#75 Service Dogs in Dental Settings

Have you ever had a Service Dog or Service Animal accompany your patient to their dental appointment? Can service animals enter the treatment room? Are there infection control considerations?  Are comfort, companion, support, therapy and emotional support animals, considered “service” animals? In this podcast the Divas discuss FAQs surrounding Service Animals in the Dental Setting. 

Resources:

• Frequently Asked Questions about Service Animals and the Americans with Disabilities Act (AwDA)  https://www.ada.gov/regs2010/service_animal_qa.html
• CDC:   Service Animals in Dental Health Care Settings - Infection Control Measures  https://www.cdc.gov/oralhealth/infectioncontrol/faqs/animals.html
• Journal of the American Dental Association: The Ethics of Service Animals in the Dental Office  https://jada.ada.org/article/S0002-8177(19)30294-6/fulltext
• U.S. Dept. of Justice Dept. of Civil Rights - Service Animals  https://www.ada.gov/service_animals_2010.htm
• Modern Practice Solutions Blog: International Assistance Dog Week https://dentalcompliancetn.com/2019/10/16/international-assistance-dog-week/
• OSHA Review Blog: AwDA Rules:  Offices Must Allow Service Animals  https://oshareview.com/2015/06/awda-rules-offices-must-allow-service-animals-dental-regulations/#:~:text=Dental%20offices%20must%20permit%20people,tasks%20for%20people%20with%20disabilities

                                                 https://www.thecompliancedivas.com

Transcript

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SPEAKER_00 0:04

Welcome. I'm Leslie Cannon. I'm Mary Gavoni. I'm Linda Harvey.

SPEAKER_01 0:10

I'm Olivia Juan. And together we are the Compliance Divas.

SPEAKER_00 0:22

Welcome to this special podcast. The Compliance Divas are today Olivia Juan and Leslie Cannum. Compadre Warrior, Road Warrior Divas are out conducting training today. So Linda Harvey and Mary Gavoni will not be with us, but Olivia and I felt that this was a very special and unique podcast because we're both big fans of animals. And today the topic is on service dogs in the dental setting. You know, the big question comes up: have you ever had a service dog or a service animal accompany your patient to their dental appointment? I've been in dentistry 50 years, and I can remember about, well, I can count on one hand how many times I've seen a service dog come to the dental practice. But in most of those cases, it was a service dog that was going through the training and it stayed with its handler the whole time in the reception room while family members would go and have dental treatment. And they were always so well behaved you hardly knew they were there. But the question is going to arise: can a service animal enter the treatment room? And are there infection control considerations? What about comfort animals, companion animals, support or therapy animals? How about emotional support animals? Are they considered service animals? So in this podcast, Olivia and I are going to discuss the facts and frequently asked questions surrounding service animals in the dental setting. And I think the most important thing is, of course, to recognize that the definition of a service animal under the Americans with Disabilities Act, a service animal is a dog that has been specifically trained for individually trained to do a work or perform a task for an individual with a disability. And the task that the dog performs must be related to a person's disability. Now, what kind of task might that be? You've probably seen service animals as they are sometimes presented in your out in public or in other places. And a person with a disability, for example, a unique one is a person with diabetes might have a dog that's trained to alert him or her when blood sugar reaches high or low levels. And that's something that is on the breath of the person that is a diabetic and needs to have a service animal alert them to that fact before they go into a health situation that might be very dangerous. A person with depression might have a dog that's trained to remind them to take their medication. Or a person with epilepsy may have a dog that's trained to detect the onset of a seizure and help that person remain safe during that seizure. Now, there's, as I mentioned, emotional support animals, therapy animals, comfort animals, or companion animals. Are they considered service animals under ADA? And actually they are not, because these terms are really used to describe animals that provide comfort just by being with a person. They've not been trained to perform a specific task or a job, and they don't qualify as service animals under ADA. But some states or local governments do have laws that allow people to take emotional support animals into public places. And that's where it's so important. Olivia, we always need to check with our state and local government for so many different regulations. This might be something that would be well worth team members checking out ahead of the surprise there's a service animal or a support animal in my reception room. Now, what do I do? So I know in dentistry, uh many times we do have patients who are very anxious about having treatment, and it may serve them very well if they have a trained support animal that accompanies them to their dental appointment. And another thing that's kind of interesting about service animals is that they don't necessarily have to be professionally trained. People with disabilities have the right to train a dog themselves, and they're not required to use a professional service dog training program. So I just want to share very quickly before I turn this presentation over to you, Olivia, that I have a service animal. I have a service dog. Many of our uh colleagues in dentistry and many of my audiences have met, Mocha. He's a chocolate lab. Um he's trained to help me because I'm hearing impaired. And I do pretty well most of the time. But one thing that's very challenging for me is hearing an alarm clock, hearing a knock on the door, hearing a telephone ring, and a lot of times hearing questions from my audiences. So I'll share with you a little later how uh Mocha helps me with the questions from my audiences. But Olivia, um, you know, as we confront the situation of having a service dog that may accompany one of our patients, can you tell us a little bit more about what kind of questions that uh the dental team could ask a patient about their service animal? And then uh can you tell us a little bit more about some of the details about where a service animal could be located and can they come into the treatment room?

