12-10-93

202-PL-574
5 1993
Mary Pell, D.O.
INTEPMED
990 44th Street S.W.
Wyoming, Michigan 49509

Dear Dr. Pell:

I am responding to your letter asking for information about

the requirements of title III of the Americans with Disabilities
Act (ADA), and this Department's regulation implementing title
111. Specifically, you have asked if a health care provider is
required to provide a sign language interpreter for a patient who
is deaf or hard of hearing if effective communication can be
achieved through other means.

The ADA authorizes the Department of Justice to provide

technical assistance to individuals and entities that are subject
to the Act. This letter provides informal guidance about the
obligation of a health care provider to provide auxiliary aids;
however, this technical assistance does not constitute a legal
interpretation of the statute, and it is not binding on the
Department.

The ADA requires public accommodations, including

physicians, to furnish appropriate auxiliary aids and services
where necessary to ensure effective communication with
individuals with disabilities. In determining what constitutes
an effective auxiliary aid or service, a physician must consider,
among other things, the length and complexity of the
communication involved. For instance, a notepad and written
materials may be sufficient to permit effective communication
when a physician is explaining possible symptoms resulting from a
simple laceration. Where, however, the information to be
conveyed is lengthy or complex, the use of handwritten notes may
be extremely slow or cumbersome 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 an treatment options for
cancer. Further discussion of this point may be found on page

cc: Records, Chrono, Wodatch, Blizard, FOIA Friedlander

n:\udd\blizard\adaltrs\pell

01-02820

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35567 of the preamble to the enclosed regulation. While the

nature of medical services is considered one factor in
determining what auxiliary aid is necessary for effective
communication, the focus should be not only on the nature of the
services, but also on-the type of communication between the
physician and the patient.

Interpreters are not usually needed for routine office

visits. However, an interpreter may be required for routine
visits, if a note pad does not provide effective communication
between the physician and the patient. For example, if your
patient's routine care includes regular office visits at which-
you record her blood pressure and weight, exchanging notes is
likely to provide an effective means of communication. But, if
your patient's routine visit involves a thorough examination and
a battery of tests which should be discussed, you should be
prepared to arrange for the services of a qualified interpreter,
as an interpreter is likely to be necessary for effective .
communication with your patient, given the length and complexity
of the communication involved.

I am enclosing a copy of this Department's regulation

implementing title III and the Title III Technical Assistance
Manual. I hope that this information is helpful to you.

Sincerely,
 John L. Wodatch
Chief
Public Access Section

Enclosures

01-02821