T.

7-8-93
Control No. 3062413127

JUL 23 1993

The Honorable J. Bennett Johnston

United States Senate
Washington, D.C. 20510-1802

Dear Senator Johnston:

This letter responds to your inquiry on behalf of XX

XX concerning the obligations of private hospitals and
other health care providers under the American with Disabilities
Act of 1990 ("ADA"). In particular, xx has inquired
about the obligation of private hospitals to provide auxiliary
aids and services for her son who is deaf and who has sought
treatment for drug addiction.

The ADA authorizes this Department to provide technical

assistance to individuals and entities that have rights or
responsibilities under the ADA. Accordingly, this letter
Provides informal guidance to assist you in responding to XX
However, this technical assistance does not constitute
a legal interpretation and is not binding on the Department of
Justice.

Title III of the ADA, which became effective on January 26,

1992, prohibits discrimination on the basis of disability and
governs the operations of any private entity that owns, operates,
leases, or leases to a place of public accommodation, including a
hospital or other service establishment. Under title III, a
public accommodation is obligated to make available appropriate
auxiliary aids and services to ensure that communication with
individuals with disabilities is as effective as that with
nondisabled persons. The auxiliary aid requirement is a flexible
one and the type of auxiliary aid or service necessary to ensure
effective communication will vary in accordance with the length
and complexity of the communication involved.

In many instances, the exchange of written notes with a

person who is deaf will suffice to ensure effective
communication. In other instances, however, such as in therapy
sessions, group meetings or lectures described by XX
the use of other auxiliary aids or services may be required.
There are a wide variety of services and devices for ensuring
effective communication with deaf persons, e.g., qualified
interpreters, notetakers, computer-aided transcription services,
written materials, TDDS, and closed caption devices for TVs. The

cc: Records, Chrono, Wodatch, Delaney, McDowney, FOIA, Friedlander

n:\udd\delaney\congress\johnston

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use of the most advanced technology is not required as long as

effective communication is achieved. For further discussion of
this matter, see, e.g., section 36.303 of the enclosed title III
regulation and pages 35,565-68; and sections 4.3000-4.3600 of the
enclosed Title III Technical Assistance Manual at pages 25-28.
Public accommodations must be given the opportunity to consult
with the patient and make an independent assessment of what type
of auxiliary aid, if any, is necessary to ensure effective
communication.

Under the ADA, the term "individual with a disability" does

not include an individual who is currently engaging in the
illegal use of drugs. A public accommodation may not, however,
discriminate against an individual who is not engaging in current
illegal use of drugs and who "has successfully completed a
supervised drug rehabilitation program or has otherwise been
rehabilitated successfully; is participating in a supervised
rehabilitation program; or is erroneously regarded as engaging in
such use." See section 36.209(a)(2) of the title III regulation;
for further discussion, see also section 36.104 of the title III
regulation and pages 35,561-35,562.

The regulation also specifically provides that a public

accommodation shall not deny health services, or services
provided in connection with drug rehabilitation, to an individual
on the basis of that individuals current illegal use of drugs,
if the individual is otherwise entitled to such services.
However, it allows a drug rehabilitation or treatment program to
deny participation to individuals who engage in illegal use of
drugs while they are in the program. See section 36.209(b) of
the title III regulation, page 35,596, and particularly the
preamble discussion at page 35,561.

If a private entity receives Medicare or Medicaid

assistance, then it also is subject to section 504 of the
Rehabilitation Act of 1973, which prohibits discrimination on the
basis of disability in federally assisted programs and
activities.

I hope this information is helpful in responding to your

constituent.

Sincerely,

James P. Turner
Acting Assistant Attorney General
Civil Rights Division

Enclosures (2)

01-02467

Many years ago, when my children were very young, a man gave
some good advice, although it has not always been easy to follow.
He told me if I were not willing to fight for the rights of my
children, who would. You see, all three of my children were born
deaf. Neither my husband nor I are deaf. It was good advice then, it
is good advice now even if my children are grown.

My husband and I tried to teach our children to fight for their

rights themselves, and in most instances they can and do. I have
come to the conclusion that there are some things they don't have
the courage or knowledge to be able to fight alone. Someone must help.

Our son is thirty-two, our daughters are twenty eight and

twenty seven. Our children were fortunate, through many years of
teaching and hard work on their part, they are able to lip read and
communicate orally. Their speech is very good, sometimes too good.
People tend to think because they talk so well they can
hear. They can not. They are not hard of hearing, they are deaf!
There is a difference. They all wear hearing aids, so what little
residual hearing they have is amplified all it can be. To talk
louder or yell will not make them hear anymore, they must lip read
or have an interpreter.
 It is a hearing world they live in. There have been many changes
in technology in the past twenty years. There are many devices
available to help them in our hearing world. There are TDD's for
their telephones so they can talk to each other. There are special
alarm clocks to awaken them, flasher for fire alarms, door bells,
and telephones. Close caption devices for their television so they
can read the dialogue on close captioned programs and rental movies.
Yet, when it comes to communication, little has changed. Laws have

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been passed to guarantee that they are not discriminated against,

that they have equal job opportunities, that they are granted the
same rights and privileged that we in the hearing world enjoy and
take for granted each and every day. Folks it don't happen! For
most deaf and hard of hearing individuals these needs are
not met adequately if at all.

