Monday, July 23, 2012

Airlines Get More Tools to Stop Bogus Service Animals from Flying in Cabins

Additional Notes: In the Federal Register of Monday, December 7, 2015, the Department of Transportation published a notice of intent, indicating that it "is exploring the feasibility of conducting a negotiated rulemaking (Reg Neg) concerning accommodations for air travelers with disabilities addressing ... service animals."  Among other interested parties that DOT wants to hear from are "service animal training organizations."

The release notes that both "airlines and disability organizations have raised concerns with the Department of passengers falsely claiming that their pets are service animals." The difference between the Department of Justice definition of "service animal" and DOT's definition has been brought to the DOT's attention, and DOT may, in the "Reg Neg," determine the appropriate definition of service animal...."  Additional safeguards may be instituted "to reduce the likelihood that passengers wishing to travel with their pets will be able to falsely claim that their pets are service animals...."

DOT also notes that bulkhead seating is sometimes not available to individuals with service animals because "bulkhead seats are now primarily located in what has been designated by airlines as the premium economy section."  Comments on these issues may, according to the release, be submitted on the website by typing in DOT-OST-2015-0246.  Department of Transportation, RIN 2105-AE12, Nondiscrimination on the Basis of Disability in Air Travel; Consideration of Negotiated Rulemaking Process.  80 Fed. Reg. 75953 (December 7, 2015).

Regulations issued in August 2015 by the Department of Veterans Affairs regarding animal access to VA facilities will affect letters that psychologists and mental health professionals may be asked to write for veterans with service dogs. As those regulations apply to visitors to and employees of VA facilities who may not themselves be veterans, people in these categories may also ask that letters be written on their behalf.  

The article I wrote with Dr. Thomas, which discusses letters that may be requested by airlines, landlords and others appears in the March 2013 issue of the Journal of Forensic Psychology Practice is substantially more comprehensive than the following treatment.  

Writing Letters about Service Dogs 

Dr. J. Lawrence Thomas and I have submitted comments to the Department of Transportation regarding the Draft Technical Assistance Manual. The American Psychiatric Association and Anne Wicklund have also submitted insightful comments. To view comments online go to the website for this item and click on the box left of "Public Submission" below Document Type on the left. 

The Department of Transportation is updating its Technical Assistance Manual, What Airline Employees, Airline Contractors, and Air Travelers With Disabilities Need To Know About Access to Air Travel for Persons With Disabilities. The Manual, which is a guide to the Air Carrier Access Act, is being revised to cover changes that have been made to ACAA regulations since 2005, when the previous edition of the Manual was released.  The 2012 revision follows the pattern of the 2005 Manual in breaking down a trip from the point a person with a disability makes a reservation through the completion of travel. 

Although there is little new in the revised Manual, it is important that individuals traveling with service animals—particularly those traveling with emotional support or psychiatric service animals—be familiar with its contents since airline personnel will refer to it, rather than the regulations, in trying to resolve disputes involving passengers who are insisting on bringing animals aboard planes.

Letters from Mental Health Professionals 

Psychologists, other mental health professionals, and medical doctors should also be aware that the Manual contains requirements regarding letters that they may provide to patients who have service animals.  A support letter must now be on the professional’s office stationery and must provide information about the professional’s license.  DOT is clearly concerned that medical professionals are signing letters written for them by patients without really knowing anything about the supposed service animal or its benefits for a patient.  Also, veterinarians should be aware that they are likely to be asked to write letters saying an animal will not need to relieve itself for eight hours.

DOT is issuing the Manual in draft form in order that those affected or interested may have a chance to comment on the revision.  Comments must be sent to DOT by October 3, 2012, though late submission will be considered “to the extent practicable.”  As the 2005 Manual was covered extensively in Service and Therapy Animals in American Society, I will focus here primarily on how DOT plans to change the Manual.

Comments on the draft Manual may be submitted at, which is a user friendly website hosted by the federal government.  In the search box on the first page I typed in “airline disability service animal,” and the first hit was the one about which I am writing here. To submit a comment, just hit the “Comment Now” box in the upper right, and a comment box with submitter information appears.  Comments submitted will be available on the site to the general public.   

