I. Introduction
This Voluntary Resolution Agreement ("Agreement") is entered into by the U.S. Department of Health and Human Services, Office for Civil Rights ("HHS OCR") and the University of Southern California ("USC") and its medical enterprise, Keck Medicine of USC ("KMUSC"). The health care components of USC and KMUSC (hereinafter collectively referred to as "the KMUSC Entities"), are set forth in Appendix A, attached hereto and incorporated by reference. HHS OCR and the KMUSC Entities shall together be referred to as the "Parties."
The purpose of this Agreement is for KMUSC Entities to affirm their compliance with Title IX of the Education Amendments of 1972, as amended, 20 U.S.C. § 1681 et seq., and its implementing regulation at 45 C.F.R. Part 86 ("Title IX"). The scope of this Agreement is defined by the HHS Title IX implementing regulation, which states that "no person shall, on the basis of sex, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any academic, extracurricular, research, occupational training, or other education program or activityoperated by a recipient which receives Federal financial assistance." 45 C.F.R. § 86.31(a).
HHS OCR initiated a compliance review of KMUSC on June 10, 2019, to assess KMUSC's compliance with Title IX in its handling of sexual harassment complaints. Pursuant to Title IX, this Agreement between the KMUSC Entities and HHS OCR resolves HHS OCR Transaction No. 18-308562, a compliance review of the KMUSC Entities' policies and procedures for responding to sex discrimination complaints made by students, employees, or patients employed by, or participating in, any KMUSC programs or activities receiving Federal financial assistance from HHS.
A. Jurisdiction: HHS OCR is responsible for enforcing Title IX of the Education Amendments of 1972, as amended, 20 U.S.C. § 1681 et seq., and its implementing regulation at 45 C.F.R. Part 86. Title IX states that "[n]o person in the United States shall, on the basis of sex, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any education program or activity receiving Federal financial assistance . . . ." 20 U.S.C. § 1681(a). See also 45 C.F.R. § 86.31(a). 20 U.S.C. § 1687 further defines "program or activity" to mean "all the operations of . . . a college, university, or other postsecondary institution." Accordingly, Title IX prohibits discrimination by universities on the basis of sex in any educational operation, program, or activity, any part of which receives Federal financial assistance ("FFA").
Under Title IX, HHS OCR has the authority, where appropriate, to negotiate and secure voluntary compliance agreements, and to bring enforcement actions, which may include administrative proceedings to suspend, terminate or refuse to grant or continue HHS financial assistance to the covered entity should HHS OCR fail to secure voluntary compliance. The KMUSC Entities receive FFA from HHS and are subject to the requirements of Title IX.
B. Purpose of the Agreement: The KMUSC Entities covered by Title IX agree to the terms stipulated in this Agreement and affirm that they will comply with all applicable provisions of Title IX. The promises, obligations or other terms and conditions set forth in this Agreement constitute the exchange of valuable consideration between the parties. Nothing in this Agreement shall constitute either 1) an admission by the KMUSC Entities of any liability, fault or non-compliance with Title IX of the Education Amendments of 1972 and its implementing regulations, 20 U.S.C. § 1681 et seq., and Section 1557 of the Affordable Care Act, 42 USCA § 18116, and/or a waiver by the USC Entities to defend against any allegations of noncompliance under any of the legal authorities previously referenced in this paragraph.
II. Definitions
For the purposes of this Agreement, the terms listed below shall have the following meaning:
A. "KMUSC Entities" means Keck Hospital of USC, USC Norris Cancer Center, USC Verdugo Hills Hospital, USC Care Medical Group, Keck School of Medicine, USC Ostrow School of Dentistry, USC School of Pharmacy, USC Engemann Student Health Center, USC Eric Cohen Student Health Center, the USC Hospital Outpatient Clinics, the USC Outpatient Clinics, the University Physician Associates Practices, and the other entities that are a part of the USC medical enterprise, which are set forth in Appendix A.
B. "KMUSC Staff" means employees, health professional students, and/or contractors under the supervision or control of the KMUSC Entities, whether paid or unpaid, including but not limited to administrators, admissions and marketing personnel, physicians, residents, interns, medical students, directors of nursing, advanced practice registered nurses, registered nurses, licensed vocational nurses, nursing assistants, nursing students, and medical assistants engaged in, furthering, benefiting from, or responsible for any educational operation, program, or activity at KMUSC Entities.
III. General Provisions
A. Administrative Actions: Subject to the KMUSC Entities' continued performance of the stated obligations and required actions contained in this Agreement and in conformity with Section III-C, Failure to Comply with the Agreement, HHS OCR shall not initiate administrative action on HHS OCR Transaction No. 18-308562.