For the past year and a half my son has been a crack cocaine
addict. I won't go into the nightmare that in itself has been, and
it has been a nightmare!

He has been through the drug addiction treatment three times

at two different hospitals in the Shreveport-Bossier area. His
father and I knew nothing about addiction or treatment, so on advice
from someone in the treatment field, it was recommended that we put
him in Riverside the first time. The only good thing I can say about
his treatment at Riverside is that it kept him off the streets for
about thirty days, he learned that there was treatment available
somewhere, and he made one good friend. Since his release from
Riverside in early March 1992, he has admitted himself to the drug
addiction unit at Doctor's Hospital three times. He spent about 34
days at Doctor's Hospital the first time there. The second time he
spent only three days in detox, since he had no more hospital days
allotted him for last year. January of this year he admitted himself
for the third time to the addiction unit and spent twenty eight days
before being discharged.

Doctor's Hospital has an excellent drug addiction program....

Their staff is excellent, the nurses are great, the doctors good, the
therapists are knowledgeable .... if you are a hearing person you will
have gone through a good drug addiction program. However, if you are

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deaf, it is inadequate. My son did learn a lot about his addiction

during this three stays there. Things we, in the hearing world, take
for granted, was not available to him. Communication!

Drug and alcohol rehabilitation is about communication. From

early morning until late at night, the addictive person is in
meetings, therapy sessions, watching drug related films, attending
AA meeting and NA meetings, group meetings and lectures. All of it
involves talking and listening and being able to understand your
problem and how to deal with it and stay in recovery. During all of
my son's stays in these hospital only twice was there an interpreter
present. That was for two Sunday afternoon meetings at Riverside at
My insistence, because my daughters would not go to a family meeting
unless an interpreter was present.

At both hospitals, staff knew he was deaf, they were amazed

that he had such good language and lip reading skills. Anyone who
lip reads, no matter how good, misses a great deal of what is being
said, even one on one. To be able to lip read the speaker must be
at close range, they must speak distinctly, correctly, normally, and
not mumble. The speaker cannot drop his head, turn his head, or
turn his back on the person who is lip reading, if he does they are
lost. Even if all of that has been done the person lip reading is
still likely not to understand, they may read the word, but due to
an inadequate vocabulary, not understand what you are talking about.
Despite the fact that these professionals who have been providing
treatment know that he cannot hear, they have expected him to get
all the benefits without an interpreter. One on one it is hard at
best, small group meetings it becomes confusing, large meetings are

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are a total loss. If one wants to know how difficult it is, put
ear plugs in your ears for one day, go to meetings of any kind, see
how much you know of what is being said and going an around
you.

See how frustrated you will become, and how frustrated and angry
those around you will become if you have to ask what is being said
repeatedly. You will find that pretty soon you will shut up and be
quiet and not ask questions anymore.
 My son was quite isolated even in the addictive unit, he could
not telephone a friend or family member, as we who are hearing, can.
There was no TDD device for him to use, so he had to depend on other
to call for him if he needed anything outside the unit. There was
no close caption device for him to enjoy television in the lounge
with the other patients. These devices are available and not very
expensive, yet none were there. Each hospital stay, he called us to
bring his close caption from home.

A week and a half ago he called a counselor- at the Deaf Action

Center after yet another relapse. She recommended that he admit
himself to Brentwood, which he did. To say I am upset is an under-
statement, I am angry, confused and totally frustrated!

A doctor from Brentwood called and asked me to come and give

some background information which I did. I expressed my concerns
about my son being able to understand everything due to his deafness
I was assured that this time he would get what he needs to kick his
addiction. That his treatment would be different this time. After
my meeting with the doctors I went upstairs to visit my son. We
visited a while and he told me what had been happening up until then
how great his counselor is. I asked if he had an interpreter, if the
films he had watched were close captioned, if they had TDD so he could

01-02471

use the telephone or a close caption for him to watch television. The
answer was "no."

On Thursday his father and I went to hear an excellent lecture

during family lecture with our son. The therapist was an excellent
speaker, the content was informative, I just wish our son could have
heard or understood everything that was presented, but he didn't.

There is no doubt in my mind that Brentwood has an excellent drug

and alcohol addiction program. But if the individual who needs it,
doesn't hear and understand, it isn't worth a damn.

