202-PL-00009 Richard J. Sagall, M.D. Post Office Box 1069 Bangor, Maine 04402-1069 Dear Dr.

Sagall:

JUN 11 1992

This letter responds to your correspondence requesting information about the provisions of the Americans with Disabilities Act (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. However, it does not constitute a legal interpretation and it is not binding on the Department. You have inquired whether a health care provider may fulfill the obligation under the ADA to ensure effective communication with a hearing impaired patient by requesting a family member to interpret or by using written communication or communication via a computer screen. The ADA requires health care providers to make available appropriate auxiliary aids and services in order to ensure effective communications. Communication through written notes, communication via computer, and providing sign language interpreters are all considered auxiliary aids and services within the meaning of the ADA. However, a note pad or computer screen may not be sufficient to provide "effective" communication in all circumstances, especially in a doctor's office when a matter of significance is being discussed. The appropriateness of a particular type of auxiliary aid or service will depend on the nature of the services being delivered -- for example, giving a flu shot versus discussing options for surgery. Effective communication is required and the means to provide that will vary depending on the length and complexity of the communication involved. cc: Records Chrono Wodatch Magagna.p1.9 Beard arthur T. 6/8/92 01-00910

-2Asking a family member to interpret for a person with a hearing impairment may be inappropriate because of factors such as emotional or personal involvement or considerations of confidentiality that may adversely affect the ability to interpret effectively. We encourage health care providers to consult with their individual patients having hearing impairments to ascertain what will be effective for each of them in particular circumstances. A health care provider is not required to provide any auxiliary aid or service that would result in an undue burden, i.e., significant difficulty or expense. Although a health care provider may not charge individuals for the auxiliary aids and services provided to them, the costs can be spread to all patients, just as other overhead expenses are. Among the factors to be considered in determining whether providing a particular auxiliary aid will cause an undue burden are the nature and cost of the service and the resources available to the care provider. If providing a particular aid or service would be an undue burden, the health care provider must provide an alternative auxiliary aid or service that is not such an undue burden and that ensures effective communication to the maximum extent feasible. I enclose a copy of the Department's Title III Technical Assistance Manual which may further clarify your obligations under Title III. We hope that this information is useful to you in evaluating your obligations under the ADA. Sincerely,

Joan A. Magagna Deputy Director Office on the Americans with Disabilities Act 01-00911

Family Health Care Richard J. Sagall, M.D., F.A.A.F.P. 358 Broadway, Suite 105 Family Practice P O Box 1069 Bangor, ME 04402-1069 207-941-8300 207-947-3134 (FAX) January 23, 1992 OADA Civil Rights Division U. S. Dept. of Justice PO Box 66108 Washington, DC 20035-6118 Dear Sirs: I am writing in need of verification of one aspect of the Americans with Disabilities Act. I am a Family Physician practicing in an office with handicap accessibility. I am writing concerning the requirements for equal accessibility for the hearing impaired. A local agency interpretation of the ADA is that I, as a physician, am required under the Americans with Disabilities Act to arrange and pay for the presence of a sign language interpreter in the office whenever a deaf patient is being seen. They feel that written communication or

communication via a computer screen does not meet the requirements of the act. In the past deaf patients have usually brought a family member or an interpreter provided by a local agency to assist with communication. Many times, when an interpreter is not available, we have communicated in the ways mentioned above without difficulty. As I understand it, the Act requires modifications unless it results in an undue burden. Since most physicians see a limited number of deaf patients, and paying for the services of an interpreter would result in the health care provider spending more money for the visit than he or she gets paid, I am wondering if the local agency's interpretation is correct? I would appreciate your input on this issue. Sincerely yours, Richard J. Sagall, M.D. RJS:rjp 01-00912