What paperwork are we legally required to do?

[rdk322]

Hi,

I'm still in training going into my last year of residency. I have completed at least 5 FMLA in the past ~10 months of clinic that in hindsight I shouldn't have completed as most patients did not demonstrate a concrete reason to need several weeks off (e.g. IOP/PHP/TMS/ECT/inpatient admission). I am trying to be more cautious about filling out these forms unwarranted and wanted guidance.

-Legally what paperwork are psychiatrists obligated to complete if any (e.g. FMLA, disability, etc)? Can we say no to all paperwork if we wanted to?
-Also where do you refer your patients requesting disability evaluation for psychiatric reasons? (Is it just any SSI office)?
-How about for those needing psychiatric clearance for commerical driving licence? (is it any DMV office)?
-The other day I had a guy asking psychiatric clearance to work as a prison guard/sign off on a statement that he can carry a firearm! I was completely baffled and felt uncomfortable filling it out so declined it altogether but didn't know where I could send him.

General concensus I heard was that I not get involved in anything that can be potentially litigious (e.g. commerical driving licence psychiatric clearance, signing off on emotional support animals, etc) unless providing supporting paperwork directed related to their illness/can be used for treatment (e.g. FMLA for inpatient admission). I have unfortunately had patients become irritable sometimes agitated when turned down and I did not have other places I could refer them to.

Thank you!

---

Members don't see this ad.

 

[Ironspy]

1. I do short term disability/FMLA forms for patients of mine needing a level of care requiring them to be away from work (IOP, inpatient, ECT, etc). They have to be impaired and engaged in treatment
2. Long term disability is an independent forensic evaluation. Some psychiatrists do these but I think saying that someone cannot improve long term is damaging to a treatment frame which is recovery oriented.
3. Psych clearance to work is an independent forensic evaluation. The most I do here is a letter saying they are under my care and currently stable. I will not comment on their ability to do their job
4. Psych clearance for firearms is an independent forensic evaluation also. I will write a generic letter saying that they are under my care and not currently suicidal or homicidal. My letter will not include the word firearm

 

[robellis]

OP just refer them to the local academic psych program that surely has some forensic faculty and they can do all of these things

 

[TexasPhysician]

There is no requirement to fill out paperwork.

That said, FMLA is broadly outlined for a reason. Birth of a child, electing to adopt, caring for an ill family member, ill, etc are all valid qualifications. Virtually every inpatient addiction patient had me fill these out. They are fast, simple, and provide limited time off. My threshold for filling these out are much lower than other paperwork.

 

[birchswing]

I know I'm a patient and not a doctor, but I have a lot of experience with this, and the answer is literally nothing.

The only thing I am aware that you can be compelled to do on a regular basis is send records to Social Security. You can charge some small amount for that that they specify. They may send you a form, as well, but you are not obligated to fill it out. I guess the other thing would be subpoenaed testimony, but that would go for anyone.

 

[FlowRate]

There is no requirement to fill out paperwork.

That said, FMLA is broadly outlined for a reason. Birth of a child, electing to adopt, caring for an ill family member, ill, etc are all valid qualifications. Virtually every inpatient addiction patient had me fill these out. They are fast, simple, and provide limited time off. My threshold for filling these out are much lower than other paperwork.

Agreed. I actively bring up FMLA with patients who are reluctant to get more intensive treatment due to concerns about taking time off of work.

 

[NickNaylor]

Unless you are forensically trained or have particular expertise in these areas, I wouldn’t get involved in disability evaluations, driving clearance, etc. As others have said, you aren’t obligated to complete any paperwork that the patient asks you to complete, and since I work in the inpatient setting I will often set pretty firm limits on the kind of paperwork I will or won’t do. Much of the time it’s more appropriate for the patient’s primary psychiatrist to complete these forms rather than me, who only sees the patient on an acute basis.

While you could say no to all paperwork, I’m not sure that that approach is all that helpful. Sometimes it‘s entirely reasonable that a patient may request FMLA leave, and not providing what assistance you can on that front is probably going to cause problems in the therapeutic relationship.

