The regulations covering service animals in Title II and III of the ADA apply to health care settings including hospitals, clinics, emergency rooms, and doctors' offices. These particular settings, however, pose serious questions as to how best to comply with the ADA and ensure the health, well-being, and safety of patients. Following is guidance from the U.S. Department of Health and Human Services and the Center for Disease Control and Prevention to help health care facilities develop policies that comply with the ADA. Note that the ADA definition of a service animal only covers dogs and, as an exception, miniature horses. Emotional support animals are not covered by the ADA.
Policy Guidance
The policy guidance below is taken directly from the Fact Sheet: Understanding How to Accommodate Service Animals in Healthcare Facilities developed by the U.S. Dept. of Health and Human Services.
During a public health emergency or disaster staff may not:
- ask about the person’s disability;
- require medical documentation, a special identification card, or training documentation for the dog;
- or ask the dog to demonstrate its ability to perform the work or task.
- When it’s not obvious what task is being performed by a service animal, staff may ask only two questions:
- Is the dog a service animal required because of a disability, and
- What work or task has the dog been trained to perform?
- Service animals can accompany the individual with a disability in all areas of the medical facility where health care personnel, visitors, and patients are normally allowed during inpatient services unless the animal's presence or behavior creates a fundamental alteration to the nature of a facility's services in a particular area or a direct threat to other persons in a particular area.
- A “direct threat” is defined as a significant risk to the health or safety of others that cannot be mitigated or eliminated by modifying policies, practices, or procedures.
- A “direct threat” is defined as a significant risk to the health or safety of others that cannot be mitigated or eliminated by modifying policies, practices, or procedures.
- A person with a disability cannot be asked to remove his or her service animal from the premises unless the dog is not housebroken, is out of control, or if the handler/owner does not take effective action to control the service animal.
- It may be appropriate to exclude a service animal from limited access areas that employ general infection control measures, such as operating rooms and burn units, where the animal’s presence may compromise a sterile field environment.
- Fear and allergies are not valid reasons for denying access to a service animal or refusing service to people using service animals.
- Fear and allergies are not valid reasons for denying access to a service animal or refusing service to people using service animals.
- People with disabilities who use service animals may not be isolated from others, treated less favorably than others, or charged with fees that are not charged to other customers without animals.
- Service animals must be harnessed, leashed, or tethered, unless these devices interfere with the service animal’s work or if an individual’s disability prevents using these devices. The handler/owner must maintain control of the animal through voice, signal, or other effective controls.
- When encountering an individual with a disability, it is acceptable to ask if they need assistance. If yes, ask how you can best assist them.
- When encountering an individual with a service animal, do not interact with or distract the animal.
Restricting Service Dogs Based on Health Care Concerns--
The Center for Disease Control and Prevention in Guidelines for Environmental Infection Control in Health Care Facilities (2003) provides the following guidance for developing policy in these areas. The excerpts below are taken directly from this document.
Risk of Disease Transmission
"No evidence suggests that animals pose a more significant risk of transmitting infection than people; therefore, service animals should not be excluded from such areas, unless an individual patient’s situation or a particular animal poses a greater risk that cannot be mitigated through reasonable measures. If health-care personnel, visitors, and patients are permitted to enter care areas (e.g., inpatient rooms, some ICUs, and public areas) without taking additional precautions to prevent transmission of infectious agents (e.g., donning gloves, gowns, or masks), a clean, healthy, well-behaved service animal should be allowed access with its handler. Similarly, if immunocompromised patients are able to receive visitors without using protective garments or equipment, an exclusion of service animals from this area would not be justified."
Deciding Upon Restricted Areas and Exclusion
"Excluding a service animal from an OR or similar special care areas (e.g., burn units, some ICUs, PE units, and any other area containing equipment critical for life support) is appropriate if these areas are considered to have “restricted access” with regards to the general public. General infection-control measures that dictate such limited access include
- the area is required to meet environmental criteria to minimize the risk of disease transmission,
- strict attention to hand hygiene and absence of dermatologic conditions, and
- barrier protective measures [e.g., using gloves, wearing gowns and masks] are indicated for persons in the affected space.
No infection-control measures regarding the use of barrier precautions could be reasonably imposed on the service animal. Excluding a service animal that becomes threatening because of a perceived danger to its handler during treatment also is appropriate; however, exclusion of such an animal must be based on the actual behavior of the particular animal, not on speculation about how the animal might behave.
Other Issues to Consider when Developing Policy
Another issue regarding service animals is whether to permit persons with disabilities to be accompanied by their service animals during all phases of their stay in the healthcare facility. Healthcare personnel should discuss all aspects of anticipatory care with the patient who uses a service animal. Health-care personnel may not exclude a service animal because health-care staff may be able to perform the same services that the service animal does (e.g., retrieving dropped items and guiding an otherwise ambulatory person to the restroom). Similarly, healthcare personnel can not exclude service animals because the healthcare staff perceives a lack of need for the service animal during the person’s stay in the facility.
A person with a disability is entitled to independent access (i.e., to be accompanied by a service animal unless the animal poses a direct threat or a fundamental alteration to the nature of services). “Need” for the animal is not a valid factor in either analysis.
For some forms of care (e.g., ambulation as physical therapy following total hip replacement or knee replacement), the service animal should not be used in place of a credentialed healthcare worker who directly provides therapy. However, service animals need not be restricted from being in the presence of their handler during this time; in addition, rehabilitation and discharge planning should incorporate the patient’s future use of the animal.
The healthcare personnel and the patient should discuss both the possible need for the service animal to be separated from its handler for a period of time during non-emergency care. They should also discuss an alternate plan of care for the service animal in the event the patient is unable or unwilling to provide that care. This plan might include family members taking the animal out of the facility several times a day for exercise and elimination, the animal staying with the patient's relatives, or boarding off-site. Care of the service animal remains the obligation of the person with the disability, not the healthcare staff.