessing information regarding MGH’s policies and procedures, MGH, together with its consultant, will meet with BCIL to discuss MGH’s plans with regard to the revision of its policies and procedures and to receive input and suggestions from BCIL regarding the same. Such input and suggestions from BCIL will be considered in good faith as part of MGH’s review process hereunder. 5. MGH shall then prepare new and revised policies and procedures, as necessary, and shall submit all such new and revised policies and procedures to BCIL. 6. Within 60 days of receiving MGH’s new and revised policies and procedures, BCIL will review and comment on them and, if necessary, propose revisions. MGH shall consider any proposed revisions and make appropriate changes in good faith. If the parties cannot agree on the modifications and/or additions to the policies and procedures, they shall follow the Dispute Resolution Procedure set out in Section VIII of this Agreement. Within 150 days of reaching agreement with BCIL on the policies and procedures, MGH shall finalize them and disseminate them to the appropriate personnel, provide copies of each to BCIL, and begin to implement them. 7. MGH, in consultation with its Access Policy Consultant or other training consultant, shall develop a training program for all employees whose practice or job responsibilities include patient and/or family contact. After MGH and its training consultant have completed the necessary preliminary work and before preparation of the program, MGH, together with its consultant, will meet with BCIL to discuss its plans regarding the training program and to receive input and suggestions from BCIL regarding the substance and format of the training program. Such input and suggestions will be considered in good faith as part of the training program development process. 8. BCIL will be furnished a copy of MGH’s Disability Training Program upon its completion, which shall be no more than 180 days after dissemination of new and modified policies and procedures, as set forth in paragraph 6, above. Within 60 days of receiving the Program, BCIL will review and comment on the Program and, if necessary, propose revisions. MGH shall in good faith consider any such proposed revisions and make appropriate changes. If the parties cannot agree on the modifications and/or additions to the Program and the dispute involves a claim that either the content of the Program fails to address a legitimate training need or MGH is failing to fulfill its training commitment described above, or BCIL can demonstrate that the training methods adopted by MGH will not achieve the training objective, they shall follow the Dispute Resolution Procedure set out in Section VIII of this Agreement. The Disability Training Program will begin to be implemented within 60 days after its adoption. 9. MGH will ensure that all employees whose practice or job responsibilities include patient and/or family contact are provided appropriate training on disability awareness and on providing equal access to medical services for patients with disabilities, including, among other things, the particular needs and concerns of patients with mobility and sensory disabilities. MGH shall also provide and promote opportunities for contractors whose practice or responsibilities include patient and/or family contact to participate in the Disability Training Program. It is anticipated that the Disability Training Program may vary for different categories of employees, and training methods will be adapted as necessary. 10. MGH will make its Disability Training Program available on an on-going basis for the duration of this Agreement. MGH shall require all newly hired employees providing direct patient assistance to be appropriately trained in their responsibilities under the Disability Rights Laws within a reasonable time from their initial hire date. MGH shall also provide opportunities for new contractors to receive similar training. C. Accessible Medical Equipment 1. MGH will engage an Accessible Medical Equipment [“AME”] consultant satisfactory to BCIL to evaluate the need for additional AME at MGH. BCIL will not unreasonably withhold its approval of such consultant. 2. Within 90 days of the AME consultant’s appointment, the consultant shall develop a survey tool to assess the existence and effectiveness of MGH’s medical equipment to provide health care services to individuals with disabilities. MGH shall submit the survey tool and list of equipment to be surveyed to BCIL for approval, which approval shall not be unreasonably withheld. BCIL shall review and comment on the survey tool and/or make recommendations for revisions within 30 days of receiving the survey tool. If BCIL recommends any revisions, MGH shall consider in good faith making appropriate changes. If the parties cannot agree on the survey tool, they shall follow the Dispute Resolution procedures set out in Section VIII, below. 3. Within 180 days of receiving BCIL’s approval of the survey tool, MGH shall complete a survey within the Facilities of equipment that is utilized in the care of patients. This equipment shall include but may not be limited to examination tables and chairs, lifts, radiologic and diagnostic equipment, wheelchair scales, positioning equipment, specialized air mattresses, or other adaptive technology for patients with disabilities, such as accessible call buttons and water sources. 