Emotional support animals

[FlowRate]

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It seems highly highly highly unlikely that (in whatever state you practice) disability evaluations are something physicians are legally obligated to provide.

Edit: After reviewing SSA.gov regulations, it looks like you can refuse to do the evaluation (potentially with good reason as the treating physician is not quite objective in disability assessment) and the SSA will pay for an independent examination.

Licensee duties relating to assistance animals. (1) A licensee who is approached by a patient seeking an assistance animal as a reasonable accommodation in housing shall either: (a) make a written finding regarding whether the patient has a disability and, if a disability is found, a separate written finding whether the need for the animal is related to that disability; or (b) make a written finding that there is insufficient information available to make a finding regarding disability or the disability-related need for the animal. *** (3) A licensee shall not make a determination related to subsection (1) of this section unless the licensee: (a) has met with the patient in person**; (b) is sufficiently familiar with the patient and the disability; and (c) is legally and professionally qualified to make the determination.

 

[WisNeuro]

It would seem that that is easy to get out of.

"There is insufficient information available to me to make a determination as I have not performed a disability exam, which is a medico-legal evaluation. Furthermore, I cannot provide such an evaluation in a clinical context as that constitutes insurance fraud (if they are using insurance)." Or simply stating "I do not perform medicolegal evaluations and am not qualified to make that determination."

 

[FlowRate]

It would seem that that is easy to get out of.

"There is insufficient information available to me to make a determination as I have not performed a disability exam, which is a medico-legal evaluation. Furthermore, I cannot provide such an evaluation in a clinical context as that constitutes insurance fraud (if they are using insurance)." Or simply stating "I do not perform medicolegal evaluations and am not qualified to make that determination."

I think that's actually a nice way of approaching the concept from the patient end as well, I already give that spiel for patients seeking other permanent disability determinations.

 

[aim-agm]

Huh. The statute says you would:
- Determine if a disability is present, and if so
- Determine if the need for the animal is related to the disability

But it skips the step of assessing if there is a need for the animal to begin with, nor that it would be an appropriate accommodation or if alternatives are reasonable. It also doesn't apparently require the patient to state that there is a need for the animal, only that they are seeking it as a reasonable accommodation; they don't even need to believe that it is a reasonable accommodation, just be seeking it. The law also doesn't require a prior physician-patient relationship, or that the patient pay the physician for the assessment that the statute obliges the physician to make.

I wonder if this is addressed elsewhere in the law or if it is just that ridiculous.

 

[Stagg737]

"Licensee duties relating to assistance animals. (1) A licensee who is approached by a patient seeking an assistance animal as a reasonable accommodation in housing shall either: (a) make a written finding regarding whether the patient has a disability and, if a disability is found, a separate written finding whether the need for the animal is related to that disability; or (b) make a written finding that there is insufficient information available to make a finding regarding disability or the disability-related need for the animal. *** (3) A licensee shall not make a determination related to subsection (1) of this section unless the licensee: (a) has met with the patient in person**; (b) is sufficiently familiar with the patient and the disability; and (c) is legally and professionally qualified to make the determination."

That's awful, but I would hope Wisneuro's recommendation would be valid there. I can't imagine ever working in a state which would legally require me to provide patients with legal evaluations if they requested it...

 

[Alemo]

To agree with @aim-agm , this statute (which seems to be in at least two states in similar forms), reads very narrowly. Obviously I'm not a lawyer but it does not seem in keeping with the spirit of the law that a "licensee" would be approached by a patient asking for such a finding, deny the request to perform such an evaluation, and then get sued for having violated the patient's 14th amendment rights. I mean (again I'm not a lawyer), but I am highly confident the right to walk up to physician and demand an evaluation from said physician is NOT enshrined anywhere in statutes or constitutional law.

A very notable exception being EMTALA which has nothing to do with this.

So @FlowRate , are you worried some disciplinary action could come to you if you fail to comply?

