What do you do when a patient comes into your office with a dog? Tell them to leave? Allow the dog no matter what? The answer is that it depends.
This article will assist physicians and their office managers to:
- Explain the difference between a “service dog” and an “emotional support animal.”
- Understand the law, rights, and limitations for patients with service dogs or comfort animals.
- Know what you must, should, and cannot do regarding service dogs and emotional support animals.
Dogs in the office fall into three categories:
- Service dogs
- Emotional support or comfort animals
Service dogs are governed by the Americans with Disabilities Act (ADA), the California Disabled Persons Act (CDPA), the Unruh Civil Rights Act, and the Fair Employment and Housing Act (FEHA). A service dog is defined as a dog trained to help an individual with a task that is related to his/her disability. Tasks can be related to either physical or psychiatric issues. A few examples are fetching dropped items, alerting to oncoming seizures, and alerting a person with bipolar disorder that he is exercising poor judgment. Disabled persons have a right to bring trained service dogs to all public places, including a medical office.
An "emotional support animal" does not perform a specific task. It is an animal that provides the owner with a sense of calm, well-being, or safety. Emotional support dogs are sometimes brought to hospitals, skilled nursing facilities, pediatric units, etc. because of their comforting presence that can actually support recovery. Neither California nor federal law provides protections for emotional support animals or pets and do not require that they be allowed in your office; it is up to your discretion. We do not recommend that you allow pets in the office because it opens the door to a variety of risk and office management issues.
The first step is to determine whether the dog is a service dog by asking, “Is your dog a service dog?” If yes, then you can ask what task the dog is trained to perform (i.e., fetch dropped items). Objectively document the answers in the patient’s records (“patient presented with service dog, stated it is trained to pick up dropped items”). You are only allowed to ask whether the dog is a service dog and what task it performs. You cannot ask the patient to "prove" that it is a service dog. Though there are no registration, certification, or identification requirements, falsely claiming a dog is a service dog is a misdemeanor.
Regardless of whether an animal is a service dog, emotional support animal, or pet, the animal must be under control, leashed at all times, and it cannot pose a threat to others. Size, breed, and other issues are not relevant. Only the individual dog’s behavior can be considered and breeds with a “bad reputation” cannot be excluded. Service dogs should not be played with by staff, as they are not considered pets.
If a dog is filthy, infested, unruly, or aggressive, you may ask the owner to take the dog outside. Be sure to objectively document the behavior and the discussion.
Reasonable accommodations for the service dog must be made, but you are not required to walk, entertain, or clean up after the dog. The animal is entirely the owner’s responsibility.
If other patients are allergic to dogs, then reasonable isolation precautions must be taken to accommodate everyone. You cannot exclude a service dog because another patient has a dog allergy.
In no event should dogs be allowed in sterile settings such as operating rooms because of the risk of infection.
Signage notifying patients is recommended. Always make sure that staffs' actions are consistent with signage and policy, as well as uniformly applied.
Please call the CAP Hotline at 800-252-0555 if you have any further questions.
Michael Valentine is a Senior Risk Manager for CAP. Questions or comments related to this article should be directed to mvalentine@CAPphysicians.com.
Mr. Valentine will be speaking about this topic at the California Medical Group Management Association (CAMGMA) 2019 Annual Conference taking place March 28-30 at the DoubleTree by Hilton Hotel Golf Resort Palm Springs. Featuring a keynote series from the highly acclaimed, Ritz-Carlton Leadership Center, the conference will provide valuable insights into improving the patient experience in your practice. Register today at www.camgma.com before the room block sells out.