4. Within 180 days of the completion of the equipment survey, MGH shall submit to BCIL a report which includes (a) the current equipment surveyed; (b) a description of any barriers to providing equal access to medical services, including, but not limited to, barriers posed by the existing equipment, or the lack thereof, its placement, installation, and/or operation: (c) recommendations for the purchase of additional equipment, relocation, supplementation, or modification of the existing equipment, and other methods to eliminate barriers, or, if no new equipment or modifications to existing equipment would overcome a barrier posed by the existing equipment or it is an undue burden to purchase or modify equipment, what alternatives should be utilized to ensure that individuals with disabilities receive equal access to medical services; and (d) a schedule for the recommended purchase and modification of the equipment and the implementation of other related barrier removal efforts. Within 45 days of receiving MGH’s report, BCIL shall review and comment on MGH’s recommendations and/or propose revisions. MGH shall consider in good faith making appropriate changes. If the parties cannot agree on the recommendations, they shall follow the Dispute Resolution procedure set out in Section VIII of this Agreement. Upon agreement, MGH shall immediately begin purchasing equipment in accordance with the schedule. VI. OUTREACH MGH agrees to review and, if necessary, update or modify its community relations policies and procedures to ensure that the community is aware of MGH’s continuing commitment to providing equal access to patients, regardless of disability. VII. REPORTING A. Status Reports 1. During the term of this Agreement, on a semi-annual basis, commencing on December 1, 2009, MGH shall provide BCIL with status reports describing the work done in the prior 6 months and work to be done in the 6 months following the report to implement the terms of Section V.A, V.B and V.C above. 2. The status reports shall include the following: a. The extent to which MGH has completed the work under this agreement; b. The extent to which MGH has modified the work under this agreement and the reason(s) for such modifications; c. A list of any renovation, modification and/or improvement project to any part of the Facilities that exceeds Two Million Dollars ($2,000,000) in construction costs and that was reviewed internally pursuant to Section V(A)(14) during such time period. d. What problems, if any, MGH has encountered that has resulted in a delay of or modification to proposed work; and e. MGH’s proposal to remedy any problems that have resulted in a delay of work required under this agreement. 3. Status Reports shall be reviewed by the Architectural, Access Policy and AME Consultants, or other qualified consultants acceptable to BCIL, who shall validate MGH’s compliance in the Status Report regarding its obligations under Sections V.A, V.B and V.C of this Agreement. The Consultants will be provided with access and information required for such validation to be meaningful. B. Final Report MGH shall submit to BCIL a final report 3 months before the expiration date of this agreement. This report shall describe MGH’s compliance with this agreement, and any unmet obligations under this agreement, the reasons they are unmet, and the proposed resolutions. C. Complaint Reporting MGH shall, consistent with any applicable patient confidentiality obligations, include a summary of written and oral complaints made to MGH through its Patient Advocacy department regarding architectural barriers, policies, practices and procedures, and accessible medical equipment as they relate to disability access. These complaint summaries will include the following information about each complaint: 1. The date of the incident that is the subject of the complaint; 2. The facility that is the subject of the complaint; 3. The issue raised in the complaint; 4. The form of the complaint (phone call, letter, email, in-person complaint, etc.); 5. The relief requested in the complaint; and 6. MGH’s response to the complaint, if any, any actions taken or planned to be taken, including the timeline for completion of any action still in progress. VIII. DISPUTE RESOLUTION Except as otherwise specified, the Parties agree that any dispute arising out of this agreement relating to its interpretation and application, including the performance of obligations set forth herein shall be addressed in the following manner: 1. Any party complaining that a violation has occurred or that a dispute has arisen as to the interpretation and application of this agreement will give notice to counsel for the other party. Such notice shall set forth the complaint/dispute and shall propose a resolution. 2. Within two weeks of delivery of the written claim of such alleged violation or dispute the parties shall meet and confer in an effort in good faith, through informal negotiation, to resolve the issue. 3. If the issue remains unresolved after a reasonable period of meeting and conferring, the parties will attempt to resolve the matter in mediation, using a mediator who is jointly selected by the parties. 4. If mediation does not resolve the dispute, it will be settled by means of arbitration. The matter must be submitted to arbitration by the complaining party within 30 days after the conclusion of mediation. Any dispute arising under the Agreement shall be submitted to Gordon Doerfer, Elizabeth Butler, or Rudolph Kass, individually on a rotating basis, and shall be conducted pursuant to the Judicial Arbitration and Mediation Services (JAMS) Streamlined Arbitration Rules and Procedures. A fourth arbitrator may be added to the panel after execution of this Agreement upon agreement by both parties. The arbitration shall take place in Boston. The award of the arbitrator will be enforceable in a court of competent jurisdiction. If any named arbitrator is no longer serving as an arbitrator, the parties shall name a mutually agreeable replacement. 