letter for emotional support animal

[whopper]

You could simply add a disclaimer that your letter does not entail that you carry any of the problems related that the pet may cause.

E.g. "While I approve an ESA for mental health purposes, I have no expertise in the responsibilities regarding the care and the behavior of the ESA as it is not within my field of specialty. The patient was referred to talk to a specialist in the field such as a veterinarian or other pet provider."

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[hamstergang]

You could simply add a disclaimer that your letter does not entail that you carry any of the problems related that the pet may cause.

Can you just claim to not have legal liability for your actions and then that's actually binding?

 

[whopper]

You must have liability for actions that are within your field of expertise, that you advocated without setting limits and for which you took responsibility.

E.g. if you wrote "I have no liability over my psychiatric practice" but continue to practice, then you cannot practice. If, however, you wrote there's mental health benefits for the patient using an ESA you can write that because that's mental health, but if you used the disclaimer above, you're clearing setting a limit you're allowed to set. You're not an animal-expert. You're a mental health expert. You're saying the person can benefit from an ESA. You have no control over the pet pissing on the floor and leaving a stain that will costs thousands to fix.

Even if you didn't write the disclaimer, and if sued you'd likely still not be held responsible, but the disclaimer gives you added walls of protection.

 

[smalltownpsych]

You must have liability for actions that are within your field of expertise, that you advocated without setting limits and for which you took responsibility.

E.g. if you wrote "I have no liability over my psychiatric practice" but continue to practice, then you cannot practice. If, however, you wrote there's mental health benefits for the patient using an ESA you can write that because that's mental health, but if you used the disclaimer above, you're clearing setting a limit you're allowed to set. You're not an animal-expert. You're a mental health expert. You're saying the person can benefit from an ESA. You have no control over the pet pissing on the floor and leaving a stain that will costs thousands to fix.

Even if you didn't write the disclaimer, and if sued you'd likely still not be held responsible, but the disclaimer gives you added walls of protection.

That would probably be one of the most ridiculous lawsuits ever. “Doctor Whopper when writing this ESA letter did you consider the possibility that your patient‘s pet might piss on the carpet? In your medical opinion, could you state with a reasonable degree of medical certainty that an animal would not piss on the carpet?”

 

[lockian]

Can you just claim to not have legal liability for your actions and then that's actually binding?

Let’s review the premise of malpractice, the 4 D’s: Dereliction of Duty Directly leading to Damage. Damage, as previously diecussed, is typically limited to the point of barely being worth the legal fees. Duty standards are easy to meet. It is reasonable to have an animal typically kept as a pet. The vast majority of pets cause minimal problems, and we are not asking for a patient to have a Komodo dragon and somehow expecting this to be a reasonable arrangement for both client and community. Finally, facilitating the presence of an animal in a home does not directly deal to damage. There are a myriad of intrinsic and environmental factors influencing animal behavior, including (surprise) the apartment itself. Maybe the apartment stressed or sickened the animal, making it behave aberrantly. No one has a friggin crystal ball. Mania is a side effect of antidepressants but that does not mean we don’t prescribe them. Discuss the “side effects” of having an animal with a patient, document that you did, weigh the pros and cons, write a prescription it it’s reasonable and let the patient act from there. There’s more to life that a smelly carpet in a ****ty apartment.

 

[WisNeuro]

That would probably be one of the most ridiculous lawsuits ever. “Doctor Whopper when writing this ESA letter did you consider the possibility that your patient‘s pet might piss on the carpet? In your medical opinion, could you state with a reasonable degree of medical certainty that an animal would not piss on the carpet?”

Damage to an apartment isn't where Drs will be hit with lawsuits. Situationslike where a dude on a Delta flight that needed about 30 stitches after being attacked by an ESA are where you're likely to be named in a lawsuit for damages. If I am the plaintiff lawyer in that case, I am definitely naming the doc who wrote the letter. As for the ridiculousness of the lawsuit, this rates about a 3 out of 10 on ridiculousness of what is usually named in the suits I work on a regular basis.