 

[VA Hopeful Dr]

I think that's actually a nice way of approaching the concept from the patient end as well, I already give that spiel for patients seeking other permanent disability determinations.

It is but I'm still surprised that you have to even do that.

 

[FlowRate]

So @FlowRate , are you worried some disciplinary action could come to you if you fail to comply?

Worried would be an overstatement. I'm aware of what the state statutes are. As are most property management companies in the area. Writing a middle-ground "the patient has a mental health condition and thinks their pet is useful" is not going to fly with those property management companies. So my default has been to tell patients I don't do those determinations, although technically I should probably document and phrase more like that it's not a specific service I provide due to being a medicolegal eval as wis suggested. I don't think the board is necessarily going to come after me but they do follow-up literally any patient complaint so I would rather not be knowingly out of line with state/board statutes.

I think assessing that someone "needs" an animal for their otherwise reasonably well controlled MDD/GAD is a pretty strong statement to make in the first place.

Actually, patients should look into training their pets to be service animals. Very low bar for that with some of the examples like wakes them up in the morning and barks at them to take their meds.

It's not like I don't help with any "disability" issues as I may at time write letters in support of work/school accommodations for example.

The law also doesn't require a prior physician-patient relationship, or that the patient pay the physician for the assessment that the statute obliges the physician to make.

I think most of those things are included in the part about knowing the patient well etc.

 

[aim-agm]

I think most of those things are included in the part about knowing the patient well etc.

It might but I'm not sure. The law precludes you from rendering the determination without knowing the patient well enough, but it might require you to attempt to obtain that level of knowledge after being approached. I'm leaning towards it not requiring previous relationship for the obligation because presumably if an established telehealth patient made the request you would be required to at least offer an in-person appointment.

This could (and should) be covered under the statutes definition of "patient", but I can't check since I don't know which state.

EDIT: Google searching the statute I think I've found the state. I can't find anywhere in the title where it defines patient (except as pertains to veterinarians).

 

[deleted1100659]

It seems highly highly highly unlikely that (in whatever state you practice) disability evaluations are something physicians are legally obligated to provide.

Edit: After reviewing SSA.gov regulations, it looks like you can refuse to do the evaluation (potentially with good reason as the treating physician is not quite objective in disability assessment) and the SSA will pay for an independent examination.

I work in a setting where I get asked to write disability letters and emotional support letters in at least 1/3 of my pts, roughly.

I never do a disability letter. I document my findings in my notes. They hire their own independent doctors anyways, as you said, personal physicians are often biased/coerced by patients so they have someone else look at all the records.

In my experience, most disability requests that I personally receive are BS. Could be my setting. Had a woman yesterday who is trying to get disability because "her foot swells". I asked her why she couldnt apply for a job that allows you to sit down and she just simply said "well then i couldnt get disability".

I understand disability in schizophrenia/psychotic disorders or bipolar 1, but in most other psych disorders, seems ridiculous usually. Taking people out of the workforce and getting rid of drive/goals is counterintuitive to treating depression.

There was a provider here who would write letters for anything, a while ago. He wrote a letter for emotional support dog, then the dog attacked the neighbor to the point of the neighbor having to have surgery.

Usually when people want an emotional support animal, its as others have said, so their dog can live with them in their apartment or something of the sorts.

I don't mind FMLA and school accomodations but my goal is to keep people working/independent. I have people with schizophrenia that are working, and have improved because they work. Physical activity is great for mental health, after all.

 

[FlowRate]

It looks like psychiatrists (and other physicians) are not included under the definition of licensee for this statute so the obligation regarding patient's seeking ESAs may not apply to @FlowRate . You could make inquiries to be more certain, which would admittedly probably be more effort than developing a boilerplate response to ESA requests.

There are three separate sections for each of the major licensing boards. One for physicians and PA's, one for nurses (presumably NP's), and one for therapists. Same wording in each.

"Licensee" means any physician, physician assistant, or anesthesiologist assistant who is licensed pursuant to this article.

Telehealth was amended to be appropriate/acceptable, doesn't have to be in person only.