MAR 16 1994

The Honorable Terry Everett U.S. House of Representatives 208 Cannon House Office Building Washington D.C. 20515 Dear Congressman Everett: This letter is in response to your inquiry on behalf of your constituent, Dr. Larry T. Howell, concerning the provision of auxiliary aids or services for persons with disabilities. We apologize for the delay in responding to your inquiry. The ADA requires public accommodations, including dentist's offices, 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 dentist 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 dentist is explaining routine dental procedures. Where the information to be conveyed is lengthy or complex, however, handwritten notes may be ineffective 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. Further discussion of this point may be found on page 35567 of the preamble to the enclosed regulation. While the nature of the dental 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 dentist and the patient. Generally, interpreters are not needed for routine office visits. However, the fact that an office visit is characterized as routine does not necessarily negate the need for interpreting services. For

instance, an interpreter may be required if a notepad does not

01-02962 -2facilitate effective communication between the dentist and an individual who is undergoing a complete dental examination and related testing procedures. Under section 36.301(c) of the regulation, when an interpreter or other auxiliary aid or service is necessary to ensure effective communication, the dentist 'must absorb the cost for this aid or service. As provided in section 36.303(f), however, the dentist is not required to provide any auxiliary aid that would result in an undue burden. The term "undue burden" means "significant difficulty or expense." Undue burden must be determined on a case-by-case basis in light of factors such as the nature and cost of the aid or service, and the overall financial resources of the practice. Further discussion of the meaning and application of the term undue burden may be found in the preamble discussion of section 36.303, on pages 35567-35568. In determining whether the provision of an interpreter would result in an undue burden, the dentist should consider not only the fees paid for providing the dental service or procedure, but also the overall financial resources of the practice. The dentist should consider other factors that would minimize the degree of burden on the practice, such as the ability to spread costs throughout the general clientele and the provision of tax credits for costs of providing auxiliary aids (which is available for eligible small businesses). The Department's Technical Assistance Manual for title III (copy enclosed) at page 26, and the ADA's legislative history, as described in the regulation's preamble, at pages 35566-35567, strongly encourage consultation with persons with disabilities in order to determine which particular auxiliary aid or service will ensure effective communication. Not only will consultation ensure that equal services are provided to individuals with

disabilities, it may also significantly reduce the costs of providing such auxiliary aids or services. Dr. Howell's letter also raises the issue of whether an outside agency such as the Alabama Institute for the Deaf and Blind may charge a public accommodation for the use of an interpreter that was not discussed with or authorized by that public accommodation. Clearly, the auxiliary aid provisions of the ADA (cited above) do not contemplate that a person with a disability can unilaterally decide on the appropriate type of auxiliary aid. Further discussion on this point can be found in the enclosed January 1993 update to the Department's Title III Technical Assistance Manual (copy enclosed) at page 5.

01-02963 -3I hope this information will be helpful to you in responding to your constituent. Sincerely,

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