- 4 Form Approved: OMB No. 0990?0269. See OMB Statement on Reverse, DEPARTMENT OF HEALTH AND HUMAN SERVICES, OFFICE FOR CIVIL RIGHTS (OCR) CIVIL RIGHTS DISCRIMINATION COMPLAINT WORK RHONE (Please Include area code) Lowe u; A I @g?st Are you ?ling this complaint for someone else? I: Yes am. If Yes, whose civil rights. do you believe were violated? FIRSTNAME - . . I believe that I have been (or someone elsehas been) discriminated against on the basis of: Race Color I National Origin Age I Religion El Sex . . . . DIsabIlIty gOther (speCIfy): Who or what agehcy or organization do you believe discriminated against you (Or someone else)? lli/l/ Gent.er A. I CITY I. . ,g \imCrIurI/I PAIL .. ?fow?U/ PHONE (Please include area co STATE MA- . I . When do you believe that the civil right discrimination'occurred? LIST - i 3 Describe'briefly- what happened. HOW and why do you believe that you have against? Please be as specific as. possible. (Attach additional pages as ne?gg?gg)? . . I (?ees. I L9H NM comhqigmw?l/prcia/S For Mr ?rst lulu?) (iota i/JOr 05> Milli, L6H ?nder/Tie, - I - ?Ir/ 9 enact mt, Facet LVN LX920 Mug/{P vb? . - Cu Li Io?r lit WA on no In?xurel new; WW ordeal? dammit mission by email represents your signature. DATE a, r, ever, 'without the information requested above, OCR maybe unable to proceed with your complaint. We collect this information under authority of Title VI of the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act ofi 973 and Other Civil rights statutes. We will use the information you provide to determine if we have jurisdiction and, if so. how we will process your complaint. information submitted on this form is treated con?dentially and is protected under the provisions'of the Privacy Act of 1974. Names or other identifying information about individuals are disclosed when it is necessary for investigation of possible discrimination, for internal systems operations, or- for routine uses, which include disclosure of information outside the Department of Health and Human Services (HHS) for purposes associated with civil rights compliance and as permitted bylaw.? it is illegal for a recipient of Federal'?nancial assistance from HHS to intimidate, threaten, coerce, or discriminate or retaliate againstyou for ?ling this complaint or for taking any other action to enfOrce your rights under Federal civil rights laws. You are not reqUired to use this form. You also may write a letter or submit a yuucomplaint electronically with the same information. To submit an electronic complaint, go,t_o OCR's web site at: To mail a complaint see reverse page for OCR Regional addresses. (FRONT) pscompIu-csmm..m EF been (or someone else has been) discriminated Please sign and date this complaint. You do not need sign if submitting this form bLe?mail because sub SIGNATURE Filing a complaint with OCR is voluntary. How The remaining information on this form is optional. Failure to answer- these voluntary questions will not? affect OCR's decision to process your complaint. Do you need special accommodations for us to communicate with you about this complaint? (Check all that apply) "Braille Large Print [j Cassette tape Computer diskette I Electronic mail [j TDD ?Sign language interpreter (specify language): I I [Vim DOther: Foreign language interpreter (specify language): If we cannot reach you directly, is there someone we can contact to help us reach-you? FIRST NAME I LAST NAM .R?w c) tuler HOME . Wu STATE Have you ?led your complaint anywhere else? If so, ease provide the following. (Attach additional pages as needed) COURT FILED CASE (If known) i To help us better serve the public, please provide the following information for the person you believe was discriminated against (you or the person on whose behalf you'are ?ling). ETHNICITY (select one) RACE (select one or more) [3 Hispanic or Latino American Indian or Alaska Native Asian Native Hawaiian or Other Pacific Islander [3 Not Hispanic or Latino Black or African American White EOther (Specify): MC) If. PRIMARY LANGUAGE SPOKEN(ifotherthen English) Andi! ((330 awn?)! .7 How did you learn about the Of? for Civil Rights? . HHS Website/Internet Search ?amin/Friend/Associate Religious/Community Org Lawyer/Legal Org Phone Directory Employer Fed/State/Local Gov Healthcare Provider/Health Plan Conference/OCR Brochure Other (specify): To mail a complaint, please type or print, and retUrn completed complaint to the OCR Regional Address based on the region where the alleged violation took place. If you need assistance completing this form, contact the appropriate region listed below. Region Region - MI, MN, 0H, Wl Region lX - AZ, CA, HI, NV, AS, GU, Office for Civil Rights, DHHS Office for Civil Rights, DHHS The US. Affiliated Pacific Island Jurisdictions JFK Federal Building Room 1875 233 N. Michigan Ave. - Suite 240 Of?ce for Civil Rights, DHHS Boston, MA 02203 Chicago, IL 60601 90 7th Street, Suite 4-100 (617) 565-1340; (617) 565-1343 (TDD) (312) 886-2359; (312) 353-5693 0' DD) San Francisco. CA 94103 (617) 565-3809 FAX (312) 886?1807 FAX - . (415) 437-8310; (415) 437?8311 (TDD) Region II - NJ, NY, PR, Vl Region (415) 437'8329 FAX Office for Civil Rights, DHHS Of?ce for Civil Rights, DHHS 26 Federal Plaza - Suite 3312 1301 Young Street - Suite 1169 New York, NY 10278 Dallas, TX 75202 (212) 264-3313; (212) 264-2355 (TDD) (214) 767-4056; (214) 767-8940 (TDD) (212)264-3039 (214) 767-0432 FAX Region - DE, DC, MD, PA, VA, WV Region VII - IA, KS, MO, NE Of?ce for Civil Rights, DHHS Office for Civil Rights, DHHS 150 