SPEAKER_01 5:38

Sure, Leslie. This is such a fun topic, and I'm really excited to have this podcast and share information with our listeners, but there's definitely some questions that the dental team member can ask. Because believe me, this comes up more often than not. I had a client, a pediatric client, that the patient's parent brought in an emotional support chicken. So it can get out of hand. We have to understand what is a service animal. So when it is not obvious what service the animal provides, you can only make a limited inquiry limited to these two questions. And the first one, Leslie, is Is the dog a service animal required because of a disability? So we're just leaving it at that. We're not really inquiring what their disability is. And the second question is what work or task has the dog been trained to do? And so uh that's definitely something that we can inquire to filter out whether it is truly a service animal or an emotional support animal. And one of the things that comes up is, you know, what if people are afraid of dogs? And I had this come up with a dentist who was deathly afraid of dogs due to a previous injury or attack as a child. But if the dog is a bona fide service animal, they cannot be refused. And not even with the allegation, well, someone might be allergic to dog hair, or someone else in the lobby might be afraid of dogs. And so this is why we need to do our research in advance. For example, there's an example of an allergist who several years ago had to settle a HIPAA violation. He was actually fined $125,000 by the Office of Health and Human Services Office for Civil Rights due to an allegation of a HIPAA violation. And what happened is that someone filed a complaint because they alleged that they were not able to bring their service animal in. And so this individual who filed the complaint went to the news media. And I know the natural inclination of someone is to defend themselves. So evidently, in speaking to the news media, the provider uh impermissibly disclosed protected health information of the patient who they tried to refuse the animal entry. And so this ended up in allergy associates agreeing to settle the case with a financial penalty of $125,000. So I think, Leslie, this is such a good podcast to cover this information and making sure that we limit our inquiries about the service animal and the task that the service animal may do. And I think you clarified that really well, Leslie, that there's this difference between a service animal and emotional support animal. Now, obviously, if the service dog is misbehaving and putting someone at risk, then at that point the dentist or management could ask for the animal to leave the premises. But wouldn't you agree, Leslie, that dogs that are trained to be service dogs are so well behaved, they understand their role and their task. And this probably does not happen for a bona fide service dog.

SPEAKER_00 9:23

Would you agree, Leslie? Absolutely. In fact, uh, one of the things that's interesting is that most service dogs, you don't even realize that they're there. I know uh many times when I go into a restaurant with Mocha, uh, the waitress and or bus person is always surprised when I get up and leave, and there was a service dog that was underneath the table the whole time.

SPEAKER_01 9:43

Yes, and I've been with you, Les, when Mocha was traveling with you and was up underneath the table when we were eating lunch, and you would never know that he was there because he was so quiet and behaved himself like a little gentleman. Uh, there's also information that's helpful for dental offices to download, and that is CDC's information on service animals in dental health care settings. And once again, it does clarify that a service animal is any animal trained to do work or perform tasks for the benefit of a person with a disability, such as yourself, Leslie, with a hearing impairment or other disability. And there really isn't any special infection prevention measure for a patient coming in with a service animal in a dental office. So there's no evidence that suggests that a service animal would pose a significant risk of transmitting infection more than people coming into a dental office. That would be different in certain surgery situations. I mean, it's not like the service animal is going into a hospital operating room where the patient is sedated anyway. So there's a big difference there. And so once again, there's no uh risk of infection allowing a service animal to present into a dental office. So it would be appropriate to let the service animal accompany the dental patient inside of the treatment room. Leslie, what can you tell us about Mocha?