 

[splik]

OP just refer them to the local academic psych program that surely has some forensic faculty and they can do all of these things

No!!! Do not do this we don’t do this.

 

[robellis]

No!!! Do not do this we don’t do this.

Who does them then lol

 

[rdk322]

Thank you so much all! That makes me feel better to know that as physicians we aren't obligated to complete any paperwork but obviousy can review case by case if pertinent to their treatment and therapeutic relationship.

@TexasPhysician That is true about FMLA paperwork not being too much work but where I struggle are the parts that ask me to comment on what they can't/can do regarding their work-specific tasks and what kind of recommendations I have for their work. Honestly, I have sent those questions back to patients to answer. Is there a better way to handle this? I have never had a patient provide me FMLA paperwork with their job description as instructed though I doubt that'd be super helpful.

@splik Yes I would be curious to know where I can send all these patients if not forensic doctors? Our academic program does not have forensic psychiatrists and I'd have to ask patients to Google forensic psychiatrists for fitness for duty evals.

 

[clausewitz2]

Who does them then lol

In some areas there are CMHCs that have community forensics services but you are not going to find those in most places. While I get not wanting to recommend any specific outside psychiatrist as such for FFD evals, for instance, but it would probably save you a lot of time and aggravation if you just did the googling yourself, wrote down four or five of the names of people advertising fitness for duty eval services, and had them saved somewhere for just this situation.

@TexasPhysician That is true about FMLA paperwork not being too much work but where I struggle are the parts that ask me to comment on what they can't/can do regarding their work-specific tasks and what kind of recommendations I have for their work. Honestly, I have sent those questions back to patients to answer. Is there a better way to handle this? I have never had a patient provide me FMLA paperwork with their job description as instructed though I doubt that'd be super helpful.

You need to know what the critical required tasks are to successfully complete their job. This probably means a job description at a minimum. You then have to be able to say for these specific tasks what, if any impact their psychiatric symptoms are likely to have on their capacity to perform these tasks and whether asking them to do these things might put people at risk. Then you decide what kind of accommodations or modifications, if any, would make it possible for them to do these tasks or reduce the risk involved due to psychiatric symptoms.

If you don't think you have enough information to answer those questions, then don't.

 

[tr]

That is true about FMLA paperwork not being too much work but where I struggle are the parts that ask me to comment on what they can't/can do regarding their work-specific tasks and what kind of recommendations I have for their work. Honestly, I have sent those questions back to patients to answer. Is there a better way to handle this? I have never had a patient provide me FMLA paperwork with their job description as instructed though I doubt that'd be super helpful.

I usually tell patients that we will have to complete any LOA paperwork in a visit because many of the things that are asked are things that I can't assess without their input, or wouldn't typically assess in a psych visit, so please send the paperwork ahead or bring it with you the day of. Then when I get to that section I just ask them about their job functions and we fill it out collaboratively.

I'm happy to support reasonable/appropriate LOA for necessary treatment but don't really need any more homework for me to do on my personal time.

 

[deleted1100659]

I agree with the others about FMLA: low threshold for it. Why? Well for one, people arent getting money while on FMLA. So they dont get free paid vacation or anything.

I cant picture filling out disability for depression or anxiety, in my humble opinion its like starting someone on a benzo with the mindset of "well they wont need this forever..." and then we all know what happens there. Plus, seems counterproductive to treatment.

For someone with a psychotic disorder or bipolar that hasnt been stabilized, I wouldnt be opposed necessarily. A good portion of my schizophrenic patients I would be worried about them working, and have no issue with them staying at home collecting a check. Some of my higher functioning ones could pull it off, but others im not so sure.

That being said..I still get people who come for disability evals, the malingers are usually easy to spot. Prior diagnosis of personality disorder. Dramatic and hysterical. All the other doctors "didnt care" and im their "last hope".

 

[nexus73]

No!!! Do not do this we don’t do this.