 

[mistafab]

I think if a dog bites a baby on the face in an airport, definitely they would add the doctor on the lawsuit list. Plus, I bet malpractice wont cover the MD on this case/defense given that it is outside what is considered psychiatric practice. I bet most docs writing an ESA don't even put it in their progress notes, don't put an end or check in date, and don't check in about how it is helping (or hurting). At least some of that should be in the note if you want to put your neck on the line and write the letter.

If we compare it to behavioral activation, we at least check in on behavioral logs, ask about activities, how it relates to symptoms, etc.

 

[lockian]

Damage to an apartment isn't where Drs will be hit with lawsuits. Situationslike where a dude on a Delta flight that needed about 30 stitches after being attacked by an ESA are where you're likely to be named in a lawsuit for damages. If I am the plaintiff lawyer in that case, I am definitely naming the doc who wrote the letter. As for the ridiculousness of the lawsuit, this rates about a 3 out of 10 on ridiculousness of what is usually named in the suits I work on a regular basis.

This is why I would not write a letter for an ESA to be in public. I’d only write one for an apartment, if I did.

 

[WisNeuro]

This is why I would not write a letter for an ESA to be in public. I’d only write one for an apartment, if I did.

And an ESA can not attack someone in the hallway of an apartment building when its owner takes it out for a walk/bathroom? Reduced chance, yes, but very much non-zero.

 

[lockian]

And an ESA can not attack someone in the hallway of an apartment building when its owner takes it out for a walk/bathroom? Reduced chance, yes, but very much non-zero.

Good point. I will narrow my policy down to cats only and other animals that do not leave the apartment. And tell others that it’s too bad that we can’t have nice things because some people have sought fit to blame doctors for the existence of negligent owners who can’t teach their pets to behave, and neighbors who are somehow too mentally or physically inept to make reasonable efforts at avoiding and escaping, or simply not provoking an animal.

 

[WisNeuro]

Good point. I will narrow my policy down to cats only and other animals that do not leave the apartment. And tell others that it’s too bad that we can’t have nice things because some people have sought fit to blame doctors for the existence of negligent owners who can’t teach their pets to behave, and neighbors who are somehow too mentally or physically inept to make reasonable efforts at avoiding and escaping, or simply not provoking an animal.

Or, just don't write ESA letters as they are not a clinical intervention and there is little or no reason to do so.

 

[lockian]

Or, just don't write ESA letters as they are not a clinical intervention and there is little or no reason to do so.

I disagree. I think they can be. The misery and isolation some people go through as a result of their mental illness makes it so that what merely makes other people feel good can be a lifesaver to the mentally ill. There is no “clinical evidence” because who would have the financial motivation to run well controlled studies on this? The cat fanciers’ society?

But, because people are irresponsible we can’t have nice things.

 

[lockian]

Or, just don't write ESA letters as they are not a clinical intervention and there is little or no reason to do so.

Also people try to assign blame where there is none. It is the domain of the MD to decide if animal will be helpful and not detrimental to the patient’s mental health. It is up to the patient to train, care for, and control the animal, and up to the people around them to exercise precautions around the animal. There are many factors to any outcome and a letter supporting the animal’s ownership is just a small piece of the puzzle.

It is sad that the litigious society we live in makes this such an issue.

 

[WisNeuro]

Also people try to assign blame where there is none. It is the domain of the MD to decide if animal will be helpful and not detrimental to the patient’s mental health. It is up to the patient to train, care for, and control the animal, and up to the people around them to exercise precautions around the animal. There are many factors to any outcome and a letter supporting the animal’s ownership is just a small piece of the puzzle.

It is sad that the litigious society we live in makes this such an issue.

I'm a bit biased, this litigious society pays me very well.

 

[deleted1100659]

Lawyers are very good at what they do, anything you write on that letter will be scrutinized and picked apart.

1. "I am not liable for any actions the animal may commit" "Ok, why aren't you liable? You wrote the letter stating the patient could take the animal whereever they want, you must have assumed the animal was completely safe, otherwise it does not seem like a good idea taking that animal to public places?"

2. "I can not predict the behavior of the animal" "Ok, so why did you write a letter saying they could take it wherever they want?"

