`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`[DO NOT PUBLISH]
`
`
`
`IN THE UNITED STATES COURT OF APPEALS
`
`FOR THE ELEVENTH CIRCUIT
`________________________
`
`No. 19-12386
`Non-Argument Calendar
`________________________
`
`D.C. Docket No. 1:14-cv-21803-KMW
`
`
`CHEYLLA SILVA, JOHN PAUL JEBIAN,
`
`
` Plaintiffs - Appellants,
`
`
`versus
`
`BAPTIST HEALTH SOUTH FLORIDA, INC.,
`BAPTIST HOSPITAL OF MIAMI, INC.,
`SOUTH MIAMI HOSPITAL, INC.,
`
`
` Defendants - Appellees.
`
`________________________
`
`Appeal from the United States District Court
`for the Southern District of Florida
`________________________
`
`(December 3, 2020)
`
`Before JORDAN, ROSENBAUM, and GRANT, Circuit Judges.
`
`PER CURIAM:
`
`
`
`USCA11 Case: 19-12386 Date Filed: 12/03/2020 Page: 2 of 18
`
`
`
`Cheylla Silva and John Paul Jebian (collectively, “Plaintiffs”) sued two
`
`hospitals, Baptist Hospital of Miami, Inc., and South Miami Hospital, Inc., and their
`
`parent organization, Baptist Health South Florida, Inc. (collectively, “Baptist”), for
`
`monetary damages and injunctive and declaratory relief under the Rehabilitation Act
`
`(“RA”), 29 U.S.C. § 794, and the Americans with Disabilities Act (“ADA”), 42
`
`U.S.C. § 12182. Plaintiffs, who are deaf, alleged that Baptist discriminated against
`
`them on the basis of disability by failing to provide appropriate auxiliary aids
`
`necessary to ensure effective communication with hospital staff. The district court
`
`granted summary judgment to Baptist on Plaintiffs’ claims for monetary relief,
`
`concluding that they could not prove the necessary element of deliberate
`
`indifference. Then, after a bench trial, the court found that Plaintiffs lacked Article
`
`III standing to obtain injunctive or declaratory relief because, in light of new policies
`
`implemented by Baptist, they could not show a likelihood of future injury at
`
`Baptist’s hospitals. After careful review, we affirm the district court’s standing
`
`ruling, but we vacate the grant of summary judgment on the claims for monetary
`
`relief and remand for further proceedings.
`
`I. BACKGROUND
`
`
`
`Plaintiffs Silva and Jebian are deaf and communicate primarily in American
`
`Sign Language (“ASL”). In May 2014, they sued Baptist for violating their rights
`
`under the RA and ADA by failing to provide appropriate auxiliary aids necessary to
`
`
`
`2
`
`
`
`USCA11 Case: 19-12386 Date Filed: 12/03/2020 Page: 3 of 18
`
`ensure effective communication with hospital staff. They sought monetary damages
`
`and declaratory and injunctive relief.
`
`Plaintiffs alleged that they visited Baptist’s hospitals on numerous occasions
`
`from 2009 to 2014 as patients or as a patient companion. While they requested live
`
`on-site ASL interpreters for most visits, the hospital relied primarily on an
`
`alternative communication method called Video Remote Interpreting (“VRI”). With
`
`this internet-connected machine, a live ASL interpreter is located remotely and
`
`communicates with the doctor and patient through a portable screen located in the
`
`hospital. Plaintiffs alleged that the VRI machines routinely did not work, and
`
`hospital staff would instead rely on family-member companions for interpretive
`
`assistance or exchange hand-written notes. Sometimes, after a VRI breakdown, an
`
`ASL interpreter would be called to assist with communication in person.
`
`
`
`The district court granted summary judgment to Baptist. The court found that
`
`Plaintiffs lacked Article III standing for injunctive relief and that they had not shown
`
`a genuine dispute as to any material fact regarding a violation of the RA and ADA.
`
`The court concluded that the denial of the requested auxiliary aids did not result in
`
`any adverse medical consequences or inhibit their communication of the “chief
`
`medical complaint” or “instructions under the treatment plan.”
