AUG 19 1993

The Honorable Jim Saxton U. S. House of Representatives 438 Cannon House Office Building Washington, D.C. 20515-3003 Dear Congressman Saxton: This letter is in response to your inquiry on behalf of your constituent, XX , who states that her son-in-law was not provided a sign language interpreter to convey information about his impending major heart surgery. I have also received the documents attached to your letter --XX letter to Governor Florio and the governor's response to it. This letter responds to your request for information about the duty of a medical institution under the Americans with Disabilities Act ("ADA") to provide the services of an interpreter under these circumstances. Both public and private institutions that provide health care are subject to the provisions of the ADA. As such, they are required to take steps to provide auxiliary aids and services that will ensure that an individual with a disability is not excluded, denied services, segregated or otherwise treated differently from other individuals. Health care institutions will only be excused from providing these auxiliary aids and services if doing so would either fundamentally alter the nature of the services provided, or would result in an undue burden in terms of difficulty or cost. The Justice Department's implementing regulations detail this requirement of non-discrimination, 28 C.F.R. SS 35.160, 36.303(a), and define auxiliary aids and services to include qualified interpreters. 28 C.F.R. S 36.303(b)(1). Therefore, a medical institution would need to provide a deaf patient with an interpreter to convey information about medical procedures, if necessary for effective communication, unless doing so would be cc: Records; Chrono; Wodatch; McDowney; Magagna; Kuczynski; FOIA; MAF. \udd\kuccynsk\saxton.cng

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-2too difficult or too costly. A similar obligation to provide an interpreter might also arise under 504 of the Rehabilitation Act and its implementing regulations, which prohibit discrimination on the basis of disability by activities and programs receiving federal financial assistance. Since determinations of what is necessary for effective communication and what constitutes an undue burden are very factspecific inquiries, it is impossible to know, without more information concerning the particular hospital involved, whether a violation of the ADA has actually occurred. Your constituent may wish to file a complaint to have the matter investigated. If the hospital involved is operated by a State or local government, she should write to: Department of Health and Human Services Region II 26 Federal Plaza New York, N.Y. 10278. If it is a private hospital, she should write to: Public Access Section Civil Rights Division U.S. Department of Justice P.O. Box 66738 Washington, D.C. 20035-6738. I hope this information will be helpful to you in responding to your constituent.

Sincerely,

Brian K. Landsberg Acting Assistant Attorney General Civil Rights Division 01-02530

CONGRESS of the UNITED STATES HOUSE of REPRESENTATIVES WASHINGTON. DC 20515-3003 July 15, 1993 Ms. Janet Reno Attorney General Department of Justice Main Justice Building, ROOM 1603 Pennsylvania & Constitution Aves. NW Washington, D.C. 20530 Dear Ms. Reno: I was appalled after reading the enclosed letter from a constituent who outlined a situation which confronted a deaf

family member. I believe that you, too, will find the letter shocking. A deaf individual was faced with major heart surgery without an interpreter. An operation such as that is frightening enough without even the knowledge of what is occurring. Consequently, I would like for you to provide information on the responsibility of a medical institution under the Americans with Disabilities Act in this situation. Thank you for your attention to this matter.

Sincerely, JIM SAXTON MEMBER OF CONGRESS HJS/brg Enclosure 01-02531 (HANDWRITTEN) DEAR GOVERNOR FLORIO, THE PASSAGE AND IMPLEMENTATION OF THE AMERICANS WITH DISABILITIES ACT IS A MUCH NEED STEP TO ENSURE ALL AMERICANS RECEIVE THE CARE IN HOSPITALS THEY ARE ENTITLED TO. HOWEVER THIS DOES NOT APPEAR TO BE THE CASE WHEN SOMEONE IS DEAF. MY SON-IN-LAW WAS RECENTLY HOSPITALIZED. HE REQUIRED MAJOR HEART SURGERY A QUADRUPLE BY-PASS. ALL THIS WITHOUT BENEFIT OF AN INTERPRETER THE HOSPITALS INVOLVED MADE A HALF-HEARTED

EFFORT TO PROVIDE THIS SERVICE. THE END RESULT WAS HE FACED THE SURGERY WITHOUT THE EXPLANATION YOU OR I, OR EVEN A SPANISH-SPEAKING PERSON, WOULD RECEIVE. THIS IS A DISGRACE AND INEXCUSABLE. THIS DISCRIMINATION MUST BE STOPPED. MOST OFTEN THE HOSPITAL'S REPLY IS THE FAMILY USUALLY PROVIDES THE INTERPRETER. "WHY SHOULD I HAVE TO DO THIS WHEN THE LAW REQUIRES THE THE HOSPITAL TO PROVIDE THESE SERVICES. I WOULD APPRECIATE IT IF YOU WOULD INVESTIGATE THIS ISSUE. HOW MANY OTHERS ARE DENIED AN UNDERSTANDABLE EXPLANATION OF MEDICAL PROCEDURES BECAUSE THE HOSPITAL STAFF CAN NOT COMMUNICATE WITH THE PATIENT?

THANK YOU FOR YOUR SUPPORT, xx VINCETOWN, NJ 08088

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