# 28 III-4.1400 III-4.

3200 August 28, 1992

The Honorable Thomas J. Bliley, Jr. U. S. House of Representatives 2241 Rayburn Office Building Washington, D.C. 20515 Dear Congressman Bliley: This letter is in response to your inquiry on behalf of your constituent, Dr. Paul E. Galanti, Deputy Executive Vice President of the Medical Society of Virginia, regarding the cost of providing auxiliary aids or services for persons with disabilities. The Americans with Disabilities Act (ADA) authorizes the Department of Justice to provide technical assistance to individuals and entities having rights or obligations under the Act. This letter provides informal guidance to assist your constituent in understanding the ADA's requirements. It does not, however, constitute a legal interpretation, and it is not binding on the Department. The ADA requires physicians to furnish appropriate auxiliary aids and services where necessary to ensure effective communication with individuals with disabilities. A physician may not impose a surcharge on any particular individual with a disability to cover the costs of measures, such as providing auxiliary aids, that are required by the ADA. These provisions appear in sections 36.301(c) and 36.303 of the enclosed ADA title III regulation, at pages 35596 and 35597, respectively. Also enclosed is the Department's Title III Technical Assistance Manual, which may provide further assistance to your constituent. Pertinent discussion may be found at pages 22 (surcharges) and 25-28 (auxiliary aids).

Under section 36.301(c) of the regulation, the cost of an interpreter must be absorbed by the doctor in the limited circumstances when an interpreter is necessary. However, as provided in section 36.303(f), a doctor is not required to provide any auxiliary aid that would result in an undue burden. The flexibility of the auxiliary aids requirement, the undue burden limitation, and the ability to spread costs over all patients should minimize any burden on the medical profession. What constitutes an effective auxiliary aid or service will depend upon the unique facts of each situation, including the length and complexity of the communication involved. Generally, a doctor may satisfy the auxiliary aid or service requirement by using a note pad and written materials where a deaf patient is making a routine office visit. By contrast, a discussion of whether to undergo major surgery may require the provision of a sign language interpreter. Further discussion of this point may be found on page 35567 of the enclosed regulation. Dr. Galanti's letter raises a specific question involving use of interpreters, concerning a deaf patient who brought a sign language interpreter for an office visit and billed the doctor for the cost of the interpreter. Clearly, the auxiliary aid provisions of the ADA (cited above) do not contemplate that a person with a disability can unilaterally decide on the appropriate type of auxiliary aid, make arrangements for the auxiliary aid, and then bill the public accommodation for the service. I hope this information will be helpful to you in responding to your constituent. Sincerely,

James P. Turner Acting Assistant Attorney General Civil Rights Division Enclosures (2)