Innovations In Clinical Neuroscience

JAN-FEB 2018

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

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51 ICNS Innovations in Clinical Neuroscience • January–February 2018 • Volume 15 • Number 1–2 R I S K M A N A G E M E N T So, it is understandable that many psychiatrists will want to accommodate patients making these types of requests, but is it really a good idea? When a patient asks you to write a letter or complete a form attesting to his or her need for an ESA, the first question to ask yourself is, "Do I truly believe that my patient needs an emotional support animal, or am I merely trying to pacify him or her?" If you believe that an ESA would be beneficial to your patient and helpful in achieving your treatment goals, and this is supported by your records, then you might want to consider honoring your patient's request. If, on the other hand, you don't think it would be beneficial but are contemplating writing the letter/filling out the form to keep your patient happy, think very carefully before doing so. By supporting a patient who does not actually need an emotional support animal, you are potentially adding to the problems caused by fake ESAs. And, although it's highly unlikely that you would in any way be found liable for any damage/harm done by the animal itself, you might still find yourself in a precarious situation if problems occur as a result of the patient having the animal. Consider the doctor who thought he was doing his patient a favor when he wrote a letter that allowed her to bring her dog into a pet-free condo. After repeated complaints by other residents, the patient found herself in litigation with the condo board, and she called upon the doctor to testify that she needed her pet for emotional support. The doctor was forced to take time out of his practice and had to endure the embarrassment of having his credibility attacked on the witness stand when it was determined that there was absolutely nothing in his records to support the letter he had written. RISK MANAGEMENT TIPS • In addition to understanding federal law, check your individual state laws to determine whether your state expands access by service animals and ESAs. For example, 23 states—including Arizona, Florida, and New York—do not specify that a service animal has to be a dog. 3 • Educate your staff on what questions may be asked of patients accompanied by animals, and have protocols in place for handling the presence of service animals. • Employ strategies to minimize discomfort for patients or staff members who might be allergic to or afraid of dogs, such as scheduling those appointments later in the day so that the office can be cleaned after the dog departs. • Consider carefully a patient's request for a letter attesting to the need for an emotional support animal. Do not provide such documentation unless your records support the need. • Never make any attestations regarding the safety of a particular animal. • Keep copies of all letters and/or forms prepared in support of your patient's ESA. • Make certain that none of your actions come back to bite you! REFERENCES 1. 28 CFR § 36.104 2. United States Department of Justice site. Civil Rights division. Disability rights section. ADA requirements: service animals.12 Jul 2011. https://www.ada.gov/service_animals_2010. htm. Accessed 29 Jan 2018. 3. American Veterinary Medical Association site. AVMA Public Policy/Animal Welfare division. Assistance animals: rights of access and the problem of fraud. 21 Apr 2017. https://www. avma.org/KB/Resources/Reports/Documents/ Assistance-Animals-Rights-Access-Fraud- AVMA.pdf. Accessed 29 Jan 2018. 4. Millan C. Doing a disservice: the harm in service dog fraud [blog post]. Cesar Milan site. https://www.cesarsway.com/dog-care/ legal-issues/Doing-a-disservice-The-harm-in- service-dog-fraud. Accessed 29 Jan 2018. 5. TEX. HUM. RES. CODE ANN. § 121.006 6. CAL. PENAL CODE § 365.7(a) 7. United States Department of Justice site. Civil rights division. Disability rights section. Frequently asked questions about service animals and the ADA. 20 Jul 2015. https:// www.ada.gov/regs2010/service_animal_ qa.html. Accessed 29 Jan 2018. 8. Ferreras J. Delta Airlines allows turkey on flight for 'emotional support.' Huffington Post Canada site. 15 Jan 2016. http://www.huffingtonpost. ca/2016/01/15/turkey-delta-airlines- emotional-support-animal_n_8995458.html. Accessed 29 Jan 2018. 9. Buhai S. Preventing the abuse of service animal regulations. New York University Journal of Legislation and Public Policy. 2016;19(4). http://www.nyujlpp.org/wp-content/ uploads/2016/12/Preventing-the-Abuse-of- Service-Animal-Regulations-19nyujlpp771. pdf. 29 Jan 2018. 10. 14 C.F.R. §382.117(b). 11. American Airlines. Emotional support/ psychiatric service animal authorization form. 7 Dec 2015. https://www.aa.com/content/ images/generic/ESAN_Form.pdf. Accessed 29 Jan 2018. AUTHOR AFFILIATION: Ms. McNary is a Senior Risk Manager at PRMS, Inc. CORRESPONDENCE: Donna Vanderpool, MBA, JD; Email: vanderpool@prms.com ICNS

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