Definition of Service Animal

In 2005, the Manual’s initial description of a service animal was: “Any animal that is individually trained or able to provide assistance to a qualified person with a disability or any animal shown by documentation to be necessary for the emotional wellbeing of a passenger.”

The proposed revision (77 Fed. Reg. 39800, July 5, 2012) would state that a service animal is: “Any animal that is individually trained or able to provide assistance to a qualified person with a disability or any animal shown by documentation to be necessary to support a passenger with an emotional or mental disability.” The difference is significant in that the earlier definition implied that a person without an emotional or mental disability could have a service animal for his or her emotional wellbeing.

How Service Animals May Assist

The 2005 Manual provided that a service animal may assist “persons with mobility impairments with balance.”  The revision is more specific, stating that a service animal may assist “persons with mobility impairments to open and close doors, retrieve objects, transfer from one seat to another, and maintain balance.”  This more correctly describes some of the tasks a mobility impairment animal may perform. People with mobility impairment dogs that perform other tasks for them, but not one of the listed ones, should consider letting DOT know in the comment period.  DOT will probably not resist expanding such a list. 

The revision would add a new task to the assistance list: “Carrying items a passenger cannot readily carry while using his or her wheelchair.” 

Consistent with the change in the basic definition of “service animal” in the preceding section, the revision says that a service animal may provide “support for persons with emotional or mental disabilities.”  In 2005, the Manual had stated that a service animal may provide “emotional support for persons with disabilities.”  Again, the change effectively states that a person with a physical but not a mental or emotional disability cannot have a dog only for his or her emotional wellbeing.

Advance Notice of Intent to Fly with Service Animal

The 2012 revision states that an air carrier my require up to 48 hours’ advance notice from a passenger who will travel with an emotional support or psychiatric service animal in the cabin, or with “any service animal on a flight segment scheduled to take 8 hours or more.”

Further, the revision states that for a flight scheduled for eight hours or more, “you may require documentation that the service animal will not need to relieve itself on the flight or can do so in a way that will not create a health or sanitation issue on the flight.”  Veterinarians can expect to be asked to write some rather silly letters because of this provision.  Presumably a letter could state something like the following:

“If Passenger A is able to take his Service Dog a relief area before a flight, and if Service Dog B relieves himself [herself] at that time, Service Dog B would ordinarily be able to make an 8 hour flight (including time at the gate and on the tarmac) without relieving himself [herself].  If a flight has several segments and Passenger A can take Service Dog B to relief areas at intermediary airports, Service Dog B would ordinarily be able to make a multi-stage flight without relieving himself [herself] in flight. These statements assume that Service Dog B does not become sick before or during a flight and does not eat food not standardly provided to him [her]."

A source advises me that one airline was actually considering a requirement that users of service animals carry doggy diapers.  From what I saw on a recent trip to Ireland, airlines might better spend their energy requiring that some passengers wear diapers, if not HAZMAT suits. 

Verification of Psychiatric Service or Emotional Support Animal Status

A carrier’s ability to check service animal status has changed from the prior Manual.  For passengers traveling with emotional support or psychiatric service animals, carriers may require documentation, not less than a year old, on the letterhead of a licensed mental health profession or medical doctor who is treating the passenger’s mental or emotional disability, stating:
  1. The passenger has a recognized mental or emotional disability (under DSM IV); 
  2. The passenger needs the service animal as an accommodation for air travel and/or activity at the passenger’s destination; 
  3. The provider of the letter is a licensed mental health professional, or a licensed medical professional treating the individual for the recognized mental or emotional disability, and the passenger is under the individual’s professional care; and 
  4. The date and type of mental health professional’s license and the state or other jurisdiction in which the license was issued.
The specific DSM condition need not be stated.  The letter may be written by a psychologist, psychiatrist, licensed clinical social worker, including a medical doctor specifically treating the passenger’s mental or emotional disability.  The items are cumulative and can all be required.  The italicized language contains new elements of what a carrier may require. 

Previously there was no mention of the documentation being on the professional’s letterhead (except in regulations).  Presumably this is a way of avoiding passengers asking their doctors to sign boiler plate documents downloaded and printed from websites.  The date and type of professional license is also a new requirement that will assure that professionals realize that airlines may want to contact them or their professional licensing boards. 

