Could you please elaborate more about differences and how it is risking liability? Thank you
A. Three pertinent laws
1) ADA- this covers "service animals". Service animals can ONLY be dogs or minihorses. They must be trained for a specific task relevant to the disability. "providing comfort" has been ruled as not a trained task. Service animals can go almost anywhere, so long as they are not disruptive (e.g., you can ask them to leave if they are biting your staff, and you can say no to a service animal in the operating theater). Other patient allergies cannot be used to refuse service animals.
2) Fair Housing Act- this law covers many, but not all multi family housing. The relevant term in this law is "emotional support animals". Emotional support animals can really be anything, aside from super huge animals. A mental health professional, must write a letter stating diagnosis and that the patient needs an emotional support animal. So when you see a person with a service kangaroo, you already know it's BS and you don't have to accommodate it being in your place of business. People get these things confused.
3) The non-discrimination subsection of the Aeronautics federal laws- this law covers air travel. The relevant terms here are "emotional support animal" or "psychiatric service animal". Pretty much anything can be an emotional support animal here, including exotics. The law does state that the airline can deny exotics, but there are clearly jerks who push the boundaries. The patient must provide a letter from a mental health professional stating the diagnosis IN THE DSM-IV, not the DSM5, or DSM-IV-TR. The patient must also provide documentation that the animal won't "relieve" itself on flights over 8 hrs. But there is challenges to who can do this.
B. Speculative Potential Liabilities.
1) Deviations from standards of care:
a. Disability is inherently a forensic issue. Overall, my read of your medical ethics shows that treating providers should avoid opining about disability. The AMA Ethical Code has mention of this. The American Psychiatric Association has statements about the ethics of this. The American Association of Psychiatry and Law ethics has statements about this. The AMA Guides to Causation has statements about this. Therefore, providing an opinion about disability almost requires the treating provider to deviate from the standards of care. I believe that this could be used in a lawsuit.
b. In Air Carriage, you are required to use the DSM-IV. This is a deviation from the standards of care. Which might be used to sue. Alternatively, if you chose to use the DSM5 and the animal was denied, I believe you could be sued for the cost of the travel expenses.
2) Lack of data.
a. There's simply no significant literature base to support any of this. I wouldn't want to go to court with nothing to back me up.
3) Who has the deepest pockets?
a. Recent dog bite cases are showing a minor trend in the injured party suing the party with the deepest pockets. Imagine the complaint for someone whose face is messed up in a dog bite. You're talking plastics, loss of revenue, etc. Complaints are higher. For example, in the portland airport dog bite case, the plaintiff sued the airport for 7 figures, with only minimal mention of the person with the emotional support dog. That is concerning for any physicians with a malpractice insurance policy.
4) Current litigation. There is a high degree of litigation at the moment regarding this issue. Do you want to be called in about this issue only to have no research to back it up.
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