# 68


III-4.3200                              January 15, 1993








W. Yates Trotter, M.D.
The Internal Medicine Group, Ltd.
National Avenue Medical Building
1900 S. National Avenue
Suite 2200
Springfield, Missouri  65804-2275

Dear Dr. Trotter:

     This letter is in response to your inquiry concerning the
responsibilities of medical offices under the Americans with
Disabilities Act of 1990 (ADA).

     The 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 you in understanding the ADA's requirements. 
However, it does not constitute a legal interpretation and it is
not binding on the Department.

     Title III of the ADA requires public accommodations,
including medical offices, to ensure effective communication with
persons with disabilities.  To ensure effective communication, a
medical office may be required to provide auxiliary aids to an
individual with a disability.

     Medical offices must provide the above auxiliary aids or
services to persons with disabilities, if such an auxiliary aid
or service is necessary for effective communication, unless doing
so would constitute a fundamental alteration of the service or an
undue burden to the public accommodation.  In cases involving
medical treatment, writing and notetaking may provide effective
communication in routine situations, but a qualified interpreter
or other auxiliary aid may be necessary in others to allow for
informed treatment recommendations and decisions.  While the
ultimate choice of the means of communication rests with the
physician, the regulation strongly encourages a doctor to consult
with a patient before providing a particular aid or service, to
determine the most appropriate way to ensure that communications
are in fact effective.  The medical office may be held liable for
an ADA violation if the communication is not effective for that
person with a disability.  A medical office may require
reasonable prior notice of the need for an auxiliary aid or
service, depending, among other things, on the exigency of the
treatment.

     Further discussion of provision of auxiliary aids and
services appears in section 36.303 of the enclosed title III
regulation, at page 35597, and in the preamble discussion of that
section, at pages 35566-68.  Further explanation appears at pages
25-27 of the enclosed Title III Technical Assistance Manual. 
Please also consult the definition of "qualified interpreter" in
section 36.104 of the regulation, at page 35594, and in the
preamble discussion at page 35553.

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


                                   Sincerely,




                                John L. Wodatch
                                     Chief
                             Public Access Section

Enclosures (2)

cc:  Congressman Mel Hancock