DJ 202-PL-802 FEB 16 1995 Kenneth M. Hrechka, D.D.S.

6130 Oxon Hill Road Oxon Hill, Maryland 20745 Dear Dr. Hrechka: This letter is in response to your inquiry concerning your obligations to provide interpreter services for deaf patients. The Americans with Disabilities Act (ADA) authorizes the Department of Justice to provide technical assistance to individuals and entities having rights or obligations under the ADA. This letter provides informal guidance to assist you in understanding the ADA's requirements. It does not, however, constitute a legal interpretation, and it is not binding on the Department. The issues and concerns raised in your letter relate most directly to the auxiliary aids and services provisions of title III. 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 situation. 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 your practice, for example, printed information and the exchange of handwritten notes might provide effective communication during routine appointments to adjust wires or check treatment progress. However, during appointments scheduled to discuss treatment options, or unexpected alterations necessary to the treatment plan, the use of printed information and handwritten notes may cc: FOIA

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not prove 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. 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 practitioner. 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 enclosed 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 or dental 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 are found in publication 907, available from the IRS. Your letter also raises the question of how to obtain interpreter services. Most states have a Deaf Services Center, or similar office, which can provide referral services for you.

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.

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I trust that this information, along with the enclosures, will be helpful to you and your patients with disabilities. Sincerely,

John L. Wodatch Chief Public Access Section Enclosure Title III Regulations Title III Technical Assistance Manual

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March 10, 1994 Association of Disabilities Act Department of Justice Civil Rights Division P. O. Box 65310 Washington, DC 20025-1530 Dear Association of Disabilities Act, I am an orthodontist, treating a woman, who is deaf. My office receptionist and I have tried to reach you by phone for over three weeks, calling every hour of the day. Apparently, your employees are overworked as your lines are always busy. I need important information answered by you, which I can not

obtain from the legal office of the American Dental Association re: disabled Americans. I operate a small professional business. I have treated deaf patients before without any difficulty. (They could read lips or we would exchange written notes). Currently, I am told I may be required to supply an interpretor for a deaf patient. Is this true? Are they available as a service through local government, social work-like organizations? Does the small business or deaf individual pay for the interpretor? Orthodontic treatment usually requires 24-36 appointment visits. The cost of a sign interpretor for this number of visits would greatly exceed all total costs I would charge, prior to considering expenses, for the orthodontic service I am providing. I have never been asked to provide this service before. If rules and regulations exist, could I be given the existing laws along with the status number and a copy of the same. Please, I wish to be informed of individual's, patient's, doctor's and small businessman's rights. I have been referred to you for assistance. Thank you in advance for your time and consideration. Sincerely, Kenneth M. Hrechka, DDS KMH/ms DIPLOMATE, AMERICAN BOARD OF ORTHODONTICS 01-03619