You mean we can't just send patients to the academic medical center ED and demand to talk to Splik for forensic eval to get their guns back?

 

[robellis]

You mean we can't just send patients to the academic medical center ED and demand to talk to Splik for forensic eval to get their guns back?

Lol..no one said send them to the ED but sending them to a forensic psychiatrist who does these evals seems reasonable

 

[nexus73]

Lol..no one said send them to the ED but sending them to a forensic psychiatrist who does these evals seems reasonable

But if you send them to the ED it's free through their medicaid.

 

[comp1]

Definitely second the above comments about disability forms, it's only for either severely psychotic people who clearly can't work (don't need forensic training for that) or for people who have a plan for treatment like an IOP or residential drug treatment that is going to take them away from work. Even then, you would only write a for a couple of days and the program would take over. This is not a broken leg. You do not heal from sitting on the couch.

 

[splik]

Who does them then lol

We only accept cases from attorneys and insurance companies and for FFD evals from HR. Patients cannot set up forensic evaluations themselves and their psychiatrists can’t refer them. Also for a lot of the things above most pts cannot afford to pay for it. If someone was accepting referrals directly I wouldn’t trust them and believe it is ethically problematic to do so. There is a tension between what we think we should be doing and our ethical duty to avoid wearing two hats and how various systems see our role. The social security system relies heavily on treating physicians records to determine eligibility. These patients can’t afford to pay for their own assessment.

You have to decide what paperwork you do and do want to do. In thinking through this, you have to ask the following questions:
- can I as the treating psychiatrist objectively answer this question?
- does completing this paperwork help further my goals of care?
- is there someone else that could more appropriately complete this?
- would it place an undue burden on my patient to decline?
- how would it affect the therapeutic relationship if I did decline?

My approach is as follows
1. I always complete paperwork in session, and never out of session. Do not do uncompensated work. So either do it in session, charge the patient a fee, or make the patient make an additional appointment to complete any paperwork.
2. I only do paperwork if it is in the service of patient care. Most commonly I will do ESA letters (no this is not a forensic eval IMHO and if you don't think you're qualified to write one, you aren't qualified to practice medicine). I will also do return to work letters for patients or FMLA paperwork for pts to attend my appointments or engage in higher level of care (e.g. IOP/PHP). I will do letters for patients to get extension on assignments for school if I believe it does not reinforce illness behavior and they are in intensive treatment.
3. I don't usually treat patients seeking disability (it is an exclusion criteria from my practice). However if I do happen to see someone I tell patients to send my records for review by social security etc. That is usually sufficient. The social security office will arrange for a psychological or psychiatric disability evaluation if the medical records aren't sufficient to make a determination.

My recommendations for different types of evaluations
1. Disability evaluations - I recommend submitting your notes. If you want you could include an additional supporting letter. They do put more weight on the treating psychiatrists determination than the independent assessment even though our ethical standards recommend against this kind of dual relationship of treater and evaluator and the courts have ruled that the treating psychiatrist should be taken more seriously than the independent evaluator!
2. capacity evaluation - I recommend proceeding with capacity regarding medical decision making, mental health care decision making. For determinations regarding testamentary capacity, matrimonial capacity, financial capacity, contractual capacity etc, a lawyer needs to be involved.
3. competency to stand trial - The defense attorney should raise a doubt about competency and a court should appoint an expert. You can submit your records or a summary letter but do not comment on competency.
4. presentencing evalaution - in some areas, they are expecting the treating psychiatrist to do these. Just submit your paperwork. Do not comment on the offense conduct just diagnosis and treatment recommendations.
5. ESAs - it is up to you whether you do them or not but it's not really a forensic evaluation. It can be very damaging to patient's mental health if they are forced to part with their pets due to no-pets rules. I have no problem writing a letter stating the pt has a mental disorder which qualifies them for an ESA. If you don't like doing them, don't do them, but don't pretend it's some special forensic evaluation.
6. FMLA forms - complete them in session if legitimate reason
7. Return to work forms including reasonable accommodations - depending on the type of work you should be able to do this for your patient. Returning to work is good. Obviously if its a public safety or health care profession etc then there should be a specific fitness for duty eval that HR should arrange or the professional licensing board. An attorney can be hired if they want their own evaluation and they will retain an independent expert.
8. restoration of gun rights or safety to have a gun - you can release your records. Don't comment on their safety to operate a gun. Just include a regular risk assessment. They can retain a lawyer who will work with an expert if needed.
9. guardianship/conservatorship - you should complete this paperwork if you believe your pt needs this.
10. Fitness for driving - this is tricky. In some jurisdictions the treating psychiatrist is the only person who can complete the paperwork. I would suggest completing if you don't have any concerns and just addend psychiatrists cannot assess driving and note if there are/are not any impairments to driving and recommend they do a driving assessment if any outstanding questions exist. Otherwise just submit your records.

