JUL 13 1994

The Honorable Mark O. Hatfield United States Senator 727 Center Street N.E., Suite 305 Salem, Oregon 97301 Dear Senator Hatfield: This letter is in response to your inquiry on behalf of your constituent, XX regarding the requirements of the Americans with Disabilities Act (ADA) for physicians to provide auxiliary aids or services to deaf patients. Title III of the ADA requires physicians to furnish appropriate auxiliary aids and services, including sign language interpreters, where necessary to ensure effective communication with individuals with disabilities. Physicians should consult with their patients to determine what type of auxiliary aid or service is appropriate for particular circumstances. However, doctors are not required to provide sign language interpreters for deaf patients upon demand. Title III of the ADA does not require a doctor to accede to a patient's specific choice of auxiliary aid or service as long as the doctor satisfies his or her obligation to provide effective communication. In determining what constitutes an effective auxiliary aid or service, doctors must consider, among other things, the length and complexity of the communication involved. For instance, a note pad and written materials may he sufficient means of communication in some routine appointments or when discussing uncomplicated symptoms resulting from minor injuries. Where, however, the information to be conveyed is lengthy or complex, the use of handwritten notes may be inadequate 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 on treatment options for cancer. cc: Records, Chrono, Wodatch, Magagna, Mobley, McDowney, MAF, FOIA



-2Dr. XX suggests that the ADA's requirements for providing sign language interpreters will not inspire physicians to take on the care of people with disabilities. However, health care professionals cannot use a patient's disability as the basis on which to refuse treatment to that individual. A physician may not impose a surcharge on any particular individual with a disability to cover the costs of providing auxiliary aids and services. Instead, the costs should be treated like other overhead expenses that are passed on to all patients. However, the obligation to provide auxiliary aids and services is not unlimited and a doctor is not required to provide auxiliary aids and services if doing so would result in an undue burden, that is, a significant difficulty or expense. The factors to be considered in determining whether there is an undue burden include the nature and cost of the action, the type of entity involved, and the overall financial resources of, the entity. Finally, as amended in 1990, the Internal Revenue Code permits small businesses to receive a tax credit for certain costs of compliance with the ADA. An eligible small business is one whose gross receipts do not exceed $1,000,000 or whose work force does not consist of more than 30 full-time workers. Qualifying businesses may claim a credit of up to 50 percent of eligible access expenditures that exceed $250 but do not exceed $10,250. Examples of eligible access expenditures include the

necessary and reasonable costs of providing readers, interpreters, and other auxiliary aids and services to persons with disabilities. The flexibility of the auxiliary aids requirement, the undue burden limitation, the ability to spread costs over all patients, and the small business tax credit should minimize any burden on the medical profession. I hope this information will be helpful to you in responding to your constituent. Sincerely,

Gerald W. Jones Acting Assistant Attorney General Civil Rights Division 01-03183