Sandra Sunderland v. Bethesda Hospital, Inc.
686 F. App'x 807
| 11th Cir. | 2017Background
- Bethesda Memorial Hospital adopted Video Remote Interpreting (VRI) for deaf patients after a 2006 DOJ settlement; nurses control whether VRI or other aids (including in‑person interpreters) are provided and are responsible for assessing effectiveness.
- Between 2011–2014, nine deaf patients (and the Florida Association of the Deaf) experienced communication failures: VRI malfunctioning (blurry, freezing, poor audio/visibility), intermittent use, or outright denial of in‑person interpreters.
- Several patients requested in‑person interpreters and were denied or given the VRI despite known problems; some clinicians resorted to gesturing or pen‑and‑paper.
- Plaintiffs sued under Section 504 (seeking compensatory damages and injunctive relief) and the ADA (seeking injunctive relief). District court granted summary judgment for Bethesda on damages (no deliberate indifference) and on standing for injunctive relief; Association’s claims were dismissed for lack of standing.
- Eleventh Circuit reviewed de novo, held triable issues of deliberate indifference for four patients (Sunderland, the Lieses, Virgadaula, Gluckman) and that Gluckman plus the Association have standing for injunctive relief; affirmed dismissal for the other patients.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether plaintiffs can recover compensatory damages under Section 504 by showing deliberate indifference | Plaintiffs: nurses had authority to decide accommodations and, knowing VRI failures, persisted without effective alternatives → deliberate indifference | Bethesda: no official had the requisite supervisory authority and lacked knowledge showing deliberate indifference | Court: Triable issues of deliberate indifference exist for Sunderland, the Lieses, Virgadaula, and Gluckman; not for Drumm, Donofrios, or Tvede |
| Whether nurses are "officials" (i.e., have discretion making them capable of deliberate indifference) | Plaintiffs: nurses exercise de facto discretion to provide/withhold VRI or interpreters and their decisions are generally not reversed | Bethesda: nurses’ decisions are supervised/ministerial and do not amount to the requisite official authority | Court: a jury could find nurses are officials based on hospital policy and practice (analogous to Liese) |
| Standing for injunctive relief — whether individual patients face a real and immediate threat of future injury at Bethesda | Plaintiffs: medical conditions make future hospital visits likely; past failures show risk of repeated discrimination | Bethesda: patients’ conditions are stable; future visits are speculative, so no concrete threat | Court: Only Gluckman demonstrated a real and immediate likelihood of returning and likely repeated discrimination; other eight patients lacked standing |
| Associational standing for the Florida Association of the Deaf to seek injunctive relief | Association: at least one member (Gluckman) has standing, claims are germane to purpose, and relief doesn’t require individual participation | Bethesda: association relies on speculative member returns and lacks injury‑in‑fact via members | Court: Association has standing because Gluckman (a member) has standing and Hunt factors are met |
Key Cases Cited
- Liese v. Indian River Cty. Hosp. Dist., 701 F.3d 334 (11th Cir. 2012) (defines deliberate indifference and the "official" standard in hospital accommodation context)
- McCullum v. Orlando Reg'l Healthcare Sys., Inc., 768 F.3d 1135 (11th Cir. 2014) (summary judgment standard and standing for injunctive relief analysis)
- Gebser v. Lago Vista Indep. Sch. Dist., 524 U.S. 274 (1998) (damages require actual knowledge and failure to respond — deliberate indifference principle)
- Houston v. Marod Supermarkets, Inc., 733 F.3d 1323 (11th Cir. 2013) (standing requires real and immediate likelihood of future injury for injunctive relief)
- Doe v. Sch. Bd. of Broward Cty., 604 F.3d 1248 (11th Cir. 2010) (fact‑intensive inquiry on who qualifies as an official with decisionmaking authority)