There is a lot of concern about liability and much of it is misplaced. There is liability inherent in everything we do but providing an opinion is much lower risk than a lot of other things as long as you feel confident with doing so and not pressured by the patient. I suggest discussing w/ malpractice carrier any liability concerns to get their feedback.

 

[FlowRate]

5. ESAs - it is up to you whether you do them or not but it's not really a forensic evaluation. It can be very damaging to patient's mental health if they are forced to part with their pets due to no-pets rules. I have no problem writing a letter stating the pt has a mental disorder which qualifies them for an ESA. If you don't like doing them, don't do them, but don't pretend it's some special forensic evaluation.

Your post is high quality as always. I'm curious about this part though. The patient could move into an apartment building that allows pets or pay the pet fee for their building. I see many requests for ESA letters as helping patients skirt appropriate boundaries/rules. It's not like pet clauses are just sprung on patients with an existing lease (in most cases.) Are you assessing the pet-patient dyad to ensure that the pet is actually having some therapeutic value? Do you reserve ESA letters for specific cases where you're actually convinced that a pet has a special purpose (e.g. I'm convinced that if a chronically suicidal borderline has a pet that is their main attachment to living then yes, it's therapeutic) or just write them for any patient who asks?

 

[adiradirim]

We only accept cases from attorneys and insurance companies and for FFD evals from HR. Patients cannot set up forensic evaluations themselves and their psychiatrists can’t refer them. Also for a lot of the things above most pts cannot afford to pay for it. If someone was accepting referrals directly I wouldn’t trust them and believe it is ethically problematic to do so. There is a tension between what we think we should be doing and our ethical duty to avoid wearing two hats and how various systems see our role. The social security system relies heavily on treating physicians records to determine eligibility. These patients can’t afford to pay for their own assessment.

What are your thoughts on custody recommendations for pediatric patients?
I guess adult patients can ask for letters of support as well to obtain custody of their kids.
In my area it is impossible to get a forensic custody evaluation without a court order.

 

[splik]

Your post is high quality as always. I'm curious about this part though. The patient could move into an apartment building that allows pets or pay the pet fee for their building. I see many requests for ESA letters as helping patients skirt appropriate boundaries/rules. It's not like pet clauses are just sprung on patients with an existing lease (in most cases.) Are you assessing the pet-patient dyad to ensure that the pet is actually having some therapeutic value? Do you reserve ESA letters for specific cases where you're actually convinced that a pet has a special purpose (e.g. I'm convinced that if a chronically suicidal borderline has a pet that is their main attachment to living then yes, it's therapeutic) or just write them for any patient who asks?

I will do it for most patients. Really the only exception is if I thought they had no business having a pet. As a resident I had this horrible narcissistic pt whose previous psychiatrist suggested he get a dog and he was abusive towards said dog. I wouldn't do a letter for a pt like that. Also I only do letters for patients to have their animal in their home, not for flying. Sometimes I might encourage a patient to get a pet, and if their place doesn't allow them they will need an ESA. Where I live is a very competitive rental market so many places get away with "no pets" and strongly prefer those without them. In some cases round here, they charge "pet rent" which can occasionally be hundreds of dollars a month!! gentrification is affecting cats and dogs now! Having a mental illness sucks. If one advantage is you get an ESA, I'm happy to sign my name to it.

