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Keeping service animals out of healthcare settings is rarely legal

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July 27, 2017

How to apply the law correctly and consistently when excluding animals from your facility

When anyone brings an animal into a healthcare setting, it is reasonable to wonder whether the animal’s presence might pose a sanitation risk. Fleas, ticks, mites, and more could threaten to undermine the facility’s infection control efforts. Since some of these animals will be service animals, however, medical and support staffers should be cautious to avoid violating the rights of patients and visitors with disabilities.

Generally speaking, government bodies, businesses, and nonprofit organizations that serve the public are required by the Americans with Disabilities Act (ADA) to permit service animals in their facilities. The law supersedes any and all breed-specific bans and prohibits covered entities from requesting documentation to prove that the animal is a service animal. But there are limited circumstances in which covered entities can exclude such animals, according to the Disability Rights Section of the U.S. Department of Justice (DOJ) Civil Rights Division.

“For example, in a hospital it would be inappropriate to exclude a service animal from areas such as patient rooms, clinics, cafeterias, or examination rooms,” the DOJ explained in a summary of the ADA’s provisions. “However, it may be appropriate to exclude a service animal from operating rooms or burn units where the animal’s presence may compromise a sterile environment.”

Balancing the need to keep medical settings safe and clean against the rights of patients with disabilities to bring service animals with them is not always easy. Applying the law correctly and consistently requires a significant amount of pre-work and communication, both within the organization and with the public.

Do your homework

Some patients and visitors will assert that their “companion animal,” “emotional support animal,” or “comfort creature” qualifies for ADA protections, but that is not the case—unless those animals also meet the definition of a service animal.

“Because we’re dealing with very clear regulations, people’s rights, compliance with those rights, we have to understand what is and what is not a service animal,” says Frank Ruelas, facility compliance professional at St. Joseph’s Hospital and Medical Center/Dignity Health in Phoenix, Arizona.

Definition. The DOJ states that a service animal is defined as a dog that has been “individually trained to do work or perform tasks for people with disabilities.” (A separate provision acknowledges that a miniature horse can similarly be individually trained as a service animal.) In order to qualify, a dog must be trained to take some specific action to help the individual with a disability.

“For example, a person with diabetes may have a dog that is trained to alert him when his blood sugar reaches high or low levels. A person with depression may have a dog that is trained to remind her to take her medication. Or, a person who has epilepsy may have a dog that is trained to detect the onset of a seizure and then help the person remain safe during the seizure,” the DOJ states.

Questions. Since some disability-related tasks are less obvious than others and the law does not require any special certification, registration, vest, or badge to prove that a dog has been trained, healthcare workers must proceed with caution if they wish to ask about a person’s service animal.

“There’s basically only two questions that they can ask,” Ruelas says: (1) whether the dog is a service animal required because of a disability, and (2) what work or task the dog has been trained to perform. These two inquiries come from the DOJ, which specifies that staff are “not allowed to request any documentation for the dog, require that the dog demonstrate its task, or inquire about the nature of the person’s disability.” The ADA does not require that a service animal be trained professionally.

Clearly, on the one hand, if patients say their dog is not a service animal, then they admit the ADA does not apply. In that case, healthcare workers would have maximum leeway to exclude the animal. If, on the other hand, the person says their dog is a service animal that has received individualized training to perform a task related to a disability, then staff should proceed as if the assertion were a proven fact—there are other factors still that could justify excluding the service animal.

It’s worth noting that state laws may impose a more generous definition of a service animal. While this would not affect enforcement of the ADA, it could impact other disability rights laws in effect where your facility operates, so do your homework.

Communicate with your team

Knowing what the law says is a prerequisite to applying it correctly. Communicating the law to your staff is key to applying it consistently.

“The overriding factor that I always am emphasizing to folks is they need to do whatever they need to do to be consistent,” Ruelas says. Perhaps that means developing a standard operating procedure or a flow chart. How will your organization handle disruptive service animals? Put it in writing.

“If you’re going to really look at the question of service animals, how you are going to address service animals in your facility, look for folks that have done so successfully—or even more importantly, unsuccessfully—that are similar to your setting and see what has worked and what has not worked for them,” Ruelas says. This topic is a prime area for collaboration with other facilities, even those outside your immediate network, he adds.

