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Medical Justice

Making healthcare safe for doctors


Lions Tigers, and Bears. Oh My. Therapy Animals in the Operating Room

07/03/18 11:25 AM

First, let’s discuss the difference between a service animal and a therapy animal. 

According to the U.S. Department of Justice, “service animals are defined as dogs that are individually trained to do work or perform tasks for people with disabilities. Examples of such work or tasks include guiding people who are blind, alerting people who are deaf, pulling a wheelchair, alerting and protecting a person who is having a seizure, reminding a person with mental illness to take prescribed medications, calming a person with Post Traumatic Stress Disorder (PTSD) during an anxiety attack, or performing other duties. Service animals are working animals, not pets. The work or task a dog has been trained to provide must be directly related to the person’s disability. Dogs whose sole function is to provide comfort or emotional support do not qualify as service animals under the ADA.” 

Under the Americans with Disabilities Act, the only animals that qualify as service animals are dogs, and now, miniature horses.  

Service miniatures horses are not given free rein (no pun intended)1 to go anywhere a service dog can go.  

The assessment factors are (1) whether the miniature horse is housebroken; (2) whether the miniature horse is under the owner’s control; (3) whether the facility can accommodate the miniature horse’s type, size, and weight; and (4) whether the miniature horse’s presence will not compromise legitimate safety requirements necessary for safe operation of the facility. 

In contrast, therapy animals are not limited to working with people with disabilities and are not legally defined. A therapy animal is allowed into a hospital as part of a treatment plan by invitation only. Therapy animals do not qualify for access protection given to service animals under the Americans with Disabilities Act (ADA).  

Examples 2 of animals (other than dogs) that are therapy animals: 

Boa Constrictors—These snakes are known for helping patients with bipolar disorder, obsessive compulsive disorder, and panic disorders, and there are even cases when these snakes can be used to prevent medical emergencies. One man in Washington has a boa that will squeeze him more tightly when it senses he’s about to have a seizure, giving him enough time to take his medication or go to a safer location until his seizure passes. (Well, I can think of potential “issues” if this does not work as intended.) 

Parrots—This is a popular animal for treating psychiatric disorders. Many species of parrot have the ability to talk to their owners and de-escalate stressful situations. Jim Eggers from St. Louis relies on his service parrot, Sadie. The parrot has been trained to repeat the mantra, “It’s OK, Jim. Calm down, Jim. You’re all right, Jim. I’m here, Jim” to calm Jim down whenever she senses he’s about to have a violent episode. Jim used to say the mantra to himself, but now with Sadie’s help he can pre-empt episodes even before they start. Sadie is also trained to alert Jim when someone comes to the door and when he leaves the faucet running. 

Recently, my wife and I met an ambitious young woman who was waiting tables. She was a college student aspiring to go to medical school.  She said planned to be a cardiothoracic surgeon. She then showed us pictures of her therapy dog, a terrier. When we asked what the therapy animal did, she explained it helped her with frequent and debilitating anxiety attacks. My response was “What a cute dog.” But, I was thinking how unlikely such as a person would be able to thrive as a cardiothoracic surgeon, where stress and anxiety are served for breakfast, lunch, and dinner. I then tried to imagine the terrier in the operating room nuzzling up to the surgeon’s leg while the patient was coming off of bypass. Or when the clamp was removed from the aorta testing the completeness of the suturing. Or any other number of stress provoking events.  

Hypothetically, would a hospital even allow a therapy animal into the OR. According to the ADA, only service animals qualify for ADA protections. And, while the ADA mandates reasonable accommodations must be made for bona fide disabilities, the ADA allows a business (in this case a hospital) to trump such a mandate if it would objectively interfere with an important business goal such as patient safety. More importantly, a credentialing committee would have questions regarding the qualifications of such an individual to even perform the job (without even getting into any discussion of the service animal). This is not dissimilar to a surgeon with epilepsy. If a service animal warns a surgeon about his impending seizure, can that surgeon safely perform the job, with or without the service animal?  

None of this is to suggest that individuals with disabilities are shut out of all specialties in medicine. On the contrary. Depending on the disability, there are many options.  

But I do not see a terrier in the operating room in the foreseeable future. 

What do you think? 


[1] I looked this up. It is “rein” and not “reign”.

[2] In this source article, they are called “service animals”, but according to the ADA, they would NOT qualify as service animals. Accordingly, they are better characterized as “therapy animals”.

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landlordJuan FitzEasyEZiga Tretjakretired Recent comment authors
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This very same topic came up on Sermo last week. I will say the same thing here that I did there. 40 years ago there were service dogs for helping the blind navigate places. But every other kind of animal was forbidden. The potential for animals misbehaving and injuring or otherwise causing discomfort, allergies, stress, or a variety of other problems is immense. In addition many people have been cheating claiming that an animal is a therapy animal when it is really a pet they are trying to get on a plane for free. I am unaware if any other… Read more »

Ziga Tretjak
Ziga Tretjak

Sadly this very interesting topic fizzles out because of inadequate regulations. I am certain that there is a provision to revise the regulations every so often
but doubt there is the will to tackle them. Perhaps I am wrong…


If the gal shows up to a med school interview with her therapy dog, it’s game over – consider a psychiatrist first. Animals can be so darn smart, and when domesticated and trained, they may smell better than some humans clipping their toenails on the train. Some dogs have been trained to detect Upper GI cancer by smell. Any ENT knows the aroma of oral cancer, so the concept is smart. There is a lot we do not know, and the distinction between service and therapy is a bit nebulous. Disability may be endstage of a chronic illness, and don’t… Read more »

Juan Fitz
Juan Fitz

Sorry to say but more than likely will not accomplish that goal especially with her condition. I deal with students and pre med students and have been able to more or less tell who will make it and who will not.
Yes that area is very stressful day in day out. Wish her the best.


As a physician who also owns short term vacation rental properties, I have been involved with emotional support animals (ESA’s). Although there is a legitimate place for service animals (who typically go through a rigorous years long training program) assisting my tenants and I have never had a problem with either a disabled tenant or service animal in my units, I have had problems with ESA’s and their owners. Unfortunately, under HUD (Housing and Urban Development) and the Fair Housing Act-which applies to all housing, not just HUD, ESA’s are allowed. And after someone’s dog ESA chewed off the leg… Read more »