I had always thought that if a person were hospitalized with

an illness, or disease and I have been told repeatedly that drug
and alcohol addiction is a disease, the hospital would and did provide
what was necessary to insure good treatment or recovery. Each and
every hospital has and does know that my son is deaf, yet no
interpreter has been provided. The Deaf Action Center tells me that
if he requests an interpreter, through staff at the hospital, one will
be provided. If I am in the hospital and cannot breathe, am I going
to have to ask before they bring me oxygen? No they are not, the
same should apply for an interpreter.

When our son is discharged from the hospital in few weeks he

will be advised to attend ninety AA or NA meetings in ninety days.
As things are now if he goes he won't know what is being said or
understand, but very little. He will be advised to find a sponsor,
someone who has been clean and sober for over a year. Someone he
can call when he needs help over the rough spots. Whom will he be
advised to come back to the hospital for aftercare and the STEPS
meetings, will an interpreter be provided?

01-02472

He will be advised that he must stay away from old friends who
use drugs and alcohol, stay away from old hangouts, that he must
make new friends. As with all deaf people he has some friends in
the hearing world, but is more comfortable in the deaf world with
his own kind.

According to my daughters, the majority of the deaf population

under forty years of age, either use drugs or alcohol.

I asked at the Deaf Action Center how many deaf and hard of
hearing person are in the Shreveport-Bossier area. They told me
about 3,000, I asked how many had spent 30 days in a treatment
facility for addiction. They said they thought many would go if
helm were available for them at the hospitals, but why go, they
won't know what is going on.

So where will our son go to make new friends? If we, in the

hearing world, had to go into deaf community to make all new friends
I think we would not fare too well.

These are a few of the obstacles our son has faced and is
facing in his search for drug rehabilitation and some obstacles he
will face when he is discharged, and comes back to the real world.

In each and every hospital stay regardless of what he got or

did not get, his hospital bill was not adjusted as to what he
understood and did not understand. He was charged full price and
should receive all the benefits that you and I in the hearing world
takes for granted each and every day.

I have written this to say if someone doesn't care enough to

speak up, nothing will change. This segment of our society in our
city of Shreveport and Bossier have no provision made for their
needs in too many areas. We do have excellent Drug treatment program

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but none for the deaf. Isn't it time that they are afforded what
the rest of us enjoy and take for granted every day of our lives.

If I don't care, who will?

XX
Shreveport, LA 71109

cc- Shreveport Times

Brentwood Hospital
Riverside Hospital
Doctor's Hospital'
KTBS TV 12
Senator J. Bennett Johnson
Senator John Breaux
Representative Jim McCrery
Representative Cleo Fields
Silent News

P. S. My son has asked for an interpreter and one is being provided for him at
Brentwood. Perhaps this time it will be different.
At least there is hope now.

(Handwritten) Our son draws SSI and all of these hospital bills have been filed on
Medicare.

01-02474
Printed from AA Grapevine Inc. August 1986

The "Lonely Handicap"

Deafness and hearing loss mean much more than a diminished or

nonexistent auditory capacity for an individual. It also means diminished or
nonexistent services for that person, particularly where drug and alcohol
problems are concerned.
"Alcoholism is a problem in all of society and unfortunately, people who are deaf
have even less potential for getting services, let alone actually receiving them," said
Dr. Gary Austin, director of Rehabilitation Institute at Southern Illinois University.
Substance abuse programs tend to be unresponsive to the hearing impaired due to
a lack of understanding of the psychosocial aspect of deafness, and certainly the
very real communication barrier that exists said Dr. Alexander Boros. On the other
hand counselors for the hearing impaired tend to shy away from working with deaf
substance abusers because they do not have the expertise in alcoholism and drug
abuse.
Dr. Boros, a staff member for Project AID (Addiction Intervention with the
Disabled) at Kent State University in Ohio, said, "The combination of fear
operating within the deaf community, and ignorance operating in the agency
world, results in barriers for the deaf alcoholic. Consequently, they are
undiagnosed, untreated, and uncounted.
This lack of current, solid data was best summarized in a report by Norton Isaacs,
PhD. and Art Berman, M.S.W. who stated, "It is a sobering fact that we know more
about the alcohol use patterns of the few thousand Lepcha of the Himalayas than we
do about the estimated 13 million hearing impaired persons in our country."

