JUL 23 1993

The Honorable H. Martin Lancaster Member, U. S. House of Representatives Room 108 Federal Building 134 N. John Street Goldsboro, North Carolina 27530 Dear Congressman Lancaster: This letter is in response to your inquiry on behalf of a constituent regarding a physicians obligation to provide auxiliary aids or services for persons with disabilities. The Americans with Disabilities Act (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 your constituent 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 public accommodations, including physicians, to furnish appropriate auxiliary aids and services where necessary to ensure effective communication with individuals with disabilities. A public accommodation 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 ADA. These requirements appear in sections 36.301(c) and 36.303 of the enclosed ADA title III regulation, at pages 35596 and 35597, respectively. Also enclosed is the Department's Title III Technical Assistance Manual, which may provide further assistance to your constituent. Pertinent discussion may be found at pages 22 (surcharges) and 25-28 (auxiliary aids). I have also enclosed the Department's Title III Technical Assistance Manual Supplement, which includes relevant discussion at pages 4-5. cc: Records, Chrono, Wodatch, Breen, Nakata, McDowney, FOIZ, MAF udd\Nakata\Congress.let\lancastr


-2Under section 36.301(c) of the regulation, the cost of an interpreter must be absorbed by the public accommodation in the limited circumstances when an interpreter is necessary. However, as provided in section 36.303(f), a doctor is not required to provide any auxiliary aid that would result in an undue burden. 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 the medical profession. 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 constituent.


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

01-02479 Congress Of the United States House of Representative H. MARTIN LANCASTER NORTH CAROLINA THIRD DISTRICT April 21, 1993

Mr. Tony E. Gallegos Acting Director Equal Employment Opportunity Commission and The Americans With Disability Act 1801 L Street, N.W. Washington, DC 20507 Dear Mr. Gallegos: I have received the enclosed information from a physician who is rightly concerned that he is going to have to hire an interpreter to deal with hearing impaired patients, and may not charge the patient for the cost of these services, nor bill the patient's insurance carrier. He indicates that the cost of the interpreter will be significantly more than his reimbursement for the health care service rendered. Is the information provided to him by the

Communication Accommodations Project correct? If the doctor may not bill the patient or the insurance carrier, how do you propose that this cost be defrayed? Was this kind of result intended by the legislation? It certainly was not my personal intention. Thank you for responding to these concerns. Sincerely yours H. Martin Lancaster Member of Congress HML: tgy Enclosure At-Large Majority Whip Washington Office: Committees: Armed Services Chairman, Morale, Welfare, and Recreation Panel Merchant Marine and Fisheries Small Business Washington Office: 2436 Rayburn House Office Building Washington, D.C. 20515 (202) 225-3415 District Office: Room 108 Federal Building 134 N. John Street Goldsboro, NC 27530 (800) 443-6847 (919) 736-1844