When an airline might contact a licensing board is not clear.  If a psychologist recommends that a patient obtain a service animal, it is not the psychologist’s fault if the animal obtained is not actually a service animal.  If, on the other hand, the psychologist says things about the animal that are inconsistent with what airline personnel observe, the airline may wonder if the psychologist is acting professionally or really wrote the letter.  Also, if the airline keeps records about professionals who recommend service animals, the airline may notice that a particular medical professional is recommending a great number of service animals.  The airline might contact the licensing authority to ask if this is typical of members of the profession they license. 

Determination that an Animal is Not a Service Animal

The revised Manual states that if a carrier decides not to accept an animal as a service animal, it must explain the reason to the passenger and document its decision in writing.  A copy of the explanation is to be provided to the passenger at the airport, or within ten calendar days of the event. 

Changing Seats if a Service Animal Does Not Fit

The 2005 Manual said that switching seats in the same class of service must be explored as an alternative before requiring that the service animal travel in the cargo compartment.” The revision gives more detailed advice to flight personnel:

“You should speak with other passengers to find a passenger—(1) Seated in an adjacent seat who is willing to share foot space with the animal, or (2) Who is willing to exchange seats with the passenger accompanying the service animal and is seated in a seat adjacent to—(a) A location where the service animal can be accommodated (for example, in the space behind the last row of seats) or (b) An empty seat. You must not deny a passenger with a disability transportation on the basis that the service animal may offend or annoy persons traveling on the aircraft.”

The italicized language is particularly important and reflects the fact that fines have been levied against airlines that have excluded legitimate service animals because airline gate personnel or flight attendants became overly accommodating to passengers with cultural or religious biases against animals.  There is an entire appendix to the Manual concerning placement of service animals in airline cabins. 

Relief Areas

The 2005 Manual made no mention of relief areas for service animals.  The revised Manual summarizes requirements on carriers with regard to relief areas.  This has been summarized in a prior blog


The Manual in general reflects an increasing recognition that people wanting to fly with their pets are trying to create evidence that those pets are psychiatric service or emotional support animals, getting bogus documents from online sites that sell paraphernalia purporting to establish a dog as a bona fide service animal.  Also, psychologists and doctors must pay more attention to the letters they put on their stationery regarding their patients’ animals, since DOT may actually complain to licensing authorities when animals turn out to be out-of-control house pets that passengers just don’t want to put in steerage.  Professionals should be able to back up what they are signing for their patients.

Users of psychiatric service animals have argued to DOT officials that psychiatric service animals should be treated the same as other service animals, and distinguished from emotional support animals, but DOT has not accepted this argument.  The distinction is an important one in Department of Justice regulations, but DOT feels that the advance notice requirement should apply to both psychiatric service and emotional support animals.  The airlines should at least have enough advance notice that they can advise passengers who will be bringing psychiatric service animals on flights of the documentation they should have when they get to the gate.

Wednesday, July 11, 2012

What is a Therapy Dog? Listen to a Poem by Diana Edelman

In April 2010, Diana Edelman, a retired teacher and poet who lived in Woodstock, met Chloe and me at Benedictine Hospital in Kingston, New York.  She asked me how she could contact me, and the next day she sent an email with a poem attached.  I found it so moving that I asked her if I could find a publisher, to which she agreed.  I sent the poem to several dog magazines but none expressed interest. 

Diana died on December 3, 2011.  She stopped taking infusions at Benedictine Hospital (in a room called 4SMC) and though I called her several times after that, and we talked about getting together, I did not make the effort that I should have made to bring Chloe to her house.  That was a failing on my part.  A serious one.

I continue to believe that Diana’s poem is the most precise statement I have ever read of what a therapy dog is and does.  To this day I cannot read it without tears.  The first picture is of Chloe wearing the bandana mentioned in the poem.  The second shows Diana with two of her grandchildren in Alaska in March 2011.  Her daughter, Susan Houlihan, tells me that even months before her death, Diana was able to hike up to eight miles. 


You padded into the infusion room on 4SMC on four short feet.

Their anatomy was so concealed by your thick carpet of curls that they looked to be mere horizontal bends at the ends of your long legs like a minimalist stick figure.

