FEB 16 1995 XX XX XX Cincinnati, Ohio XX Dear XX

This is in response to your letter regarding the Americans with Disabilities Act (ADA). You have asked whether the ADA would require medical care providers to require their employees to refrain from wearing fragrances when they are providing services to a person who has multiple chemical sensitivities. The ADA authorizes the Department of Justice to provide technical assistance to individuals and entities that have rights or responsibilities under the Act. Pursuant to that authority, this letter provides informal guidance to assist you in understanding the ADA. However, this technical assistance does not constitute a legal interpretation of the statute, and it is not binding on the Department. A medical care facility, such as the University of Cincinnati Medical Center, may be covered under either title II or title III of the ADA. Title II prohibits discrimination on the basis of disability by State and local government entities. Title III prohibits such discrimination by places of public accommodation and commercial facilities. Both title II and title III require covered entities to make reasonable modifications to policies, practices, and procedures when such modifications are necessary to avoid discrimination against persons with disabilities. Use of fragrances is usually a matter of personal choice by individual employees, rather than a business or employment policy. In most circumstances, it would not be "reasonable" to require an employer to regulate such personal choices by its employees.

cc: FOIA


-2I hope this information is helpful to you and fully responds to your inquiry. Sincerely,

John L. Wodatch Chief Public Access Section


XX XX Cincinnati OH XX XX November 28, 1994 United States Department of Justice Title III, ADA P.O. Box 66738 Washington, D.C. 20035-6738 Dear Sir or Madam: Enclosed is a letter which I recently sent to the University of Cincinnati Medical Center due to a lack of any effort on their part to accommodate my special needs. I am disabled due to Multiple Chemical Sensitivity which I developed after

years of exposure to solvents while in the printing business. Due to this condition, I become very ill when exposed to fragrances, tobacco odors, chlorine, Phenol, petroleum products and many other Volatile Organic Compounds. I am a very reasonable person and realize that VOC's are necessary for many businesses to provide the products and services that keep our economy going. However, to request personnel of a specific department to refrain from wearing fragrances on one a specific day so that a person with MCS can have access to medical care, and to be mocked is reprehensible. Please advise if access to medical care is covered under the Americans with Disabilities Act, and if asking medical providers to have their personnel to refrain from using fragrances on a specific day that services would be provided to a MCS sufferer is an unreasonable request. Sincerely, XX XX

01-03626 XX XX Cincinnati OH XX XX November 16, 1994 University of Cincinnati Medical Center Mr. Jack Cook, CEO 234 Goodman Street, ML 0700 Cincinnati, Ohio 45267 Dear Mr. Cook: I write today out of concern for all patients with disabilities having a need for access to medical services at your facilities. The perception of those

being disabled and needing some special accommodations often seems to be limited to those restricted to wheel chairs or without sight; disabilities that one can be aware of quickly and visually. There are many other cases when individuals are in need of special services or accommodations that may not be so apparent. These disabilities include, but are not limited to, persons with speech problems, heart and breathing problems, which may be accommodated in most instances with a minimum of courtesy and inconvenience. In addition to normal inhalant allergies and asthma that are suffered by many, I am disabled due to a condition most frequently called Multiple Chemical Sensitivity Syndrome, (MCS). Individuals with this condition have strong reactions to chemical exposures, usually Volatile Organic Compounds, (VOC's), which may cause a variety of symptoms including respiratory difficulties, raising of blood pressure, coughing, choking, gagging, vomiting, numbness & pains in extremities or torso, dizziness, and mental confusion along with more typical allergic symptoms. Common irritants which effect me are; perfumes and other fragrances; exhaust and petroleum products; smoke odors, active or residual, from cigars, cigarettes and fireplaces; aerosol cleaners and propellants; cleaning products including phenol and pine tar products; chlorine; alcohol; new carpeting and composite wood products. Some of these I will agree are very hard to avoid and eliminate from all environments, however irritants such as fragrances can and should be easy to avoid for allergic and irritated patients in a medical setting. Although I have had a multitude of milder problems while attempting to receive medical care which I will lightly elaborate on a little later, the main incident which has caused me to write concerns the Oral Surgery Department and a total disregard for my needs as a disabled patient. On the afternoon of September 27, 1994, after being advised by my dentist that I should have a tooth removed by an oral surgeon, I called the Oral Surgery Department in the Medical Subspecialties Building and explained my situation and need to have the area fragrance free for the day I would have Oral Surgery. I truly felt that since you were a hospital setting where I had received most of my medical attention over the past few years, and all departments would have access to my medical records, that some attempt to accommodate me would be routine. 01-03627 I was promptly told in a very nasty, huffy tone, that not being able to wear perfume would be a violation of the employees personal rights. I responded to her attitude with a statement that; "I believed the Americans with Disabilities Act would consider not being able to wear perfume on one day after being requested for a specific patient a reasonable accommodation. I felt this was especially so since this was a medical necessity, not just an

