APR 15 1994






The Honorable Charles Grassley
United States Senate
Washington, D.C. 20510-1502

Dear Senator Grassley:

     This letter is in response to your inquiry on behalf of your
constituent, John H. Roberts, M.D., regarding the provision of
interpreters during office visits to his patients with hearing
impairments.  Specifically, your constituent was concerned about
the costs of providing such interpreters.

     Title III of the Americans with Disabilities Act (ADA), 42
U.S.C.   12181-12189, prohibits discrimination on the basis of
disability by places of public accommodation. The professional
office of a health care provider is a place of public
accommodation subject to the requirements established in this
Department's regulation implementing title III, 56 Fed. Req.
35544 (July 26, 1991).

     Title III of the ADA requires physicians to furnish
appropriate auxiliary aids and services where necessary to ensure
effective communication with individuals with disabilities,
unless doing so would result in an undue burden, or would
fundamentally alter the nature of the service provided. What
constitutes an effective auxiliary aid or service will vary
depending on the unique facts of each situation. The particular
communication needs of the individual and the nature of the
communication involved, including features such as length and
complexity, will determine which auxiliary aid or service is
required.

     An interpreter is not, therefore, mandated in every office
visit situation. In some circumstances involving short, simple
communication, a health care provider may satisfy the auxiliary
aid or service requirement by using a note pad and written



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materials. At the other extreme, discussion of whether to
undergo major surgery is a prototypical situation in which an
interpreter will be required for someone who needs one. The
regulation envisions a wide range of situations involving health
matters that may be sufficiently lengthy or complex to require
the provision of an interpreter. Because effective communication
of symptoms or case history is an important diagnostic tool in
medical treatment, many office visits might require the provision
of an interpreter for someone who needs one.

      A doctor is not, however, required to provide an auxiliary
aid that would result in an undue burden. In determining whether
the provision of an interpreter would result in an undue burden,
the physician should consider not only the fees paid for
providing the medical service or procedure, but also the overall
financial resources of the practice. The physician should
consider other factors that would minimize the degree of burden
on the practice, such as the ability to spread costs throughout
the general clientele and the provision of tax credits for costs
of providing auxiliary aids (which is available for eligible
small businesses).

      We hope that this information is useful to you in addressing
the concerns of your constituents The flexibility of the
auxiliary aids requirement, the undue burden limitation, and the
ability to spread costs over all patients should minimize any
burden on the medical profession.

      For your information I have enclosed a copy of the
Department's regulation implementing title III and our Title III
Technical Assistance Manual. A public accommodation's obligation
to provide auxiliary aids is addressed in section 36.303 of the
regulation, in the preamble to section 36.303 (pages 35565-
35568), and in section III-4.3000 (pages 26-30) of the technical
assistance manual.

                                    Sincerely,



                                 Deval L. Patrick
                            Assistant Attorney General
                               Civil Rights Division

Enclosures
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