Your curly coat, the color of brown sugar melting into oatmeal, covered every inch of you.

You stopped at my chair, my pole, my suspended plastic bags and tubing—my unit.

"Poodle!" I exclaimed.

"Labradoodle," explained your human. "This is Chloe."

My fingers burrowed into your warm swirls.

There were enough of them to make a curly cap for every chemo skinhead who frequents 4SMC.

But you didn't appear to flaunt your profusion of furry adornment among us—the monastic order of bare naked skulls.

Instead—in a gesture of solidarity—you appeared in a turquoise bandana neckerchief, a Caribbean lagoon in your expanse of whirling sands.

The simple, square, 99 cent bandana. The oldest, most basic chemo accessory.

As you know, Chloe, advanced cancer treatment is a harsh world, which compassionate, skillful humans struggle to soften, using blunt tools.
"Advanced" refers to the disease, not the treatments.
Most of these are the medical equivalent of aerial crop spraying.

Every gain extracts its price.
A patient counts her bonus days of life on one hand and her losses on the other.
The two, inseparable, are a package deal.
It's a tough contract to sign.

But when push comes to shove, the contractee makes her trades one by one.
How many days can she buy with her hair?
How many with the tender flesh of her mouth?
How many with the feeling in her hands and feet?
Her settled stomach?
Her functioning gut?
Her memory?
How many days does a white cell fetch, or a red?
Those tiny protectors and energizers that once rafted exuberantly in her river of life.
What is the barcode on 24 hours and 24 more and 24 more?

Well, in this particular 24, Chloe, I was in the right place at the right time.
Both my bands devouring your luscious curls, your solid form, I already felt a heave in my chest and water channeling toward my eyes.

Then I glanced up from your flanks and noticed your labradoodle face close to mine.
Your eyes, the exact same color as your everywhere curls, were the softest, most inviting, pure and honest I'd ever seen.
They asked in the simplest, wordless way, "How are you today?"

It was out of the question to lie to such eyes—even a teeny, tiny bit.
I burst out crying.

Soft as they looked, Chloe, your eyes bored like diamond bits down through the endless strata of solid facts and hopeful strategies that I'd futilely attempted to assemble over the three years since diagnosis .... from mountains of information, misinformation, conflicting information, laughable confusion, the relentless pressure to be positive, and just plain pipe dreams.

You knew that deep below all those ever shifting mirage layers was a simple clear pond that was actually there.

When its waters surfaced I knew it was there, too.

After only a few minutes your human led you away to another lucky person at the end of a tube.

I was so sorry to see you go, Chloe.

You brought me more peace than I've known in a good while.

Now there's a photograph of your brown sugar and oatmeal labradoodle self in my brain.
I can look in your open vessel eyes whenever I want and dip into that clear, honest pool.
Revived for another 24.

And I had thought that brief encounters with total strangers where you gaze into each other's eyes and you are never the same again only happened in the movies.

Diana Edelman, 2010

Monday, July 2, 2012

Army Medical Journal Describes Service and Therapy Dog Programs For Wounded Warriors

Sixteen articles on various canine-related activities that involve wounded soldiers and veterans appear in The United States Army Medical Department Journal for the second quarter of 2012. At least one article might satisfy the rigorous requirements of a refereed journal, but most are interesting and there is a wealth of data to prove that there are people in the military who see the benefits of service and therapy dogs for those wounded in foreign wars. 

No Opinion Expressed on Army Medical Command Policy

Given the policies adopted by Forts Bliss and Campbell following a January 30 memorandum issued by the Army Medical Command at Fort Sam Houston, Texas, it must be asked whether the authors of the papers in the Army’s medical journal are in agreement with Herbert A. Coley, Chief of the Clinical Services Division, and his decision to apply a very restrictive definition to the term “service dog” in Army contexts.  I could find only two references to Coley’s memorandum throughout the entire issue of the Journal, both of which acknowledged its existence but neither of which elaborated on it.  One paper refers to “proponents of much less training,” which may be a reference to soldiers and veterans who have trained or are trying to train their own service dogs in contravention of Coley’s memorandum, but even if that is the intent, it is not clear that any of the authors in the medical journal are happy with Coley’s policy. 

