12-10-93 202-PL-574 5 1993 Mary Pell, D.O. INTEPMED 990 44th Street S.W. Wyoming, Michigan 49509 Dear Dr.

Pell: I am responding to your letter asking for information about the requirements of title III of the Americans with Disabilities Act (ADA), and this Department's regulation implementing title 111. Specifically, you have asked if a health care provider is required to provide a sign language interpreter for a patient who is deaf or hard of hearing if effective communication can be achieved through other means. The ADA authorizes the Department of Justice to provide technical assistance to individuals and entities that are subject to the Act. This letter provides informal guidance about the obligation of a health care provider to provide auxiliary aids; however, this technical assistance does not constitute a legal interpretation of the statute, 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. In determining what constitutes an effective auxiliary aid or service, a physician must consider, among other things, the length and complexity of the communication involved. For instance, a notepad and written materials may be sufficient to permit effective communication when a physician is explaining possible symptoms resulting from a simple laceration. Where, however, the information to be conveyed is lengthy or complex, the use of handwritten notes may be extremely slow or cumbersome and the use of an interpreter may be the only effective form of communication. Use of interpreter services is not necessarily limited to the most extreme situations -- for example, a discussion of whether to undergo surgery or to decide an treatment options for

cancer. Further discussion of this point may be found on page cc: Records, Chrono, Wodatch, Blizard, FOIA Friedlander n:\udd\blizard\adaltrs\pell


-235567 of the preamble to the enclosed regulation. While the nature of medical services is considered one factor in determining what auxiliary aid is necessary for effective communication, the focus should be not only on the nature of the services, but also on-the type of communication between the physician and the patient. Interpreters are not usually needed for routine office visits. However, an interpreter may be required for routine visits, if a note pad does not provide effective communication between the physician and the patient. For example, if your patient's routine care includes regular office visits at whichyou record her blood pressure and weight, exchanging notes is likely to provide an effective means of communication. But, if your patient's routine visit involves a thorough examination and a battery of tests which should be discussed, you should be prepared to arrange for the services of a qualified interpreter, as an interpreter is likely to be necessary for effective . communication with your patient, given the length and complexity of the communication involved. I am enclosing a copy of this Department's regulation implementing title III and the Title III Technical Assistance Manual. I hope that this information is helpful to you. Sincerely,

John L. Wodatch Chief Public Access Section