North Carolina Psychiatric Association
4917 Waters Edge Drive #250 Raleigh,North Carolina 27606 919/859-3370 or
919/951-0067 

April 5, 1994

The Honorable Jesse Helms
Dirksen Building Room 403
lst and C Streets, NE
Washington, DC  20510

Dear Senator Helms:

     I recall you expressed a number of concerns
regarding Title III of the Americans with Disabilities
Act. I have contacted the North Carolina Governor's Advocacy 
Council and the North Carolina Medical Society, and no one seems to 
have a definitive answer to a question I pose to your staff for research.

What is a reasonable accommodation?
     A Greensboro psychiatrist providing services to a deaf person has been
told that he, the psychiatrist, must provide an interpreter for the
psychotherapy session. We may assume it is for approximately 30-45 minutes.
The Service agency which provides signers (interpreters for a deaf person) 
charges for a minimum of two hours. The result is that the physician has a 
total loss (or more) of income from treating the individual. If the doctor
(particularly one in solo practice or in practice with one or two other
physicians) refuses to provide a service he can be charged with discrimination
on the basis of handicap. Are there "reasonable 
accommodation" guidelines on a threshold of size of the provider entity, such
as a clinic with 10 or more employees as opposed to one or two doctors who
share a nurse and secretary.

A second question relates to who determines what is a reasonable 
accommodation?

     Is it the health care provider or is it the patient?  The Medical 
Society staff person told me that a physician made inquiry after a patient 
insisted upon the doctor paying for an interpreter of the patient's choice.
Again, what is reasonable accommodation




















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Sen. Helms
April 5, 1994
Page 2 of 2

     If I can get some clear recommendations on this I
will plan to publish, with your permission, your staff's
response to these questions in our bi-monthly
newsletter.

      I thank you and your staff for any help you can
provide.  I'm sure you know that you and your staff have
a superb reputation for problem-solving on behalf of
your constituents.

     I look forward to a response.

Sincerely,



Katherine P. Hux, MPH
Executive Director

cc:  Dr. Michael Zarzar
     Dr. Roger Perilstein


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