`
`
`
`Plaintiffs appealed, and we vacated and remanded for further proceedings.
`
`Silva v. Baptist Health S. Fla., Inc., 856 F.3d 824, 831 (11th Cir. 2017). First, we
`
`
`
`3
`
`
`
`USCA11 Case: 19-12386 Date Filed: 12/03/2020 Page: 4 of 18
`
`held that the court “erroneously denied prospective injunctive relief on the basis of
`
`Article III standing, concluding in error that Plaintiffs did not show they were likely
`
`enough to return to the hospitals in the future or otherwise to suffer discrimination
`
`again at those facilities.” Id. “[G]iven Plaintiffs’ numerous visits to Defendants’
`
`facilities and the wealth of evidence showing repeated VRI malfunctions,” we
`
`reasoned that there was “good reason to believe” that the VRI malfunctions “will
`
`continue to happen at Defendants’ facilities when Plaintiffs do return,” which was
`
`enough to establish standing for injunctive relief. Id. at 832–33.
`
`
`
`Second, we found that the district court applied an incorrect standard for
`
`Plaintiffs’ effective-communication claims. Id. at 833–35. We explained that
`
`Plaintiffs did not need to establish an adverse consequence resulting from an
`
`inability to communicate effectively. Id. Rather, the focus is on “the equal
`
`opportunity to participate in obtaining and utilizing services.” Id. at 834 (emphasis
`
`in original). Therefore, the proper inquiry is “whether the hospital provided the kind
`
`of auxiliary aid necessary to ensure that a deaf patient was not impaired in
`
`exchanging medically relevant information with hospital staff.” Id. at 835.
`
`Ineffective communication occurs, we stated, “if the patient experiences a real
`
`hindrance, because of her disability, which affects her ability to exchange material
`
`medical information with her health care providers.” Id.
`
`
`
`4
`
`
`
`USCA11 Case: 19-12386 Date Filed: 12/03/2020 Page: 5 of 18
`
`
`
`We noted, however, that this standard “does not mean that deaf patients are
`
`entitled to an on-site interpreter every time they ask for it.” Id. “If 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.” Id. at 836. We stated that this inquiry is “inherently fact-
`
`intensive” and, as a result, “an effective-communication claim often presents
`
`questions of fact precluding summary judgment.” Id.
`
`
`
`Applying the proper standard, we concluded that a reasonable jury could find
`
`that Baptist’s failure to offer appropriate auxiliary aids impaired Plaintiffs’ ability to
`
`exchange medically relevant information with hospital staff. Id. at 836–40. But we
`
`did not go further and address whether Plaintiffs had proved Baptist’s deliberate
`
`indifference, which was necessary to win monetary relief, because the district court
`
`had not addressed that issue. Id. at 841.
`
`
`
`On remand, the parties filed supplemental summary-judgment briefing
`
`regarding the issue of deliberate indifference. After holding a hearing, the district
`
`court entered an order granting summary judgment on that issue to Baptist. The
`
`court found no evidence that Baptist was “actually aware of any instance in which
`
`[hospital staff] communicated ineffectively with Plaintiffs.” The court noted that
`
`hospital staff attempted to provide alternative aids when they did not obtain a live
`
`interpreter or working VRI machine, that there was no evidence that Plaintiffs “ever
`
`
`
`5
`
`
`
`USCA11 Case: 19-12386 Date Filed: 12/03/2020 Page: 6 of 18
`
`complained to or informed Defendants that they were not receiving proper
`
`assistance” at the time of treatment, and that the mere fact that the VRI machines
`
`malfunctioned on occasion was not sufficient to establish deliberate indifference.
`
`Thus, the court entered partial summary judgment on Plaintiffs’ claims for monetary
`
`damages.
`
`
`
`The district court then held a bench trial in November 2018 on Plaintiffs’
`
`claims for declaratory and injunctive relief. At trial, Baptist presented evidence that
`
`beginning in 2014 or 2015, it revised its policies to require the provision of live in-
`
`person interpreters upon request by a patient or guest, to provide VRI while waiting
`
`for a live interpreter, and to schedule live interpreters for scheduled appointments.