SPEAKER_00 11:17

Well, first of all, I'm always very concerned when I take him to a dental office. I'm worried about, you know, how clean are the floors and would there inadvertently have been a sharps item, even an ortho wire or something that he might step on. And uh, I'm worried a little bit, you know, could he lick his paws afterward and be exposed to um, you know, very harsh disinfectants? So my concern is more for his uh safety when I go into a dental setting. So I try to bring someone with me and and uh they would accompany me to the reception room, and then I'll switch off to my husband, who's also a handler for Mocha, uh, to keep him in the reception area while I'm having treatment. And that way I feel a little bit better for his safety. But if he were to accompany me, and many uh individuals who do have service dogs are independent and travel independently and live alone, and so they don't have anyone to manage their service animal. That uh dog can come into the treatment room and sit right at the foot of the chair. And again, service dogs are incredibly well trained. They are actually required to follow their handler's command at least 90% of the time. Now, there is that 10% of the time, and I have to admit, when Mocha gets outside and sees a squirrel, sometimes uh all bets are off because he's crazy about squirrels. And so he's at full attention and not focused on me in the great outdoors. But um that there's really very, very uh few instances where I felt uncomfortable having him with me. And uh one of those is where I'm I take him with me when I'm on speaking engagements, and uh he'll be underneath the uh the drape table and he'll get nice and relaxed and then start snoring. And so you can hear snoring through the microphone, and it sounds like somebody's asleep. It's actually just Mocha.

SPEAKER_01 13:06

That's funny, Leslie. As you know, Leslie, I have miniature horses. And years ago, I was invited, I actually sent a letter to St. Jude's Hospital in Memphis, which is a children's hospital. And years ago at that time, the only animals that had been brought into the children's hospital were dogs. And so I asked the hospital, I said, you know, would it be okay if I bring in some of my miniature horses? Because I was showing horses in Memphis. And the hospital invited us to come, and they did tell us ahead of time to be mentally prepared because the children that we were going to visit were cancer patients. And so we pull up with our horse trailer at the hospital, and even though they told us to be prepared, I was mentally and emotionally not prepared to see these children who had no hair with targets drawn on their heads for chemotherapy. And we brought the horses out and they had their little IV towers on wheels, and they were petting the horses and giving them some of their coke and pop, and it was just so adorable and loving. And the hospital sent us a letter thanking us for bringing the horses in. We also brought the horses into a local nursing home to visit patients, and I also worked with um a handicap group some years back and working with uh letting the handicapped special needs children to ride the horses with special handlers. So it's so it's a wonderful thing to participate in. And Leslie, you know, miniature horses are actually recognized as a service animal. And the reason being is as you know, with Mocha, years and years of training is invested into making a service dog. They're so highly trained to assist that individual with a disability. But unfortunately, a dog may live 10, 15, 16 years, and those later years are often not very productive years as a senior dog. Whereas miniature horses live up to 25 years, and some have even lived 40 years. I know I have a little miniature horse passed away recently, but he was uh 29 years old. So if lots and lots of years of training goes into a miniature horse, there's going to be more longevity to assist that person with a disability. And they are just so cute, Leslie, seeing pictures of them on airplanes with their little special boots sitting with their handler. And you know, there's other animals that make great emotional support dogs. Uh, I have miniature pigs on my farm. I have Julianas and Cooney Cooney pigs, and they're extremely brilliant animals. And I Leslie, I know people laugh because I kept my pigs in the house for the first three months. And people know that I'm a tidy housekeeper and ask, well, how did you have pigs in your house? Well, they're just naturally litter box trained. So they lived in my sunroom and used a litter box. They're very clean animals and extremely smart. You can teach them tricks, they learn their names, they learn voice commands. I elected not to keep them in my house long term because they love to hear the kitchen cabinets open and close and slamming them shut. And they would get the zoomies in my house and their little hooves running on the floors became a little bit unnerving. So they live outside with the other farm animals. But I would like to emphasize just two more things, is just a repeat just for our listeners to make sure they have grasped it that when it is not obvious what the service animal provides, keep your inquiries limited because the last thing you want is an Americans with Disability Act violation filed against your dental office. So you can only ask is the dog a service animal required because of a disability? And the and the other question is what worker task has the dog been trained to do? The staff member cannot ask about the person's disability or ask for medical documentation or ID card. And you mentioned that earlier, Leslie, when you said that it might be someone that has mental health disability or diabetes, they can't see the disability, but there is a special service the animal provides. And just to reiterate an important point that you cannot ask the handler, the dis disabled person, to remove the animal from the premises unless the dog is out of control and the handler's not able to gain control, which that would be highly doubtful with the amount of training they have, or if the dog is not housebroken. And I don't know how these handlers train miniature horses to be housebroken. Um, but that's definitely something to consider. Now I have brought my horses into the house for Christmas photos and and things like that, but I'm sure it can be done. Leslie, what are more thoughts that you have?

