Francois v. Our Lady of the Lake Hosp, 8f4th370

Background

Damian Francois, a deaf ASL user who is “virtually illiterate,” was admitted after being shot and became permanently paralyzed; family members told hospital staff he needed an interpreter.
From admission (April 11) through April 15 the hospital used whiteboards, family members, picture boards, and video-remote interpreting (VRI) but did not provide an on‑site ASL interpreter.
A hospital care coordinator who knows ASL met Francois on April 12 and avers Francois did not request additional services or an interpreter then.
On April 15 family/friends notified the hospital the VRI was ineffective and requested an on‑site interpreter; the hospital provided an on‑site interpreter on April 16, after which Francois was told of his permanent paralysis.
Francois sued under Section 504 of the Rehabilitation Act and Section 1557 of the ACA seeking damages and relief; the district court granted summary judgment for the hospital, reasoning Francois failed to show intentional discrimination (actual notice).
On appeal the Fifth Circuit affirmed, holding the record could show constructive notice but not the actual subjective notice required for compensatory damages under the RA/ACA.

Issues

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether hospital had actual notice such that its delay in providing an on‑site interpreter amounts to intentional discrimination (required for compensatory damages)	Francois: need for on‑site interpreter was open and obvious; family informed staff; expert says writing/lipreading were inadequate; delay caused harm	Hospital: staff reasonably believed whiteboard, family assistance, and VRI were effective; no request for on‑site interpreter until Apr 15; on‑site provided Apr 16	No actual notice shown; summary judgment for Hospital (no intentional discrimination)
Whether alternative communication methods used were effective enough to satisfy RA/ACA obligations	Francois: alternatives were inadequate and he did not understand key information	Hospital: nurses and records indicate Francois appeared to understand; history obtained via whiteboard and family; VRI attempted	Court found record supports that effective communication was achievable without an on‑site interpreter, so alternatives did not establish liability absent actual notice
Whether family’s statement at admission constituted an adequate request/notice for an on‑site interpreter	Francois: grandmother told staff upon admission he needed an interpreter, which should have triggered on‑site services	Hospital: family request alone does not oblige on‑site interpreter unless necessary; staff met with Francois and he did not ask for an interpreter then	Request alone insufficient to show the hospital subjectively knew only an on‑site interpreter would suffice
Availability of emotional‑distress or "denial of self‑determination" damages	Francois: seeks compensatory damages for emotional injury and for denial of self‑determination	Hospital: emotional‑distress damages are limited under Fifth Circuit precedent	Court declined to reach novel ‘‘denial of self‑determination’’ theory and applied Cummings to bar emotional‑distress damages; affirmed dismissal because no intentional discrimination

Key Cases Cited

Smith v. Harris Cnty., 956 F.3d 311 (5th Cir. 2020) (summary judgment and knowledge principles applied)
Miraglia v. Bd. of Supervisors of La. State Museum, 901 F.3d 565 (5th Cir. 2018) (intentional discrimination requires actual notice)
Windham v. Harris Cnty., 875 F.3d 229 (5th Cir. 2017) (open, obvious, and apparent accommodation exception)
Silva v. Baptist Health S. Fla., Inc., 856 F.3d 824 (11th Cir. 2017) (hospitals may rely on less than on‑site interpreters when effective communication is achievable)
Delano‑Pyle v. Victoria Cnty., 302 F.3d 567 (5th Cir. 2002) (intentional discrimination where officers knew communication attempts were ineffective)
Cadena v. El Paso Cnty., 946 F.3d 717 (5th Cir. 2020) (subjective awareness plus refusal to provide effective accommodation supports intent)
Perez v. Drs. Hosp. at Renaissance, Ltd., [citation="624 F. App'x 180"] (5th Cir. 2015) (nonprecedential example where repeated requests and ineffective methods created fact dispute)
Cummings v. Premier Rehab Keller, P.L.L.C., 948 F.3d 673 (5th Cir. 2020) (emotional‑distress damages unavailable in similar RA/ADA context)