Seyfarth Synopsis: The Sixth Circuit Court of Appeals approved state-owned hospital’s exclusion of nursing student’s service animal that posed a direct threat to patients and staff with severe allergies where no reasonable alternatives existed to mitigate the threat.

The Sixth Circuit Court of Appeals recently issued a decision in Bennett v. Hurley Med. Ctr. concerning the use of a service animal in a state-owned hospital under Title II of the ADA that provides useful guidance on how health care facilities should assess whether a service animal poses a direct threat to the health and safety of others. This decision is also relevant for private health care facilities because the direct threat analysis is the same under Title III of the ADA.

The plaintiff was a nursing student who worked at a hospital as part of her educational program for four hours once a week for six weeks. She has a panic disorder and her service dog was trained to recognize symptoms of a forthcoming panic attack so that she could immediately take her medications.

The hospital at first approved the student’s request that her service dog accompany her on her rotation. However, on the very first day one staff member and one patient experienced allergic reactions to the dog. In response, the hospital revoked its approval of the service animal. The hospital offered the alternative accommodation of crating the service dog on a separate floor from those with allergies in the hospital and plaintiff taking necessary breaks to be with the service dog. The hospital had determined that relocating patients and staff with dog allergies from the floor where the plaintiff had to work (her university program supervisor was on that floor) would be unworkable and directly compromise patient care.

The court first held that the hospital had not engaged in intentional discrimination by refusing to allow the plaintiff to have her dog accompany her on rotations. The court concluded that the hospital’s decision was motivated by staff and patient complaints of allergic reactions to the dog – not the disability.

The court then considered whether the hospital had violated Title II of the ADA by not modifying its policy to accommodate the service dog on Plaintiff’s rotations. After reviewing the DOJ’s implementing regulations, DOJ guidance, and “scant” relevant case law to determine what constitutes reasonable accommodation of a service animal in a healthcare setting, the court concluded that “service animals are permitted as a reasonable accommodation unless they are ‘out of control,’ ‘not housebroken,’ would fundamentally alter the activities of the public entity, or, if, after conducting an individualized assessment of the animal, the public entity concludes that the service animal poses a direct threat.” The court then concluded that the service dog’s presence did constitute a direct threat because of the actual allergic reactions that took place and the lack of a workable alterative to mitigate that threat. Specifically, the court found that separating the service dog from allergic patients and staff was not possible.

While this decision provides helpful guidance to health care facilities on the issue of service animal access, it should not be viewed as license to exclude service animals from such facilities. The U.S. Department of Justice has taken the position that blanket exclusions of service animals from health care facilities are not permissible, consistent with the principle that exclusions based on the direct threat defense must be based on an individualized assessment of the circumstances presented. Here, there was concrete evidence of the direct threat and the hospital demonstrated that there was no way to mitigate it.