`
`Baptist’s witnesses testified that these policies had been consistently implemented
`
`since they were adopted. Based on this new evidence, the district court concluded
`
`that, at the time of trial in November 2018, Plaintiffs lacked Article III standing for
`
`injunctive or declaratory relief because there was no evidence that they would suffer
`
`future discrimination if they returned to Baptist’s hospitals. So the court dismissed
`
`their claims for injunctive or declaratory relief for lack of standing, and Plaintiffs
`
`timely appealed.
`
`II. STANDARDS OF REVIEW
`
`
`
`We review a district court’s grant of summary judgment de novo, viewing the
`
`evidence and drawing all reasonable inferences in favor of the non-moving party.
`
`
`
`6
`
`
`
`USCA11 Case: 19-12386 Date Filed: 12/03/2020 Page: 7 of 18
`
`Crane v. Lifemark Hosps., Inc., 898 F.3d 1130, 1133–34 (11th Cir. 2018). 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). When a district court dismisses a claim for lack of standing, we review
`
`the court’s legal conclusions de novo and its factual findings for clear error.
`
`McCullum v. Orlando Reg’l Healthcare Sys., Inc., 768 F.3d 1135, 1141 (11th Cir.
`
`2014); Houston v. Marod Supermarkets, Inc., 733 F.3d 1323, 1328 (11th Cir. 2013)
`
`(“[W]e review the district court’s legal conclusions de novo, including the court’s
`
`conclusion concerning standing.”).
`
`III. DISCUSSION
`
`Claims under the RA and ADA are “governed by the same substantive
`
`standard of liability.” Silva, 856 F.3d at 830. “To prevail, a disabled person must
`
`prove that he or she was excluded from participation in or denied the benefits of the
`
`hospital’s services, programs, or activities, or otherwise was discriminated against
`
`on account of her disability.” Id. at 831; see 42 U.S.C. § 12182(a); 29 U.S.C.
`
`§ 794(a). Under this standard, a hospital violates the RA and ADA when it “fails to
`
`provide ‘appropriate auxiliary aids and services’ to a deaf patient, or a patient’s deaf
`
`companion, ‘where necessary to ensure effective communication.’” Silva, 856 F.3d
`
`at 831 (quoting 28 C.F.R. § 36.303(c)(1)).
`
`
`
`7
`
`
`
`USCA11 Case: 19-12386 Date Filed: 12/03/2020 Page: 8 of 18
`
`
`
`Deaf patients are not “entitled to an on-site interpreter every time they ask for
`
`it,” however. Id. at 835. “If 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.” Id. at 836.
`
`Whether a particular aid is effective “largely depends on context, including,
`
`principally, the nature, significance, and complexity of treatment.” Liese v. Indian
`
`River Cty. Hosp. Dist., 701 F.3d 334, 343 (11th Cir. 2012).
`
`A deaf plaintiff may be entitled to injunctive relief upon a showing that the
`
`hospital failed to provide a means of effective communication. Silva, 856 F.3d at
`
`831. But “[t]o recover monetary damages, a disabled person must further show that
`
`the hospital was deliberately indifferent to her federally protected rights.” Id.
`
`We have already concluded that a reasonable jury could find that Baptist’s
`
`failure to offer appropriate auxiliary aids impaired Plaintiffs’ ability to exchange
`
`medically relevant information with hospital staff. Id. at 836–40. The questions
`
`before us now are (1) whether that past failure was the result of “deliberate
`
`indifference,” such that Plaintiffs can recover monetary damages, and (2) whether
`
`Plaintiffs are likely to experience ineffective communication in future visits.
