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# 43 III-4.

2600 October 28, 1992

Mr. Steven J. Cole Vice President and General Counsel Council of Better Business Bureaus, Inc. 4200 Wilson Boulevard Arlington, Virginia 22203-1804 Dear Steve: This letter is in response to your inquiry regarding whether physicians must assist patients with disabilities in dressing and undressing. The 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 you in understanding the ADA's requirements. However, it does not constitute a legal interpretation or legal advice and it is not binding on the Department of Justice. The ADA requires public accommodations to make "reasonable modifications in policies, practices, or procedures when the modifications are necessary to afford goods [and] services . . . to individuals with disabilities, unless the public accommodation can demonstrate that making the modifications would fundamentally alter the nature of the goods [or] services . . . ." 28 C.F.R. 36.302(a). In most cases, we believe that providing assistance in dressing and undressing would not fundamentally alter the nature of the service provided by a physician. You are quite correct to point out that the regulations generally do not require a public accommodation to provide its customers or clients with services of a personal nature, including dressing. 28 C.F.R. 36.306. We do not think,

however, that this limitation to the general rule applies to assistance in dressing and undressing provided by physicians. The personal services limitation is a narrow one and must be interpreted in light of the nature of the services provided and the assistance required. Because the nature of medical services is inescapably very personal, it is not unreasonable to require physicians to provide assistance with dressing or undressing, even though other public accommodations may not be required to provide such assistance. Moreover, because undressing is commonly crucial to the provision of medical services, applying the personal services limitation to assistance in dressing and undressing would inappropriately deny medical care to large numbers of individuals with disabilities. I regret the long delay in answering your request and hope that the delay has not created a hardship for you. I really do appreciate the fine work that the Council of Better Business Bureaus' Foundation has done in helping implement the ADA. I especially value Barbara Bode's efforts on the technical assistance grant and out on the hustings. She has been an invaluable resource and has helped open communications between business and the disability rights community. Thanks again for your inquiry, and let me know if we can be of any further help to you. Sincerely,

John L. Wodatch Chief Public Access Section cc: James McIlhenny Barbara Bode