3. "I can not vouch for the temperament of the animal" "Ok, so you have never even seen this animal in person, have no experience with it, state openly that you have no idea how hostile it could be, and you wrote a letter stating its fine to bring it in public wherever they want?"

4. "Patient states they benefit from the animal" "In what way exactly? Can you point to all the research that clearly shows this animal is indicated for their disorder?"

its very easy. In the legal system, doing the right and good intentions does not always hold up.

 

[WisNeuro]

Lawyers are very good at what they do, anything you write on that letter will be scrutinized and picked apart.

1. "I am not liable for any actions the animal may commit" "Ok, why aren't you liable? You wrote the letter stating the patient could take the animal whereever they want, you must have assumed the animal was completely safe, otherwise it does not seem like a good idea taking that animal to public places?"

2. "I can not predict the behavior of the animal" "Ok, so why did you write a letter saying they could take it wherever they want?"

3. "I can not vouch for the temperament of the animal" "Ok, so you have never even seen this animal in person, have no experience with it, state openly that you have no idea how hostile it could be, and you wrote a letter stating its fine to bring it in public wherever they want?"

4. "Patient states they benefit from the animal" "In what way exactly? Can you point to all the research that clearly shows this animal is indicated for their disorder?"

its very easy. In the legal system, doing the right and good intentions does not always hold up.

Also, they know that liability carriers are very loathe to take something to arbitration or trial due to the cost, and will likely settle for a decent amount rather than pay the expense of litigation.

 

[smalltownpsych]

I don’t like to write pet letters for many of the reasons discussed, but as I mentioned above, I have written a couple when I decide it makes sense. I also understand the importance of thinking through clinical decisions making for a stance of how I would justify it on court as that is a rubric that I often use. My question is, are there many cases has a psychiatrist or psychologist been called into court over this or been held liable in same way? In my mind, the risk is pretty minimal so I tend not to worry that much about the liability aspect of this argument.

 

[lockian]

Lawyers are very good at what they do, anything you write on that letter will be scrutinized and picked apart.

1. "I am not liable for any actions the animal may commit" "Ok, why aren't you liable? You wrote the letter stating the patient could take the animal whereever they want, you must have assumed the animal was completely safe, otherwise it does not seem like a good idea taking that animal to public places?"

2. "I can not predict the behavior of the animal" "Ok, so why did you write a letter saying they could take it wherever they want?"

3. "I can not vouch for the temperament of the animal" "Ok, so you have never even seen this animal in person, have no experience with it, state openly that you have no idea how hostile it could be, and you wrote a letter stating its fine to bring it in public wherever they want?"

4. "Patient states they benefit from the animal" "In what way exactly? Can you point to all the research that clearly shows this animal is indicated for their disorder?"

its very easy. In the legal system, doing the right and good intentions does not always hold up.

Again, very sad that we have to think about this sort of scenario.

But this is in part why I personally would not write ESA letters allowing for the animal to be in public, just to allow them to be in an apartment. Full disclosure, I’ve only written letters for cats who don’t leave apartments. But as wisneuro correctly pointed out, animals, particularly dogs, may have to leave the home sometimes. So there may be liability there. But then where does it end? If someone visits a person with an RSA cat and that cat bites them, is the doctor liable then too?

I suppose you can put “any and all behavior of the animal and its outcomes is the owner’s responsibility and the patient understands this.”

 

[Candidate2017]

It is sad that the litigious society we live in makes this such an issue.

We are a society of many freedoms and rights. But it isn't free. We don't get to sit in a circle and sing kumbaya. Because all our freedoms and rights are constantly challenged by others asserting their freedoms and rights supercede our rights. Our rights need to be defended, including by ballot box and/or litigation.

Anyway, I don't write any ESA "doctor's note". But I would be happy to write a employment reference letter, which would help patients get a job, better job, or promotion, which would lead to a myriad of benefits. Alas, patients never ask me.

 

[lockian]

We are a society of many freedoms and rights. But it isn't free. We don't get to sit in a circle and sing kumbaya. Because all our freedoms and rights are constantly challenged by others asserting their freedoms and rights supercede our rights. Our rights need to be defended, including by ballot box and/or litigation.

