Supplemental Response to First Set of Interrogatories to the US Department of Health, Education, and Welfare

     [||a45a87b2-dfe0-4267-af5b-86cac70bc6f9||] IN THE UNITED STATES DISTRICT COURT 
FOR THE NORTHERN DISTRICT OF INDIANA 

HAMMOND DIVISION 

  

BERNICE TERRY, et al., 

  

  

Plaintiffs, 

7. Civil No. H 76-373 

METHODIST HOSPITAL OF GARY, INC., 

et al., 

Defendants. 

7 

RICHARD GORDON HATCHER, et al., 

Plaintiffs, 

Vv. Civil No. H 77-154 

METHODIST HOSPITAL OF GARY, INC., 

et al., 

Defendants. 

/ 
  

SUPPLEMENTAL RESPONSE TO FIRST SET OF INTERROGATORIES 
TO THE UNITED STATES DEPARTMENT OF HEALTH, 

EDUCATION, AND WELFARE 
  

Defendant Joseph A. Califano, Secretary of the Department 

of Health, Education and Welfare, by his undersigned attorneys, 

hereby supplements his response, pursuant Eo Rule 33 of the 

Federal Rules of Civil Procedure, to plaintiffs' first set 

of interrogatories as follows: 

Interrogatory No. 1. Describe the complete assignment and 
  

delegation of, and structure for civil rights responsibilities 

within HEW: 

(a) between the central Office for Civil Rights and 

central office or divisions administering the substantive HEW 

programs;  



(b) between the central Office for Civil Rights and 

  

the regional offices; 

(c) between the central offices administering the 

substantive HEW programs and the regional offices: 

(d) between the divisions in the regional offices 

responsible for or with authority over substantive HEW programs 

and the divisions responsible for securing civil rights compliance. 

Specifically include responsibility concerning the Hill-Burton 

program, and programs established under the Public Health Act 

and. under Title V, XVIII, and XIX of the Social Security Act. 

Response to Interrogatory No. 1. Attached to these responses 
  

is a copy of the statement of organization, functions and 

delegations of authority of the Office for Civil Rights, 

Office of the Secretary, Department of Health, Education and 

Welfare as it appeared in 42 Federal Register 31647-31652 
  

(Attachment 1-S) on Wednesday, June 22, 1977. This document 

describes the current organization of the Office for Civil 

Rights which is presently being implemented and contains the 

information sought in these interrogatories. 

In addition, attached are documents developed by the 

Public Health Service (PHS), Region V, and the Office for 

Civil Rights (OCR), Region V (Attachments 2-S, 3-S, 4-85, 

5-5, and 6-S). These documents implement procedures agreed 

upon by the two offices to review applicants for Hill-Burton 

funds for compliance with Title VI. These procedures include 

the involvement of the State agency in collecting data required 

by OCR to make a civil rights determination. 

Information in this interrogatory was supplied by Norman 

Chachkin Associate Director, Policy, Planning and Research  



  

(hereinafter Norman Chachkin) and Alfred J. Sanchez, Chief 

Chief of Health Branch, OCR, Region V (hereinafter Alfred Sanchez). 

Interrogatory No. 2. Describe any guidelines, directives, 
  

policies or agreements which relate to the structures and 

functions set forth in the answer to Interrogatory 1. State 

whether, when and why these guidelines, directives and policies 

were instituted, and whether, when and why they have changed since 

1970, 

Response to Interrogatory No. 2. No guidelines, directives, 
  

policies or agreements which relate to the above have yet 

been executed. The previous statements of organization, 

functions and delegations of authority relating to the Office 

for Civil Rights appeared at 39 Federal Register 11325 

(March 27, 1974) as amended by 39 Fed. Reg. 43866 (December 19, 1974). 

Information in this interrogatory was supplied by 

Norman Chachkin. 

Interrogatory No. 3. State the name, position, level or 
  

title of the person responsible for and/or head of each of the 

assignments and responsibilities set forth in Interrogatory 1, 

specifically including the persons in the central office and 

Region V responsible for assuring civil rights compliance by 

Indiana health facilities receiving federal funds. 