I have a template. It takes me 30 seconds.

 

[PsyDr]

What are your thoughts on custody recommendations for pediatric patients?
I guess adult patients can ask for letters of support as well to obtain custody of their kids.
In my area it is impossible to get a forensic custody evaluation without a court order.

They should be court ordered, to protect you. Child custody is arguably the practice area with the highest risk. If you're doing them for free, you're leaving 5 figures on the table at the risk of professional sanctions. In some states, there are laws that dictate how these are performed which may include prohibition against who performs them.

 

[FlowRate]

Having a mental illness sucks. If one advantage is you get an ESA, I'm happy to sign my name to it.

The most common situation I run into is that a stable patient I haven't seen in 3+ months sends me a message that they need an "ESA letter." In many of those cases, I feel off just sending my template letter stating that the patient has a permanent disability-related need for a specific animal, which is what I'm required to write by state law. What is the process or standard you recommend using for determining a disability related need for a specific animal?

 

[adiradirim]

They should be court ordered, to protect you. Child custody is arguably the practice area with the highest risk. If you're doing them for free, you're leaving 5 figures on the table at the risk of professional sanctions. In some states, there are laws that dictate how these are performed which may include prohibition against who performs them.

I strictly avoid making any official recommendations and I word my notes carefully for sure.
I would like to know if there is anyone who I can refer families to that will do an evaluation and make recommendations for custody?

I'm assuming there is nobody that does that.

 

[PsyDr]

I strictly avoid making any official recommendations and I word my notes carefully for sure.
I would like to know if there is anyone who I can refer families to that will do an evaluation and make recommendations for custody?

I'm assuming there is nobody that does that.

If there are family law attorneys in your area, there are psychologists and/or psychiatrists that regularly perform child custody evaluations. All of the family law attorneys have the contact information for these services. They even have preferred ones. Tell them to ask their attorney for a reference. You're very likely to hear that they know who to go to, but it's too expensive. These evaluations cost a fair amount of money. Patients are trying to use their healthcare insurance for legal purposes to avoid this cost.

 

[Merovinge]

I strictly avoid making any official recommendations and I word my notes carefully for sure.
I would like to know if there is anyone who I can refer families to that will do an evaluation and make recommendations for custody?

I'm assuming there is nobody that does that.

Are you still a child fellow? This should definitely be covered by your fellowship which I believe has to include a forensic aspect for training. I specifically discuss with every patient upfront in any of these situations (i.e. contentious divorce) that I do not perform evaluations for court proceedings and am there as a biased/therapeutic relationship for the child and they must agree to these terms before I take them on as a patient.

 

[adiradirim]

Are you still a child fellow? This should definitely be covered by your fellowship which I believe has to include a forensic aspect for training. I specifically discuss with every patient upfront in any of these situations (i.e. contentious divorce) that I do not perform evaluations for court proceedings and am there as a biased/therapeutic relationship for the child and they must agree to these terms before I take them on as a patient.

You are correct, except COVID has wrecked a lot of those rotations where we were not allowed to go anywhere so many experiences outside of the hospital including court/forensic/school were all substituted by virtual lectures by people in those locations... you can imagine how helpful that is.

Of course as a fellow I have zero power to screen anyone. Even after explaining that I do not make recommendations, I've been requested to testify on the behalf of the child in court. I declined and that goes fine. Thankfully it isn't a common situation, I just thought I'd see what other's thought!

Thanks!

