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​
-3-
I 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