Alcoholism and Hearing Impairment

"The deaf live in a world designed for hearing people. They live
in a speech society, not a deaf society. And that always poses
a problem being a minority person," said Dr. Boros.
Karen Steitler, director of the Substance and Alcohol Intervention Services for
the Deaf (SAISD), at the Rochester Institute of Technology in New York, said,
"When you have this kind of social isolation, when you have failures in school, an
inability to hold a job, or to produce an appropriate income to raise a family, when
you find you are blocked in your interaction with people because of communication
problems--these are all frustrations. Frustration that is repeated with no let up create
substantial amounts of stress. The big lure of drugs and alcohol is that they become
a relief from that anxiety and stress."
"Deafness has been called the "lonely handicap,' and alcoholism is
the lonely disease--they definitely make for a deadly duo," said Carol
Wentzel, a deaf services specialist and substance abuse therapist
for the hearing impaired from Cypress, California.
The isolation experienced by the deaf in a hearing world represents
a unique and painful experience. Helen Keller once said, "Being blind
cut me off from the world of things, but being deaf cut me off from the
world of people."
Modern technology has reduced a few of the communication barriers for
the deaf. With the advent of closed captioning for television, the
deaf are able to enjoy a small handful of programs, that is, if the
deaf person can afford the somewhat expensive decoder devices for their
television.

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TDD's (teletype devices for the deaf) were an advance that for
time allowed the hearing impaired access to telephone communication
with the outside world. Again, however, the number of facilities
that have installed TDD's and the number of deaf who can afford TDD's
is limited.
In deaf household, doorbell can be hooked to lights that flash,
and special devices are available that cause lights to flash alerting
deaf parents of a baby's cry.
In addition to the isolation and limited communications, lack
of knowledge among the hearing impaired about substance abuse issues
is substantial.
Dr. Austin says the general hearing population has improved
their knowledge and attitudes toward drug and alcohol abuse in the
last 5 to 10 years, largely due to mass media communications.
However, the deaf do not have access to much of the information that
has been presented over the radio and on television pertaining to
drug and alcohol education.
In an interview with The U.S. Journal, conducted via TDD, Barbara
Pollard, M.S.W., L.C.S.W., an assistant professor of social work at
Gallaudet College, Washington, D.C., who is hearing impaired, said,
"Alcoholism has been a taboo subject in the deaf community. There
is a lack of information and an inaccessibility of media programs
addressing this issue.
Wentzel pointed out that the deaf do not understand the concept
of alcoholism as a disease. That is reflected even in their sign
language which, she says, lacks signs for words such as "addiction"
and "alcoholism." "The deaf use words such as 'hooked' or 'drunk;' or
would say "drink, drink, drink," all of which have very moral
cannotation

Treatment and Services Availability

"If you look at the delivery systems and the intervention systems
that are available, it would have to be only a minuscule part of
one percent," said Dr. Austin. Dr. Boros said that the deaf people
with drug or alcohol problems "tend to die as alcoholic ... they don't
get help. They don't get help, at least in part, because the agencies
don't respond to them.
The inability to communicate with hearing impaired accounts for a
large part of the poor response. There are few substance abuse
professionals or doctors who are proficient in sign language.

Cultural Considerations
Even with the communication barrier overcome, the cultural (life-
style) and psychosocial components of a hearing impaired lifestyle
must be understood and appreciated.
Issues that need to be taken into consideration include whether
the client was brought up in a deaf home or a hearing home, and
whether his/her first language was English or ASL (American Sign
Language). Also, was the client educated in a deaf residential school,
or mainstreamed into public schools?

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Dr. Boros said, "Deaf people represent so many different back-

grounds and levels of communication. Researchers lump them all
together and call them deaf -- but their backgrounds are all really
quite different."
He said that prevention efforts are staring in the schools with
the young deaf population, because of the difficulty in reaching the
deaf adults population with substance abuse problems.
Part of the problem in reaching the adult deaf is that those who
have substance abuse problems "are invariably from outside of the
deaf community." He explained that the deaf community refers to those
deaf who work and socialize together. Those who do not mix with the
deaf community are referred to as the deaf population.
"About 5% of our deaf alcoholic clients come from the deaf
community, and about 95% come from the deaf population," he said.
He added that because those in the deaf population cannot be reached
through the deaf organizations, yet also cannot be reached through
media efforts, we are starting prevention with today's population--
because we can't reach the adults."
Wentzel emphasizes further that there needs to be an awareness in
the professional community that, for the most part, deaf individuals d
not have medical insurance, and therefore do not have the option of
paid inpatient care. Even if there were more of these treatment
programs available for the deaf, paying for treatment is difficult due
to the number of hearing impaired unemployed and under-employed.
She said that recovering deaf and hearing impaired individuals
must be encouraged to "band together and to go into the field of
alcoholism counseling. The field is void of hearing impaired people
who are skilled and have an understanding of drug and alcohol problems
With s sigh she added, "One in 1,000 will get help for their
problems. For every one of the deaf persons in my group on Monday
nights, I swear there are 1,000 others out there who are not in
treatment."

Susan Thanepohn; U.S.Journal

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