T.

7-1-94

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

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Mr. 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

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