steven p. rosenberg, m.d., p.a.
                          elaine zoberman-saltiel, m.d,
                          DIPLOMATES OF THE AMERICAN BOARD OF DERMATOLOGY
                          FELLOWS OF THE AMERICAN ACADEMY OF DERMATOLOGY
August 2, 1993

Congressman Clay Shaw
1512 East Broward Boulevard
Ft. Lauderdale, FL 33301

Dear Congressman Shaw:

I would appreciate your helping to clarify a matter that developed 
today in reference to our compliance with the Americans with 
Disabilities Act.  I have supported the principles and concepts of the 
ADA, but as a result of some confusion today I realize that this is a 
complicated issue.

Specifically, a patient was provided an appointment who is hearing 
impaired and she demanded that we provide an interpreter.  The legal 
advice that I was able to receive from the Florida Medical Association 
indicates that we are required to "ensure effective communication".  I 
have been practicing for approximately fifteen years and have taken 
care of numerous patients with various disabilities.  In the past we 
have never had difficulty by communicating with written notes in those 
individuals who are hearing impaired.  The nature of the dermatology 
practice is such that the majority of issues are relatively 
straightforward and can be handled efficiently in this fashion.  As 
there appears to be some confusion between the patient's demands and 
the legal advice that I had received which indicates that such notes 
should be acceptable unless the physician feels otherwise, I would 
appreciate clarification.

I would also like to point out that the cost for obtaining an 
interpreter have minimum charges of between $60.00-$75.00.  An initial 
office visit is $50.00 and as you are aware, many third party payers 
including Medicare reimburse office visits in the $22.000-$40.00 range.  
This would result in a net loss per patient visit in a situation where 
our overhead costs are already astronomical.  

I am curious whether this places an "undue burden" according to the 
definitions of the act.

In addition, I would like to know whether we can bill the patient for 
the cancellation fee that the interpreter charges should the patient 
fail to keep their appointment.  The interpreter services indicated 
that if the services are not cancelled with twenty four hour notices 
that there is a charge and that we would be responsible for the full 
amount even if the patient does not show.  I understand my financial 
responsibility to provide this service for the hearing impaired but I 
am also concerned that there may opportunities where patients cancel at 
the last minute or do not show and therefore these costs would not be 
associated with my actually providing an office visit.  
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Finally, I would like to know whether third party payers including 
Medicare will reimburse for interpreter services and if so, more 
specifically how should we go about obtaining such payment from 
Medicare.  

Your prompt help and cooperation would be appreciated. Please do not 
hesitate to contact me by phone should that be necessary.  You may also 
fax information to me at 407/640-8098.

Sincerely, 

Steven P. Rosenberg, M.D.

SPR/dm












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