`
`A. Deliberate Indifference
`
`
`
`We begin with the issue of deliberate indifference. In this context, deliberate
`
`indifference occurs “when the defendant knew that harm to a federally protected
`
`
`
`8
`
`
`
`USCA11 Case: 19-12386 Date Filed: 12/03/2020 Page: 9 of 18
`
`right was substantially likely and . . . failed to act on that likelihood.” Liese, 701
`
`F.3d at 344 (quotation marks omitted). “[D]eliberate indifference requires that the
`
`indifference be a deliberate choice, which is an exacting standard.” Id. (citation and
`
`quotation marks omitted). Negligence alone is not enough. Id. In other words, the
`
`plaintiff “must show ineffective communication done with knowledge that it was
`
`substantially likely to occur.” Crane, 898 F.3d at 1135.
`
`
`
`Here, we find that there is sufficient evidence for a reasonable jury to conclude
`
`that Baptist was deliberately indifferent to Plaintiffs’ federal rights.1 Plaintiffs
`
`requested an in-person interpreter during most of their visits to Baptist’s hospitals,
`
`putting hospital staff on notice that they required an interpretive aid. Despite these
`
`requests, the hospitals relied primarily on VRI; ordinarily a live, in-person
`
`interpreter would be called to help only when VRI proved ineffective or inadequate.
`
`
`
`While the choice to rely primarily on VRI instead of in-person interpreters
`
`alone does not establish deliberate indifference, Liese, 701 F.3d at 343 (“[T]he
`
`simple failure to provide an interpreter on request is not necessarily deliberately
`
`indifferent to an individual’s rights under the RA.”), the plaintiffs presented
`
`substantial evidence that the VRI machines routinely failed to facilitate effective
`
`
`1 We review the district court’s grant of summary judgment on the issue of deliberate
`
`indifference based on the summary-judgment record as it existed at the time of the district court’s
`decision. We do not consider the evidence subsequently produced at the bench trial on Plaintiffs’
`claims of injunctive relief.
`
`
`
`9
`
`
`
`USCA11 Case: 19-12386 Date Filed: 12/03/2020 Page: 10 of 18
`
`communication. See Silva, 856 F.3d at 836–40. Sometimes the VRI picture would
`
`be choppy, unclear, or would cut out, and sometimes the VRI machine failed to
`
`operate at all. See id. In Silva, we described how the malfunctioning of the VRI
`
`machines “could generate a reasonable inference of an impaired informational
`
`exchange” that was likely to occur each time Plaintiffs visited Baptist’s hospitals.
`
`Id. at 837, 832.
`
`
`
`Given that Plaintiffs “routinely” experienced these VRI malfunctions at
`
`Baptist’s hospitals over a period of several years, a jury could reasonably infer that
`
`hospital staff knew that the continued reliance on VRI as an interpretive aid, without
`
`correcting its deficiencies, was “substantially likely” to result in the impaired
`
`informational exchange experienced by Plaintiffs. See Crane, 898 F.3d at 1135;
`
`Silva, 856 F.3d at 840 (noting that Jebian, in tending to decline the use of VRI at
`
`Baptist’s hospitals, “acted reasonably in anticipating that the VRI would not
`
`facilitate effective communication”). A jury could thus conclude that Plaintiffs
`
`experienced instances of ineffective communication as a result of a “deliberate
`
`choice” by Baptist officials, rather than mere negligence. See Liese, 701 F.3d at 344.
`
`B. Standing
`
`
`
`Next, we consider whether Plaintiffs Silva and Jebian have standing to obtain
`
`prospective injunctive relief. “To satisfy the injury-in-fact requirement for
`
`constitutional standing, a plaintiff seeking injunctive relief in relation to future
`
`
`
`10
`
`
`
`USCA11 Case: 19-12386 Date Filed: 12/03/2020 Page: 11 of 18
`
`conduct must show a sufficient likelihood that he will be affected by the allegedly
`
`unlawful conduct in the future.” Silva, 856 F.3d at 832 (quotation marks omitted).
`
`The threat of future injury must be real and immediate, not merely conjectural or
`
`hypothetical. Id. “To establish such a threat, each patient must show that (1) there
`
`is a real and immediate likelihood that he or she will return to the facility and (2) he
`
`or she will likely experience a denial of benefits or discrimination upon their return.”
