JUN 28 1993

The Honorable J. Bennett Johnston
United States Senate
136 Hart Senate Office Building
Washington, D.C. 20510-1802

Dear Senator Johnston:

     This letter is in response to your inquiry an behalf of your 
constituents, the doctors at the Goodwood Woman's Center. The
physicians have asked whether they are required by the Americans 
with Disabilities Act to provide interpreters to their patients 
with hearing impairments when the cost of doing so exceeds the 
fee charged for an office visit.

     The Americans with Disabilities Act 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 your
constituents in understanding the Act's requirements. It does
not, however, constitute a legal interpretation, and it is not
binding on the Department.

     The Americans with Disabilities Act requires physicians to 
furnish appropriate auxiliary aids and services where necessary 
to ensure effective communication with individuals with 
disabilities. A physician may not impose a surcharge on any
particular individual with a disability to cover the costs of
measures, such as providing auxiliary aids, that are required by 
the Act. The applicable regulatory provisions appear in sections 
36.301(c) and 36.303 of the enclosed title III regulation, at
pages 35596 and 35597, respectively. Also enclosed are the
Department's Title III Technical Assistance Manual and the
January 1993 Supplement to the Manual, which may provide
further assistance to your constituents. Pertinent discussion may be
found in the Technical Assistance Manual at pages 22 (surcharges) 
and 25-28 (auxiliary aids)"

cc: Records; Chrono; Wodatch; McDowney; Bowen; Miller; FOIA,
MAF
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Under section 36.301(c) of the regulation, the cost of an 
interpreter must be absorbed by the doctor in circumstances when 
an interpreter is necessary. However, as provided in section
36.303(a), a doctor is not required to provide any auxiliary aid 
that would result in an undue burden, i.e., significant
difficulty or expense. 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 a 
medical provider.

What constitutes an effective auxiliary aid or service will 
depend upon the unique facts of each situation, including the
length and complexity of the communication involved. For
example, in some instances a doctor may satisfy the auxiliary aid 
or service requirement by using a note pad and written materials 
where a deaf patient is making a routine office visit. By
contrast, a discussion of whether to undergo major surgery will 
generally require the provision of an interpreter. Other
situations may also require the use of interpreters to ensure
effective communication, depending on the facts of the particular 
case. Further discussion of this point may be found on page
35567 of the enclosed regulation.

I hope this information will be helpful to you in responding to your 
constituents.

                                       Sincerely,





                                       James P. Turner
                                Acting Assistant Attorney General
                                      Civil Rights Division

Enclosures


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                            GOODWOOD 
                         WOMAN'S CENTER
                   OBSTETRICS AND GYNECOLOGY
       7662 Goodwood Blvd., Suite B-201 o Baton Rouge, LA 70806
          Office (504) 925-8261 o Ans. Service (504) 927-1300

February 19, 1993

Senator J. Bennett Johnson
United States Congress
Washington, D.C. 20510-1802

Dear Senator Johnson:

We are writing you over concerns regarding the recently passed 
Americans with Disabilities Act.  More and more today it seems that 
laws and regulations are being passed by government with little regard 
to the actual affects of these laws when put into practice.  The 
above stated Act requires that we provide a person fluent in sign 
language for all hearing impaired patients.  As we have recently 
learned the cost of providing such an interpreter is a minimum of 
$60.00

When seeing an obstetrical patient covered by Medicaid we are 
reimbursed $27.00.  For private pay patients the fee is $33.00.  Thus 
for each hearing impaired obstetrical visit, we will lose from $27.00 
to $33.00 not including overhead costs.  Where we as physicians are 
often asked or required to provide our services free of charge, we 
are now being required to pay to care for patients.

Prior to the act we have always provided medical care for the hearing 
impaired with little difficulty, however, now this is becoming 
financially impossible. With the rising costs of medicine being a 
real concern today, regulations such as the Americans with Disabilities 
Act will only serve to make matters worse.

Sincerely,


Michael T. Perniciaro, M.D.             Debra A. Baehr, M.D.



Renee S. Harris, M.D.                   Kathy H. Guidry, M.D.



Susan F. Puyau, M.D.                    

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