5. All communications, negotiations and/or documents exchanged by and between the parties in the course of an arbitration shall be confidential, except for communication of information that is generally available to the public. No evidence of any communications, negotiations and/or documents or any admission made or recommendation agreed to during the course of any arbitration will be admissible or subject to discovery outside of the arbitration proceeding or adjudication, civil action or other legal proceeding. The Arbitrator shall issue such protective orders as may be necessary to protect confidential information from unnecessary disclosure and shall specifically designate information subject to the protective order as Confidential and Sensitive Information. On a reasonable date after the termination of jurisdiction over an Action, and consistent with the Parties’ Counsels’ obligations to retain case documents pursuant to their malpractice insurance policies, each party shall return or destroy all documents obtained from the other party during the course of the arbitration, and shall provide to the other party an authorized representative’s attestation indicating that all such information has been returned or destroyed. 6. Attorneys' fees and costs attributable to dispute resolution pursuant to this arbitration, including costs for the services of any arbitrator, will be awarded as follows: a. If Plaintiffs prevail on all claims raised in the dispute resolution process, they shall recover their reasonable attorney's fees, expenses and costs in full; b. If Plaintiffs prevail on some but not all claims raised in the dispute resolution process they shall recover their reasonable attorneys' fees, expenses and costs excluding time, expenses and costs in accordance with Hensley v. Eckerhart, 461 U.S. 424 (1983) and its progeny and offset by the reasonable attorneys' fees, expenses and costs incurred by MGH for time spent defending Claimants’ unsuccessful claims that the arbitrator finds to have been frivolous, unreasonable, or without foundation; and c. If MGH prevails on all claims raised in the dispute resolution process, MGH shall recover its reasonable attorney's fees, expenses and costs in full from Plaintiffs for time spent defending Claimants' unsuccessful claims that are found by the arbitrator to have been frivolous, unreasonable or without foundation. IX. MISCELLANEOUS PROVISIONS. 7. Notice or Communication to Parties Any notice or communication required or permitted to be given to the Parties hereunder shall be given in writing by email and first class United States mail, addressed as follows: To Claimants: Daniel S. Manning Greater Boston Legal Services 197 Friend Street Boston, MA 02114 E-mail: dmanning@gbls.org To Massachusetts General Hospital Joshua Abrams Office of General Counsel Partners Healthcare 50 Staniford Street Boston, MA 02114 E-mail: jabrams@partners.org 8. Modification in Writing No modification of the Agreement shall be effective unless in writing and signed by authorized representatives of all Parties. 9. Agreement Binding on Assigns and Successors The Agreement shall bind any assigns and successors of the Parties. Counsel shall be notified in writing within thirty (30) days of the existence, name, address and telephone number of any assigns or successors of MGH. 10. No Admission of Liability In entering into the Agreement, MGH does not admit, and specifically denies, that it has violated or failed to comply with any Disability Rights Laws. For Massachusetts General Hospital: ________________________________ Peter L. Slavin, MD President Massachusetts General Hospital ________________________________ Brent L. Henry Joshua Abrams Nelson Ross Counsel for Massachusetts General Hospital For Claimants: ________________________________ Bill Henning Boston Center for Independent Living ________________________________ Theresa Baino Claimant ________________________________ Stacy Berloff Claimant ________________________________ Kellyann Binari Claimant ________________________________ Pamela Daly Claimant ________________________________ Daniel S. Manning Laura Keohane Donna McCormick Robyn Powell Greater Boston Legal Services Melissa Kasnitz Kevin Knestrick Disability Rights Advocates Counsel for Claimants ATTACHMENT A Buildings with Licensed MGH Occupancies To Be Included in Survey (Owned and Leased) Building Name Address Location Status Comments Bartlett Building 40 Blossom Street Boston Owned Bartlett Extension 40R Blossom Street Boston Owned Blake Building 273 Charles Street Boston Owned Bowdoin Square 1 Bowdoin Square Boston Leased Bulfinch Building 66 Blossom Street Boston Owned Burr Proton Therapy Center 30 Fruit Street Boston Owned Charles River Plaza East 165 Cambridge Street Boston Owned Charles River Plaza South 175 Cambridge Street Boston Owned Charles Street Parking Garage 165 Cambridge Street Boston Owned Cox Building 100 Blossom Street Boston Owned Edwards Cardiopulmonary 60 Blossom Street Boston Owned Edwards Research 60 Blossom Street Boston Owned Ellison Tower 267 Charles Street Boston Owned Founders House 265 Charles Street Boston Owned Fruit Street Parking Garage Fruit Street Boston Owned Gray / Bigelow 90 Blossom Street Boston Owned Gray / Jackson 80 Blossom Street Boston Owned Holiday Inn Select 5 Blossom Street Boston Leased MGH Back Bay 388 Commonwealth Ave Boston Leased New Chardon #25 25 New Chardon Street Boston Leased Parkman Street Parking Garage 10 Parkman Street Boston Owned Professional Office Building 275 Cambridge Street Boston Owned Wang Ambulatory Care Cntr 15 Parkman Street Boston Owned Warren 275 Charles Street Boston Owned Wellman-Thier 60 Blossom Street Boston Owned Exclude floors 2 up West End House 16 Blossom Street Boston Owned First floor only; DPH waiver to provide services in other MGH facilities White Building 55 Fruit Street Boston Owned Yawkey Center Outpatient Care 32 Fruit Street Boston Owned Includes Parking Garage Other Locations Building Name Address Location Status MGH Imaging Center 13th Street, # 149 Charlestown Leased Charlestown Healthcare 73 High Street Charlestown Leased MGH Charlestown MentalHealth Clinic 76 Monument Street Charlestown Leased Chelsea Adult Med 100 Everett Avenue Chelsea Leased Chelsea Health Center 151 Everett Avenue Chelsea Leased Emerson Hospital 131 Ornac Road Concord Leased MGH North Shore ACC 100 A Endicott Street Danvers Owned Everett Health Center 19 Norwood Street Everett Leased Revere Health Center (Ocean) 300 Ocean Ave Revere Leased Revere