JUL 13 1994

The Honorable Toby Roth Member, U. S. House of Representatives 2101 South Oneida Street Green Bay, Wisconsin 54304 Dear Congressmen Roth: This is in response to your inquiry on behalf of your constituent, Mr. Steve Barnett, regarding a health care providers obligation to provide auxiliary aids or services to persons with disabilities. I apologize for failing to respond to your prior correspondence. My office has no record of receiving that letter. Title III of the Americans with Disabilities Act (ADA) requires public accommodations, including health care providers, to furnish appropriate auxiliary aids and services, including sign language interpreters, where necessary to ensure effective communication with individuals with disabilities. Health care providers should consult with their patients to determine what type of auxiliary aid or service is appropriate for particular circumstances. However, health care providers are not required to provide sign language interpreters for deaf patients upon demand. Title III of the ADA does not require a provider to accede to a patients specific choice of auxiliary aid or service as long as the provider satisfies his or her obligation to ensure effective communication. In determining what constitutes an effective auxiliary aid or service, health care providers must consider, among other things, the length and complexity of the communication involved. For instance, a note pad and written materials may be 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, Hill, McDowney, FOIA, Friedlander n:\Udd\hille\policylt\roth2.ltr1 01-03186

-2Mr. Barnett suggests that provision of sign language interpreters will cause his clinic to lose money when treating individuals with disabilities. However, health care professionals cannot use a patient's disability as the basis for refusing treatment to that-individual. A health care provider 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 health care provider 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 health care professionals. I hope this information will be helpful to you in responding to your constituent. Sincerely,

Deval L. Patrick Assistant Attorney General Civil Rights Division