# 28


III-4.1400
III-4.3200


                                                 August 28, 1992




The Honorable Thomas J. Bliley, Jr.
U. S. House of Representatives
2241 Rayburn Office Building
Washington, D.C.  20515

Dear Congressman Bliley:

     This letter is in response to your inquiry on behalf of your
constituent, Dr. Paul E. Galanti, Deputy Executive Vice President
of the Medical Society of Virginia, regarding the cost of
providing auxiliary aids or services for persons with
disabilities.

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

     The ADA 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 ADA.  These provisions
appear in sections 36.301(c) and 36.303 of the enclosed ADA title
III regulation, at pages 35596 and 35597, respectively.  Also
enclosed is the Department's Title III Technical Assistance
Manual, which may provide further assistance to your constituent. 
Pertinent discussion may be found at pages 22 (surcharges) and
25-28 (auxiliary aids).

     Under section 36.301(c) of the regulation, the cost of an
interpreter must be absorbed by the doctor in the limited
circumstances when an interpreter is necessary.  However, as
provided in section 36.303(f), a doctor is not required to
provide any auxiliary aid that would result in an undue burden. 
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 the medical profession. 
     
     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.  Generally,
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 may require the provision of a
sign language interpreter.  Further discussion of this point may
be found on page 35567 of the enclosed regulation.    

     Dr. Galanti's letter raises a specific question involving
use of interpreters, concerning a deaf patient who brought a sign
language interpreter for an office visit and billed the doctor
for the cost of the interpreter.  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, make arrangements for the
auxiliary aid, and then bill the public accommodation for the
service.

     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 (2)