`
`Id. (quotation marks omitted). The district court found that the first element was
`
`met but the second was not.
`
`
`
`Plaintiffs make two main arguments in support of their contention that the
`
`district court erred in dismissing their injunctive relief claims for lack of standing.
`
`First, they contend that the district court violated the mandate rule and the doctrine
`
`of law of the case in finding that they lacked standing. Second, they assert that the
`
`court was required to determine whether Baptist’s policies rendered their claims
`
`moot, not whether the policies deprived them of standing.2
`
`
`
`
`
`1. The doctrine of law of the case does not apply
`
`Plaintiffs first argue that our holding in Silva that the plaintiffs “have Article
`
`III standing to proceed with their claims for injunctive relief,” Silva, 856 F.3d at 833,
`
`
`2 The plaintiffs also assert that a court “must first determine whether there has been a
`
`violation of the statute[s]” before assessing whether injunctive relief is appropriate. But standing
`under Article III is a “threshold matter required for a claim to be considered by the federal courts.”
`Via Mat Int’l S. Am. Ltd. v. United States, 446 F.3d 1258, 1262 (11th Cir. 2006).
`11
`
`
`
`
`
`USCA11 Case: 19-12386 Date Filed: 12/03/2020 Page: 12 of 18
`
`is binding in this appeal under the doctrine of law of the case and that the district
`
`court violated our mandate by concluding otherwise. We disagree.
`
`“The mandate rule is a specific application of the ‘law of the case’ doctrine[,]
`
`which provides that subsequent courts are bound by any findings of fact or
`
`conclusions of law made by the court of appeals in a prior appeal of the same case.”
`
`Friedman v. Market St. Mortg. Corp., 520 F.3d 1289, 1294 (11th Cir. 2008)
`
`(quotation marks omitted). A trial court may not alter, amend, or act contrary to the
`
`mandate of an appellate court regarding issues that were “decided expressly or by
`
`necessary implication.” Id. (quotation marks omitted). However, “the law of the
`
`case doctrine does not apply to bar reconsideration of an issue when (1) a subsequent
`
`trial produces substantially different evidence, (2) controlling authority has since
`
`made a contrary decision of law applicable to that issue, or (3) the prior decision was
`
`clearly erroneous and would work manifest injustice.” Wheeler v. City of Pleasant
`
`Grove, 746 F.2d 1437, 1440 (11th Cir. 1984) (quotation marks omitted).
`
`
`
`Here, the first exception to the law-of-the-case doctrine applies. The district
`
`court was required to assess Plaintiffs’ standing at the time of trial in November
`
`2018. See United States v. Amodeo, 916 F.3d 967, 971 (11th Cir.), cert. denied, 140
`
`S. Ct. 526 (2019) (“To have a case or controversy, a litigant must establish that he
`
`has standing, which must exist throughout all stages of litigation.” (quotation marks
`
`omitted)). And at trial, Baptist presented new evidence regarding its hospitals’
`
`
`
`12
`
`
`
`USCA11 Case: 19-12386 Date Filed: 12/03/2020 Page: 13 of 18
`
`policies beginning in 2014 or 2015. This evidence was not part of the summary-
`
`judgment record when we decided Silva in May 2017, and it showed that Baptist
`
`implemented policies mandating live in-person ASL interpreters upon request. So
`
`at the time of trial, there was new evidence that Baptist offered live in-person ASL
`
`interpreters upon request, which Plaintiffs’ counsel admitted was more generous
`
`than what federal law demanded.
`
`
`
`Law of the case does not apply in this situation because the district court based
`
`its standing decision on a different record than did this Court when addressing the
`
`propriety of summary judgment. See Davis v. Town of Lake Park, Fla., 245 F.3d
`
`1232, 1237 n.1 (11th Cir. 2001) (“Law of the case does not apply in this situation
`
`because [the later district judge] based his post-trial order on a different record than
`
`did [the earlier district judge] when addressing summary judgment.”). “The first
`
`exception to the doctrine recognizes that the law of the case is the law made on a
`
`given set of facts, not law yet to be made on different facts.” Jackson v. State of Ala.