8. Independence Mall West - Suite 372 601 East 12th Street - Room 248 Philadelphia. PA 19106-3499 Kansas City, MO 64106 (215) 861 -4441; (215) 861-4440 (TDD) (816) 426-7277; (816) 426-7065 (TDD) (215) 861-4431 FAX (816) 426-3686 FAX Region Region - 00, MT, ND, SD, UT, WY Region - AK, tD, OR, WA I Office for Civil Rights, DHHS . Of?ce for Civil Rights, DHHS Office for Civil Rights, DHHS 61 Street. SW. - Suite 16T70 999 18th Street, Suite 417 2201 Sixth Avenue - Mail Stop RX-11 Atlanta, GA 30303-8909 Denver, CO 80202 Seattle, WA 98121 (404) 562-7886: (404) 562-7884 (TDD) (303) 844-2024; (303) 844-3439 (TDD) '(206) 615-2290; (206) 615-2296 (TDD) (404) 562-7881 FAX (303) 844-2025 FAX (206) 615-2297 FAX - Burden Statement . . Public reporting burden for the collection of information on this complaint form is estimated to average 45 minutes per response, including the time for reviewing instructions, gathering the data needed and entering and reviewing the information on the completed complaint form. An agency may not conduct or sponsor, and a person is not required to respond to, a collection 'of information unless it displays a valid control number. Send this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: Reports Clearance Of?cer, Office of Information Resources Management, 200 Independence Ave. SW, Room 531H, Washington, DC 20201. Please do not mail complaint form to this address. HHS-699 (7709) (BACK) gut/1c, (I a 9 57 DEPARTMENT OF HEALTH HUMAN SERVICES OFFICE OF THE SECRETARY Voice (617) 565-1340, (800) 368-1019, TDD (617) 565- 1343, (800) 537-7697 Ge, FAX (617) 565-3809, ht fm' Of?ce for Civil Rights, Region I JFK Federal Building, Room 1875 - Government Center APR 3 2814 Boston,MA 02203-0002 Cheryl Quintal Lowell, MA 01854 Our Reference Number: 14-175881 Dear Ms. Quintal: On February 10, 2014, the U.S. Department of Health and Human Services (HHS), Of?ce for Civil Rights (OCR), Region I, received your complaint alleging that Lowell General Hospital is not compliant with Section 504 of the Rehabilitation Act of 1973.1 Speci?cally, you allege that you were denied access to effective communication when you were denied an in person interpreter and given interpreter services through a VR system that had technical problems. This allegation could re?ect noncompliance with Section 504. Thank you for bringing this matter to attention. Your complaint is an integral part of enforcement efforts. OCR enforces Federal civil rights laws which prohibit discrimination in the delivery of health and human services because of race, color, national origin, disability, age, and under certain circumstances, sex and religion. OCR also enforces the Health Insurance Portability and Accountability Act?s Privacy, Security, and Breach Rules. OCR enforces Section 504, which prohibit recipients of Federal ?nancial assistance from HHS (covered entities) from excluding quali?ed individuals with disabilities or denying them an equal opportunity to receive program bene?ts and services. To comply with Section 504, those covered entities must ensure effective communication, by providing auxiliary aids and services, if needed to ensure that effective communication, when the provision of such aids or services does not result in a fundamental alteration (change in the basic nature of the service) or undue ?nancial and administrative burden for the covered entity. Effective communication with a quali?ed person who is deaf or hard of hearing is communication that allows the person an equal opportunity to participate in, and enjoy the bene?ts of, a Service, program, or activity. Pursuant to regulations at 45 C.F.R. 84.61, Section 504 incorporates the procedural provisions of Title which provisions include that OCR shall ?seek the cooperation of recipients in 1 29 United States Code (U.S.C.) 794, et seq., as implemented by 45 Code of Federal Regulations (C.F.R.) Part 84. . 2 Title VI of the Civil Rights Act of 1964, as amended, 42 U.S.C. 2000d, et seq., as implemented by 45 CPR. Part 80. obtaining compliance and shall provide assistance and guidance to recipients to help them comply 45 C.F.R. In ful?lling our obligation to investigate complaints ?led with this of?ce, OCR conducts a thorough and detailed review of all complaints (as well as any other information provided to OCR, if applicable), and requests and obtains additional relevant documentation when necessary. After conducting such a review of your complaint, OCR has determined to resolve this matter through the provision of technical assistance to LGH regarding the scope of its obligations under Section 504. Should OCR receive a similar allegation of noncompliance against LGH in the future, OCR may initiate a formal investigation of that matter. Based on the foregoing, OCR is closing this case without further investigation, effective the date of this letter. determination as stated in this letter applies only to the allegations in this complaint that were reviewed by OCR. Under the Freedom of Information Act, we may be required to release this letter and other information about this case upon request by the public. In the event OCR receives such a request, we will make every effort, as permitted by law, to protect information that identi?es individuals or that, if released, could constitute a clearly unwarranted invasion of personal prlvacy. If you have any questions regarding this matter, please contact Phil Lewis, Investigator, at (617) 565-1355 (Voice), (617) 565-1343 (TDD). Sincerely, Sumo gm Susan M. Pezullo Rhodes Regional Manager