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Is it too easy to obtain an emotional support animal prescription?

SALT LAKE CITY — If “a peacock, a pig and a hamster walk into an airport” sounds like the beginning of a bad joke — and airlines clearly think so — then welcome to the controversy surrounding emotional support animals.

Airlines have the sympathy of landlords, too. They say the joke could as easily begin: “a guinea pig, a hedgehog and a cat are looking for an apartment.”

Staff in public transportation companies and housing rental offices are increasingly finding themselves challenged to sort through which types of service or support animals must be allowed by law. According to these companies, some individuals are cheating by introducing ordinary pets as doctor-prescribed “emotional support” animals in order to bring them into housing where pets are banned or to avoid fees such as pet deposits, pet rent or travel costs.

“I can’t go 30 minutes any time I’m around landlords without someone bringing up assistance animals,” said Paul Smith, executive director of the Utah Apartment Association, which advocates for landlords. “That’s the No. 1 issue for landlords. Landlords want to accommodate people with disability, but want to cut down on fraud.”

To legally gain accommodation for an emotional support animal requires an “impairment that substantially limits one or more major life activities,” Smith said. “In addition, the animal has to be a medical necessity — it’s not just that having a cat makes me happy. Having the cat treats the medical condition. Our frustration is not that we don’t think there are people who genuinely need one. But under that definition, the animal has to be a medical necessity. We don’t think that definition is met most of the time.”

Tiffany Thayne, 25, plays with her emotional support dog Dusty in her apartment in Provo on Wednesday, March 13, 2019. Thayne is training Dusty, a Collie puppy.
Tiffany Thayne, 25, plays with her emotional support dog Dusty in her apartment in Provo on Wednesday, March 13, 2019. Thayne is training Dusty, a Collie puppy.
Steve Griffin, Deseret News

Nor do people police their own behavior, he added. “It’s like a movie theater that puts up a sign: 'Don’t bring candy in.' People do it because it saves them money.”

The problem is, there’s more at stake than candy, he said. “We want to protect those who are legitimately handicapped by cutting down on fraud so that landlords’ hackles don’t go up every time somebody asks.”

Landlords know that anyone can go online and buy a letter that "prescribes" an emotional support animal. The Deseret News set out to test how easy it was to obtain such a letter, and within a couple of hours had two in hand from separate sources — each for under $100 and each documenting the "need" for an emotional support animal. That ease of providing so-called proof, coupled with what Smith describes as a dramatic increase in renters saying they "must" have an emotional support animal, has fueled skepticism that could make it harder for those who really need emotional support animals to have them.

The backlash is real and has already led to stricter policies. Airlines, which allow emotional support animals in airplane cabins under the Air Carrier Access Act, have beefed up rules, many requiring documentation 48 hours in advance, limiting emotional support animals to cats and dogs and requiring a veterinarian’s note the animal is healthy. And states have been amending housing rules. The Utah Legislature, for instance, just made it a Class C misdemeanor to lie about the need for an emotional support animal or misrepresent a pet as being an emotional support animal.

When animals alleviate pain

Kathy Klotz believes animals can be almost magical in their ability to help people in certain circumstances. As executive director of Intermountain Therapy Animals, she’s seen “kids abused and abandoned who often just shut down completely — and dogs make them wake up and start participating in life.” She’s seen seniors push harder to get better in physical therapy because animals are “huge motivators to keep doing what they need to do.” Sometimes, animals just brighten things up and people need that.

Emotional support animals, however, are supposed to do more than that. They are supposed to facilitate more abundant living for people who struggle with mental and emotional challenges.

Heather Tuttle

That’s certainly been the case for Tiffany Thayne, 25, who credits her collie puppy Dusty with helping her mentally while keeping her active.

In high school, Thayne was in a car accident that left several of her friends seriously injured and another person dead, and she has since struggled with anxiety, depression and PTSD. Her symptoms worsened after her sister died from an illness in October. Thayne asked the therapist she’d been seeing for several years whether an emotional support dog might help. She got Dusty after her therapist agreed and provided a letter.

