MAR 16 1994






The Honorable Terry Everett
U.S. House of Representatives
208 Cannon House Office Building
Washington D.C.  20515

Dear Congressman Everett:

     This letter is in response to your inquiry on behalf of your
constituent, Dr. Larry T. Howell, concerning the provision of
auxiliary aids or services for persons with disabilities. We
apologize for the delay in responding to your inquiry.

     The ADA requires public accommodations, including dentist's
offices, 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 dentist 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 dentist is explaining
routine dental procedures. Where the information to be conveyed
is lengthy or complex, however, handwritten notes may be
ineffective 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. Further discussion of this point may
be found on page 35567 of the preamble to the enclosed
regulation. While the nature of the dental 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 dentist and the patient. Generally,
interpreters are not needed for routine office visits. However,
the fact that an office visit is characterized as routine does
not necessarily negate the need for interpreting services.  For
instance, an interpreter may be required if a notepad does not







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facilitate effective communication between the dentist and an
individual who is undergoing a complete dental examination and
related testing procedures.

     Under section 36.301(c) of the regulation, when an
interpreter or other auxiliary aid or service is necessary to
ensure effective communication, the dentist 'must absorb the cost
for this aid or service. As provided in section 36.303(f),
however, the dentist is not required to provide any auxiliary aid
that would result in an undue burden. The term "undue burden"
means "significant difficulty or expense." Undue burden must be
determined on a case-by-case basis in light of factors such as
the nature and cost of the aid or service, and the overall
financial resources of the practice. Further discussion of the
meaning and application of the term undue burden may be found in
the preamble discussion of section 36.303, on pages 35567-35568.

     In determining whether the provision of an interpreter would
result in an undue burden, the dentist should consider not only
the fees paid for providing the dental service or procedure, but
also the overall financial resources of the practice. The
dentist 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).

     The Department's Technical Assistance Manual for title III
(copy enclosed) at page 26, and the ADA's legislative history, as
described in the regulation's preamble, at pages 35566-35567,
strongly encourage consultation with persons with disabilities in
order to determine which particular auxiliary aid or service will
ensure effective communication. Not only will consultation
ensure that equal services are provided to individuals with
disabilities, it may also significantly reduce the costs of
providing such auxiliary aids or services.

     Dr. Howell's letter also raises the issue of whether an
outside agency such as the Alabama Institute for the Deaf and
Blind may charge a public accommodation for the use of an
interpreter that was not discussed with or authorized by that
public accommodation. Clearly, the auxiliary aid provisions of
the ADA (cited above) do not contemplate that a person with a
disability can unilaterally decide on the appropriate type of
auxiliary aid. Further discussion on this point can be found in
the enclosed January 1993 update to the Department's Title III
Technical Assistance Manual (copy enclosed) at page 5.




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

                             Sincerely,



                          James P. Turner
                   Acting Assistant Attorney General
                        Civil Rights Division

Enclosures





























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