“Here’s the thing: We’re talking about an area of information-sharing that’s far from anything that could be considered proprietary,” Ruelas says.

When can an animal that qualifies as a service animal be excluded from a healthcare setting? There are several scenarios identified by the DOJ:

Is the animal housebroken? If a service animal is unable to control its bladder and bowel movements, then there is sufficient basis under the ADA to exclude it from a facility. Even if you can lawfully exclude an animal, however, remember that you should continue to offer services to its handler.

Is the handler controlling the animal? The patient or visitor who brings a service animal into a healthcare setting must keep it under control at all times. The animal must wear a harness or leash in public, unless wearing one would inhibit the animal’s work, according to the DOJ.

Handlers are not permitted to let their dogs wander away, but there are certain scenarios that healthcare workers should keep in mind to avoid assuming that an animal is wandering or otherwise out of control. A veteran suffering from post-traumatic stress disorder, for instance, could have a service animal that is trained to enter unfamiliar spaces and confirm that there are no threats present. In this case, the animal would be off-leash while inspecting a room for its handler, and it could still be considered under control.

Is the animal being overly disruptive? A bark here and there would be insufficient under the ADA to exclude a service animal. But repeated barking in quiet places without provocation could be grounds for exclusion.

Is the animal undermining what you’re offering the public? This is arguably the most subjective category identified by the DOJ, which explains that the ADA does not require you to change your policies, practices, or procedures if doing so would “fundamentally alter” the nature of your operation.

“In most settings, the presence of a service animal will not result in a fundamental alteration. However, there are some exceptions,” the DOJ explains. “For example, at a boarding school, service animals could be restricted from a specific area of a dormitory reserved specifically for students with allergies to dog dander.”

If allergy sufferers and service animals must share space, then the facility should accommodate them both to the best of its ability, assigning them to different areas within a room or different rooms within a building, the DOJ notes. A patient’s allergies (or fear of dogs) would be an inadequate basis to exclude the animal.

As an example of a scenario in which facilities do not have to accommodate a service animal, Ruelas says he has had people insist upon bringing a dog into the operating room, which could compromise operating room sanitation. So he has refused this request, while still permitting the animal in patient rooms.

Keep the patient in mind

You and your team should know when it’s appropriate to ask someone to remove animals from your facilities. You should be prepared to do so politely and firmly. But you should also approach each situation with the patient in mind, Ruelas says. Step back and view your facility and staff from the perspective of a patient or visitor with a disability. Build your policies and procedures with that point of view in mind.

“I like to actually walk in the shoes of the patient that might have a service animal. When that person comes through, whom are they going to first interact with?” Ruelas says, noting that it could be staff at a registration or information desk. “Those are going to be your key touch points who need to be educated on whatever process you come up with. It’s nice if everyone knows, but certainly start with those critical touch points first and then develop it beyond that, after you’ve established a good foundation.”

Expect pushback, remain empathetic, and be prepared to calmly explain the law and your local policies, Ruelas says. It is common for someone who has had to defend an animal’s presence repeatedly in the past to become defensive when faced even with fair questions, so take steps to avoid escalating the situation unnecessarily. Respectfully ask the questions you are permitted to ask and make a determination, then calmly explain the rules and process. Being able to educate the handler could help defuse the immediate situation or, at the very least, clearly communicate the rationale behind your actions if the individual complains about you to regulators or media outlets.

Follow up as patients and visitors leave. If you ask your staff to notify you when someone with a service animal is about to depart from your facility, you can initiate a brief conversation with patients at the exit, Ruelas says. Ask them about their experience, and about how you can better meet their needs in the future or make the process smoother. If they don’t notice anything that could or should change, count this as a success.

Ruelas cautions that all the above factors should be discussed with whomever at your facility is responsible for signing off on legal language. That likely means pulling those staff members into the conversation sooner rather than later.

“Before you start down the path of self-development and self-education, find out whom you’re going to have to answer to, whom you’re going to have to justify and provide information to so that you can get their buy-in,” Ruelas says. “If legal says, ‘Well, that’s all well and fine, Frank, but I need to hear this from an ADA expert,’ then you need to go down that path.”




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