United States Court of Appeals

for the Fifth Circuit

No. 20-30707

Damian Francois, 

Plaintiff—Appellant,

versus

Our Lady of the Lake Hospital, Incorporated, 

Defendant—Appellee.

Appeal from the United States District Court

for the Middle District of Louisiana

USDC No. 3:17-CV-393

Before Jones, Southwick, and Costa, Circuit Judges.

Leslie. H. Southwick, Circuit Judge:

Damian Francois sued Our Lady of the Lake Hospital for disability 

discrimination. He now appeals the district court’s grant of summary 

judgment to the Hospital, which dismissed his claims that the Hospital 

violated the Rehabilitation Act and Affordable Care Act by failing to provide 

an on-site interpreter until the sixth day of his hospital stay. We AFFIRM.

United States Court of Appeals

Fifth Circuit

FILED

August 6, 2021

Lyle W. Cayce

Clerk

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FACTUAL AND PROCEDURAL BACKGROUND

According to the record, Damian Francois is a deaf and “virtually 

illiterate” individual who communicates primarily in American Sign 

Language (“ASL”). This appeal concerns whether there is evidence in the 

summary-judgment record that creates a genuine dispute of material fact 

about whether the Hospital had actual notice that an on-site interpreter was 

necessary to provide appropriate medical care to Francois.

On April 11, 2017, Francois was admitted to the Hospital after his 

uncle shot him in the back. Francois’ grandmother, Leona Deemer, testified 

in a deposition that she told the ambulance crew, the “lady at the front desk,” 

and a doctor that Francois was deaf and “needed an interpreter.” She also 

testified that she told Francois’ attendant nurses that he was unable to 

understand many written or complex words. That first night, Francois 

underwent emergency surgery that saved his life but did not prevent his 

permanent paralysis.

The next morning, Francois met with John Deshotel, who was a Care 

Coordinator at the Hospital. Deshotel communicated with Francois in ASL, 

which is Deshotel’s second language. He also spoke in English because 

Deemer was there too. According to Deshotel’s sworn affidavit, he told 

Francois during this meeting that “the hospital wanted to meet his needs 

throughout his admission”; asked Francois if he needed any additional 

services, and Francois answered that he did not; and told Francois “if he 

needed any additional services, that he could ask for me and that I would 

come meet with him.” According to Deshotel’s affidavit, neither Francois 

nor Deemer requested an interpreter during that meeting.

During Francois’ first five days, the Hospital relied on several 

methods of communication other than an on-site interpreter. It relied 

primarily on the use of a whiteboard/dry-erase board and nonverbal cues. At 

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various times, the Hospital also relied for interpretive assistance on a board 

with pictures, Francois’ family, and a video remote interpreter.

1

The nurses attending Francois testified that he appeared to 

understand their written and nonverbal communications. Allison Berry, 

assigned to Francois on April 12, testified to multiple instances when she 

communicated with Francois using the whiteboard and Francois nonverbally 

indicated that he understood. Another nurse, Katelyn Ferachi, was assigned 

to Francois on April 15. She testified that Francois “never gave any 

indication that he did not understand [whiteboard notes] or that [using the 

whiteboard] was not appropriate for him.” She also testified that, when the 

Hospital’s staff would use the whiteboard to communicate, Francois would 

“answer with either a nonverbal cue or a written answer on the board.”

There are hospital records showing that difficulties arose in 

communicating with Francois. On several occasions, communications with 

Francois about his medical history were “limited.” Two of those records, 

though, indicate that the Hospital was able to obtain Francois’ medical 

history using methods other than an on-site interpreter, i.e., “by writing 

questions and interviewing [Francois’] grandmother,” and by the “use of a 

dry erase board and sign language through family member at bedside.”

As of April 14, his third full day in the Hospital, Francois’ medical 

condition was stable, but the Hospital knew that Francois was paralyzed. At 

that point, the Hospital was ready to transfer him from a trauma unit to a 

rehabilitation unit. That day, one of Francois’ friends, Paula Rodriguez, sent 

1 The district court credited the Hospital’s reliance on Francois’ family for 

interpretive assistance as assisting effective communication. An ADA regulation, though, 

prohibits reliance on family members for interpretive assistance absent exceptions that are 

not applicable here, 28 C.F.R. § 35.160(c)(2), and an ACA regulation incorporates this 

prohibition by reference, 45 C.F.R. § 92.102(a). 