HealthCare Center (Broadway) 300 Broadway Revere Leased MGH West - 52 Second Ave 52 Second Avenue Waltham Leased MGH West - PARC Building 40 Second Avenue Waltham Leased Buildings with Non-Licensed MGH Occupancies To Be Included in Survey (Owned and Leased) Building Name Address Location Status Comments Charles River Plaza North 185 Cambridge Street Boston Owned Exclude floors 4 up Emerson Place #0 0 Emerson Place Boston Leased Emerson Place #10 10 Emerson Place Boston Leased Hawthorne Place #01 1 Hawthorne Place Boston Leased Longfellow Place #02 2 Longfellow Place Boston Leased Longfellow Place #05 5 Longfellow Place Boston Leased MGH Downtown 294 Washington Street Boston Leased North End Health Center 332 Hanover Street Boston Leased Staniford Street #50 50 Staniford Street Boston Leased Other Locations Building Name Address Location Comments MGH Fresh Pond 185 Alewife Brook Parkway Cambridge Leased Building #114 114 16th Street Charlestown Leased Charlestown Boys & Girls Club 15 Green Street Charlestown Leased Charlestown Health Center Parking Lot 75 West School Street Charlestown Leased Charlestown Parking Garage 199 13th Street Charlestown Owned Chelsea Imaging Center 80 Everett Avenue Chelsea Leased North Shore MOB 100 B Endicott Street Danvers Owned by PHS Patriot Place One Patriot Place Foxboro Leased General Med. Assoc. 101 River Street Weston Leased Description of Areas to Be Included and Excluded in the Barrier Removal Survey Clinical Areas: All useable areas where patient care, diagnosis and treatment takes place, including inpatient and outpatient status, and including areas occupied by clinical and supporting department administration if the public travels to these areas. Includes: • Inpatient units of all categories • Outpatient areas including hospital and physician organization practices, private MD practices in owned buildings • Ambulatory care practice areas as described above in leased sites except for private hospital-affiliated MD practices where we have no jurisdiction over, or full knowledge of, privately leased sites • Labs (blood, infusion, pharmacy, etc) open to patients in leased and owned buildings • Any patient care, research or administrative facilities where “human subjects” (who perceive themselves to be patients) are seen for clinical research or clinical trials purposes • Any sites where patient care or health information is provided free of charge to the community Excludes: • Physically discreet areas room types on a floor that provide clinical and/or operations support, but are clearly closed to patients and visiting public, such as service corridors on inpatient units, support closets accessible to staff only, locker rooms, nurse stations, etc • OR's and procedure rooms and related support areas where patients are sedated and not ambulatory or in control of their movement in and out of the space. • Administrative floors in leased space where there are few or no visitors, and no patients or human subjects, and that are not open to the public. • Vertical shafts, penetrations and wall areas on clinical floors. Public Areas Includes: • In owned buildings, all areas open to patients and visiting public, patients and human subjects, such as corridors, lobbies, lounges, bathrooms, on floors where any clinical or administrative activity takes place. Also, amenity services, whether leased or owned. • In leased buildings, common areas on the ground floor and leased floors that patients and visiting public would use (to the extent possible under lease). • Owned parking structures and lots. Excludes: • Vertical shafts and penetrations • Exterior and interior wall area • Mechanical and building systems infrastructure areas (roof, atrium, etc.) Research Areas Includes: • Areas that human subjects would go for clinical trials. Excludes: • Research labs and animal facilities. Other areas excluded: Operations and clinical support floors not open to visitors or patients, such as Buildings & Grounds shops, pharmacy and clinical lab processing areas, etc. ATTACHMENT B Scope of the Architectural Barriers Assessment Massachusetts General Hospital ADA Surveys Scope Definition Updated '5-29-09 B=Basic B=Selected Option D=Declined Option H=Hourly 1; Standards and Laws as Basis for Surveys 2; Standards to be used in surveys; 3; Current ADA Standards (1994); B; Yes. 4; Proposed New ADA Standards; B; Yes, for internal informational purposes only 5; UFAS; D; No 6; State Standards; B; Yes 7; Local Standards; D; None 8; Client - specific preferences; D; None 9; Program Access issues for 504 compliance; D; No 10; Question staff to understand programs and access options; D; No 11; Construction and Manufacturing Tolerances; B; 12; Acceptable Measurements; B; 13 14; Areas/Elements to Survey 15; Use Codes to survey; B; 16; Site work; B; Yes 17; Exterior routes in Public Right of Way (on or immediately adjacent to facility property or constructed by or controlled by facility) ; B; Yes, as necessary to provide accessible routes to the hospital from the nearest subway and bus stops and from the nearest parking garages, and over public ways between hospital controlled facilities on campus, and from accessible passenger loading zones into and connecting each of the primary accessible entrance(s) to the facilities. 18; Site surveys; B; Yes 19; Campus and site accessible routes; B; Yes 20; Entrances; B; Yes 21; Slopes & cross slopes; B; Yes 22; Parking; ; 23; Accessible areas; B; Survey all public parking areas for circulation path requirements - discuss dispersal of accessible spaces w/ 24; All areas; B; 25; On-Street parking; D; Not included 26; Parking requirements; B; Yes 27; Entrances; B; Yes 28; GSF / ADA Healthcare category; B; Yes, what is this? 29; Program access; D; No 30; Transportation; ; 31; Transportation Vehicles; D; No 32; Fixed routes & Stops (including shuttle services); D; No 33; Bus stops - Public transportation; B; Yes, when on or immediately adjacent to facility property or constructed by or controlled by facility. 