JAN 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 cc: Records; Chrono; Wodatch; McDowney; Novich; FOIA; MAF. :udd:novich:hancock 01-01842​

-2determine 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 01-01843​ THE INTERNAL MEDICINE GROUP, LTD. NATIONAL AVENUE MEDICAL BUILDING - SUITE 2200 1900 S. NATIONAL AVENUE * SPRINGFIELD, MISSOURI 65804 - 2275*(417) 887-4000 September 25, 1992

Melton D. Hancock 318 Cannon House Office Building Washington, D.C. 20515

Dear Representative Hancock: I am writing you in regard to the recent Federal Disability Act. You will see a copy of a bill sent to me by an interpreter service related to a deaf mute patient, XX I took care of XX (b)(6) for eight or ten years without the benefit of an interpreter. When XX was recently in the hospital with a perforated bowel it was necessary to have an interpreter because matters were very complex. Recently XX had shown up with an interpreter and I am being billed $50.00 for a 15-20 minute office call, whereas my charges to the patient are $39.00. My attorneys tell me that if I refuse to see the patient or attempt to get other reimbursement that I am subject to federal penalty. Obviously this is a flaw in the bill which should be corrected, as in the long term it will have a negative rather than a positive effect on disabled people. My only recourse at present is to refuse to have the interpreter unless I have prearranged some payment agreement ahead of time. As you will note in my reply, I am paying the bill simply to avoid trouble which such a bureaucratic entanglement could bring about. Incidentally, I would very much appreciate your supporting the movement to make English the official language of the United States. If this is not done we will have the same problem with all sorts of nationalities including Turks, Vietnamese, Japanese, et cetera, who might appear in our office and demand interpreter service because they would be considered disabled in that they could not speak the English which I ordinarily use with my patients. We are long overdue in making English our official language as it is essentially the official second language of an entire World now. The cost to our government and to citizens if we do otherwise will be disastrous. Furthermore, the tendency for Hispanics and other minority groups to demand their elementary and secondary education in their own tongue can only be disruptive to the melting pot effect which our country should achieve. Sincerely, DEPARTMENT OF JUSTICE W. Yates Trotter, M.D. WYT:lv Enclosure 01-01844 INVOICE INTERPRETER REFERRAL SERVICE INVOICE #1287 INVOICE DATE: August 31, 1992 SERVICES RENDERED TO: Dr. Yates Trotter

1900 South National Suite 2200 Springfield MO 65804 DATE/TIME: 8/31 2:15-3:05pm (2 hours) NAME OF CLIENT/PATIENT: XX CONTACT PERSON: Dr. Trotter INTERPRETER'S NAME: Lorene Joslin TERMS: $25.00 PER HOUR / 2 HOUR MINIMUM TOTAL DUE: $50.00 PLEASE COMPLETE THE QUESTIONS BELOW AND RETURN WITH YOUR INVOICE. FEEDBACK: Was Interpreter sufficient? Was communication understood? Would you use this interpreter again? Yes Yes Yes No No

No Only if needed

COMMENTS: (Handwritten) The bill is paid with protest. We did not ask or require interpreter services for these calls. No arrangements were made beforehand with you. In future, unless we request services you will not be paid. THANK YOU FOR USING LAKES COUNTRY INTERPRETER REFERRAL SERVICE! Please remit to: LAKES COUNTRY REHABILITATION CENTER Federal Tax ID #43-1035671 2626 West College Road Springfield MO 65802 01-01845