 

[Mass Effect]

I will do it for most patients. Really the only exception is if I thought they had no business having a pet. As a resident I had this horrible narcissistic pt whose previous psychiatrist suggested he get a dog and he was abusive towards said dog. I wouldn't do a letter for a pt like that. Also I only do letters for patients to have their animal in their home, not for flying. Sometimes I might encourage a patient to get a pet, and if their place doesn't allow them they will need an ESA. Where I live is a very competitive rental market so many places get away with "no pets" and strongly prefer those without them. In some cases round here, they charge "pet rent" which can occasionally be hundreds of dollars a month!! gentrification is affecting cats and dogs now! Having a mental illness sucks. If one advantage is you get an ESA, I'm happy to sign my name to it.

I have a template. It takes me 30 seconds.

I have a big problem with psychiatrists writing these letters just because they think it might help. It's not really thinking about the rights of those who intentionally live in pet-free buildings. My nephew is hugely allergic to cats. His parents live in a pet-free building in order to keep him feeling well. When we label any animal as an ESA just because someone is anxious or something, it infringes on people like my nephew's right to live in a pet-free environment. If patients want pets, they'll have to find a building that allows them.

And for the record, this comes from someone who grew up with pets and for the first time in my life over the past 2 years, has no pets. So it's not like I'm an animal hater. But people with no mental illness should be allowed to live somewhere where they're comfortable too. Having a psychiatric disorder should not entitle you to infringe on the rights of those who can't be around animals for one reason or another.

 

[robellis]

I have a big problem with psychiatrists writing these letters just because they think it might help. It's not really thinking about the rights of those who intentionally live in pet-free buildings. My nephew is hugely allergic to cats. His parents live in a pet-free building in order to keep him feeling well. When we label any animal as an ESA just because someone is anxious or something, it infringes on people like my nephew's right to live in a pet-free environment. If patients want pets, they'll have to find a building that allows them.

If a patient has a letter from their psychiatrist for an ESA does that mean the landlord is forced to allow them to live there?

 

[Mass Effect]

If a patient has a letter from their psychiatrist for an ESA does that mean the landlord is forced to allow them to live there?

I'm not sure if they're forced to, but many landlords will which sucks for the people who already live there and purposely chose that place get away from pets.

 

[FlowRate]

If a patient has a letter from their psychiatrist for an ESA does that mean the landlord is forced to allow them to live there?

The short version is that as long as the pet is a reasonable animal (especially dog) and not destructive then yes, the fair housing act requires them to waive any associated pet fees or rules against pets because the psychiatrist has asserted that the pet is a necessary accommodation for a mental health disability.

 

[WisNeuro]

I want to see someone with pet allergies allege that the allergy is disabling, and challenge the presence of an ESA. I'd be all for laws about ESAs allowed in housing IF there were a shortage of places that allow pets. I've always had a cat(s) and have never found it hard to find a place that allowed pets. Even in grad school where I was looking for only cheap housing. Similar to @Mass Effect , I have a personal problem with infringing on the rights and health of others, especially when there is not good data to begin with that ESAs actually do much beyond the simple benefits of owning a pet, of which similar positive benefits can be had with less restrictive methods.

 

[PsyDr]

If a patient has a letter from their psychiatrist for an ESA does that mean the landlord is forced to allow them to live there?

No. ESAs are dictated by the Fair Housing Act. This act does not cover every type of property or situation.

1) Applicability of the Act. Only certain types of properties are covered by the FHA. Essentially, it covers bigger apartment buildings. Situations when the property is owned by an individual, are specifically not covered by the FHA (i.e., property owned by Aunt Sally). The rental property must be something like a multi-residence property, in which the landlord does not reside or similar. It get hairy when dealing with a single family dwelling owned by someone who owns many properties. Rental property management services make this determination complicated.

2) "reasonableness" doctrine still applies. The FHA only covers reasonable acts. Your note means nothing if the animal is dangerous, or disruptive (e.g., your note is not going to force a landlord to allow a hippopotamus). However, normal wear and tear from the animal remains reasonable. Bite marks, urine stains, etc, are not "reasonable."