Response to Interrogatory No. 3. Enforcement is 
  

Cynthia G. Brown; the Director of the Division of Technical 

Review and Assistance is Lloyd Henderson; the Chief of the Health 

Branch has not yet been selected; the Chief of the Compliance 

Program Branch is Don Vernon; the Deputy Director, Program Review & 

Assistance is Wilbert A. Cheatham; the Director of the Division 

of Intra-Departmental Technical Assistance is Hal Hunton; 

the Chief of the Health Branch is Louise Lucas; the Associate  



Director, Policy, Planning & Research is Norman J. Chachkin; 

  

the Director, Division of Policy & Procedures is Michael 

Middleton; the Chief of the Handicapped Discrimination Branch 

has not yet been selected, the Chief of the Racial & National 

Origin Discrimination Branch is Edward Redman; the Regional 

Director, OCR, Region V, is Kenneth A. Mines; the regional 

structure has not yet been revised in accordance with the 

descriptive statement in the Federal Register on June 22, 1977 
  

but the current Chief of the Health Branch in Region V is 

Alfred Sanchez. | 

Information in this interrogatory was supplied by 

Norman Chachkin. 

Interrogatory No. 4. Describe the complete assignment 
  

relationship between HEW and state agencies which administer 

state plans with respect to programs established under the 

Public Health Act and under Titles V and XIX of the Social 

Security Act. Specifically include the delegation and 

assignment of civil rights responsibilities; the specific 

functions and responsibilities of the central office, the 

regional offices and the state agencies; whether, why and 

to what extent these arrangements differ as between different 

regional offices and different state agencies; and the 

extent to which the central office of HEW exerts control or 

authority over the civil rights responsibilities of the state 

agencies. 

Response to Interrogatory No. 4. The relationship 
  

between the Washington office for civil rights and the 

regional offices for civil rights does not differ from region 

to region except that specified in the statement of organization, 

functions and delegations of authority attached in answer to  



» 

interrogatory #1, and such general relationships are fully 

   
described in that attachment. 

The assignment relationship between HEW and the State Agencies 

which administer plans under the Public Health Service Act as 

regards health facilities construction is as described in the 

Health Care Facilities Loan Program Policy and Procedures Manual 

which states, in part: 

The State Health Planning and Development Agency designated 

(conditionally or fully) under Title XV of the Public Health 

Service Act will conduct the health planning activities and 

perform the functions prescribed by Section 1523. It will serve 

as the designated planning agency of the State for the purposes 

of Section 1122 of the Social Security Act (if the State has 

made an agreement pursuant to such section) and will administer 

a State certificate-of-need program which applies to new 

institutional health services proposed to be offered or developed. 

As regards the assignment of Civil Rights responsibilities: 

The Office of Management and Budget Circular A-95 

encourages the establishment of a network of State and areawide 

planning and development clearinghouses to help in the coordination 

and review of proposed Federal and federally assisted projects 

by agencies responsible for State, areawide and local planning; 

for implementation of pertinent sections of the Demonstration 

Cities and Metropolitan Development Act of 1566 and the National 

Environmental Policy Act of 1969; and for furthering the 

objectives of State and local Civil Rights laws. Procedures 

for implementing the provisions of Circular A-95 vary among 

the States. Specific information on the submission of proposals 

and supporting date may be obtained from the State Health 

Planning Agency or the State Hill-Burton Agency. 

In Region V there is also an informal agreement with the 

Office of Civil Rights which provides for an OCR regional review 

 



in addition to that required of the states. (Refer to answer to 

   
interrogatory 10 for further information on this issue). 

Information for this response was supplied by Norman 

Chachkin and Alfred Sanchez. 

Interrogatory No. 5. State whether HEW has issued any 
  

guidelines, letters, directives, policy statements, manuals, 

agreements or other communications discribing or pertaining 

to the functions, assignments and responsibilities set forth in 

the answer to Interrogatory 4. If the answer is yes, 

specifically identify and describe all such documents. 

Response to Interrogatory No. 5. In addition to the 
  

statement attached to interrogatory 1 (Attachments 1-S), 

the attached pages from the Loan Manual contain the only other 

responsive material HEW could locate. (Attachment 7-8). 

Information for this response was submitted by Alfred Sanchez. 

Interrogatory No. 8. Identify all guidelines and policy 
  

statements for facility and agency compliance with Title VI 

and/or Section 504 which were given to any of the defendants 

in this action or to any recipients of federal funds for health 

facilities or under continuing programs in Region V and attach 

copies of each to this discovery instrument. : 

Response to Interrogatory No. 8 as it Applies to the 
  

Northern Indiana Health Systems Agency. The attached memorandum, 
  

"Factors to be Considered" was distributed about a year ago 

in draft form to all HSA's in Region V. (Attachment 8-5). 

The HSA's were advised to implement the factors since. they 

were likely to become official guidelines. | 

Information for this response was submitted by Alfred Sanchez. 

Interrogatory No. 9. Describe all actions and communications 
  

taken by the other defendants in this action which assure or 

purport to give assurances of compliance with civil rights 

obligations, including but not limited to assurances given  



  

pursuant to 45 C.F.R. 80.4(a). Specifically identify all 

documents containing such assurances, including the date 

received, and attach copies. of each to this discovery instrument. 

