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NOV 20 1992 Ms. Sheri L. Mabey Office Manager 2059 E. Sahara, Suite C Las Vegas, Nevada 89104 Dear Ms.

Mabey: This letter responds to your inquiry regarding the provision of an interpreter for a hearing-impaired patient. The Americans with Disabilities Act (ADA) authorizes the Department of Justice to provide technical assistance to individuals having rights or obligations under the Act. This letter provides informal guidance to assist you 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 a physician to furnish auxiliary aids and services when necessary to ensure effective communication, unless an undue burden or fundamental alteration of the physician's services would result. What constitutes effective communication depends upon the facts of each situation, including the length and complexity of the communication involved. For instance, a discussion of whether to undergo major surgery may require the provision of a qualified sign language interpreter, while a routine office visit may not. While the physician is encouraged to consult with the patient in determining what is needed to ensure effective communication, the ultimate decision as to what measures to take to ensure effective communication rests with the physician. Thus, a hearing-impaired patient cannot insist or require that an interpreter be provided at the physician's expense in every situation. Relevant ADA provisions appear in section 36.303 of the enclosed ADA title III regulation at page 35597, and related discussion is found in the preamble to the regulation at page 35553. In response to your particular inquiry, please note that use of family members as interpreters should be approached with 01-01732​ -2-

caution, as discussed on page 35597 of the preamble. Also enclosed is the Department's Title III Technical Assistance Manual. Pertinent discussion appears at pages 25-28. I hope this information is helpful to you. Sincerely, John L. Wodatch Chief Public Access Section Civil Rights Division Enclosures (2) cc: The Honorable Harry Reid 01-01733​ R. Garn Mabey, Jr., M.D. Obstetrics and Gynecology 2059 E. Sahara, Suite C Las Vegas, Nevada 89104 (702) 369-4200 July 30, 1992 Donnie Loux Nevada Developmental Disabilities Council Dorothy Porther, Director Equal Employment Opportunity Commission RE: Hearing Disabled Patients Dear Mr. Loux: Last Friday Sami from your council contacted me to discuss my payment arrangements for an interpreter for one of our hearing impaired patients. He informed me at that time that it was Federally mandated that I pay for this interpreter. After reviewing the file with the office staff and Dr. Mabey, it was apparent that the patient did not need an interpreter present, but because in the past it was something she did not have to pay for, she would continue to request that service. The patient has been coming to our office for over two years; this is the second

pregnancy Dr. Mabey has taken care of her for; she has a mother-inlaw, husband and brother who can all communicate to her if there is a problem, and at least one or more is present at each visit, and on prior visits, the interpreter was there as well. Dr. Mabey can communicate with her without any interpreter--family member, etc., present. Her visits at our office are for routine pregnancy care--they are straightforward and direct. Dr. Mabey's questions to her can be easily answered by pen and paper if needed. After reviewing some of the guidelines from the Washington office and Senator Reid's office locally, we have complied with all needed requirements with respect to this patient. As I explained to Sami, the cost for us to provide this service to a patient would exceed the amount we would be reimbursed for Dr. Mabey's time and expertise. This would place an undue hardship on our office in that we would not only be providing an interpreter free of charge, but her care as well. This is against the ADA guidelines. 01-01734​ July 30, 1992 Page 2 RE: Hearing Impaired Patients A standard office visit for a new patient, after being reimbursed by the carriers, would mean approximately $10-15 of income for that patient if we were required to pay for an interpreter. On a pregnant patient, for the 10-12 visits prior to their delivery, the delivery time and postpartum care, it is possible that the interpreter's fee alone could be over two-thirds of the amount reimbursed for the total nine-months of care provided by Dr. Mabey. This seems to be an extreme hardship--especially in light of the fact that there are family members, in this particular case, that are able and willing to provide that service at no charge. You should also note that patients frequently are late, and forget to call to cancel their appointments. This patient was over 30 minutes late for the appointment Sami wanted me to pay for an interpreter. We believe we have made every effort to reasonably accommodate all

patients. Sincerely, Sheri L. Mabey Office Manager cc: Senator Harry Reid John Wodatch, Director, ADA 01-01735