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a text message to the Civil Rights Coordinator at the Hospital requesting an 

interpreter for Francois. It appears that the text message resulted in the 

Hospital’s attempting, unsuccessfully, to use a virtual remote interpreter.

On April 15, Rodriguez visited the Hospital, told medical personnel 

that the virtual remote interpreter was ineffective, and requested an on-site 

interpreter for Francois. Rodriguez later testified that on April 15, Francois 

still did not know that he was permanently paralyzed. Instead, he thought 

that he would have another surgery and walk again.

The Hospital provided an on-site interpreter the next day, April 16. 

On that day, with an on-site interpreter present, Francois met with Dr. Malia 

Eischen, who explained to Francois his diagnosis and prognosis of permanent 

paralysis. A medical record indicates that, during this meeting, Francois’ 

family “expressed concern that [Francois] was not understanding 

communication that had previously been provided.” 

Francois remained in the Hospital until May 17. From April 16 to May 

17, the Hospital provided an on-site interpreter on 61 occasions.

Francois sued the Hospital in the United States District Court for the 

Middle District of Louisiana. In the live complaint, Francois asserted claims 

against the Hospital under Section 504 of the Rehabilitation Act (“RA”), 29 

U.S.C. § 794; Title III of the Americans with Disabilities Act (“ADA”), 42 

U.S.C. § 12182; Section 1557 of the Patient Protection and Affordable Care 

Act (“ACA”), 42 U.S.C. § 18116; and the Louisiana Commission on Human 

Rights, La. Rev. Stat. § 51:2231. Francois sought a declaratory judgment, 

injunctive relief, compensatory damages, costs and attorneys’ fees, and any 

other relief necessary and appropriate. In February 2018, the district court 

dismissed Francois’ state-law claims. In October 2019, Francois voluntarily 

dismissed his ADA claim. Only his RA and ACA claims remained. The 

Hospital filed for summary judgment on those two remaining claims.

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After briefing, the district court granted summary judgment in favor 

of the Hospital. As for Francois compensatory-damages claims, the court 

held that Francois failed to establish the requisite intentional discrimination 

because he “failed to present evidence that [the Hospital’s] staff had actual 

notice that [Francois’] rights were being violated.” The court reasoned that 

the Hospital “made good faith efforts to accommodate [Francois] and 

believed that communication via written messages and family assistance was 

effective, especially considering [Francois] never indicated a lack of 

understanding or requested an interpreter or to meet with Deshotel.” 

According to the court, the summary-judgment evidence “may demonstrate 

negligence or carelessness,” but not intentional discrimination. As for the 

injunctive-relief claims, the court held that Francois lacked standing because 

he failed to show an injury in fact. As for available damages, the court 

correctly observed that that emotional-distress damages are unavailable 

under Cummings v. Premier Rehab Keller, P.L.L.C., 948 F.3d 673 (5th Cir. 

2020), cert. granted, --- S. Ct. ----, 2021 WL 2742781 (July 2, 2021) (No. 20-

219). The district court then determined that compensatory damages for 

“denial of self-determination” are unavailable too.2

The district court dismissed all of Francois’ remaining claims with 

prejudice and entered final judgment for the Hospital. Francois timely 

appealed. 

2 Francois argues that Cummings was incorrectly decided as to the availability of 

emotional-distress damages. He also argues that, under Cummings, damages for “denial of 

self-determination” should be available. We do not address these issues because of our 

holding that Francois did not make a summary-judgment showing of intentional 

discrimination. 

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DISCUSSION

We review the grant of summary judgment de novo, applying the same 

standards as the district court. Smith v. Harris Cnty., 956 F.3d 311, 316 (5th 

Cir. 2020). Summary judgment is appropriate “if the movant shows that 

there is no genuine dispute as to any material fact and the movant is entitled 

to judgment as a matter of law.” Fed. R. Civ. P. 56(a). “A dispute is 

genuine if the evidence is such that a reasonable jury could return a verdict 

for the nonmoving party.” Dyer v. Houston, 964 F.3d 374, 379 (5th Cir. 

2020). “A fact is material if its resolution could affect the outcome of the 

action.” Id. (quotation marks and citation omitted). On appeal from 

summary judgment, we view the facts in the light most favorable to the 

nonmoving party and draw all reasonable inferences in its favor. SEC v. 

Kahlon, 873 F.3d 500, 504 (5th Cir. 2017).