Anyway, I don't write any ESA "doctor's note". But I would be happy to write a employment reference letter, which would help patients get a job, better job, or promotion, which would lead to a myriad of benefits. Alas, patients never ask me.

Patients probably don’t want to advertise their mental illnesses to employers or potential employers unless things are really hitting the fan and something like FMLA or workplace accommodations are needed.

 

[WisNeuro]

Patients probably don’t want to advertise their mental illnesses to employers or potential employers unless things are really hitting the fan and something like FMLA or workplace accommodations are needed.

Have you seen social media in the past few years? People want to advertise their mental illness, real and made up, to just about everyone these days. Get ready for another surge in DID cases!

 

[allantois]

ESA is another nonsense paperwork that medical professionals are expected to provide. Most of these are done by PCPs these days. I have one (for a legitimate anxiety disorder I've been diagnosed and treated for) for my apartment which otherwise would charge an arm and a leg for for pet rent. In my state, there is a lot of HOAs that prohibit animal ownership, but have to allow it for ESAs

 

[lockian]

Have you seen social media in the past few years? People want to advertise their mental illness, real and made up, to just about everyone these days. Get ready for another surge in DID cases!

I try not to be on social media. For my own mental health.

 

[lockian]

We are a society of many freedoms and rights. But it isn't free. We don't get to sit in a circle and sing kumbaya. Because all our freedoms and rights are constantly challenged by others asserting their freedoms and rights supercede our rights. Our rights need to be defended, including by ballot box and/or litigation.

Anyway, I don't write any ESA "doctor's note". But I would be happy to write a employment reference letter, which would help patients get a job, better job, or promotion, which would lead to a myriad of benefits. Alas, patients never ask me.

I don't have the expectation that anyone sit in a circle and sing kumbaya, but to recognize that due to competing interests every event is multifactorial, that people typically have good intentions and take reasonable precautions, and that sometimes **** still happens. If a dog bit you in the face, that's why you have insurance for healthcare and other collaborative safety nets.

 

[michaelrack]

We are a society of many freedoms and rights. But it isn't free. We don't get to sit in a circle and sing kumbaya. Because all our freedoms and rights are constantly challenged by others asserting their freedoms and rights supercede our rights. Our rights need to be defended, including by ballot box and/or litigation.

Anyway, I don't write any ESA "doctor's note". But I would be happy to write a employment reference letter, which would help patients get a job, better job, or promotion, which would lead to a myriad of benefits. Alas, patients never ask me.

Patients don't ask you for an employment reference letter??? You must not be an inpatient psychiatrist dealing with patients who have made threats towards others at work

 

[michaelrack]

I don't have the expectation that anyone sit in a circle and sing kumbaya, but to recognize that due to competing interests every event is multifactorial, that people typically have good intentions and take reasonable precautions, and that sometimes **** still happens. If a dog bit you in the face, that's why you have insurance for healthcare and other collaborative safety nets.

You have insurance, and I have insurance. But there are a lot of people out there with no insurance (or medicaid from a state they are no longer living in, which is the same as having no insurance) and no safety nets.

 

[WisNeuro]

I don't have the expectation that anyone sit in a circle and sing kumbaya, but to recognize that due to competing interests every event is multifactorial, that people typically have good intentions and take reasonable precautions, and that sometimes **** still happens. If a dog bit you in the face, that's why you have insurance for healthcare and other collaborative safety nets.

I have insurance and money, but if a dog goes at my face, I'm still suing the person who owns the dog. And if its an ESA, I'm naming everyone involved just out of principle.

Also, even with good insurance, many people would still be looking at 4 figures plus out of pocket for something like the guy on the Delta flight.

 

[lockian]

I have insurance and money, but if a dog goes at my face, I'm still suing the person who owns the dog. And if its an ESA, I'm naming everyone involved just out of principle.

Also, even with good insurance, many people would still be looking at 4 figures plus out of pocket for something like the guy on the Delta flight.