inconvenience." I was quickly promised that the department head would call me back later that afternoon. On Thursday, September 29, 1994, after my appointment at the allergy/asthma clinic on the third floor, I went down to the Oral Surgery Department to attempt to explain further what the problem was, and try to get an appointment to have my tooth removed. Upon my entry and initial start of explanation to the two receptionists, one being a black woman and one being a white woman, the black woman immediately left stating; "I'm going to get out of here!" I proceeded to try to talk to the white woman in an atmosphere of overpowering fragrance that was not relieved by the handkerchief I was trying to use to filter the air as I would inhale. Her attitude continued to prevail, as I was choking and gagging in an effort to talk to her. She finally said she would have her chief call me the following day, stating a note was still attached to her computer. Her "chief" was said to have been out for meetings the past few days which was why I had not been called back as previously promised. As I left the reception area and started to try to breathe non-contaminated air, I continued to choke and had to run to the restroom to vomit & catch my breath. Once I regained most of my composure, I went back upstairs to have a nurse in the allergy clinic check my BP and Peak Flow for comparison to before the exposure and then I left. As of this date, I have still not received any type of contact, appointment or explanation, from anyone in the UCMC Oral Surgery Department. In my frustration, I started calling other area Oral Surgeons the next week with an explanation of my problem and found one where a nurse was also fragrance sensitive. I had my tooth removed at his office without any additional problems. What makes this experience even more frustrating is the fact that I have been told by other hospital employees on numerous occasions that hospital policy states perfumes are not to be worn, especially where anesthesia is in use because so many people have problems when under the effect of an anesthetic. A previous situation that was frustrating occurred on July 19, 1994, and involved the Hand Surgery Department and the Same Day Surgery Department at Holmes. I had been scheduled for Carpal Tunnel surgery on my left wrist and had taken great pains to explain to the nurse the problems I have when exposed to perfume and alcohol when interviewed on the phone prior to the scheduled surgery date. I also requested if at all possible to use zephryne or iodine if a topical cleaning agent was needed and to have everyone refrain from wearing perfume the morning of the surgery. After assuring me that perfume was already a no-no in a surgical area anyway, she said she would make extra notes to be sure

no-one wore anything the day of my surgery. She also had me call the surgeon's office to go over my problems and medications with his office. I spoke directly with the surgeon's nurse, after which she spoke to the doctor and called me back stating everything would be OK. On the morning of the surgery, my first exposure that caused problems was when the assisting surgeon entered with a strong residual odor of tobacco smoke on him. He assured me that after he scrubbed and wore a mask, I wouldn't have a problem. Shortly after this, the scrub nurse came

01-03628 in to take me into the OR with a very strong odor of perfume that caused immediate breathing problems. I had to ask her three times to leave because I couldn't breathe with the irritation of her perfume. Notations had been made on my chart, however this nurse had apparently been off for a few days and had not been advised. The lead surgeon then came in and canceled my surgery due to his fear of my going into respiratory distress, and the fact that I still had feeling in my fingertips most of the time. I had actually been a little relieved for the cancellation of the surgery since I didn't feel all of my pains & cramps in my arms and hands are related to carpal tunnel. Many of them involve my forearms and upper arms and seem to frequently occur after an exposure. Although frustrated that a seemingly simple request for accommodation had not been considered important enough to see that it was carried out. The most frustrating part of this incident was the fact that billings were still sent out to Medicare and Medicaid for services that were aborted due to hospital errors. I am also frustrated that some personnel in the Allergy/asthma Department are allowed to wear perfumes and use scented lotions. There are many others in the waiting room each Thursday with allergies that have reactions to fragrances. Their reactions may not be as severe as mine, but it's enough that they remark about it in the waiting area. On one hand I would like to commend you on making the entire facility smoke free, however on the other hand to allow smoking just outside the doors of the buildings also presents a problem for those irritated. This is especially so for the walkway between the Main Clinic building and the Medical Subspecialties Building. Additionally, allowing vehicles to idle just outside the sliding doorways near the Outpatient Pharmacy is a problem on a regular basis when it's cool outside. Please realize, I have to take great steps in my routine daily activities to

avoid exposures that cause problems, and I always have to be aware of how I can escape to clean air should a person with cologne or perfume enter an area. I also realize that I cannot force the entire world to adapt just for me, so that I may function and travel about without risk of exposure. However, there are many individuals that have similar reactions or allergies to fragrances, and medical care is one area that should make that extra little effort to accommodate all disabilities. I still can't believe the attitude that was displayed by the woman in the Oral Surgery Department, or that the some individuals in the Allergy Department are permitted to wear fragrances regularly when they are very aware of the problems it may cause. Sincerely, XX cc Department Head, UCMC Oral Surgery Dept. United States Department of Justice, re: ADA Title III 01-03629