34; Public & Patient vs Employee Areas; ; 35; Patients; B; Yes, all areas used by ambulatory patients [Does not typically include OR's and recovery areas where all patients are assisted and which exclude family members unless covered below.] 36; General public, visitors & family; B; Survey all Patient, Family, Visitor & Public spaces 37; Activity Rooms; B; Survey all Patient, Family, Visitor & Public spaces 38; Auditoriums; B; Survey all Patient, Family, Visitor & Public spaces 39; Cafeterias & Restaurants; B; Survey all Patient, Family, Visitor & Public spaces 40; Chapels; B; Survey all Patient, Family, Visitor & Public spaces 41; Classrooms; B; Survey all Patient, Family, Visitor & Public spaces 42; Conference Rooms; B; Survey all Patient, Family, Visitor & Public spaces 43; Daycare Centers; B; Survey all Patient, Family, Visitor & Public spaces 44; Diagnostic services areas; B; Survey all Patient, Family, Visitor & Public spaces 45; Gardens, Courtyards, Outdoor Plazas, etc.; B; Survey all Patient, Family, Visitor & Public spaces 46; Gift & Retail Shops; B; Survey all Patient, Family, Visitor & Public spaces 47; Internet Stations; B; Survey all Patient, Family, Visitor & Public spaces 48; Learning Centers; B; Survey all Patient, Family, Visitor & Public spaces 49; Libraries; B; Survey all Patient, Family, Visitor & Public spaces 50; Lounges, Day Rooms, etc.; B; Survey all Patient, Family, Visitor & Public spaces 51; Museum and Exhibit spaces; B; Survey all Patient, Family, Visitor & Public spaces 52; Pharmacies; B; Survey all Patient, Family, Visitor & Public spaces 53; Physical Therapy & Occupational Therapy areas; B; Yes, however, spaces and elements used to teach people with disabilities adaptive approaches to environmental difficulties are not required to comply with any accessibility standards. 54; Playgrounds; B; Survey all Patient, Family, Visitor & Public spaces 55; Transient Lodging; B; Survey all Patient, Family, Visitor & Public spaces 56; Treatment Areas; B; Survey all Patient, Family, Visitor & Public spaces 57; Waiting Rooms; B; Survey all Patient, Family, Visitor & Public spaces 58; etc.; B; Survey all Patient, Family, Visitor & Public spaces 59; Student/intern/resident areas (May need to separate students ; D; No 60; Auditoriums; D; No 61; Break Rooms; D; No 62; Classrooms; D; No 63; Conference Rooms; D; No 64; Dressing Rooms/Locker Rooms; D; No 65; Libraries; D; No 66; Lounges; D; No 67; Non-public areas; D; No 68; Research Areas; D; No 69; Showers; D; No 70; Sleep Rooms; D; No 71; Work Stations; D; No 72; etc.; D; No 73; Volunteer areas; D; No 74; Break Rooms; D; No 75; Classrooms; D; No 76; Conference Rooms; D; No 77; Dressing Rooms/Locker Rooms; D; No 78; Lounges; D; No 79; Non-public areas; D; No 80; Work Stations; D; No 81; etc.; D; No 82; Areas for physicians' with hospital privileges (All physicians may; D; No 83; Auditoriums; D; No 84; Break Rooms; D; No 85; Classrooms; D; No 86; Conference Rooms; D; No 87; Dressing Rooms/Locker Rooms; D; No 88; Libraries; D; No 89; Lounges; D; No 90; Non-public areas; D; No 91; Research Areas; D; No 92; Showers; D; No 93; Sleep Rooms; D; No 94; Work Stations; D; No 95; etc.; D; No 96; Staff classrooms in MOB's and hospitals; B; Yes, but only if they are ever used by patients or public during or after hours 97; Staff conference rooms in MOB's and hospitals; B; Yes, but only if they are ever used by patients or public during or after hours 98; Non-public areas used by staff only (includes storage & mechanica; D; No - Reasonable accommodations will be made as needed 99; Patient rooms; ; 100; Accessible rooms & target acc. rms.; B; 101; One of ea. type in ea. location; D; No 102; All; D; No 103; Toilet rooms; B; 104; Accessible patient room toilet rooms; B; 105; Patient common use toilet, shower, and tub rooms; B; 106; Public toilet rooms; B; 107; Selected employee toilet rooms ; D; No 108; All employee toilet rooms; D; No 109; Private office toilet rooms; D; No 110; Transient lodging; ; 111; Public use, in house hotel rooms; B; Yes, including any sleep areas within or adjacent to lounges. 112; Doctors' sleep rooms; D; No 113; Employee only areas; ; 114; Common Use areas; D; Not when used only by employees 115; Work areas; D; Not when used only by employees 116; Work stations such as employee only areas of nurse stations; D; Not when used only by employees 117; Maintenance & storage; D; Not when used only by employees 118; Landlord-controlled areas (where Client is tenant); D; No 119; Stop at lease lines; D; No 120; Accessible routes; D; No 121; Elevators; D; No 122; Circulation paths; D; No 123; Parking; D; No 124; Toilet rooms; D; No 125; etc.; D; No 126; Tenants (except doctors) (where Client is landlord); D; No 127; Stop at door; D; No 128; Accessible routes; D; No 129; Circulation paths; D; No 130; Public areas; D; No 131; Other; D; No 132; Doctor's offices in MOB's and Hospitals; B; Yes, in spaces where healthcare services are provided 133; Front door; B; Yes, in spaces where healthcare services are provided 134; Reception / Waiting / Checkin; B; Yes, in spaces where healthcare services are provided 135; Processing station (vitals); B; Yes, in spaces where healthcare services are provided 136; Toilet rooms; ; 137; General public toilet rooms; B; 138; Specimen toilet rooms; B; 139; Dressing rooms; B; 140; Exam rooms; B; 141; Special procedure rooms; B; 142; Labwork areas (blood draw); B; 143; Consultation rooms; B; Yes. Using Consultation Room survey selection guidelines. 144; Doctors' private offices; B; Yes. Using Private Physician's, Practitioner's, and Provider's Offices survey selection guidelines. 