NOV 20 1992


Ms. Sheri L. Mabey
Office Manager
2059 E. Sahara, Suite C
Las Vegas, Nevada 89104

Dear Ms. Mabey:

        This letter responds to your inquiry regarding the provision
of an interpreter for a hearing-impaired patient.

        The Americans with Disabilities Act (ADA) authorizes the
Department of Justice to provide technical assistance to
individuals having rights or obligations under the Act. This
letter provides informal guidance to assist you 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 a physician to furnish auxiliary aids and
services when necessary to ensure effective communication, unless
an undue burden or fundamental alteration of the physician's
services would result. What constitutes effective communication
depends upon the facts of each situation, including the length
and complexity of the communication involved. For instance, a
discussion of whether to undergo major surgery may require the
provision of a qualified sign language interpreter, while a
routine office visit may not. While the physician is encouraged
to consult with the patient in determining what is needed to
ensure effective communication, the ultimate decision as to what
measures to take to ensure effective communication rests with the
physician. Thus, a hearing-impaired patient cannot insist or
require that an interpreter be provided at the physician's
expense in every situation.

        Relevant ADA provisions appear in section 36.303 of the
enclosed ADA title III regulation at page 35597, and related
discussion is found in the preamble to the regulation at page
35553. In response to your particular inquiry, please note that
use of family members as interpreters should be approached with

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caution, as discussed on page 35597 of the preamble. Also
enclosed is the Department's Title III Technical Assistance
Manual. Pertinent discussion appears at pages 25-28.

        I hope this information is helpful to you.

                                        Sincerely,

                                     John L. Wodatch
                                          Chief
                                  Public Access Section
                                  Civil Rights Division

Enclosures (2)

cc: The Honorable Harry Reid
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                                R. Garn Mabey, Jr., M.D.
                               Obstetrics and Gynecology
                                2059 E. Sahara, Suite C
                                Las Vegas, Nevada 89104
                                    (702) 369-4200

                                     July 30, 1992

Donnie Loux
Nevada Developmental Disabilities Council

Dorothy Porther, Director
Equal Employment Opportunity Commission

RE: Hearing Disabled Patients

Dear Mr. Loux:

Last Friday Sami from your council contacted me to discuss my
payment arrangements for an interpreter for one of our hearing
impaired patients. He informed me at that time that it was
Federally mandated that I pay for this interpreter.

After reviewing the file with the office staff and Dr. Mabey, it
was apparent that the patient did not need an interpreter present,
but because in the past it was something she did not have to pay
for, she would continue to request that service. The patient has
been coming to our office for over two years; this is the second
pregnancy Dr. Mabey has taken care of her for; she has a mother-in-
law, husband and brother who can all communicate to her if there is
a problem, and at least one or more is present at each visit, and
on prior visits, the interpreter was there as well.

Dr. Mabey can communicate with her without any interpreter--family
member, etc., present. Her visits at our office are for routine
pregnancy care--they are straightforward and direct. Dr. Mabey's
questions to her can be easily answered by pen and paper if
needed.

After reviewing some of the guidelines from the Washington office
and Senator Reid's office locally, we have complied with all needed
requirements with respect to this patient.

As I explained to Sami, the cost for us to provide this service to
a patient would exceed the amount we would be reimbursed for Dr.
Mabey's time and expertise. This would place an undue hardship
on our office in that we would not only be providing an interpreter
free of charge, but her care as well. This is against the ADA
guidelines.

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July 30, 1992
Page 2
RE: Hearing Impaired Patients

A standard office visit for a new patient, after being reimbursed
by the carriers, would mean approximately $10-15 of income for that
patient if we were required to pay for an interpreter. On a
pregnant patient, for the 10-12 visits prior to their delivery, the
delivery time and postpartum care, it is possible that the
interpreter's fee alone could be over two-thirds of the amount
reimbursed for the total nine-months of care provided by Dr.
Mabey. This seems to be an extreme hardship--especially in light
of the fact that there are family members, in this particular case,
that are able and willing to provide that service at no charge.

You should also note that patients frequently are late, and forget
to call to cancel their appointments. This patient was over 30
minutes late for the appointment Sami wanted me to pay for an
interpreter.

We believe we have made every effort to reasonably accommodate all
patients.

                                        Sincerely,

                                        Sheri L. Mabey
                                        Office Manager

cc: Senator Harry Reid
    John Wodatch, Director, ADA

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