Francois contends that his need for an on-site interpreter was “open 

and obvious” and that the Hospital’s failure to provide one until April 16 

constitutes intentional discrimination. He claims that, because of the 

Hospital’s delay in providing an on-site interpreter, Francois did not 

understand until the sixth day in the Hospital that he was paralyzed and 

wrongfully believed that he would have surgery and walk again.

The Hospital disagrees with Francois’ view of the evidence. It asserts 

that the evidence shows that its staff had no reason to know that their means 

of communication were ineffective. The Hospital contends that an on-site 

interpreter was not requested until April 15, and at no time did Francois’ 

nurses or Deshotel have reason to believe that an on-site interpreter was 

necessary. The Hospital’s position is that it took reasonable steps to 

accommodate Francois and arranged for an on-site interpreter as soon as it 

learned of Francois’ need for one.

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First, we will explain the analytical frameworks for Francois’ claims 

for disability discrimination under Section 504 of the RA and Section 1557 of 

the ACA. Second, we will analyze whether Francois presented sufficient 

evidence to survive summary judgment. We conclude that Francois failed to 

make a summary-judgment showing of intentional discrimination because 

the evidence, viewed in the light most favorable to Francois, is not sufficient 

for a reasonable jury to determine that the Hospital had actual knowledge of 

the need for an on-site interpreter.

I. The analytical frameworks

Section 504 of the RA prohibits disability discrimination by recipients 

of federal funds. 29 U.S.C. § 794(a).3 The RA’s implementing regulations 

provide additional requirements and guidance. First, a recipient of federal 

funds must “provide appropriate auxiliary aids to persons with impaired 

sensory, manual, or speaking skills, where necessary to afford such persons an 

equal opportunity to benefit from the service in question.” 45 C.F.R. 

§ 84.52(d)(1) (emphasis added). Second, “aids, benefits, and services, to be 

equally effective, are not required to produce the identical result or level of 

achievement for handicapped and nonhandicapped persons, but must afford 

handicapped persons equal opportunity to obtain the same result, to gain the 

same benefit, or to reach the same level of achievement, in the most 

integrated setting appropriate to the person’s needs.” Id. § 84.4(b)(2). 

3 Section 504 of the RA provides in relevant part: 

No otherwise qualified individual with a disability in the United States, as 

defined in section 705(20) of this title, shall, solely by reason of her or his 

disability, be excluded from the participation in, be denied the benefits of, 

or be subjected to discrimination under any program or activity receiving 

Federal financial assistance or under any program or activity conducted by 

any Executive agency or by the United States Postal Service.

29 U.S.C. § 794(a).

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“The remedies, procedures, and rights available under the Rehabilitation Act 

parallel those available under the ADA.” Cadena v. El Paso Cnty., 946 F.3d 

717, 723 (5th Cir. 2020). Thus, precedent interpreting or applying the ADA 

applies with equal force to a claim under the RA. Id. 

Section 1557 of the ACA prohibits discrimination based on any of the 

grounds protected under Title VI, Title IX, the Age Discrimination Act, and 

the RA, during the provision of health care. 42 U.S.C. § 18116(a).4 The 

ACA’s implementing regulations also provide additional requirements and 

guidance. First, a health program or activity receiving federal funds must 

“provide appropriate auxiliary aids and services, including interpreters and 

information in alternate formats, to individuals with impaired sensory, 

manual, or speaking skills, where necessary to afford such persons an equal 

opportunity to benefit from the service in question.” 45 C.F.R. § 92.102(b) 

(emphasis added). Under the ACA, auxiliary aids include, among other 

things, “[i]nterpreters on-site or through video remote interpreting (VRI) 

services,” “note takers,” “written materials,” “exchange of written notes,” 

4 Section 1557 of the ACA provides in relevant part:

Except as otherwise provided for in this title (or an amendment made by 

this title), an individual shall not, on the ground prohibited under title VI 

of the Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.), title IX of the 

Education Amendments of 1972 (20 U.S.C. 1681 et seq.), the Age 

Discrimination Act of 1975 (42 U.S.C. 6101 et seq.), or section 794 of title 

29, be excluded from participation in, be denied the benefits of, or be 

subject to discrimination under, any health program or activity, any part of 

which is receiving Federal financial assistance, including credits, 

subsidies, or contracts of insurance, or under any program or activity that 

is administered by an Executive Agency or any entity established under 

this title (or amendments). The enforcement mechanisms provided for 

and available under such title VI, title IX, section 794, or such Age 

Discrimination Act shall apply for purposes of violations of this subsection.

