JUN 29 1992 DJ 202-PL-186 Leonard Perez, M.D. 503 W. Columbus, Suite B Bakersfield, California 93301 Dear Dr.

Perez: This responds to your request for information about 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 accessibility standards. However, it does not constitute a legal interpretation and it is not binding on the Department. You inquire about your obligations to provide a sign language interpreter when you are treating deaf patients. The ADA requires health care providers to provide auxiliary aids and services where necessary to communicate effectively with their patients with speech, hearing and vision impairments. Sign language interpreters and communication via pen and paper are both types of auxiliary aids and services. A health care provider can choose among various alternatives as long as the result is effective communication. Whether a particular aid or service will provide effective communication in a particular circumstance depends on the nature and complexity of the communication involved. While a routine appointment for a simple and familiar treatment procedure might not require the services of an interpreter, a lengthier appointment to discuss diagnosis and treatment options might well necessitate such services. A health care provider cannot charge the patient with a disability for the cost of providing a particular auxiliary aid or service. However, such costs can be treated as any other overhead costs and passed along to all patients. A health care provider is not obligated to provide a particular auxiliary aid or service if doing so will cause an undue financial burden. In such a case, however, alternative

cc: Records Chrono Magagna.pl.186 arthur T. 6/26/92 01-00980 ​ -2auxiliary aids or services that will not cause such a burden must be provided. The factors to be considered in determining whether there is an undue burden include the cost and nature of the service, the size and resources of the covered entity and the number of employees. I have enclosed a copy of the Department's recently published Technical Assistance Manual which may further assist you in understanding your obligations under the ADA. I hope this information will be useful to you. Sincerely, Joan A. Magagna Deputy Director Office on the Americans with Disabilities Act Civil Rights Division Enclosure 01-00981 ​ Leonard Perez, M.D. ILLEGIBLE May 15, 1992 U.S. Department of Justice Americans with Disabilities P.O. Box 66118 Washington DC 20035-6118 Re: LAW REQUIRING THE PROVIDING OF A SIGNING INTERPRETER FOR THE DEAF I have recently become aware of the new law that states one must provide a signing interpreter for a deaf person if one is to provide services to them. I understand that this is at the expense of the one providing the services. Some of the documents that I have read, states that one is not obligated to provide this service

at ones expense if it causes a financial burden on the business. I am in a part-time private medical practice in my community in the specialty of Obstetrics and Gynecology. I have several deaf patients in my practice, all of which I have communicated with on paper quite well. The interpreting services charge $40.00 per hour, with a minimum of one hour of service. Many of my patients are recipients of Medi-Cal (Medicaid). Medi-Cal pays me $14.78 for a return visit whether I spend 10 minutes or one hour with the patient. As you can see, in addition to having to pay for my office and office staff, I must pay $25.22 (40.00-14.78) in order to see this patient. This would put a financial burden on my practice by creating a negative cash flow. IN THIS SITUATION, WOULD I STILL BE LEGALLY OBLIGATED TO PROVIDE AN INTERPRETER AT MY EXPENSE FOR THESE PATIENTS? Sincerely, Leonard Perez, MD 01-00982