mailed between December 2, 1992 and December 14, 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. S 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. S 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 cc: Records, Chrono, Wodatch, Breen, Contois, Friedlander, FOIA Udd:Contois:PL.dressingandundressing 01-01764 -2provide 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



FROM: Steven J. Cole Vice President and General Counsel RE: CBBBF Technical Assistance Grant-Outpatient Medical Facilities

DATE: July 20, 1992 I hope that this is finding you well. I know that you must be exceedingly busy, but I hope that all of the hard work you and your staff have been doing is now beginning to pay off. We have received and incorporated your staff's helpful comments on the final set of industry-specific brochures, and Jim McIlhenny has given final approval of copy for printing, which is now imminent.

In the brochure directed to outpatient medical facilities we have included a sentence that was in the draft reviewed and accepted by the DOJ reviewer but that, in my mind, raises a question under your regulations. I would appreciate it if you would be able to provide for our use in connection with questions that might arise after the booklets are distributed, or for future printing, a confirmation of DOJ's interpretation. The brochure will ask the following question: "What assistance must health care facilities provide for patients and clients who use wheelchairs or other mobility devices to ensure equal and effective treatment and services?" Our answer includes the following sentence: "Medical and health care facilities must provide assistance to undress and dress as needed or requested by patients with disabilities unless doing so fundamentally alters the services provided." 4200 Wilson Boulevard Arlington, VA 22203-1804 (703) 276-0100 FAX (703) 525-8277 The name Better Business Bureau is a registered servicemark of the Council of Better Business Bureaus, Inc. Page two... John Wodatch It was my understanding that services of a personal nature, defined to include assistance in dressing, 28 CFR S 36.306, are not required by Title III, ibid. At the same time, it was my understanding that notwithstanding the personal services limitation on all requirements of the regulation, 1 a public accommodation that customarily provides a personal service to its customers must do so for persons with disabilities who require the assistance. See 56 Fed. Reg. 35571 (July 26, 1991) and DOJ Technical Assistance Manual, III-4.2600, p. 24 (January 24, 1992).

Accordingly, it would be very helpful to receive from you a confirmation that we have correctly advised medical facilities that they are obligated to provide dressing and undressing assistance where needed or requested (in the absence of a showing that such services would fundamentally alter the services of the facility), whether or not the facility customarily provides the services to its patients. Thank you for your prompt attention to this. And, again, thank you and your staff for the excellent cooperation we have received on this important project. cc: James McIlhenny Barbara Bode

1 The preamble to the final rule explains that this limitation applies to all requirements, including those pertaining to modifications to policies and procedures, a point not clear in the proposed rule. See 36 Fed. Reg. 35571 (July 26, 1991).