JUN 29 1992

DJ 202-PL-186

Leonard Perez, M.D.

503 W. Columbus, Suite B
Bakersfield, California 93301

Dear Dr. Perez:

This responds to your request for information about the

Americans with Disabilities Act (ADA). The ADA authorizes the
Department of Justice to provide technical assistance to
individuals and entities having rights or obligations under the
Act. This letter provides informal guidance to assist you in
understanding the ADA accessibility standards. However, it does
not constitute a legal interpretation and it is not binding on
the Department.

You inquire about your obligations to provide a sign

language interpreter when you are treating deaf patients.

The ADA requires health care providers to provide auxiliary

aids and services where necessary to communicate effectively with
their patients with speech, hearing and vision impairments. Sign
language interpreters and communication via pen and paper are
both types of auxiliary aids and services. A health care
provider can choose among various alternatives as long as the
result is effective communication. Whether a particular aid or
service will provide effective communication in a particular
circumstance depends on the nature and complexity of the
communication involved. While a routine appointment for a simple
and familiar treatment procedure might not require the services
of an interpreter, a lengthier appointment to discuss diagnosis
and treatment options might well necessitate such services.

A health care provider cannot charge the patient with a

disability for the cost of providing a particular auxiliary aid
or service. However, such costs can be treated as any other
overhead costs and passed along to all patients.

A health care provider is not obligated to provide a

particular auxiliary aid or service if doing so will cause an
undue financial burden. In such a case, however, alternative
cc: Records Chrono Magagna.pl.186 arthur T. 6/26/92

01-00980
​ -2-

auxiliary aids or services that will not cause such a burden must
be provided. The factors to be considered in determining whether
there is an undue burden include the cost and nature of the
service, the size and resources of the covered entity and the
number of employees.

I have enclosed a copy of the Department's recently

published Technical Assistance Manual which may further assist
you in understanding your obligations under the ADA. I hope this
information will be useful to you.

Sincerely,

Joan A. Magagna
Deputy Director
Office on the Americans with Disabilities Act
Civil Rights Division

Enclosure

01-00981
​ Leonard Perez, M.D.
ILLEGIBLE

May 15, 1992

U.S. Department of Justice

Americans with Disabilities
P.O. Box 66118
Washington DC 20035-6118

Re: LAW REQUIRING THE PROVIDING OF A SIGNING INTERPRETER FOR

THE
DEAF

I have recently become aware of the new law that states one
must provide a signing interpreter for a deaf person if one is to
provide services to them. I understand that this is at the expense
of the one providing the services. Some of the documents that I
have read, states that one is not obligated to provide this service
at ones expense if it causes a financial burden on the business.
I am in a part-time private medical practice in my community
in the specialty of Obstetrics and Gynecology. I have several deaf
patients in my practice, all of which I have communicated with on
paper quite well. The interpreting services charge $40.00 per
hour, with a minimum of one hour of service. Many of my patients
are recipients of Medi-Cal (Medicaid). Medi-Cal pays me $14.78 for
a return visit whether I spend 10 minutes or one hour with the
patient. As you can see, in addition to having to pay for my
office and office staff, I must pay $25.22 (40.00-14.78) in order
to see this patient. This would put a financial burden on my
practice by creating a negative cash flow.

IN THIS SITUATION, WOULD I STILL BE LEGALLY OBLIGATED TO

PROVIDE AN INTERPRETER AT MY EXPENSE FOR THESE PATIENTS?

Sincerely,

Leonard Perez, MD

01-00982