`
`State Tenure Comm’n, 405 F.3d 1276, 1283 (11th Cir. 2005). Our decision in Silva
`
`said nothing, either expressly or by necessary implication, about whether Plaintiffs
`
`established standing based on the trial record, which was substantially different than
`
`the summary-judgment record we considered in Silva. So, neither law of the case
`
`nor the mandate rule applies. See Wheeler, 746 F.2d at 1440.
`
`
`
`13
`
`
`
`USCA11 Case: 19-12386 Date Filed: 12/03/2020 Page: 14 of 18
`
`
`
`To the extent Plaintiffs suggest it was inappropriate for the district court to
`
`rely on Baptist’s new evidence, we disagree. “The request for declaratory and
`
`injunctive relief ha[d] to be assessed in light of the revised [Baptist] policies that
`
`were in place at the time of trial.” J.W. ex rel. Tammy Williams v. Birmingham Bd.
`
`of Educ., 904 F.3d 1248, 1267 (11th Cir. 2018). While Plaintiffs hint at improper
`
`motives behind Baptist’s failure to produce this evidence earlier, they fail to provide
`
`any legal reason why the court could not have relied on it.
`
`
`
`
`
`2. The district court did not err by failing to address mootness
`
`Plaintiffs maintain that, because Baptist adopted new policies after the
`
`allegedly discriminatory actions, the district court was required to determine whether
`
`such policies rendered their claims moot. And they contend that this case is not moot
`
`for a variety of reasons. But their arguments miss the mark.
`
`
`
`The Supreme Court has often remarked that “the doctrine of mootness can be
`
`described as the doctrine of standing set in a time frame: The requisite personal
`
`interest that must exist at the commencement of the litigation (standing) must
`
`continue throughout its existence (mootness).” Friends of the Earth, Inc. v. Laidlaw
`
`Envtl. Servs. (TOC), Inc., 528 U.S. 167, 189 (2000) (quotation marks omitted). But
`
`this description “is not comprehensive.” Id. Standing and mootness, though they
`
`both arise from Article III’s case-or-controversy requirement, are “distinct doctrines
`
`that must not be confused.” Sheely v. MRI Radiology Network, P.A., 505 F.3d 1173,
`
`
`
`14
`
`
`
`USCA11 Case: 19-12386 Date Filed: 12/03/2020 Page: 15 of 18
`
`1189 n.16 (11th Cir. 2007). And there will be “circumstances in which the prospect
`
`that a defendant will engage in (or resume) harmful conduct may be too speculative
`
`to support standing, but not too speculative to overcome mootness.” Friends of the
`
`Earth, 528 U.S. at 190; see Sheely, 505 F.3d at 1182 n.10 (“Even though a case is
`
`not moot, that does not mean that injunctive relief follows automatically;
`
`undoubtedly, injunctive relief requires something more than the mere possibility
`
`which serves to keep the case alive.” (quotation marks omitted)).
`
`
`
`Here, the district court did not err by failing to consider mootness. Plaintiffs
`
`were required to establish their standing to seek prospective injunctive relief based
`
`on “evidence adduced at trial.” Lujan v. Defs. of Wildlife, 504 U.S. 555, 562 (1992)
`
`(quotation marks omitted); see Amodeo, 916 F.3d at 971 (“To have a case or
`
`controversy, a litigant must establish that he has standing, which must exist
`
`throughout all stages of litigation.”). Baptist’s revised policies, which were in place
`
`at the time of trial, were relevant to the inquiry. Therefore, the likelihood of future
`
`injury to Plaintiffs—specifically the likelihood they will experience a denial of
`
`benefits or discrimination upon their return to Baptist’s hospitals—“ha[d] to be
`
`assessed in light of the revised [Baptist] policies that were in place at the time of
`
`trial.” J.W., 904 F.3d at 1267; see id. at 1267–69 (holding that, in light of revised
`
`policies that were adopted before trial, the plaintiffs failed to establish a likelihood
`
`of future injury sufficient to provide standing to obtain declaratory and injunctive
`
`
`
`15
`
`
`
`USCA11 Case: 19-12386 Date Filed: 12/03/2020 Page: 16 of 18
`
`relief). Because standing and mootness are distinct doctrines, and even assuming
`
`Baptist’s revised policies did not moot the case, the district court was permitted to
`
`conclude that Plaintiffs did not have standing to obtain prospective injunctive relief.
