APR 15 1994

The Honorable Charles Grassley United States Senate Washington, D.C. 20510-1502 Dear Senator Grassley: This letter is in response to your inquiry on behalf of your constituent, John H. Roberts, M.D., regarding the provision of interpreters during office visits to his patients with hearing impairments. Specifically, your constituent was concerned about the costs of providing such interpreters. Title III of the Americans with Disabilities Act (ADA), 42 U.S.C. ​ 12181-12189, prohibits discrimination on the basis of disability by places of public accommodation. The professional office of a health care provider is a place of public accommodation subject to the requirements established in this Department's regulation implementing title III, 56 Fed. Req. 35544 (July 26, 1991). Title III of the ADA requires physicians to furnish appropriate auxiliary aids and services where necessary to ensure effective communication with individuals with disabilities, unless doing so would result in an undue burden, or would fundamentally alter the nature of the service provided. What constitutes an effective auxiliary aid or service will vary depending on the unique facts of each situation. The particular communication needs of the individual and the nature of the communication involved, including features such as length and complexity, will determine which auxiliary aid or service is required. An interpreter is not, therefore, mandated in every office visit situation. In some circumstances involving short, simple communication, a health care provider may satisfy the auxiliary aid or service requirement by using a note pad and written


-2materials. At the other extreme, discussion of whether to undergo major surgery is a prototypical situation in which an interpreter will be required for someone who needs one. The regulation envisions a wide range of situations involving health matters that may be sufficiently lengthy or complex to require the provision of an interpreter. Because effective communication of symptoms or case history is an important diagnostic tool in medical treatment, many office visits might require the provision of an interpreter for someone who needs one. A doctor is not, however, required to provide an auxiliary aid that would result in an undue burden. In determining whether the provision of an interpreter would result in an undue burden, the physician should consider not only the fees paid for providing the medical service or procedure, but also the overall financial resources of the practice. The physician 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). We hope that this information is useful to you in addressing the concerns of your constituents 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.

For your information I have enclosed a copy of the Department's regulation implementing title III and our Title III Technical Assistance Manual. A public accommodation's obligation to provide auxiliary aids is addressed in section 36.303 of the regulation, in the preamble to section 36.303 (pages 3556535568), and in section III-4.3000 (pages 26-30) of the technical assistance manual. Sincerely,

Deval L. Patrick Assistant Attorney General Civil Rights Division Enclosures 01-02996