145; Other areas; B; Yes, in spaces where healthcare services are provided 146; Employee only areas; D; No - Reasonable accommodations will be made as needed 147; Exam rooms; ; 148; Typical & new issue room/facility; B; 149; At least one of ea. type in ea. location; B; 150; All; D; No 151; Patient Dressing rooms; ; 152; One per location; B; 153; Laboratories, Special procedure, and research rooms; ; 154; Patient testing (blood draw, urine, etc.); B; 155; Special procedure rooms; ; 156; Exam, treatment, and special procedure rooms; ; 157; Active, ambulatory patients and/or guests; B; 158; Passive patients w/out guests or family; D; No 159; Specimen collection toilet rooms; B; 160; Patient Dressing rooms; B; 161; Research; D; No 162; Employee only areas; D; No 163; Doors; B; Yes, where used by at least one covered group of users 164; Stairs; ; 165; ADA-covered stairs; B; Yes. 166; State-covered stairs; B; Yes 167; All other stairs - key issues; B; Yes, but for circulation path, signage, and alarm issues only 168; All other stairs - full detail; D; No 169; Signage; ; A detailed signage solution is outside the scope of this survey 170; Required signs; ; 171; Permanent room or space designator signs; B; 172; Directional or functional space information signs; B; 173; Other required signs; B; Yes 174; Suggested wording for selected signs; D; No 175; Full detail sign survey / specs; D; No 176; Alarms; ; 177; Survey; B; Work with hospital alarm consultants to coordinate survey approach and verify compliance during normal testing cycles. 178; Test; B; 179; Telephones and Communications systems; ; 180; TTY's; B; Yes 181; Pay telephones; B; Yes 182; House telephones; ; 183; Public House Phones; B; Workiing with Hospital, identify and survey only banks used by patients and the general public. 184; Employee Only Phones; D; No - Reasonable accommodations will be made as needed 185; Signage related to House Phones; B; Yes, at public use House Phones only 186; Patient Telephones and Nurse call units; B; Discuss w/ Hospitals 187; ATMs; ; 188; Full detail; B; Yes 189; Interpretation for people w/visual impairments; B; Yes. Note accommodations provided. If talking ATM's are provided, consider them compliant. 190; Non-Clinical Equipment; ; 191; Point of sale devices; B; Only where used by patient or general public 192; Vending machines; B; Only where used by patient or general public 193; Kiosks for information and other transactions; B; Only where used by patient or general public 194; Pantry drink & food dispensers; B; Only where used by patient or general public 195; Infection control solution and foam dispensers; B; Only where used by patient or general public 196; Other; B; Only where used by patient or general public 197; Clinical Equipment; D; Not in this contract. Exploring hiring an Equipment Consultant now. Scope to be determined separately. 198; Exam tables; D; 199; Exercise equipment; D; 200; Imaging, diagnostic, & testing equipment; D; 201; Other equipment with architectural space requirements that is ; D; 202; Other equipment with no architectural space requirements; D; 203; Patient scales to accommodate wheelchair users and bariatric ; D; 204; Physical Therapy & OT equipment; D; 205; Other; D; 206; Furniture; B; Yes, Verify required accessible route widths between furniture and required features such as knee clearances at accessible units. Verify that clear floor spaces are available for wheelchair users in waiting rooms. Will survey in patient and public use areas only. 207; Furnishings; B; Yes, verify required accessible route widths between furnishings, protruding object problems, and required features such as knee clearances at accessible units and operable controls within reach. Will survey in patient and public use areas only. 208; "Sinks" by type under 1994 Standards as "G" Severity; ; 209; Lavatories (associated with toilets); B; Yes 210; True sinks (under ADA Standards at 9.2.2(7)); ; 211; Accessible kitchenettes in transient lodging; B; Yes. 212; Accessible housing (>6 mo.stay) kitchenettes; D; 213; Common use "sinks" (dispensers); ; 214; Conference room bar "sinks"; B; Only where used by patient or general public 215; Break room "sinks"; B; Only where used by patient or general public 216; Pantry "sinks" on nursing units; B; Only where used by patient or general public 217; Doctors' surgery scrub "sinks"; D; Only where used by patient or general public 218; Other; B; Only where used by patient or general public 219; Program Access "sinks"; B; Only where used by patient or general public 220; "Activities of Daily Living" OT program; D; Only where used by patient or general public 221; Classroom "sinks" for student use; B; Only where used by patient or general public 222; Graduate student reasearch lab. "sinks"; D; Only where used by patient or general public 223; Other; O; Discuss w/ Hospitals 224; Chem/Bio safety "sinks"; ; 225; Eye wash units; B; Only where used by patients &/or the general public 226; Emergency Showers; B; Only where used by patients &/or the general public 227; Required hand washing "sinks"; ; 228; Commercial kitchens; D; No 229; Patient rooms - currently designated as "Accessible"; B; 230; Patient rooms - NOT currently designated as "Accessible" but; B; 231; Patient rooms - NOT required to be accessible.; D; No 232; Corridor; D; No 233; Nurse station; D; No 234; Exam rooms; ; 235; Selected for survey; B; Survey in Pilot, Discuss before full survey. 236; Not selected for survey; D; No 237; Laboratories; D; 238; Research; D; 239; Classroom; D; 240; Employee only; D; 241; Procedure and treatment rooms; B; Survey in Pilot, Discuss before full survey. 242; Other; B; Survey all in Pilot, Discuss before full survey. 243; Soiled utility "sinks"; D; 244; Work station employee only "sinks"; D; 245; Soiled utility clinical "sinks"; D; 246; Laundry "sinks"; D; 247; Doctors' surgery scrub "sinks"; D; 248; Janitors' mop "sinks"; D; 249; Dish & pot washing "sinks"; D; 250; Food preparation "sinks"; D; 251; Laboratory procedure "sinks"; D; 252; Fume hood "sinks"; D; 253; Darkroom "sinks"; D; 254; Teaching demonstration "sinks"; D; 255; Other; D; 256 257; Facilities, Areas, and Elements to Survey / Review 258; Landlord-controlled facilities with lease renewals in less than "x" months (short term); D; 259; Landlord-controlled facilities with lease renewals in less than "y" months (long term); B; Will survey only sites where healthcare services are provided. Will survey internal practice spaces only. 260; Facilities to be abandoned in "x" mo. (short term); D; No 261; Areas undergoing alteration during the survey period; B; 262; Areas scheduled for alteration in "x" mo.; D; Coordinate timing of surveys, alterations, and future barrier removal work in all areas to increase project efficiencies and reduce costs. 