202-PL-00009                                   JUN 11 1992


Richard J. Sagall, M.D.
Post Office Box 1069
Bangor, Maine 04402-1069

Dear Dr. Sagall:

     This letter responds to your correspondence requesting
information about the provisions of 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. However, it does not constitute a legal interpretation and
it is not binding on the Department.

     You have inquired whether a health care provider may fulfill
the obligation under the ADA to ensure effective communication
with a hearing impaired patient by requesting a family member to
interpret or by using written communication or communication via
a computer screen.

     The ADA requires health care providers to make available
appropriate auxiliary aids and services in order to ensure
effective communications. Communication through written notes,
communication via computer, and providing sign language
interpreters are all considered auxiliary aids and services
within the meaning of the ADA. However, a note pad or computer
screen may not be sufficient to provide "effective" communication
in all circumstances, especially in a doctor's office when a
matter of significance is being discussed. The appropriateness
of a particular type of auxiliary aid or service will depend on
the nature of the services being delivered -- for example, giving
a flu shot versus discussing options for surgery. Effective
communication is required and the means to provide that will vary
depending on the length and complexity of the communication
involved.

cc:  Records Chrono Wodatch Magagna.p1.9 Beard
     arthur T. 6/8/92

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                                   - 2 -

     Asking a family member to interpret for a person with a
hearing impairment may be inappropriate because of factors such
as emotional or personal involvement or considerations of
confidentiality that may adversely affect the ability to
interpret effectively.

     We encourage health care providers to consult with their
individual patients having hearing impairments to ascertain what
will be effective for each of them in particular circumstances.

     A health care provider is not required to provide any
auxiliary aid or service that would result in an undue burden,
i.e., significant difficulty or expense. Although a health care
provider may not charge individuals for the auxiliary aids and
services provided to them, the costs can be spread to all
patients, just as other overhead expenses are. Among the factors
to be considered in determining whether providing a particular
auxiliary aid will cause an undue burden are the nature and cost
of the service and the resources available to the care provider.
If providing a particular aid or service would be an undue
burden, the health care provider must provide an alternative
auxiliary aid or service that is not such an undue burden and
that ensures effective communication to the maximum extent
feasible.

     I enclose a copy of the Department's Title III Technical
Assistance Manual which may further clarify your obligations
under Title III.

     We hope that this information is useful to you in evaluating
your obligations under the ADA.

                                   Sincerely,

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

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                              Family Health Care
Richard J. Sagall, M.D., F.A.A.F.P.                    358 Broadway, Suite 105
     Family Practice                                   P O Box 1069
                                                       Bangor, ME 04402-1069
                                                       207-941-8300
                                                       207-947-3134 (FAX)

January 23, 1992

OADA
Civil Rights Division
U. S. Dept. of Justice
PO Box 66108
Washington, DC 20035-6118

Dear Sirs:

I am writing in need of verification of one aspect of the Americans with
Disabilities Act. I am a Family Physician practicing in an office with
handicap accessibility.

I am writing concerning the requirements for equal accessibility for the
hearing impaired. A local agency interpretation of the ADA is that I, as a
physician, am required under the Americans with Disabilities Act to arrange
and pay for the presence of a sign language interpreter in the office whenever
a deaf patient is being seen. They feel that written communication or
communication via a computer screen does not meet the requirements of the
act.

In the past deaf patients have usually brought a family member or an
interpreter provided by a local agency to assist with communication. Many
times, when an interpreter is not available, we have communicated in the ways
mentioned above without difficulty.

As I understand it, the Act requires modifications unless it results in an
undue burden. Since most physicians see a limited number of deaf patients, and
paying for the services of an interpreter would result in the health care
provider spending more money for the visit than he or she gets paid, I am
wondering if the local agency's interpretation is correct?

I would appreciate your input on this issue.

Sincerely yours,

Richard J. Sagall, M.D.

RJS:rjp

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