Response to Interrogatory No. 9 as It Applies to the 
  

Northern Indiana Health Systems Agency. Attached are assurances 
  

rendered by the Northern Indiana HSA. (Attachment 9-S). 

Information for this response was submitted by Alfred Sanchez. 

Interrogatory No. 14. Describe completely all procedures, 
  

standards and guidelines required of state agencies which 

administer the Medicaid, and Title VI programs to assure compliance 

with the state agencies' obligations under Title VI and Section 504, 

prior to their approval of applications by health facilities for 

participation in these programs. Identify and/or attach 

copies of guidelines, instructions, regulations, directives 

or agreements pertaining to such procedures. 

Response to Interrogatory No. 14. State agencies which 
  

administered the Medicaid and Title VI programs are subject 

t0 the Office for Civil Rights' Title VI regulation, 45 C.F.R. 

Part 80 and the Office for Civil Rights' Section 504 tepulation. 

45 C.F.R. Part 84. State agencies are not required to submit 

separate assurances of compliance with these regulations. 

Additional information from the Public Health Service 

has been requested. This response will be supplemented when 

that information is received. 

Information in this interrogatory was supplied by 

Norman Chachkin. 

Interrogatory No. 15. Describe completely all procedures, 
  

standards and guidelines promulgated by HEW to assure that 

health facilities approved by state agencies for participation 

in Medicaid and Title V are in compliance with Title VI and 

 



  

   
Section 504. Identify and describe, and/or attach copies of 

guidelines, instructions, regulations, directives or 

agreements pertaining to such procedures. 

Response to Interrogatory No. 15. Guidelines under 
  

Title VI for hospitals and nursing homes have been issued 

by the Office for Civil Rights and were most recently amended 

in 1969. (Attachments 10-S and 11-S). In addition, health 

facilities which desire to participate Medicaid, Medicare, 

or Title V programs are required to execute assurances of 

compliance. (Attachment 12-5). 

Information in this response was supplied by Norman Chachkin. 

Interrogatory No. 16. Describe all procedures, and 
  

standards required by HEW for Title VI and Section 504 clearance 

by a health facility prior to its participation in the Medicare 

program. Set forth and/or attach copies of guidelines, 

instructions, regulations, directives or agreements pertaining 

to such procedures. 

Response to Interrogatory No. 16. See response to 
  

interrogatory no. 15. 

Interrogatory No. 17. Describe all procedures promulgated 
  

by HEW pursuant to Title VI and Section 504 regarding civil 

rights clearance prior to the commencement of a project to 

relocate or create a satellite of a health facility that is 

participating in the Medicare, Medicaid, or Title V programs. 

Include: 

(a) whether, how and why the procedures differ for 

each of the programs; and | 

(b) the date such procedures were promulgated and 

by whom. Identify and describe, and/or attach copies of 

guidelines, instructions, regulations, directives or agreements 

pertaining to such procedures. 

Response to Interrogatory No. 17. No specific procedures 
   



  

for pre-construction clearance have been issued by HEW 

pursuant to Title VI or §504. Where information comes to the 

attention of the Office for Civil Rights concerning health 

care facility construction which indicates potential non- 

compliance with Title VI, 45 C.F.R. Section 80.7 (c) provides 

that the Office will conduct an appropriate review or investigation 

and will seek to remedy any discrimination which is found. The 

regulations under Section 504 require program accessibility 

by August 2, 1977, except for programs for which accissibility 

is prevented by structural barriers; a transition plan within 

six months of the date of issuance of the regulations by all 

recipients barriers which prevent program accessibility within 

three years from the issuance of the regulations, and achievement 

of this goal within that timeframe. Applications for construction 

with Federal funds or federal funding guarantees are required 

to demonstrate eligibility for funding. 

Information in this response was supplied by Norman Chachkin. 

Interrogatory No. 22. Describe in detail the factors 
  

considered and basis upon which proposals for the construction 

and/or expansion of Broadway Methodist Hospital were reviewed, 

evaluated, recommended and/or approved by HEW, as to the 

following items: 

(a) location of the laundry at Broadway; 

(b) Joint and shared planning among hospitals in 

Lake County, and particularly any efforts by Nethodise Hospital 

of Gary, Inc., 0 avoid duplication of services; 

(c) plans by Methodist Hospital of Gary, Inc., for 

Family Practice Residence programs; 

(d) plans by Methodist Hospital of Gary, Inc., for 

attracting and retaining physicians and nurses to and in Gary;  



(e) the construction and renovation tiemtable as proposed 

  

by Methodist Hospital of Gary, Inc., regarding Gary Methodist 

Hospital and Broadway Methodist: Hospital; 

