# 68 III-4.

3200 January 15, 1993

W. Yates Trotter, M.D. The Internal Medicine Group, Ltd. National Avenue Medical Building 1900 S. National Avenue Suite 2200 Springfield, Missouri 65804-2275 Dear Dr. Trotter: This letter is in response to your inquiry concerning the responsibilities of medical offices under the Americans with Disabilities Act of 1990 (ADA). 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 and it is not binding on the Department. Title III of the ADA requires public accommodations, including medical offices, to ensure effective communication with persons with disabilities. To ensure effective communication, a medical office may be required to provide auxiliary aids to an individual with a disability. Medical offices must provide the above auxiliary aids or services to persons with disabilities, if such an auxiliary aid or service is necessary for effective communication, unless doing so would constitute a fundamental alteration of the service or an undue burden to the public accommodation. In cases involving medical treatment, writing and notetaking may provide effective communication in routine situations, but a qualified interpreter

or other auxiliary aid may be necessary in others to allow for informed treatment recommendations and decisions. While the ultimate choice of the means of communication rests with the physician, the regulation strongly encourages a doctor to consult with a patient before providing a particular aid or service, to determine the most appropriate way to ensure that communications are in fact effective. The medical office may be held liable for an ADA violation if the communication is not effective for that person with a disability. A medical office may require reasonable prior notice of the need for an auxiliary aid or service, depending, among other things, on the exigency of the treatment. Further discussion of provision of auxiliary aids and services appears in section 36.303 of the enclosed title III regulation, at page 35597, and in the preamble discussion of that section, at pages 35566-68. Further explanation appears at pages 25-27 of the enclosed Title III Technical Assistance Manual. Please also consult the definition of "qualified interpreter" in section 36.104 of the regulation, at page 35594, and in the preamble discussion at page 35553. I hope this information is helpful to you in responding to your constituent. Sincerely,

John L. Wodatch Chief Public Access Section Enclosures (2) cc: Congressman Mel Hancock