263; Areas scheduled for alteration in "y" mo.; D; Coordinate timing of surveys, alterations, and future barrier removal work in the area to increase project efficiencies and reduce costs. 264; Optional elements / spaces by Severity to survey & show in DB; ; 265; A Severity: Barriers that might be a safety consideration for ; B; Yes 266; B Severity: Barriers that block access to a significant number of ; B; Yes 267; C Severity: Barriers that are a major inconvenience to a significant number of ; B; Yes 268; D Severity: "Barriers" rated by ETA as a minor inconvenience to ; B; Survey in Pilot, then review 269; E Severity: ADA Compliant, non-compliant w/state stds.; B; Yes 270; F Severity: Compliant w/ both ADA & State stds.; D; No 271; Parking; D; No 272; Entry doors; D; No 273; Drinking fountains; D; No 274; Telephones; D; No 275; Transaction counters; D; No 276; Elevators and related controls; D; No 277; ATM's; D; No 278; All areas, spaces, and elements; D; No 279; G Severity: Compliant w/ 94 ADA stds.,but not all others; B; "Grandfather" clauses in proposed regulations at 36.304(d) & 36.403(a)(1) 280 281; Type of survey 282; ETA Modified Standard Barrier Survey; B; Yes 283; ; ; 284; Who to do surveys 285; ETA Team (Architectural Access Consultants); B; Yes 286; Facility Staff; D; No 287; Client's Consultants (Arch. Access Consultants); D; No 288; Single or team surveyors; B; Typically teams of surveyors 289; ETA team assistants; B; Yes 290; Facility staff or Facility-assigned asistants; D; No 291; Short term tag-along assistants; B; Yes, for typical space types 292; Quality assurance; ; 293; Statistical analysis; B; Yes 294; Spot checks; B; Yes 295; % resurveys; B; Yes, if team members have not worked w/ ETA previously, or if other analysis indicates the need to spot check 296; On-site training; B; Yes 297 298; How to Survey 299; "Pilot" or "Model" Survey(s); B; Pilot Survey will include representative facilities, areas, and elements sufficient to show how the process will work, what the databases will include, and how reports and information will be available. 300; Room by room, issue by issue, or floor by floor; B; Combination 301; Location codes; ; 302; Notation of Location Codes for Barriers; B; 303; Field notations on drawings; B; Yes, when normal room numbers are not available 304; Carefully lettered on drawings; O; Discuss w/ Hospitals 305; CAD overlay layer; O; Discuss w/ Hospitals 306; Responsibility Code use; ; 307; "Q" list for field determination; O; Discuss w/ Hospitals after Pilot 308; Pre-Survey per Possible Solution type; D; Discuss w/ Hospitals after Pilot 309; Post-Survey per Possible Solution type; O; Discuss w/ Hospitals after Pilot 310; Post survey individual barrier analysis and responsibility assignments; O; Discuss w/ Hospitals after Pilot 311; Photographs; ; 312; Every barrier; B; 313; Client pref.'s. integrated into process; D; None 314; Survey forms; D; None 315; Possible Solutions; D; None 316; Additional information fields; D; None 317; Level of effort developing solutions; ; 318; Examples:; ; 319; Slope problems in parking, entrances; B; Standard surveyor effort 320; Ramp design; B; Standard surveyor effort 321; Phasing for public toilet room barrier removal (by floor); B; Standard surveyor effort 322; Phasing for patient room barrier removal (by patient room ; B; Standard surveyor effort 323; Facilitate integration with & provide input to FM's coordinating ; B; Standard surveyor effort 324; Other; O; Project Specific as documented in Instructions to Surveyors 325; Other; O; Project Specific as documented in Instructions to Surveyors 326; Effort to develop or identify Alternative Methods, Readily Achievable ; B; Survey Process for Alternative Methods, Readily Achievable Second Options and Administrative Solutions is still under development. 327; On-site alt. method search; ; 328; Relocation & directional signs; ; 329; Using different sites; ; 330; Coordinating between facilities; ; 331; Services offered by different doctors; ; 332; Assignment of members/patients; ; 333; Cost estimating verification effort; ; 334; Set cost factors for statewide costs; D; 335; Tailor to local city costs; B; 336; Tailor to specific site/facility; O; 337; Prereview Possible Solutions lists before surveys; D; 338; Review Solutions Used lists post survey; B; 339; Degree of difficulty in gaining access to facilities and spaces; ; 340; Presurvey meetings/ presentations w/local staff; B; 341; Scheduling; B; 342; Methods / protocol / number of individuals with whom to coord.; B; 343; Off-hour access scheduling; B; Yes, as necessary 344; Surgeries; B; Yes, as necessary 345; Exam rooms; B; Yes, as necessary 346; Procedure rooms; B; Yes, as necessary 347; Other areas; B; Yes, as necessary 348; Interaction with users and staff; ; 349; Explanation of what we're doing; B; 350; Questions to be answered; B; 351; Tag-along facility staff; D; 352; Security procedures; ; 353; Notifications; B; 354; Badges; B; 355; Checkin requirements; B; 356; Access to locked rooms/areas; B; 357; Parking availability; B; 358; Availability of survey team work area (room) in each facility; ; 359; Central location; B; 360; Lockable room w/ team having keys; B; 361; Pagers, cell phone use; B; 362; Availability and usability of plans from FM; ; 363; Hard copy provided by FM; B; 364; CAD files provided by FM; B; 365; Sketches by surveyors; B; 366; None; D; 367 368; Report Options 369; Survey status reports; O; Discuss w/ Hospitals during Pilot 370; Quick reports for selected Responsibility