APR 26, 1993 The Honorable John Tanner U.S. House of Representatives 1427 Longworth House Office Building Washington, D.C.

20515-4208 Dear Congressman Tanner: This letter responds to your inquiry on behalf of your constituent, (b)(6) regarding 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's requirements. However, it does not constitute a legal interpretation or legal advice and it is not binding on the Department of Justice. In your letter, you indicated that (b)(6) is studying to be an emergency medical technician. According to your letter, due to XX disability, XX performs a specific skill (insertion of the Pharyngeo Tracheal Lumen Airway, or PTL) from a different position than is typical. The Tennessee EMS Board has ruled that this method is unacceptable for purposes of certifying XX as a licensed emergency medical technician. Under title II of the ADA, public entities are prohibited from discriminating against qualified individuals with disabilities on the basis of disability in the granting of licenses or certification. A person is a "qualified individual with a disability" with respect to licensing or certification if he or she can meet the essential eligibility requirements for receiving the license or certification. See section 35.130(b)(6) of the enclosed title II regulation at pages 35704 and 35705. Whether a particular requirement is "essential" depends on the facts of the case. As discussed in the Justice Department's preamble, or interpretive commentary, to the title II regulation, cc: Records, Chrono, Wodatch, Bowen, Foran, McDowney, FOIA Udd:Foran:Tanner.Con

01-02014 -2the phrase "essential eligibility requirements" is taken from the definitions in the regulations implementing section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), so caselaw under section 504 is applicable to its interpretation. See preamble to title II regulation at 35704. Generally, a public entity is prohibited from applying eligibility criteria that screen out or tend to screen out individuals with disabilities from fully and equally enjoying any service, program, or activity. A public entity may, however, impose neutral rules and criteria that screen out, or tend to screen out, individuals with disabilities if the criteria are necessary for the provision of the service, program, or activity being offered. See 28 C.F.R. 35.130(b)(8). With respect to XX particular inquiry, the Tennessee EMS Board is permitted to impose eligibility criteria (i.e., require a skill be performed in a certain way) that screen out, or tend to screen out, individuals with disabilities if the criteria are "necessary" to ensure that the Board is licensing persons who can safely perform the duties of emergency medical technicians. At the same time, however, public entities are obligated under section 35.130(b)(8) to make reasonable modifications in policies, practices, or procedures when the modifications are necessary to avoid discrimination on the basis of disability, unless the public entity can demonstrate that making the modifications would fundamentally alter the nature of the service, program or activity. The ADA establishes two avenues for enforcement of the requirements of title II: private suits by individuals and suits by the Department of Justice after investigation by one of eight designated agencies. If XX believes that XX rights under the ADA have been violated, XX may file a private suit

pursuant to section 203 of the Act, or file a complaint with the Department of Health and Human Services. In addition to contacting a private attorney, there are a number of avenues that XX could pursue in order to resolve privately the issues raised in his letter, including consulting State or local authorities, disability rights organizations, or organizations that provide alternative dispute resolution services (such as arbitration or negotiation). For your convenience, we have enclosed a list of organizations serving XX area. These listings come from various sources, and the Department cannot guarantee that the listings are current and accurate. These groups may be able to refer XX to national or regional groups with a focus on a particular type of disability. XX local or State bar associations may be able to give (b)(6) names of private attorneys or mediation services.

01-02015 -3I hope this information has been useful to you. Sincerely, James P. Turner Acting Assistant Attorney General Civil Rights Division Enclosures (2)

01-02016 Congress of the United States House of Representatives March 22, 1993 Honorable Janet Reno Attorney General Department of Justice Main Justice Building Washington, D.C. 20530 Dear Madam Attorney General: I am enclosing copies of the information that has been shared with me by my constituent, XX . Please review this and respond with any information you feel may be helpful in responding to XX .

As you will note, (b)(6) XX is currently enrolled in a local community college studying to be an Emergency Medical Technician. Since XX than many of the students, XX also performs some of the skills differently. This had not proven to be a problem until a specific skill known as the insertion of the Pharyngeo Tracheal Lumen Airway (PLT). Apparently, the accepted, but not mandated, position for doing this is for the technician to be at the top of the patient's head. XX patient's head. The Tennessee EMS Board has XX . XX If they do not accept performance, he can not become a licensed EMT. The full details and descriptions of this case are included in the information that XX has provided. Is there anything in the Americans With Disabilities Act or its regulations that would address this situation? Is Tennessee's EMS Board acting within its rights to exempt XX from service as an EMT based solely on his performance of this one skill, or has XX been the victim of discrimination based on (b)(6) needs to know how to proceed by XX , since that is when the current semester ends. It would be most helpful if you could respond to my inquiry on XX behalf so that I might get this information to XX well before that date. Congratulations on your confirmation! I look forward to working with you and hope that you will feel free to call upon me whenever I may be of assistance. Additionally, I hope that you or 01-02017​ your staff will not hesitate to contact me if I may provide additional information about (b)(6). Thank you for your time and attention to this matter. Sincerely, John Tanner, M. C. JT/gw

01-02018 (b)(6) December 31, 1992

To Whom It May Concern: I am currently enrolled at XX as an Emergency Medical Technician. Having been XX I have to perform some skills differently than other people. The Tennessee Emergency Medical Service, so far, has been unwilling to accept this difference on one skill. That skill is the insertion of the Pharyngeo Tracheal Lumen Airway (PTL). A description of the PTL and technique for insertion is enclosed. One thing that is not mentioned in the description or technique for insertion is the position the EMT is to be in when inserting the PTL. The accepted position is for the EMT to be positioned at the top of the patient's head. XX Tom Coley, EMT-P, and director of the EMT program at (b)(6) requested that he be allowed to video tape me doing this skill. He also asked that the Tennessee EMS board be allowed to see this tape in order to make a decision. I had no problem with this and on XX the Tennessee EMS Board reviewed the tape. On XX I asked Tom Coley what conclusion the EMS Board had come to. Tom said that he did not have time to discuss it with me but for me not to worry about it. On XX , the XX of class for the XX semester, Tom discussed it with me. Tom said that the EMS Board would not accept the way that I perform this skill. He also said that he was in agreement with the state. Within the next day or two I contacted Judy Gaffron of the State EMS Board to discuss it with her. She stated that their lawyers advised her not to tell me if they would accept the way that I do this skill. She did not come right out and tell me but she did lead me to believe that they would turn it down, I know that they will. Since time was up for the XX semester, the EMS Board and Tom Coley decided to let me wait until next semester to perform the PTL skill for a grade. They said it would give me time to practice doing it their way. The next semester runs from (b)(6)

01-02019 On (b)(6) I contacted the Tennessee State Representative Roy Herron's office in Nashville. They said that they would look into it. As of this date I have not heard from his office. The way that I perform this skill does not in any way compromise the patient. The only reason the EMS Board has given me is that it is not the accepted way. Two other questions that I have been asked by Tom Coley and Judy Gaffron are: How will I be able XX and how will I be able at the same time? After hearing these two questions I am expecting more trouble in the future. Below is a list of the names and phone numbers of the people that I have mentioned. Tom Coley - (901)425-2612 Judy Gaffron - (615)367-6262 Roy Horron - (615)741-4576 Ann Hirsch at J.A.N. is the person who advised me to contact your office. Any help that you can provide will be appreciated.

Thank You, (b)(6) JV:po