SPEAKER_00 18:22

Well, the main thing I think people need to remember is uh as you mentioned, you you can't ask someone directly what their disability is. It's just it's simply, is your service animal um does do they do something to provide a service for a disability? And that answer is yes or no. You know, it's not, you know, here's what my disability is. And then what task has that animal been trained to do? Well, for someone, for example, in a wheelchair, uh, it might be that the animal goes to retrieve something for them or opens a door and it does something specific for them. And uh from in my circumstances, I'm very happy to tell people that my uh my service dog uh wakes me up and lets me know when there's an alarm, a fire alarm, or someone knocking on the door or a phone ringing. But he also does something that's kind of unique, and that is um when I travel and I speak for groups, large groups, a lot of times there are questions because I speak the same topics as you, Olivia. There's uh ocean and infection control and other regulations, and I have to hear those questions correctly. So I ask my audience members to write them down on index cards, three by five cards, and to put those cards into a little basket. I've trained Mocha to go get the basket from where the audience members are in the basket's in the aisle between the two rows of chairs, usually, and sometimes there's 500, a thousand people in a room, and he'll bring those questions up to me in that basket uh to the podium so that I can read the questions and I can answer those questions accurately and concisely without struggling to hear someone tell me from way out in a deep lecture hall, you know, tell me their question. And a lot of times they don't hear it right. So it's I think in wrapping up, it's important to remember that you cannot not only uh not have someone with their disabilities, but you can't demand to see a registration card because service animals do not need to be officially registered. Um, and Olivia, did you have something to add to that?

SPEAKER_01 20:22

I wanted to bring up that you know, you have Labradors and we've seen German shepherds at service animals and other larger breeds, even the doodles are becoming popular as service dogs, but it could be even a small toy dog. Uh, I have a contact here where I live that has a shih tzu that's a service dog. And the shihtzu can sense if she's having a seizure. Amazing. Once again, we have to be really careful in making these inquiries because it may not be the standard breeds that we're accustomed to seeing. Isn't that true, Leslie?

SPEAKER_00 20:55

That's right. And and so being prepared, number one, knowing what your local and county regulations are, knowing what the you can ask and you cannot ask questions are. And then maybe at your next morning huddle, discussing with the team, what do we do if someone comes in with a service dog and we haven't had uh been acquainted with a patient with a service dog? Let's go through what that would look like and and how we might respond and make sure that nobody on our team inadvertently asks the no-no questions. Let's make sure that we keep it all compliant. And uh I think that really uh covers most of the uh things we wanted to have our listeners and audiences uh go through and hear about.

SPEAKER_01 21:34

Yeah, I think this is great. And Leslie, uh, you're gonna post those resources because there's several articles that I think our listeners would enjoy. And Leslie has even included an article that appeared on my website that was written by a dog handler trainer that's some really helpful information for people to download and take advantage of these resources during their meetings.

SPEAKER_00 21:59

That's right. We're going to have that on the Compliance Divas website. And in wrapping up, uh, remember that patients presenting to a dental facility with a service dog uh should not be denied access to care because they have a service animal. And remember that uh we need to make sure that we show respect and compassion. And uh whenever, wherever anyone is allowed to go in the public, uh, any place that places of public accommodation, service dogs are allowed there as well. They have uh very strong rights. So we bring clarity and compliance to clarity and simplicity to compliance by navigating the regulatory environment to keep you on course. We always welcome your questions. Please send them to support at the compliancedevas.com. And again, those resources for Olivia's website, the blog that has information about service animals, uh, will be posted there as well. The CDC information and another article that uh will help you in training your team on uh respect and uh compassion for those with service animals. And that concludes this podcast of the compliance divas.