42 U.S.C. § 18116(a).

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and “other effective methods of making aurally delivered information 

available to individuals who are deaf or hard of hearing.” Id. 

§ 92.102(b)(1)(i). 

Section 504 of the RA and Section 1557 of the ACA provide private 

causes of action. See RA, 29 U.S.C. § 794a; ACA, 42 U.S.C. § 18116(a) 

(incorporating the “enforcement mechanisms” of the other civil rights 

statutes). For disability-discrimination claims, the ACA incorporates the 

substantive analytical framework of the RA. Doe v. BlueCross BlueShield of 

Tenn., Inc., 926 F.3d 235, 239 (6th Cir. 2019) (“By referring to four statutes, 

Congress incorporated the legal standards that define discrimination under 

each one.”).5

 Accordingly, we will analyze Francois’ RA and ACA claims 

together. 

To establish a prima facie case for disability discrimination under the 

RA, and by extension the ACA, a plaintiff must show that: (1) he has a 

qualifying disability; (2) he is being excluded from participation in, denied 

the benefits of, or otherwise discriminated against by a covered entity; and 

(3) such discrimination is by reason of his disability. Miraglia v. Bd. of 

Supervisors of La. State Museum, 901 F.3d 565, 574 (5th Cir. 2018). A prima 

facie case requires evidence that the plaintiff’s disability, limitation, and 

necessary reasonable accommodation were “known by” the covered entity. 

5 The Ninth Circuit recently agreed with the Sixth Circuit’s BlueCross BlueShield 

holding that the ACA incorporates the substantive analytical framework of the RA for 

disability-discrimination claims, but it implicitly disagreed with the BlueCross BlueShield 

holding about whether the RA prohibits disparate-impact discrimination. See Doe v. CVS 

Pharmacy, Inc., 982 F.3d 1204, 1210–12 (9th Cir. 2020), cert. granted in part, --- S. Ct. ----, 

2021 WL 2742790 (July 2, 2021) (No. 20-1374). The grant of certiorari in CVS Pharmacy

is limited to “[w]hether section 504 of the Rehabilitation Act, and by extension the ACA, 

provides a disparate-impact cause of action for plaintiffs alleging disability discrimination.” 

Petition for Writ of Certiorari, CVS Pharmacy, Inc. v. Doe, No. 20-1374 (U.S. Mar. 26, 

2021). 

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Windham v. Harris Cnty., 875 F.3d 229, 236 (5th Cir. 2017). “Plaintiffs 

ordinarily satisfy the knowledge element by showing that they identified their 

disabilities as well as the resulting limitations to [the covered] entity or its 

employees and requested an accommodation in direct and specific terms.” 

Smith, 956 F.3d at 317. “When a plaintiff fails to request an accommodation 

in this manner, he can prevail only by showing that ‘the disability, resulting 

limitation, and necessary reasonable accommodation’ were ‘open, obvious, 

and apparent,’ to the entity’s relevant agents.” Windham, 975 F.3d at 237.6

Establishing a prima facie case entitles a plaintiff to pursue equitable 

relief. Miraglia, 901 F.3d at 574. Compensatory damages, however, require 

a showing of intentional discrimination. Id. This circuit has declined to 

“delineate the precise contours” of intentional discrimination. Id. at 575. At 

a minimum, though, “intent requires that the defendant at least have actual 

notice of a violation.” Id. 

Francois expressly abandoned his claim for injunctive relief, so all that 

remains for us are his claims for declaratory relief, nominal damages, and 

compensatory monetary damages. Francois has not pressed on appeal that 

his claims for declaratory relief should survive even in the absence of 

intentional discrimination.7

 Likewise, he has made no attempt to argue that 

6 We have not resolved “what type of knowledge is required” for a showing of an 

“open, obvious, and apparent” disability, limitation, and necessary reasonable 

accommodation. Windham, 975 F.3d at 237. “Although our caselaw speaks generally in 

terms of the entity’s subjective knowledge, we do not appear to have confronted this 

question directly.” Id. (footnote omitted). 