3) Insurance. Because reasonableness applies, the note cannot force an undue burden on the landlord. The landlord workaround is to "approve" the ESA, pending consultation with their commercial property insurance. Then they come back and inform the applicant that their commercial insurance either does not allow ESAs or charge ungodly premiums for properties with ESAs. This is usually true, and allows the landlord to say "no" because it would be discriminatory to pass the premium costs on to the tenant.


The flying thing is the other other animal law, found under the Air Carriage Access Act. This law weirdly requires you to certify that this is your patient, provide a DSM-IV-TR diagnosis, and certify that the animal is needed. Exotic animals are specifically excluded in this law. The animal must be able to hold it for 7-8hrs, not be aggressive, and not be disruptive. I forget if the provider has to make statements about the animals' ability, or if it is up to the patient. You don't want to do it anyway, as DSM-IV-TR is almost de facto evidence of a departure from the standard of care. And if you inform the patient incorrectly, and they are prevented from flying, you have caused actual monetary damages (e.g., "He said it would be fine, they refused to allow me to fly to China, which cost me $7000 in flights, $5000 in hotel fees, etc"). The Portland Airport lawsuit showed that when something happens, the attorneys will sue any party involved.

 

[hamstergang]

You don't want to do it anyway, as DSM-IV-TR is almost de facto evidence of a departure from the standard of care.

I think this was a good post overall, but I have 2 comments. This part has been debated in this forum before -- no one else thinks that the law really requires such a strict reading. You can write a letter using DSM 5 and it would be accepted, or you treat the patient through DSM 5 and write the letter with the DSM IV counterpart. Neither is actually an issue.

The Portland Airport lawsuit showed that when something happens, the attorneys will sue any party involved.

But was the psychiatrist, therapist, or doctor who wrote the letter for the animal sued? Was the letter writer sued in any case in the US so far?

 

[PsyDr]

I think this was a good post overall, but I have 2 comments. This part has been debated in this forum before -- no one else thinks that the law really requires such a strict reading. You can write a letter using DSM 5 and it would be accepted, or you treat the patient through DSM 5 and write the letter with the DSM IV counterpart. Neither is actually an issue.

But was the psychiatrist, therapist, or doctor who wrote the letter for the animal sued? Was the letter writer sued in any case in the US so far?

1) I would argue that one should be familiar with the legal requirements in the area in which one chooses to practice, DSM-IV-TR or no.

2) AFAIK, no provider has been sued. Until the Portland case, which introduced contributory negligence and liability, no airport had been sued.

Laws and Ethics Related to Emotional Support Animals

The use of animals for therapeutic benefit is well-established. For example, for individuals with a disability such as blindness, trained service dogs can enhance the ability to live independently and participate fully in society. An emotional support animal (ESA) is an untrained animal that is...

jaapl.org

Who may be held legally liable for emotional support animal attacks? | Penney & Associates - Personal Injury Lawyers

A lawsuit filed has been filed in Oregon two years after an emotional support animal mauled a 5-year-old girl in Portland. Who may face liability?

www.penneylawyers.com

 

[comp1]

You can be sued whether you write the letter or not. Inaction provides no more protection than action in our litigious society. Never forget that the Tarasoff decision was based on inaction (and made up out of whole cloth.) Do what's best for the patient and document why.

 

[Mass Effect]

You can be sued whether you write the letter or not. Inaction provides no more protection than action in our litigious society. Never forget that the Tarasoff decision was based on inaction (and made up out of whole cloth.) Do what's best for the patient and document why.

I disagree. No one is going to sue you for not writing a letter allowing Fluffy to move in with your anxious patient. The evidence just isn't strong enough to warrant it and I would say a damn good case could be made that you didn't want to infringe on the rights of others by doing something with no significant evidence just because.

Like @WisNeuro I'm waiting for a resident in one of these complexes to sue to have the ESA evicted.

 

[comp1]

To be fair...no one has specifically sued a doctor for writing a letter allowing Fluffy to move in either. I'm not saying ESAs are a good idea. I'm saying that litigation risk shouldn't be playing a role in your decision making either way.