B. Effective Date and Term of the Agreement: This Agreement shall become effective on the date it is signed by all parties (the "Effective Date"). This Agreement will be in effect for two (2) years (the “Term”), provided that during the Term the KMUSC Entities comply with the obligations set forth in Section IV of this Agreement, at which time if HHS OCR determines that the KMUSC Entities completed all actions required by the Agreement, HHS OCR’s review and monitoring of the Agreement shall end. Notwithstanding the Term of this Agreement, the KMUSC Entities acknowledge they have a responsibility to comply with Title IX for so long as they continue to receive FFA. HHS OCR agrees to provide any necessary assistance or review of documents required under this agreement
C. Failure to Comply with the Agreement: If HHS OCR identifies a potential compliance concern or believes the KMUSC Entities have failed to comply with any provision of this Agreement, HHS OCR will provide USC with both timely written notice of details of the compliance concern, and an opportunity to review and address the identified concern in a timely manner. The parties will confer and attempt to reach agreement as to what steps may be necessary to resolve any compliance issue. If an agreement is not reached, HHS OCR may terminate this Agreement within thirty (30) calendar days' written notice to USC of the termination of the Agreement, including the factual basis and rationale, and take appropriate measures to effectuate the KMUSC Entities' compliance with Title IX. Such measures may include HHS OCR reopening HHS OCR Transaction No. 18-308562. HHS OCR may also exercise all rights available under Title IX, including, but not limited to, issuing noncompliance findings and initiating enforcement proceedings where appropriate. Prior to issuing any finding of noncompliance, HHS OCR will provide USC with written notice of the potential noncompliance, including the facts and information it is relying upon to reach the finding, and a meaningful opportunity for USC to respond and provide information that would demonstrate compliance. Prior to initiating enforcement proceedings, HHS OCR will first provide an opportunity for USC to meet the compliance obligation, following the process described above.
D. Effect on Other Compliance Matters: The terms of this Agreement do not apply to any other issues, reviews, investigations, or complaints of discrimination that are unrelated to the subject matter of this Agreement and that may be pending before HHS OCR. Any unrelated compliance matter arising from subsequent reviews or investigations shall be addressed and resolved separately. Nothing in this Agreement shall be construed to limit or restrict HHS OCR's statutory and regulatory authority to conduct future complaint investigations and compliance reviews related to the KMUSC Entities. This Agreement does not address or resolve issues involved in any other complaint investigation, compliance review or administrative action under Federal laws by other Federal agencies, including any action or investigation under Title IX. Any compliance matter arising from subsequent or separate reviews or investigations by HHS OCR shall be addressed and resolved independently, including but not limited to matters arising under the Health Insurance Portability and Accountability Act of 1996 ("HIPAA"), Pub. L. No. 14-191, 110 Stat. 1936 (1996) (codified in scattered sections of 26, 29 and 42 U.S.C.).
E. Prohibition Against Retaliation and Intimidation: The KMUSC Entities shall not retaliate, intimidate, threaten, coerce, or discriminate against any person who has filed a grievance or complaint or who has assisted or participated in the investigation of any matter addressed in this Agreement.
F. Modification of Agreement: This Agreement may be modified by mutual agreement of the parties in writing.
G. Third Party Rights: This Agreement can be enforced only by the parties specified in this Agreement, their legal representatives and assigns. This Agreement shall be unenforceable by third parties and shall not be construed to create third party beneficiary rights.
H. Technical Assistance: HHS OCR will provide appropriate technical assistance to the KMUSC Entities regarding compliance with this Agreement, as requested and as reasonably necessary.
I. Authority of Signer: The individuals who sign this Agreement on behalf of the KMUSC Entities represent that they are authorized to bind the KMUSC Entities to the Agreement.
J. Contact Persons: The parties hereby designate the following persons as contacts for any notice, report or document required by this Agreement, except as otherwise may be required.
- For the Office for Civil Rights
Yun-kyung Lee
Deputy Regional Manager, Pacific Region
U.S. Department of Health & Human Services
Office for Civil Rights
90 7th Street, Suite 4-100
San Francisco, CA 94103 - For the University of Southern California
Ajay R. Vyas, Esq.
Assistant Vice President, Healthcare Compliance
University of Southern California
1500 San Pablo Street
Los Angeles, CA 90033
Leon Rodriguez, Esq.