If a dog bites someone’s face, something is very wrong. One or more of the following things is likely at play:

1) dog is very unhealthy. Healthy animals do not attack unprovoked. In which case you also need to sue the vet
2) the owner is negligent or somehow incapacitated in that moment, preventing them from controlling the dog
3) the person who was bitten either severely provoked the animal or did nothing to defend themselves. It’s almost instinctive for people to cover their faces when attacked. If it’s a baby, the parents did not protect it.

Very little of this has to do with the doctor who wrote an ESA letter, except perhaps the negligence of an owner which could be predicted based on their level of function.

But, again, because people seek someone else to blame in an effort to make things “right” or even, we can’t have nice things.

 

[lockian]

You have insurance, and I have insurance. But there are a lot of people out there with no insurance (or medicaid from a state they are no longer living in, which is the same as having no insurance) and no safety nets.

Then we really should look at why social safety nets are as bad as they are.

 

[WisNeuro]

If a dog bites someone’s face, something is very wrong. One or more of the following things is likely at play:

1) dog is very unhealthy. Healthy animals do not attack unprovoked. In which case you also need to sue the vet
2) the owner is negligent or somehow incapacitated in that moment, preventing them from controlling the dog
3) the person who was bitten either severely provoked the animal or did nothing to defend themselves. It’s almost instinctive for people to cover their faces when attacked. If it’s a baby, the parents did not protect it.

Very little of this has to do with the doctor who wrote an ESA letter, except perhaps the negligence of an owner which could be predicted based on their level of function.

But, again, because people seek someone else to blame in an effort to make things “right” or even, we can’t have nice things.

You forgot 4) there is no actual clinical reason for this animal to be in this situation (e.g., plane, housing which restricts animals in most cases. In case of liability, blame lies on everyone who has a hand in that, including whomever wrote the ESA in this case. It'd be easy enough to compile a list of references to support the plaintiff in these cases to essentially force an insurance carrier to settle rather than go to trial.

 

[lockian]

You forgot 4) there is no actual clinical reason for this animal to be in this situation (e.g., plane, housing which restricts animals in most cases. In case of liability, blame lies on everyone who has a hand in that, including whomever wrote the ESA in this case. It'd be easy enough to compile a list of references to support the plaintiff in these cases to essentially force an insurance carrier to settle rather than go to trial.

Yes there is, if it is documented that the patient’s function is impaired without the animal and improved with. But I don’t think we should continue this conversation; we are not going to agree. And I may not write any more ESA letters because I do value not getting sued, but I will continue to actively resent our litigious society and our field’s stance on the issue. I also intend to refuse ESA letters by referencing our litigious society as the reason, not my clinical judgment.

 

[lockian]

Yes there is, if it is documented that the patient’s function is impaired without the animal and improved with. But I don’t think we should continue this conversation; we are not going to agree. And I may not write any more ESA letters because I do value not getting sued, but I will continue to actively resent our litigious society and our field’s stance on the issue. I also intend to refuse ESA letters by referencing our litigious society as the reason, not my clinical judgment.

I might even literally say, “sorry, some ESA bit a guy in the face and the guy sued everyone involved, so now i can’t give ESA letters out anymore.”

 

[lockian]

People in this thread also position their arguments as if an animal is a ticking time bomb threatening to attack, and the reality is that cases like the guy on a flight whose face got bitten are vanishingly rare and multiple bad circumstances must align for something like that to occur.

 

[smalltownpsych]

Apparently the guy who was attacked by the dog on the plane is suing the airline. Doesn’t look like whoever said he needed a support animal is on the hook for it.

 

[Ironspy]

Apparently the guy who was attacked by the dog on the plane is suing the airline. Doesn’t look like whoever said he needed a support animal is on the hook for it.

Airline has deeper pockets

 

[WisNeuro]

People in this thread also position their arguments as if an animal is a ticking time bomb threatening to attack, and the reality is that cases like the guy on a flight whose face got bitten are vanishingly rare and multiple bad circumstances must align for something like that to occur.