7 On appeal, Francois’ briefs focus on two questions: (1) whether the Hospital 

committed intentional discrimination, and (2) whether he can pursue damages for “denial 

of self-determination.” A claim for declaratory relief is equitable in nature and not subject 

to the intentional-discrimination standard. See Miraglia, 901 F.3d at 574. Francois, 

however, has not pressed that his claims for declaratory relief (or equitable relief generally) 

are subject to a lower evidentiary burden, that the district court erred by dismissing those 

claims, and that we should reverse and remand on that ground. As they are not pressed on 

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his nominal-damages claims, if any exist, are not subject to the same 

intentional-discrimination standard as a claim for compensatory monetary 

damages. As a result, to survive summary judgment, Francois must have 

offered evidence of intentional discrimination, which as we just stated means 

he must at least show the Hospital’s actual notice. Miraglia, 901 F.3d at 574. 

The district court granted the Hospital’s motion for summary 

judgment because Francois failed to show intentional discrimination. A 

claim of intentional discrimination requires evidence sufficient for a 

reasonable jury to conclude that the Hospital had actual notice that its failure 

to provide an on-site interpreter until April 16 denied Francois an equal 

opportunity to participate in the medical process. We agree with the 

Eleventh Circuit that when “effective communication under the 

circumstances is achievable with something less than an on-site interpreter, 

then the hospital is well within its ADA and RA obligations to rely on other 

alternatives.” Silva v. Baptist Health S. Fla., Inc., 856 F.3d 824, 836 (11th 

Cir. 2017). Here, the claims of intentional discrimination fail unless there is 

evidence the Hospital actually knew that it was not effectively 

communicating with Francois with the methods it was using.

We have affirmed a district court’s finding of intentional 

discrimination when a hearing-impaired arrestee could not understand the 

police officer, the officer was aware that his attempts to communicate were 

ineffective, and the officer failed to try more effective methods of 

communication. Delano-Pyle v. Victoria Cnty., 302 F.3d 567, 575–76 (5th Cir. 

2002). We have held in a non-precedential opinion that a plaintiff raised a 

genuine dispute of material fact where “on several occasions, an interpreter 

appeal, those arguments are forfeited. Adams v. Unione Mediterranea Di Sicurta, 364 F.3d 

646, 653 (5th Cir. 2004); see also United States v. Sineneng-Smith, 140 S. Ct. 1575, 1579 

(2020) (explaining that courts must “follow the principle of party presentation”). 

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was requested but not provided,” the hospital’s chosen means of 

communication were “often ineffective,” and the hospital “ignored clear 

indications” that further accommodation was necessary. Perez v. Drs. Hosp. 

at Renaissance, Ltd., 624 F. App’x 180, 185 (5th Cir. 2015). Most recently, 

we held that a plaintiff had shown intentional discrimination when a jail’s 

staff was subjectively aware of a detainee’s need for a wheelchair, 

accommodated her only with crutches, watched her fall while using the

crutches, and still refused to provide a wheelchair. Cadena, 946 F.3d at 726. 

Accordingly, our intentional-discrimination cases turn on the 

defendant’s subjective awareness of the need for further accommodation. 

II. Analysis of the summary-judgment evidence

We now review the summary-judgment record.

First, the testimony of Francois’ linguistics expert establishes, at 

most, constructive notice of Francois’ need for an on-site interpreter. The 

expert, Dr. Judy Shepard-Kegl, stated that “writing, lipreading, and speech” 

were “wholly inadequate for communication access” for Francois. She 

explained that it would be “wishful thinking on the part of the service 

providers” to assume that writing, lipreading, and speech were sufficient 

methods of communication, and that such an assumption was “evidence of 

how little communication was actually happening.” A reasonable jury could 

conclude from the expert’s testimony that the Hospital should have known 

that Francois needed further accommodation. What the Hospital should have 

known, though, is not evidence of actual notice. 

Second, evidence that Francois in fact did not understand the nurses’

communications does not show that the Hospital (or its staff) knew that 

Francois was not understanding. By contrast, the nurses testified that 

Francois appeared to understand their written and nonverbal 

communications. We do not suggest that the nurses’ testimony about 

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successful communication is enough to secure summary judgment.8 Here, 

though, the record is devoid of evidence that the Hospital knew that its 

efforts to communicate with Francois were ineffective. 

Only Deemer testified as to some evidence that made the Hospital’s

staff aware that Francois was not understanding. She testified that after a 

nurse wrote Francois a note, he “was just looking at her” because “he didn’t 

understand what she was saying.” She also testified that he “will draw up in 

his shoulders or flop his hands” when he does not understand but did not 

indicate whether this ever happened at the Hospital. This evidence, though, 

does not defeat the Hospital’s motion for summary judgment because there 

is no indication that the Hospital quit trying to communicate with Francois 

or that its efforts were ultimately unsuccessful. As a result, Deemer’s 

testimony does not constitute evidence that the Hospital actually knew that 

only an on-site interpreter would suffice. 