Need for Additional Service Dogs

One of the papers, citing earlier research (American Journal of Public Health, 99(9), 1651-1658) says that “approximately 40% of Iraq and Afghanistan Veterans treated at American health centers during the previous 6 years [2002-2008] were diagnosed with PTSD, depression, or other mental health issues…. In 2007, Brashear and Rintala [SCI Psychosocial Process, 20(1)] reported that 30% of Veterans with spinal cord injuries indicated at least some interest in obtaining a service dog, and 42% desired information concerning service dogs.” 

If 40% of returning soldiers seeking any kind of medical help suffer from psychological or neurological traumas, many of whom are interested in getting service dogs, the need for dogs runs to the thousands, probably tens of thousands.  If there is an overall weakness to this dedicated issue of the Army’s medical journal, it is that it makes no further effort to quantify the number of dogs required to satisfy this need.  While the programs described are all excellent, the excellence often concerns relatively small numbers of dogs for relatively small populations of soldiers and veterans. 

Programs Described in Army Medical Command Journal

Still, credit must be given where credit is due, and many of the articles in the Army Medical Department Journal are worth a close read by all segments of the medical community as well as by service and therapy dog trainers.   The major findings of the dedicated issue of the Journal are the following:

  1. Learning to give commands to therapy dogs was determined to be beneficial to wounded soldiers under self-assessment measures of psychological function, work performance, and quality of interaction.  However, no difference was detected in a comparison with wounded soldiers who did not work with dogs as to mood state, stress level, resilience, and fatigue. "Several Soldiers informed the Warrior Family Support Center Director that they enjoyed the dog sessions, looked forward to seeing the dogs again and regretted the conclusion of the study." Despite the generally nonsignificant results of the study, the researchers felt that the anecdotal evidence supporting the program argued for continued development. 
  2. Eight combat and operational stress control dogs (“COSC dogs”) have been deployed in Iraq and Afghanistan after training to be therapy dogs, with specific modifications for the war theater environment, such as learning to tolerate extreme noise and get on and off of helicopters.  The dogs were found to help communications between occupational therapists, who became handlers of the dogs, and a wide range of personnel in war zones.
  3. Occupational therapists who became handlers of COSC dogs have to live with the dogs virtually all the time, unlike military working dogs in theater (e.g. dogs to detect IEDs), which presents problems because of the extreme heat and sand storms in the Middle East, and because some dining facilities will not admit dogs, but the therapists all felt the experience was extremely rewarding.
  4. NEADS, a service dog training program in Princeton, Massachusetts, has been training dogs for wounded warriors at the Walter Reed National Military Medical Center.  Some wounded soldiers are learning to train service dogs for other soldiers.  NEADS has developed a special fitted harness that can be used by veterans with prosthetics.  Dogs are trained to pick up dropped items, even credit cards and coins.  NEADS has undertaken a pilot study on use of service dogs by veterans with PTSD.
  5. The Washington Humane Society’s Dog Tags Behavior and Grooming Training Program allows participants to learn skills in working with dogs, skills that may lead to post-discharge employment. Certain staff at the Walter Reed Warrior Transition Brigade can bring pets to work if the dogs are certified by Therapy Dogs International.
Although the scientific results are minor, the anecdotal information on the value of service and therapy dogs is considerable.  The most important result of the material is that it provides strong evidence that the rank and file Army and medical staff working with wounded soldiers and veterans is extremely positive to continued use and expansion of service and therapy dog programs. 


Critics of the January 30 Army Medical Command policy, including me, are concerned that it is designed to guarantee that numbers of soldiers and veterans receiving service and support dogs will remain low and that the need will continue to far outstrip the number of dogs and programs available.  Implementation of the restrictive service dog policy at Forts Bliss and Campbell has had disastrous results in morale, and the successes of those programs that have been implemented at other locations cannot pave over the failure to provide dogs to a large segment of wounded soldiers and veterans. 

Nevertheless, it is not surprising that medical personnel in the Army would not take on the establishment above them, and the research and descriptive articles included in this issue of The United States Army Medical Department Journal are a welcome addition to the professional literature on service and therapy dogs.