Responding to Requests for Service and Emotional Support Animals in Health Care Facilities

The headlines have been undeniably splashy: an alligator helps a man cope with depression; miniature horses come to the rescue of stress-laden university students; an emotional support peacock is denied admission on a cross-country flight. But the swell in animals accompanying people in public places, including health care facilities, has sown considerable confusion among management and staff at these locations. And health care providers must grapple with some unique challenges that arise when a patient presents at a hospital or clinic appointment with an animal. What types of animals must you legally permit to enter? Can staff ask for verification of an animal’s status? What about sterilization concerns and allergy issues?

Managing these challenges requires an understanding of the major differences between the different types of animals that assist their human handlers.

Service Animals

  • Protected under federal law and the law of nearly every state
  • Individually trained (but not necessarily professionally trained) to do work or perform specific tasks for people with disabilities
  • Not required by law to wear special identification or have a specific certification
  • Generally dogs under federal law, but miniature horses may qualify in certain circumstances; state or local law may recognize other types of animals

Emotional Support Animals

  • Not protected under federal law; may be protected under state or local law
  • Provide therapeutic or companionship benefits to individuals just by being with  them
  • Not trained to perform any specific jobs or tasks
  • Also called comfort or companion animals

Therapy Animals

  • Generally not protected by law; permitted into public accommodations through agreements or contracts with facilities
  • Have more training than emotional support animals, but are trained to interact with many different types of people, not a particular individual

To illustrate the distinction between these different types of animals with an example, a dog that is trained to sense that a person with Post Traumatic Stress Disorder (“PTSD”) is about to have an anxiety attack, and then take a specific action to help that individual avoid or lessen the impact of the attack, would qualify as a service animal. A dog that lacks such training but simply calms the person with PTSD by its presence is not considered a service animal under the law, but may be considered an emotional support animal or therapy animal.

Administrators at health care facilities should develop a comprehensive animal policy that: (1) accounts for federal, state, and local laws; (2) applies to patients, visitors, and volunteers; and (3) is available to the public for review. Note that the same policy may not extend to facility staff asking to be accompanied by an animal in the workplace. Different laws may apply to staff in this context, and you should consult with human resources professionals and employment counsel for guidance in this area.

Drafting an Animal Policy

Here are a few basic tips for drafting your facility’s animal policy:

  • As a general rule, facilities must permit service animals into any area of the facility that is open to the public, including most patient areas (e.g., examination rooms and waiting rooms), but it may be appropriate to exclude a service animal from a specific area where the animal’s presence may compromise a sterile environment (e.g., a procedure or operating room).
  • Before denying an individual’s request to be accompanied by an animal in the facility, have a management-level staff member conduct an individualized evaluation of the animal, patient, and health care situation and document that evaluation.
  • When it is not obvious what work an animal performs, staff may ask two questions only:
    • (1) Is the animal a service animal required because of a disability?
    • (2) What work or task has the animal been trained to perform?
  • Staff must rely upon the answers given to those questions in making their assessment.
  • Staff may not ask about the nature or extent of a person’s disability; require documentation of the person’s disability; ask for “certification” or other proof of an animal’s training; or ask to have the animal demonstrate its work.
  • Allergies and fear of an animal are not valid reasons for denying access or refusing service to people accompanied by service animals.

For helpful FAQs addressing service and emotional support animals, visit