Third, Francois argues that his medical records show that the 

Hospital “knew Mr. Francois was not communicating effectively and 

nonetheless failed to summon or provide an ASL interpreter.” Several 

medical records do support that communications with Francois about his 

medical history were “limited.” The medical records also show, though, 

that Francois’ medical history was obtained by several methods short of 

bringing in an on-site interpreter, including writing questions on the

8 As the Eleventh Circuit explained, “it is error to conclude on summary judgment 

that the mere successful communication of the primary symptoms, treatment plan, and 

discharge instructions is enough, as a matter of law, to preclude liability under the ADA 

and RA.” Silva, 856 F.3d at 835. Rather, the opportunity must focus on whether the 

plaintiff is receiving an equal opportunity to participate in the overall informational 

exchange. RA, 45 C.F.R. § 84.52(d)(1); ACA, 45 C.F.R. § 92.102(b). In this case, we must 

consider these statutory requirements in light of the additional burden that Francois show 

intent.

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whiteboard, asking Francois’ grandmother about his medical history, and 

utilizing Francois’ grandmother for ASL interpretive assistance. 

Accordingly, the records do not show that the Hospital actually knew that 

nothing short of an on-site interpreter was enough. Rather, the evidence 

shows only that, from the Hospital’s perspective, “effective communication 

under the circumstances [was] achievable with something less than an on-site 

interpreter.” Silva, 856 F.3d at 836. 

Fourth, Francois argues that the Hospital’s failure to comply with its 

internal policy is evidence of intent.9 The policy mirrors the regulatory 

requirements in that an interpreter must be utilized only if “necessary.” See 

RA, 45 C.F.R. § 84.52(d)(1); ACA, 45 C.F.R. § 92.102(b). It follows that the 

Hospital did not violate the policy unless other methods were not effective. 

Ultimately, this argument fails because it does not dispute the otherwiseuncontroverted evidence that the Hospital’s staff believed that effective 

communication was achievable with something less than an on-site 

interpreter.

Finally, Francois argues that Deemer made a satisfactory request for 

an interpreter. Deemer testified that she told hospital staff upon Francois’ 

admittance that he “was speech and hearing impaired, and [that] he needed 

an interpreter.” Even with this evidence, the summary-judgment record falls 

short of establishing that the Hospital had actual knowledge that only an onsite interpreter would meet Francois’ needs. A patient is not entitled to an 

on-site interpreter merely because he or someone on his behalf requests one. 

9 The policy states that “[i]nterpreter services will be provided in all necessary

circumstances where there is a need for complex diagnostic or treatment information to be 

communicated effectively with a sensory-impaired patient.” It also states that 

circumstances which “may” require an interpreter include, among other things, 

“[d]iscussing presenting symptoms, medications, [and] medical history,” as well as 

“[e]xplaining diagnosis, prognosis[,] or treatment options.”

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See Silva, 856 F.3d at 835–36. Rather, a patient is entitled to an on-site 

interpreter when necessary. RA, 45 C.F.R. § 84.52(d)(1); ACA, 45 C.F.R. 

§ 92.102(b). The morning after Deemer made the request, the Hospital sent 

an employee who communicated in ASL to Francois’ room. During that 

meeting, Francois never asked for an interpreter in response to a direct 

question about the services he needed. Later, when another request was 

made, the Hospital promptly provided an ASL interpreter and continued to 

do so throughout Francois’ hospital stay. Considered along with the 

evidence showing that the Hospital’s staff subjectively believed that they 

were adequately communicating with Francois via other means, the record 

does not support a finding of intentional discrimination. 

The summary-judgment evidence, viewed in the light most favorable 

to Francois, is sufficient for a reasonable jury to determine that the Hospital 

should have known that Francois needed an on-site interpreter. Fatal to 

Francois’ claims, the evidence is not sufficient for a reasonable jury to 

determine that the Hospital had actual knowledge of Francois’ need for an 

on-site interpreter.

The Hospital is entitled to summary judgment because Francois failed 

to make a summary-judgment showing of intentional discrimination. 

Francois has made no attempt to argue in this appeal or in district court that 

his nominal-damage claims, if any exist, are not subject to the same 

intentional-discrimination standard. Further, Francois has expressly 

abandoned his claims for injunctive relief and has not pressed his claim for a 

declaratory judgment on appeal. AFFIRMED.

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