(f) hospital-based physician offices; 

(g) plans for gonstencE ion of condominium for private 

practice by physicians; 

(h) relationship of Methodist Hospital of Gary, Inc., with 

medical schools and plans for medical education training programs, 

internships and residencies at Gary Methodist Hospital and 

Broadway Methodist Hospital; 

(1) health needs and patterns of utilization of medical 

care facilities, and particularly emergency room facilities, 

by the following population categories: 

(1) black 

(2) Hispanic 

(3) elderly 

(4) handicapped 

(5) women of child-bearing age 

(6) children (under age 18) 

(7) lower income residents; 

(J) projections as to number of patients by race at 

each Health Services Building, Gary and Broadway; 

(k) catchment areas of projected patient population 

groups; 

(1) response by community groups; 

(m) impact of the construction and/or expansion of 

Broadway Methodist Hospital on residents of caliment Township; 

(n) problems of convenience and accessibility by lower 

income, racial minority, and/or handicapped residents of Gary to 

Broadway Methodist Hospital, by public transportation or otherwise,  



  

particularly in relation to use of linear accelerator, outpatient 

services and services unavailable at Gary Methodist Hospital; 

(0) impact of the construction and/or expansion of 

Broadway Methodist Hospital on Calumet Township in relation to 

jobs, housing patterns, property values, small businesses, 

pharmacies; 

(p) impact of the construction and/or expansion of 

Broadway Methodist Hospital on non-medical employees at Gary 

Methodist Hospital; 

(gq) impact of the construction and/or expansion of 

Broadway Methodist Hospital on further potential medical 

patients residing in Calument Township; 

(r) impact of the construction and/or expansion of 

Broadway Methodist Hospital on the location of practice by 

phusician specialists; 

(s) impact of the construction and/or expansion of 

Broadway Methodist one (i) the ratio of doctors to patients 

and on (ii) the ratio of nurses to patients at Gary Methodist 

Hospital. 

Response to Interrogatory No. 22. HEW is still in the 
  

process of evaluating these factors and no final determinations 

have been made. Because it was determined that the actions 

of other hospitals in Lake County affect those of Gary 

Methodist and Broadway Methodist Hospitals, the review will 

encompass all hosptials in Lake County. 

Information for this response was supplied by Norman Chachkin. 

 



    

I declare under penalty of perjury that to the best 

of my knowledge the foregoing answers are true and correct. 

i 

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7 of = ; 

hl TRL I A an 
  

EDWARD KOVEN 

Assistant Regional Attorney 
Region V 
Chicago, Illinois 

2 7 2 rd ~ Ps 

L_~ Tl Sl Z LZ { ir if CA Sa 

NORMAN CHACHKIN 

Office of Civil Rights 
Department of Health, Education 

and Welfare 
Washington, D. C. 

  

Respectfully submitted, 

(0 Lecco 2 Ress 
  

REBECCA L. ROSS 

Attorney, Department of Justice 
10th & Constitution Ave., NW 
Washington, D. C. 20530 
Telephone: 739-2230 

 



    

CERTIFICATE OF SERVICE 
  

I certify that copies of Supplemental Response to First 

Set of Interrogatories to the United States Department of 

Health, Education, and Welfare have been served this 16th day 

of August, 1977 by mailing postage prepaid to: 

Jack Greenberg, Beth J. Lief, 
Melvin R. Leventhal 
10 Columbus Circle 
New York, New York 10019 

Julian Allen 
2009 Broadway 
Gary, Indiana 46407 

Marilyn G. Rose 
Christine B. Hickman 
1751 NM Street, NW 
Washington, D. C. 20036 

Attorneys for Plaintiffs, Terry, 
Hatcher, Page, Metro Corp., Inc. 

Theodore Sendak 

Attorney General 
State House 

Indianapolis, Indiana 46320 

Attorney for State Defendant 

Anthony DeBonis 
720 West Chicago Avenue 
Fast Chicago, Indiana 

Attorney for Kiplan Kaplan, as 
Executive Director of the Northern 
Indiana Comprehensive Health 
Systems Agency, Inc. 

Bruce Sayers 

HODGES, DAVIS, GRUEMBER, COMPTON 

& SAYERS 

5525 Broadway 
Gary, Indiana 46410 

Attorneys for Defendants, Methodist 
Hospital of Gary, Inc. and Denis 
E. Ribordy 

(Re beeen iY [x SS 
REBECCA L. ROSS 
  

Attorney, Department of Justice 
10th & Constitution Ave., NW 
Washington, D. C. 20530 
Telephone: 739-2230 [||a45a87b2-dfe0-4267-af5b-86cac70bc6f9||]