`
`See Friends of the Earth, 528 U.S. at 190; Sheely, 505 F.3d at 1182 n.10.
`
`3. The district court properly concluded that Plaintiffs lacked standing
`
`Plaintiffs do not directly challenge the district court’s findings of fact and
`
`
`
`conclusions of law regarding their standing to obtain declaratory or injunctive relief.
`
`As a result, apart from the arguments we have discussed and rejected above,
`
`Plaintiffs have abandoned any challenge to the grounds offered by the district court
`
`for its standing determination. See Sapuppo v. Allstate Floridian Ins. Co., 739 F.3d
`
`678, 680–81 (11th Cir. 2014) (explaining that issues not plainly and prominently
`
`raised on appeal are deemed abandoned). “[I]t follows that the judgment is due to
`
`be affirmed.” Id.
`
`
`
`In any event, the district court did not err in finding that Plaintiffs failed to
`
`prove a real and immediate, as opposed to merely conjectural or hypothetical, threat
`
`of future injury at Baptist’s hospitals. See Silva, 856 F.3d at 832. Even assuming
`
`Plaintiffs established that there was a real and immediate likelihood that they will
`
`return to Baptist’s hospitals, the court’s finding that they will not “likely experience
`
`a denial of benefits or discrimination upon their return” is well supported by the trial
`
`record. Id. (quotation marks omitted).
`
`
`
`16
`
`
`
`USCA11 Case: 19-12386 Date Filed: 12/03/2020 Page: 17 of 18
`
`
`
`In particular, the district court did not clearly err in finding that, at least since
`
`2015, Baptist had implemented policies at its hospitals that mandated providing live,
`
`in-person ASL interpreters upon a patient’s or a guest’s request. See McCullum, 768
`
`F.3d at 1141. In making that finding, the court credited the testimony of multiple
`
`witnesses for Baptist, who described these policies during a November 2018 bench
`
`trial. According to these witnesses, hospital staff did not have discretion to deny
`
`such a request, the hospitals would arrange for an interpreter to be present for
`
`scheduled appointments at the time of the appointment, and hospital staff would no
`
`longer rely on friends or family for interpretation purposes. In addition, the court
`
`found that Plaintiffs had not offered any evidence to contradict Baptist’s witnesses
`
`on these points, such as evidence of ineffective communication during their visits
`
`since the implementation of the new policies in 2014 and 2015. Likewise on appeal,
`
`Plaintiffs do not identify any evidence to contradict the district court’s findings.
`
`
`
`Based on the district court’s well-supported findings, it is not likely that
`
`Plaintiffs will “experience a denial of benefits or discrimination upon their return”
`
`to Baptist’s hospitals. Silva, 856 F.3d at 832 (quotation marks omitted). So they
`
`have not established a real and immediate threat of future injury. Id. The court
`
`therefore properly dismissed their claims for injunctive relief for lack of standing.
`
`IV. CONCLUSION
`
`
`
`17
`
`
`
`USCA11 Case: 19-12386 Date Filed: 12/03/2020 Page: 18 of 18
`
`
`
`In sum, we vacate the district court’s grant of summary judgment on
`
`Plaintiffs’ claims for monetary relief, concluding that they have presented sufficient
`
`evidence of deliberate indifference. We affirm the court’s dismissal for lack of
`
`standing on their claims for prospective declaratory and injunctive relief.
`
`
`
`AFFIRMED IN PART; VACATED AND REMANDED IN PART.
`
`
`
`18
`
`