Innovations In Clinical Neuroscience

JAN-FEB 2018

A peer-reviewed, evidence-based journal for clinicians in the field of neuroscience

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49 ICNS Innovations in Clinical Neuroscience • January–February 2018 • Volume 15 • Number 1–2 This ongoing column is dedicated to providing information to our readers on managing legal risks associated with medical practice. We invite questions from our readers. The answers are provided by PRMS, Inc. (, a manager of medical professional liability insurance programs with services that include risk management consultation, education and onsite risk management audits, and other resources to healthcare providers to help improve patient outcomes and reduce professional liability risk. The answers published in this column represent those of only one risk management consulting company. Other risk management consulting companies or insurance carriers may provide different advice, and readers should take this into consideration. The information in this column does not constitute legal advice. For legal advice, contact your personal attorney. Note: The information and recommendations in this article are applicable to physicians and other healthcare professionals so "clinician" is used to indicate all treatment team members. QUESTIONS Question 1. A patient of mine recently arrived for an appointment with a mangy, smelly dog in tow. She claimed that the dog was a service animal, so I allowed it to stay. Afterward, other patients and staff complained about the dog. Can I refuse to allow the animal back into the office in the future? Question 2. A patient recently rescued a dog from a shelter, and she's grown extremely attached to it. Her mood has vastly improved, and she reports a lessening of her anxiety when encountering unfamiliar situations. She would like me to write a "prescription" stating that the dog is medically necessary so that she can take the dog with her wherever she goes. Should I honor her request? What are my obligations? ANSWER We've received numerous calls of late from psychiatrists asking about patients and their dogs. Some of the calls concern service animals used to assist those with disabilities and others pertain to emotional support or comfort animals as described in the second question. In order to best clarify your obligations as a psychiatrist, I'll review the two categories separately. Service dogs . As defined by the Americans with Disabilities Act (ADA), service animals are dogs (and occasionally miniature horses) that are individually trained to do work or perform tasks for people with disabilities including physical, sensory, psychiatric, intellectual, or other mental disabilities. 1 These animals might perform such tasks as "guiding people who are blind, alerting people who are deaf, pulling a wheelchair, alerting and protecting a person who is having a seizure, reminding a person with mental illness to take prescribed medications, calming a person with posttraumatic stress disorder (PTSD) during an anxiety attack, or performing other duties." 2 Under the ADA, state and local governments, businesses, and nonprofit organizations that serve the public—including stores, restaurants, airplanes, and physician offices— generally must allow service animals to accompany people with disabilities in all areas where the public is normally allowed to go. 2 A true service dog is a highly trained, well- behaved animal that quietly goes about its job and does not interfere with the businesses or people it encounters, thus becoming "virtually invisible while working." 3 Service dogs can be a godsend to people with disabilities, allowing them greater independence, mobility, and security than they might not otherwise have. Accordingly, laws have been written broadly to allow individuals to use service animals without enduring additional burdens. There is no requirement for certification of service dogs, nor is there any requirement that the dogs undergo any type of formal training. Though many do, there is no requirement that service animals wear any special gear or identifiers, such as vests or tags. Unfortunately, these broadly written laws also make it easier for unscrupulous people to claim that their dogs are service animals, thus "Vetting" Service Dogs and Emotional Support Animals by Ann L. McNary, JD Innov Clin Neurosci. 2017;15(1–2):49–51 Risk Management

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