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JAN 10 1995 The Honorable Robert "Bud" Cramer, Jr. U.S.

House of Representatives 1318 Longworth House Office Building Washington, D.C. 20515-0105 Dear Congressman Cramer: This letter is in response to your inquiry (code: 1klh) on behalf of your constituent, Robert S. Moorman, Jr. M.D., who wrote to express his concerns over certain provisions of the Americans with Disabilities Act (ADA), specifically those related to the provision of interpreter services for deaf patients. The issues raised by Dr. Moorman relate most directly to the auxiliary aids and services provisions of title III of the ADA. Such aids and services are measures that are undertaken to ensure "effective communication" for individuals with impaired speech, hearing and/or vision, as well as those who are profoundly deaf. The auxiliary aids requirement is intended to be flexible, reflecting the variable nature of what constitutes "effectiveness" in any particular setting. In addition to the specific nature of the disability involved, factors used to determine communication effectiveness in any given circumstance include the length, complexity and importance of the information being exchanged. In Dr. Moorman's practice, for example, printed information and the exchange of handwritten notes might provide effective communication during routine appointments to check treatment progress or where relatively minor adjustments are being made to the treatment plan. However, during appointments scheduled to discuss treatment options, particularly those involving invasive procedures; significant alterations to the treatment plan, or protocols requiring specific patient participation or follow-up activities, the use of handwritten notes or other printed materials may not prove to be effective and the use of an interpreter may be necessary. Further discussion of this point is found on page 35567 of the enclosed title III regulation. cc: FOIA 01-03576​ -2-

Ideally, the determination of which particular auxiliary aid or service will ensure effective communication in a given situation is reached through a process of consultation between patient and physician. In addition to establishing effective communications requirements, such consultation might well reduce the level of anxiety many people feel where problems with their health are concerned. This may be particularly true for those patients who communicate almost exclusively using their eyes. 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. The Department of Justice ADA Title III Technical Assistance Manual provides additional guidance on page 26. Under section 36.301 (c) of the ADA title III regulation, when an interpreter or other auxiliary aid or service is necessary to ensure effective communication, the medical practitioner must absorb the cost of this aid or service, unless this would result in an undue burden. As provided in section 36.303 (f), the term "undue burden" means "significant difficulty or expense". In determining whether providing a sign language interpreter or other auxiliary aid or service would result in an undue burden, the practitioner should consider the overall financial resources of the practice, not just the fees paid for a particular procedure or treatment session. Consideration should be given to other factors that would minimize the degree of burden on the practice, such as the ability to spread costs throughout the general patient population and the provision of tax credits for small businesses for costs incurred to provide auxiliary aids. Eligibility criteria for this credit is found in Publication 907, available from the IRS. Although Dr. Moorman did not raise the issue in his letter to you, it is important to note that in those circumstances where interpreter services are required to ensure effective communication, the interpreter must be "qualified". As defined in the enclosed regulation, a "qualified interpreter" has the ability to interpret "effectively, accurately, and impartially, both receptively and expressively, using any necessary specialized vocabulary." Further discussion of this issue may be found in the ADA Title III Technical Assistance Manual at III-4.3200.

01-03577​ -3I trust that this information, along with the enclosures, will be helpful in your response to your constituent. Sincerely, Kerry Alan Scanlon Acting Assistant Attorney General Civil Rights Division Enclosures 01-03578​ ROBERT S. MOORMAN, JR., M.D., P.A., F.A.C.S. PATRICIA MASSENGILL McCOY, M.D. Ophthalmology 303 WILLIAMS AVENUE,S.W. * SUITE 1411 * HUNTSVILLE,ALABAMA 35801 * (205)533-3210 November 2, 1994 Honorable Representative Robert "Bud" Cramer, Jr. U. S. House of Representatives 1318 Longworth House Office Bldg. Washington, D. C. 20510 Dear Bud: I just received the enclosed letter stating that I must pay for the services of an interpreter on any deaf patient I see who may request it. The letter states that I also may not discriminate, which I presume that I cannot refuse to see such a deaf patient. In many cases, particularly if it is a Medicare patient, my fee for the service provided would be considerably less than the fee charged by the interpreter. I cannot believe that it is the intent of Congress that I must pay out of my pocket to provide

for an interpreter. If that, in deed, is the intent of Congress, I would certainly hope that we could get this part of this legislation repealed. As soon as you are through with your busy campaign, I would appreciate it if you could investigate this issue and give me your interpretation as to what I must do when a deaf patient requests an interpreter. Sincerely, Robert S. Moorman, Jr., M. D. RSM/lc 01-03579​ ALABAMA INSTITUTE FOR DEAF AND BLIND Regional Center AIDB Established 1858 October 28, 1994 Dr. Robert S. Moorman, Jr. 303 Williams Avenue, Suite 1411 Huntsville, AL 35801 Dear Dr. Moorman: On July 26, 1990, the Americans with Disabilities Act (ADA) was passed. This civil rights legislation enables persons with disabilities equal access and opportunity to participate fully in all life activities. For you, this means making your services accessible for all persons with disabilities. The Alabama Institute for Deaf and Blind has been providing quality. interpreting services in the north Alabama area for the past eight years. During this time, we have been charging agencies/businesses and industry for services rendered. Medical professionals have not been charged for our services. Effective November 1, 1994, all customers will be charged $25.00/hour plus mileage for services rendered. Title III of the ADA, 28 C.F.R. 36.303 states that this charge is not to be passed to the consumer. A qualified interpreter will help to ensure effective communication between you and the deaf patient, thereby reducing the time required for the visit. We hope you will continue providing quality care and accessibility for your deaf patients. If you have questions or would like more information regarding services available through AIDB, please contact our office. Thank you for all your support.

Sincerely, Frances R. Smallwood Interpreter Coordinator L. Diann Willis Regional Director 2707 Artie Street,S.W., Suite 18, Huntsville, Alabama 35805-4769 (205)539-7881(Voice/TDD) 01-03580