DJ 202-PL-802

FEB 16 1995

Kenneth M. Hrechka, D.D.S.

6130 Oxon Hill Road
Oxon Hill, Maryland 20745

Dear Dr. Hrechka:

This letter is in response to your inquiry concerning your

obligations to provide interpreter services for deaf patients.

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
ADA. 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 issues and concerns raised in your letter relate most

directly to the auxiliary aids and services provisions of title
III. Such aids and services are measures that are undertaken to
ensure "effective communication" for individuals with impaired
speech, hearing and/or vision, as well as those who are
profoundly deaf. The auxiliary aids requirement is intended to
be flexible, reflecting the variable nature of what constitutes
"effectiveness" in any particular situation.

In addition to the specific nature of the disability

involved, factors used to determine communication effectiveness
in any given circumstance include the length, complexity and
importance of the information being exchanged. In your practice,
for example, printed information and the exchange of handwritten
notes might provide effective communication during routine
appointments to adjust wires or check treatment progress.
However, during appointments scheduled to discuss treatment
options, or unexpected alterations necessary to the treatment
plan, the use of printed information and handwritten notes may

cc: FOIA
01-03616

not prove effective and the use of an interpreter may be

necessary. Further discussion of this point is found on page
35567 of the enclosed title III regulation.

Ideally, the determination of which particular auxiliary aid

or service will ensure effective communication in a given
situation is reached through a process of consultation between
patient and practitioner. 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. The enclosed Department of Justice
ADA Title III Technical Assistance Manual provides additional
guidance on page 26.

Under section 36.301 (c) of the ADA title III regulation,

when an interpreter or other auxiliary aid or service is
necessary to ensure effective communication, the medical or
dental practitioner must absorb the cost of this aid or service,
unless this would result in an undue burden. As provided in
section 36.303(f), the term "undue burden" means "significant
difficulty or expense". In determining whether providing a sign
language interpreter or other auxiliary aid or service, would
result in an undue burden, the practitioner should consider the
overall financial resources of the practice, not just the fees
paid for a particular procedure or treatment session.

Consideration should be given to other factors that would

minimize the degree of burden on the practice, such as the
ability to spread costs throughout the general patient population
and the provision of tax credits for small businesses for costs
incurred to provide auxiliary aids. Eligibility criteria for
this credit are found in publication 907, available from the IRS.

Your letter also raises the question of how to obtain

interpreter services. Most states have a Deaf Services Center,
or similar office, which can provide referral services for you.
In those circumstances where interpreter services are required to
ensure effective communication, the interpreter must be
"qualified".

As defined in the enclosed regulation, a "qualified

interpreter" has the ability to interpret "effectively,
accurately, and impartially, both receptively and expressively,
using any necessary specialized vocabulary." Further discussion
of this issue may be found in the ADA Title III Technical
Assistance Manual at III-4.3200.

01-03617

I trust that this information, along with the enclosures,

will be helpful to you and your patients with disabilities.

Sincerely,

John L. Wodatch
Chief
Public Access Section

Enclosure
Title III Regulations
Title III Technical Assistance Manual
01-03618

March 10, 1994

Association of Disabilities Act

Department of Justice
Civil Rights Division
P. O. Box 65310
Washington, DC 20025-1530

Dear Association of Disabilities Act,

I am an orthodontist, treating a woman, who is deaf. My office

receptionist and I have tried to reach you by phone for over three
weeks, calling every hour of the day. Apparently, your employees
are overworked as your lines are always busy.

I need important information answered by you, which I can not

obtain from the legal office of the American Dental Association re:
disabled Americans. I operate a small professional business. I
have treated deaf patients before without any difficulty. (They
could read lips or we would exchange written notes). Currently,
I am told I may be required to supply an interpretor for a deaf
patient. Is this true? Are they available as a service through
local government, social work-like organizations? Does the small
business or deaf individual pay for the interpretor? Orthodontic
treatment usually requires 24-36 appointment visits. The cost of
a sign interpretor for this number of visits would greatly exceed
all total costs I would charge, prior to considering expenses, for
the orthodontic service I am providing.

I have never been asked to provide this service before. If

rules and regulations exist, could I be given the existing laws along
with the status number and a copy of the same.

Please, I wish to be informed of individual's, patient's,

doctor's and small businessman's rights. I have been referred to
you for assistance.

Thank you in advance for your time and consideration.

Sincerely,
Kenneth M. Hrechka, DDS
KMH/ms
DIPLOMATE, AMERICAN BOARD OF ORTHODONTICS
01-03619