Cheylla Silva v. Baptist Health South Florida, Inc.
2017 U.S. App. LEXIS 8151
| 11th Cir. | 2017Background
- Plaintiffs Cheylla Silva and John Paul Jebian are profoundly deaf, communicate primarily in ASL, and visited Defendant hospitals (Baptist Hospital, South Miami Hospital, and parent Baptist Health) many times.
- Plaintiffs requested live, on-site ASL interpreters but hospitals primarily used Video Remote Interpreting (VRI); Plaintiffs allege frequent VRI malfunctions (frozen, choppy, poor image) or unavailability.
- Hospitals sometimes relied on handwritten notes, family members, or delayed in-person interpreters; Plaintiffs say these methods impaired exchange of medically relevant information.
- Plaintiffs sued under Title III of the ADA and Section 504 of the Rehabilitation Act seeking injunctive relief and damages; district court granted summary judgment for Defendants on standing and ineffective-communication grounds.
- The Eleventh Circuit reversed: (1) Plaintiffs have Article III standing to seek injunctive relief, and (2) the correct liability standard focuses on whether failure to provide appropriate auxiliary aids impaired exchange of medically relevant information (not on adverse medical outcomes or plaintiffs’ ability to recount exact missed content).
- The court remanded for further proceedings, including consideration of whether Defendants acted with deliberate indifference (required for monetary damages).
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Article III standing for injunctive relief | Silva and Jebian will likely return to defendants’ facilities given location, doctors, records, and prior visits; VRI problems will recur | Plaintiffs’ future visits and future VRI malfunctions are speculative | Plaintiffs have standing: frequent past visits, plans to return, and recurring VRI failures create a real and immediate likelihood of future injury |
| Proper standard for ineffective-communication claims | Liability requires showing hospital failed to provide appropriate auxiliary aids that impaired exchange of medically relevant information; plaintiffs need not prove adverse medical outcomes or specify every missed detail | Court should require proof of misdiagnosis, incorrect treatment, or inability to convey chief complaint/treatment understanding | The court adopted the impairment-of-exchange standard: focus on whether communication was substantially unequal; adverse medical outcomes or exact recall not required |
| Use of VRI and reliance on companions | Plaintiffs: VRI frequently malfunctioned and reliance on family or notes is not an appropriate substitute; VRI must deliver high-quality video | Defendants: VRI is an acceptable auxiliary aid and met policy; occasional failures don’t establish liability as a matter of law | VRI can satisfy obligations if it ensures effective communication; fact questions remain whether VRI malfunctioning and reliance on companions resulted in impaired exchanges |
| Monetary damages standard (deliberate indifference) | Plaintiffs rely on repeated prior incidents and policies favoring VRI to show knowledge and failure to act | Defendants argue no deliberate indifference; technical compliance and isolated incidents defeat damages claims | Remanded: plaintiffs must prove deliberate indifference to recover damages; district court must address whether triable issues exist on that element |
Key Cases Cited
- McCullum v. Orlando Reg’l Healthcare Sys., Inc., 768 F.3d 1135 (11th Cir.) (distinguishes injunctive relief from damages and discusses VRI use and effectiveness)
- Liese v. Indian River Cty. Hosp. Dist., 701 F.3d 334 (11th Cir.) (requires deliberate indifference for compensatory damages and treats effectiveness of auxiliary aids as fact-intensive)
- Houston v. Marod Supermarkets, Inc., 733 F.3d 1323 (11th Cir.) (standing inquiry: likelihood of return and real and immediate threat of future injury)
- Shotz v. Cates, 256 F.3d 1077 (11th Cir.) (disability-discrimination standards under ADA/RA)
- Cash v. Smith, 231 F.3d 1301 (11th Cir.) (ADA and RA claims governed by same substantive standard)
- Bircoll v. Miami–Dade Cty., 480 F.3d 1072 (11th Cir.) (perfect communication not required; communication must be effective)
- Nat’l R.R. Passenger Corp. v. Morgan, 536 U.S. 101 (U.S.) (distinguishes discrete discriminatory acts from continuing violations)
- Havens Realty Corp. v. Coleman, 455 U.S. 363 (U.S.) (continuing violation doctrine: ongoing practices can bring earlier acts into relevance)