Codes; O; Discuss w/ Hospitals during Pilot 371; Barriers as approved by QA team; O; Discuss w/ Hospitals during Pilot 372; Database, Export, & Report; ; 373; Lotus Notes; O; Discuss options w/ Hospital &/or Corporate IT 374; Excel Version; B; Coordinate w/ Hospital &/or Corporate IT 375; Word Version; B; Coordinate w/ Hospital &/or Corporate IT 376; Adobe Reader Version; B; Coordinate w/ Hospital &/or Corporate IT 377; Internet Browser Software and Version; B; Coordinate w/ Hospital &/or Corporate IT 378; Facility Management Software; B; Coordinate output with Archibus and AutoCAD systems in use 379; Administrative Privileges; B; Coordinate w/ Hospital &/or Corporate IT 380; Report Generation Methods; ; 381; Online view access with search; B; 382; Pre-generated reports in PDF, Word or Excel formats; B; 383; Executive Level Summary Reports; B; 384; Project Completion Status Reports; ; 385; Surveys; B; 386; Barrier Removal; B; 387; Report Delivery Methods; ; 388; Self-Service Reports (pre-defined); B; 389; Scheduled Reports (user-defined); B; 390; Pre-Defined Draft and Final Reports; B; 391; Interim & Final report formats to include under Basic Services (archdata, bid, phased); ; 392; ArchData by Location Code; B; 393; Bid version of ArchData by Location Code; B; 394; Phase Code sorted with Location Code subsort; B; 395; Barrier Number sorted; B; 396; Other:__________________________________________; H; 397; Report adjustments requested; H; 398; Number of Hard Copies of Reports (with hard copies of photos); ; 399; Interim Report(s); D; 400; "Final" Reports; D; 401; Database & viewer on CD; D; 402; Web-based database with passworded access; B; Yes 403; Specific detailed analyses & reports; H; 404; Coord.w/prior surveys & barrier removal work; D; No 405; Incorporate prior survey reports in database; D; No 406; Barrier Removal Process; ; 407; Field verification of reported barriers with client's representative; O; Discuss w/ Hospitals 408; ETA review of solutions over specified dollar amount w/client; O; Discuss w/ Hospitals 409; Responsibility Code Assigned to each Barrier; B; Included. Details to be determined after Pilot 410; Added to the Possible Solution Database (Automated); B; 411; Added during the Barrier Removal Process (Manual); B; 412; Maintenance Items; B; 413; Policy and Procedure Items; B; 414; Permitted Items (city); B; 415; Permitted Items (state); B; 416; Integrate barriers with existing renovation/capital projects; O; Discuss w/ Hospitals 417; Determine funding source (different budget); O; Discuss w/ Hospitals 418; Possible removal of maintenance items (different budget); O; Discuss w/ Hospitals 419; Evaluate major cost items; O; Discuss w/ Hospitals 420; Large dollar items vs alternative solutions; O; Discuss w/ Hospitals 421; Verify claims of technical infeasibility; O; Discuss w/ Hospitals 422; Alternative Methods; O; Discuss w/ Hospitals 423; Explore options when items are not readily achievable; O; Discuss w/ Hospitals 424; Assist w/barrier removal planning post-Action Plan; O; Discuss w/ Hospitals 425; Evaluate priorities of each barrier listed for removal; O; Discuss w/ Hospitals 426; Phase & Severity Code review; O; Discuss w/ Hospitals 427; Room by room vs. element by element; O; Discuss w/ Hospitals 428; Budget development; ; 429; Based on solution review with client; O; Discuss w/ Hospitals 430; Based on estimated costs with client; O; Discuss w/ Hospitals 431; Contractor and/or Architect review; O; Discuss w/ Hospitals 432; Plan reviews during barrier removal; O; Discuss w/ Hospitals 433; Full set; O; Discuss w/ Hospitals 434; Major rooms & spaces; O; Discuss w/ Hospitals 435; Parkiing, patient rooms, toilets, tubs & showers, exam rooms, cafeterias, waiting rooms, gift shops, lobbies, etc.; O; Discuss w/ Hospitals 436; Major and repetitive elements; O; Discuss w/ Hospitals 437; Counters, casework, signage, ramps, curb ramps, etc.; O; Discuss w/ Hospitals 438; Review RFI's from design and construction teams; O; Discuss w/ Hospitals 439; Field reviews during barrier removal; ; 440; Rooms; O; Discuss w/ Hospitals 441; Elements; O; Discuss w/ Hospitals 442 443; Other Facility information 444; Size; B; Each Hospital will provide Archibus data 445; Age; B; 446; Original construction; B; 447; Last major renovation; B; 448; Local code & enforcement history; B; 449; Location (City, State, Zip); B; 450 451; Expenses 452; Travel time to site/campus; B; 453; Transportation & Parking; B; 454; Per diem allowances or limits; B; 455; Markups; B; 456; Lodging availability & costs; B; 457 458; Consulting, Training, & Orientation 459; Develop training videos/brochures for in-house use; O; Discuss w/ Hospitals 460; Design and Construction Teams; ; 461; Client Design & Construction PM's and others; B; 462; Consulting Arch's. & Eng's.; B; 463; Contractors; B; 464; Administrative & Managerial staff; B; 465; Facility mgt. & maintenance staff - Operations Support; B; 466; "Customer service" staff; B; 467; Housekeeping staff; B; 468 469; Other Optional or Additional Services 470; Corporate compliance planning; O; Discuss w/ Hospitals 471; Corp. IT systems integration planning; O; Discuss w/ Hospitals 472; Other corp. systems integration planning; O; Discuss w/ Hospitals 473; Presentations of findings, review project status, discuss work completed & work remaining, revise procedures, etc, as appropriate; B; 474; Public review & comment coordination; D; NA 475; Public review & comment presentations; D; NA 476; Consult &/or coord. Surveys & BR work w/ local & state AHJs; H; 477; Lawsuit defense & expert witness; H; 478; Plan reviews for alterations projects; ; 479; Review plans against survey; H or Lump; 480; Review schematic design drawings; H or Lump; 481; Review design development documents; H or Lump; 482; Review construction documents; H or Lump; 483; Construction observation; H; 484; Review Internal Design Standards for FM's; H; 485; Modify Reports based on Client or FM requested changes; B H; 486; Other; H; END; ; END; END