Seyfarth Shaw, LLP
975 F Street, NW
Washington, D.C. 20004
IV. Obligations
A. Title IX Coordinator: USC has designated a Title IX Coordinator (the Vice President for Equity, Equal Opportunity, and Title IX (EEO-TIX), as well as a Deputy EEO-Title IX Coordinator for Healthcare to coordinate USC's efforts to comply with Title IX, including the investigation of sex discrimination complaints filed by USC students, employees, or third parties (i.e., patients) employed by, or participating in, any KMUSC programs or activities receiving FFA from HHS. The Title IX Coordinator directly supervises the Deputy EEO/Title IX Coordinator for Healthcare and indirectly oversees the investigators and intake staff within the Office for Equity, Equal Opportunity, and Title IX (EEO-TIX) who are dedicated to healthcare matters and who directly report to the Deputy EEO-Title IX Coordinator.
USC agrees to maintain the positions of Title IX Coordinator and Deputy EEO-Title IX Coordinator for Healthcare to coordinate KMUSC's efforts to comply with Title IX. The coordination of these efforts will include the investigation of sex discrimination complaints filed by students, employees, or patients with respect to any educational or other University operation, program, or activity at KMUSC Entities, with the support of the dedicated EEO-TIX intake and investigative staff.
KMUSC will continue to periodically notify all students, employees, and patients engaged in, furthering, benefiting from, or responsible for any educational operation, program, or activity at KMUSC Entities of the name, title, office address, email address, and telephone number of the Title IX Coordinator and the Deputy EEO-Title IX Coordinator for Healthcare (including through the websites of the EEO-TIX Office, Keck Medicine of USC, the Patient Information Handbook, Keck School of Medicine, USC Engemann Student Health Center, USC Eric Cohen Student Health Center, and each KMUSC facility's communications with new patients benefiting from any educational operation, program, or activity at KMUSC Entities).
B. Resolution Process for Sexual Misconduct (i.e., Title IX Grievance Procedures): USC has published a Policy on Prohibited Discrimination, Harassment, and Retaliation and related Resolution Process for Sexual Misconduct, which is the equivalent of the University's Title IX grievance procedures for students, employees, and third parties, as well as a Resolution Process for Discrimination, Harassment, and Retaliation.
The Policy on Prohibited Discrimination, Harassment, and Retaliation provides for the prompt and equitable response to sex discrimination grievances filed by students, employees, or patients with respect to any educational or University operation, program, or activity at KMUSC Entities. The Policy on Prohibited Discrimination, Harassment, and Retaliation contains the name, title, office address, email address, and telephone number of the Title IX Coordinator and the Deputy EEO/Title IX Coordinator for Healthcare.
USC agrees to continue to maintain a legally-compliant Title IX policy and USC will continue to make the Policy and Resolution Processes readily available to all students, employees, and patients with respect to any educational or other University operation, program, or activity at KMUSC Entities (including through the websites of the EEO-TIX Office, Keck Medicine of USC, the Patient Information Handbook, Keck School of Medicine, USC Engemann Student Health Center, USC Eric Cohen Student Health Center, and each USC facility's communications with new patients benefiting from any educational or University operation, program, or activity at KMUSC Entities).
C. Notice of Non-Discrimination: USC will continue to maintain its EEO-TIX Notice of Non-Discrimination on its websites so that the notice is readily available to all students, employees, and patients engaged in, furthering, benefiting from, or responsible for any educational or University operation, program, or activity at the KMUSC Entities (including through the websites of the EEO-TIX Office, Keck Medicine of USC, the Patient Information Handbook, the Keck School of Medicine, the USC Engemann Student Health Center, the USC Eric Cohen Student Health Center, and each KMUSC facility’s communications with new patients).
The notice includes reference to Title IX; the prohibition against retaliation; the name, title, office address, email address, and telephone number of the Title IX Coordinator and the Deputy EEO/Title IX Coordinator for Healthcare; and the right to file complaints with the U.S. Department of Health and Human Services, Office for Civil Rights, along with the address and website link where individuals may file a complaint.
D. Standards for Sensitive Health Exams: Within sixty (60) calendar days of the Effective Date of this Agreement, the KMUSC Entities will adopt the policy entitled "Standards for Sensitive Health Exams" substantially in the form attached hereto as Exhibit A (the "SHE Standards"), to govern KMUSC Entities, KMUSC Staff, and each KMUSC facility with respect to every educational operation, program, or activity conducted at KMUSC Entities where the SHE Standards can apply, including, but not limited to, exams by medical students and researchers.
