JUN 28 1993 The Honorable J.

Bennett Johnston United States Senate 136 Hart Senate Office Building Washington, D.C. 20510-1802 Dear Senator Johnston: This letter is in response to your inquiry an behalf of your constituents, the doctors at the Goodwood Woman's Center. The physicians have asked whether they are required by the Americans with Disabilities Act to provide interpreters to their patients with hearing impairments when the cost of doing so exceeds the fee charged for an office visit. The Americans with Disabilities Act 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 your constituents in understanding the Act's requirements. It does not, however, constitute a legal interpretation, and it is not binding on the Department. The Americans with Disabilities Act requires physicians to furnish appropriate auxiliary aids and services where necessary to ensure effective communication with individuals with disabilities. A physician may not impose a surcharge on any particular individual with a disability to cover the costs of measures, such as providing auxiliary aids, that are required by the Act. The applicable regulatory provisions appear in sections 36.301(c) and 36.303 of the enclosed title III regulation, at pages 35596 and 35597, respectively. Also enclosed are the Department's Title III Technical Assistance Manual and the January 1993 Supplement to the Manual, which may provide further assistance to your constituents. Pertinent discussion may be found in the Technical Assistance Manual at pages 22 (surcharges) and 25-28 (auxiliary aids)" cc: Records; Chrono; Wodatch; McDowney; Bowen; Miller; FOIA, MAF \udd\millerc\policy\johnson.cng 01-02433​

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Under section 36.301(c) of the regulation, the cost of an interpreter must be absorbed by the doctor in circumstances when an interpreter is necessary. However, as provided in section 36.303(a), a doctor is not required to provide any auxiliary aid that would result in an undue burden, i.e., significant difficulty or expense. The flexibility of the auxiliary aids requirement, the undue burden limitation, and the ability to spread costs over all patients should minimize any burden on a medical provider. What constitutes an effective auxiliary aid or service will depend upon the unique facts of each situation, including the length and complexity of the communication involved. For example, in some instances a doctor may satisfy the auxiliary aid or service requirement by using a note pad and written materials where a deaf patient is making a routine office visit. By contrast, a discussion of whether to undergo major surgery will generally require the provision of an interpreter. Other situations may also require the use of interpreters to ensure effective communication, depending on the facts of the particular case. Further discussion of this point may be found on page 35567 of the enclosed regulation. I hope this information will be helpful to you in responding to your constituents. Sincerely,

James P. Turner Acting Assistant Attorney General Civil Rights Division Enclosures

01-02434​ GOODWOOD WOMAN'S CENTER OBSTETRICS AND GYNECOLOGY 7662 Goodwood Blvd., Suite B-201 o Baton Rouge, LA 70806 Office (504) 925-8261 o Ans. Service (504) 927-1300 February 19, 1993 Senator J. Bennett Johnson United States Congress Washington, D.C. 20510-1802 Dear Senator Johnson: We are writing you over concerns regarding the recently passed Americans with Disabilities Act. More and more today it seems that laws and regulations are being passed by government with little regard to the actual affects of these laws when put into practice. The above stated Act requires that we provide a person fluent in sign language for all hearing impaired patients. As we have recently learned the cost of providing such an interpreter is a minimum of $60.00 When seeing an obstetrical patient covered by Medicaid we are reimbursed $27.00. For private pay patients the fee is $33.00. Thus for each hearing impaired obstetrical visit, we will lose from $27.00 to $33.00 not including overhead costs. Where we as physicians are often asked or required to provide our services free of charge, we are now being required to pay to care for patients. Prior to the act we have always provided medical care for the hearing impaired with little difficulty, however, now this is becoming financially impossible. With the rising costs of medicine being a real concern today, regulations such as the Americans with Disabilities Act will only serve to make matters worse. Sincerely, Michael T. Perniciaro, M.D. Debra A. Baehr, M.D.

Renee S. Harris, M.D.

Kathy H. Guidry, M.D.

Susan F. Puyau, M.D. 01-02435