Vanishingly rare somewhat subjective. You can find a few dozen cases over the past several years with a quick google search, and those are just the publicize cases. And, as more and more of these letters get written, and more of these untrained animals get out there, that incidence will only increase. As for liability, I was also curious about that. In a quick google search of law firms that have commented and litigate such manners, I was able to find a handful that list that the medical professionals who vetted the ESA, either who wrote the letter, or a vet who signed off on it, can be liable in such circumstances. Obviously it still has to go through proceedings, but you can easily find firms who are more than happy to pursue this course of action. And, like I said, pretty easy to introduce a document with several dozen citations arguing against the practice to push a liability carrier to settle before arbitration or trial.

 

[Riptoe]

The college I went to brought dogs into the library during exam/reading weeks.

This college had/has a serious, serious mental health crisis issue institutionally. I guess they thought dogs helped make up for policies that worsened students' mental health. Don't want to mention the college but it's been in the national news for this reason multiple times and for multiple aspects of them actively creating or worsening mental health issues.

The dorms I lived were occupied by flying cockroaches, ants, etc.

Not sure you could have harmed the place by adding more flora and fauna.

I was recently on the college's subreddit and freshman are moving in asking which dorms are the worst, and the one I lived in freshman year someone responded to: That place is still standing? It is kind of amazing given that it was subaquatic much of the year. I would have avoided putting a dog in there for the dog's health.

Sounds like my college, did it happen to be in virginia?

 

[CB5T]

I don't know man. Here in the OP setting. I don't think it's a rabid lap dog that will do us in. The humans with PD pathology empowered with narcissistic cultural influences are much more dangerous in my opinion. I don't think you need to practice with legal fear as one of your guiding principles. Simple, positive intention, trying to be useful, good clinical work, and grey rocking the dangerous humans, should manage most risk. Who knows what the emotionally soothed chaotic people would be up to otherwise if they didn't have the constructive relationship with their animal. Or how about the lonely ones and suicide.

Risk management and good clinical practice is not just about managing risk to you the clinician, by treating every person asking for an ESA letter like a malingering, maladaptive, manipulator who needs the Truth Business given to them.

I think that whole attitude might increase your legal risk.

 

[birchswing]

Sounds like my college, did it happen to be in virginia?

Lol. Yes.

The tales I could tell from the very early 2000s. Fortunately some people have been braver than me and told their stories. Not sure if it has made a difference.

My only advice to anyone going to college would be: Don't leave your "home" psychiatrist. I guess they have a new one now. For years (more than a decade?) didn't have any at all.

 

[mistafab]

I don't know man. Here in the OP setting. I don't think it's a rabid lap dog that will do us in. The humans with PD pathology empowered with narcissistic cultural influences are much more dangerous in my opinion. I don't think you need to practice with legal fear as one of your guiding principles. Simple, positive intention, trying to be useful, good clinical work, and grey rocking the dangerous humans, should manage most risk. Who knows what the emotionally soothed chaotic people would be up to otherwise if they didn't have the constructive relationship with their animal. Or how about the lonely ones and suicide.

Risk management and good clinical practice is not just about managing risk to you the clinician, by treating every person asking for an ESA letter like a malingering, maladaptive, manipulator who needs the Truth Business given to them.

I think that whole attitude might increase your legal risk.

Agree or not, a psychiatrist is forced to play the role of behaviorist in at least some sense. To encourage rule-bending, special treatment, or avoidance is anti-therapeutic in my perspective. Pets are great. But the above is not.

 

[birchswing]

Agree or not, a psychiatrist is forced to play the role of behaviorist in at least some sense. To encourage rule-bending, special treatment, or avoidance is anti-therapeutic in my perspective. Pets are great. But the above is not.

It also creates a debt to the therapist, which is somewhat anti-therapeutic--some would argue. I would probably agree. Plus it's sort of heady machinations that takes you out of the frame. It doesn't seem relevant to therapy. In that way, I think using a letter milli is better.

But I would make a distinction about it being an exception. Regardless of how you feel about it, it's the law that you have the right to an ESA in housing, for example, if you qualify. In a way making a point that a person shouldn't qualify because of your own opinion is making an exception to the law and the right.

I think I said before I don't think you all should be in this position. And maybe it's a pedantic point, but the way it's written it sounds more like a right for a class of people than it does an exception.