E. Training: Within six months of the Effective Date of this Agreement, KMUSC will update its current employee training modules to include information regarding the requirements of Title IX in the healthcare setting, and will submit to HHS OCR the proposed revisions which will include potential Title IX issues that may arise in the context of the provider-patient relationship; the roles and responsibilities of chaperones; and the identification of those health care providers who are qualified and charged with determining the medical standard of care when such issues arise in the context of a possible Title IX matter. This requirement shall only apply to persons/entities to whom this Agreement applies.
Within six months of the Effective Date of this Agreement, KMUSC will ensure that staff members serving as medical chaperones will receive training on the SHE Standards. Thereafter, KMUSC will provide training on SHE Standards upon hiring and repeated on an annual basis. KMUSC shall maintain a training registry that documents the names and dates of the staff members receiving SHE Standards training.
F. Reporting Requirements: With this agreement, KMUSC submits to HHS OCR: (a) copies of the Policy on Prohibited Discrimination, Harassment and Retaliation, Resolution Process for Sexual Misconduct, Resolution Process for Discrimination and Harassment, and the Notice of Non-Discrimination in effect as of that date; (b) a copy of the SHE Standards in effect as of that date. Within thirty (30) calendar days of the KMUSC’s submissions under section IV.F.1.(a), HHS OCR will approve the KMUSC submissions or request revisions. The parties will work cooperatively to ensure that the final versions of KMUSC’s submissions will be completed within forty-five (45) calendar days after the Effective Date of this Agreement.
- Within one (1) year of the Effective Date of this Agreement, the Title IX Coordinator and the Deputy EEO-Title IX Coordinator for Healthcare will submit the first Annual Report to HHS OCR, which will review KMUSC's compliance with this Agreement and Title IX. The first Annual Report will include, for the first year of the Agreement:
- Spreadsheet summaries of reports or formal complaints, with allegations of sex discrimination, filed against KMUSC Entities or any member of the KMUSC Staff, with the EEO-TIX Office, Keck Hospital of USC's Office of Patient and Family Experience, 1-800-USC-CARE, Risk Management of Keck Hospital of KMUSC, Risk Management of USC Norris Cancer Center, Risk Management of USC Verdugo Hills Hospital, and/or any of the other KMUSC Entities; After OCR’s review of the spreadsheet, upon OCR request, KMUSC will provide to OCR the complete investigation file, including all documentation, interview notes, correspondence, and reports, for any report or complaint of sex discrimination, within twenty (20) calendar days of OCR’s request.
- The spreadsheet will include categories of information, as mutually agreed upon;
- A factual summary of the implementation of Section IV(A-F), during the first year of this Agreement; and
- Recommendations by the University for any revisions or modifications to policies and procedures to enhance KMUSC's efforts to prevent, address, and remediate sex discrimination.
- Within two (2) years of the Effective Date of this Agreement, the Title IX Coordinator and the Deputy EEO-Title IX Coordinator for Healthcare will submit the second Annual Report to HHS OCR, which will review the KMUSC Entities' overall compliance with this Agreement and Title IX. The second Annual Report will include, for the second year of the Agreement:
- Spreadsheet summaries of reports or formal complaints, with allegations of sex discrimination, filed against KMUSC Entities or any member of the KMUSC Staff, with the Title IX Coordinator or the Deputy Title IX Coordinator, Keck Hospital of USC's Office of Patient and Family Experience, 1-800-USC-CARE, Risk Management of Keck Hospital of USC, Risk Management of USC Norris Cancer Center, Risk Management of USC Verdugo Hills Hospital, and/or any of the other KMUSC Entities; After OCR’s review of the spreadsheet, upon OCR request, KMUSC will provide to OCR the complete investigation file, including all documentation, interview notes, correspondence, and reports, for any report or complaint of sex discrimination, within twenty (20) calendar days of OCR’s request.
- The spreadsheet will include categories of information, as mutually agreed upon;
- A factual summary of the implementation of Section IV (A-F), during the second year of this Agreement; and
- Recommendations by the University for any revisions or modifications to policies and procedures to enhance KMUSC's efforts to prevent, address, and remediate sex discrimination.
V. Signatures
The individuals signing represent that they are authorized to execute this Agreement and legally bind the parties to the Agreement.
For KMUSC
/s/ Steven D. Shapiro
Steven D. Shapiro
Senior Vice President for Health Affairs
University of Southern California
Date: 5/31/2022
For United States Department of Health and Human Services
/s/ Yun-kyung Lee
Yun-kyung Lee
Deputy Regional Manager, Pacific Region
United States Department of Health and Human Services
Office for Civil Rights
Date: 6/1/2022