“He makes it so I exercise at least twice a day. When I don’t feel like getting out of bed, I have to get out of bed to take care of him,” said Thayne, a geology major at Brigham Young University. She also suffers from social anxiety and likes that Dusty makes her “get out of her shell” as strangers ask her about him when they go on walks.

Right now, Dusty offers support and comfort to Thayne, but she is also working on training him to become a service animal to perform a specific task: help keep her safe when she has night terrors and sleepwalks. Last summer, she broke her foot during one of her nighttime episodes.

A professional service dog trainer is teaching Dusty, and Thayne is helping him adjust to public places so he will be well-behaved in any circumstance.

“It’s really sad when people abuse the system. I don’t want people to think I’m doing that,” said Thayne. “There’s a big difference between how people treat their animals when they’re supposed to be a companion and a tool rather than just a pet.

“It makes it harder for people who actually need the dogs,” she added.

Fruit Heights therapist Jeffrey Gregson has prescribed emotional support animals — but not often and not to everyone who asks. “I have had many requests, but only granted a few,” he told the Deseret News. “I’ve had many millennials ask for it, often unwarranted. I find it beneficial for those who are alone and suffering from depression.”

When Analisa Uribe, of Monmouth, Oregon, was 9, her father took his own life. She and her little sisters were home with him at the time. Uribe, 21, has since experienced anxiety, depression and symptoms of PTSD.

When she moved from Utah to Oregon for college, she struggled. “I ended up in a really dark place where I was having suicidal thoughts and couldn’t ever calm myself down, no matter how hard I tried,” she said.

Her therapist prescribed medication, but that made her feel like she was always in a fog. Her mom suggested she consider an emotional support animal — and her therapist agreed the right companion animal could help her a lot. Indeed, her miniature dachshund, Winston, has made all the difference, Uribe said.

She’s learned physical pressure helps her PTSD and panic — and Winston knows instinctively when she needs help. “If Winston sees that I’m upset, he will climb up on me or lay on my chest,” she said. Within minutes, panic subsides.

Marc Hallacker, 32, a maintenance worker in Salt Lake, said the initial reason he wanted an emotional support animal was because he wanted a dog and wasn’t allowed to because of his apartment rules. But his long-time therapist agreed his need is real.

Tiffany Thayne, 25, walks emotional support dog Dusty outside her apartment in Provo on Wednesday, March 13, 2019. Thayne is training Dusty, a Collie puppy.
Tiffany Thayne, 25, walks emotional support dog Dusty outside her apartment in Provo on Wednesday, March 13, 2019. Thayne is training Dusty, a Collie puppy.
Steve Griffin, Deseret News

“I didn’t want to cheat the system, but use the system,” said Hallacker, who suffers from anxiety that stems from bullying in his youth.

A dog didn’t end up being a good fit for him; he was too worried about what it might be doing when it was home alone and he said he doesn’t handle uncertainty well. Instead, Hallacker now has a pair of English budgies, which he calls “cute little fluffers.” The birds stay in a cage, but Hallacker benefits from having something to take care of.

Landlords don't want to take vital support from people who struggle daily in ways specifically helped by caring for and being loved by animals, Smith said. But the sheer volume makes it hard to not be cynical or want to just say no.

Confusion about creatures

Misunderstanding about different types of helper animals complicates the issue. Most people know little about the roles animals are allowed to assume and the access each is accorded, Klotz said. There are three distinct categories of animals that provide different types of support:

  • Service animals (usually dogs) are specially trained to provide specific assistance to people with disabilities, such as leading blind individuals. A service dog may be trained to alert before someone has a seizure or let someone who’s hearing-impaired know the doorbell rang. A service animal helps one person and has the most access rights, basically welcome anywhere under the Americans with Disabilities Act.
Tiffany Thayne, 25, plays with her emotional support dog Dusty in her apartment in Provo on Wednesday, March 13, 2019. Thayne is training Dusty, a Collie puppy.
Tiffany Thayne, 25, plays with her emotional support dog Dusty in her apartment in Provo on Wednesday, March 13, 2019. Thayne is training Dusty, a Collie puppy.
Steve Griffin, Deseret News
  • Therapy dogs have lots of training but no special access: They can go where they are invited — like hospitals or nursing homes or schools, where they bring pleasure or encouragement to patients, residents and students. Children who "read with a dog" lose self-consciousness about their lack of skills and forge new ones, for example. Therapy animals are owned by a person who volunteers with the animal as part of a team that provides service to individuals or groups in those different settings. The creatures are chosen for their calm temperaments and friendly personalities.
  • Emotional support or “comfort” animals (usually, but not always, cats and dogs) are not specially trained like service or therapy animals. According to the Animal Legal & Historical Center at Michigan State University, though, each is a “companion animal that provides therapeutic benefit to an individual with a mental or psychiatric disability.” A “prescription” from a qualified health care provider allows them to use public transportation with the person they support or live in housing where animals might not be allowed, per Fair Housing Act rules. They are not granted access to public places, like restaurants or libraries, the way that service dogs are.

Klotz has seen challenges created for all three types of animals when people don’t respect the rules. And she’s particularly concerned that legitimate helper animals will be shut out in backlash over suspected abuse — for example, that therapy dogs won’t be invited into places where they can be helpful if others misuse access given to emotional support animals.

Her concerns also include the danger untrained emotional support animals may pose to people and other animals in places like airplanes and airports. When an untrained dog bites a passenger on a plane or two untrained emotional support animals fight, access becomes harder for even well-trained animals.

Web surfing for support

While landlords must trust that a letter from a doctor is valid, it’s an issue made more complicated by what Smith calls “online certification mills,” which sell letters prescribing an emotional support animal for a fee, no therapy needed.

The Deseret News decided to see how hard it would be to get an emotional support animal letter online without having a particular need (or even owning an animal). Reporter Erica Evans went after the cheapest option she could find easily: a website which offers airline and housing recommendation forms for $79.

The website advertises “Live and fly with your pet legally and hassle free,” and boasts 30,000 happy customers nationwide. She started filling out the form, but got interrupted after inputting only basic information, including her name and phone number. No worries; within a half hour the company called her, though she hadn’t completed the online intake.

She was connected first to a doctor in California, where the receptionist asked, “Are you calling for a medical marijuana card?” Evans clarified that she needed an emotional support animal letter. That doctor passed Evans's case to another doctor, who identified himself as a cardiologist, internist and family doctor in Florida.

In an 11-minute conversation, the Florida doctor asked Evans about her mental state and how it interferes with daily life. He said his purpose was to learn whether she has a mental disorder that would allow her to qualify for an emotional support animal certificate.

Evans responded honestly that she has never been diagnosed with a mental or emotional disorder and has never seen a therapist or psychiatrist. She described how she feels when she is most anxious or sad and said her cat makes her feel better. The doctor asked Evans how long she has been having problems but did not ask how frequently she experiences symptoms she described, such as trouble falling asleep and difficulty working when she is anxious.

Tiffany Thayne, 25, plays with her emotional support dog Dusty in her apartment in Provo on Wednesday, March 13, 2019. Thayne is training Dusty, a Collie puppy.
Tiffany Thayne, 25, plays with her emotional support dog Dusty in her apartment in Provo on Wednesday, March 13, 2019. Thayne is training Dusty, a Collie puppy.
Steve Griffin, Deseret News

“I’m looking for more, to be honest,” the doctor eventually said. Then he listed issues that might qualify a person for an emotional support animal: panic attacks, PTSD, autism, brain damage, experience with sexual assault or not being able to hold a job or leave the house.

In response, Evans told him she didn’t want to exaggerate her symptoms but that she had been having “a really hard time” based on recent life events.

Finally, he said, “I think we can OK this,” and Evans received a PDF letter in her email that day.

Evans applied for and received a second letter signed by a licensed clinical social worker in New Mexico, a few hours after filling out a 10-minute multiple-choice questionnaire online and paying $84. The website asked questions such as "How often do you feel overwhelmed by current life circumstances?" and "How often do you feel depressed or saddened?" Once again, Evans answered based on her real experience, exaggerating only slightly.

Two questions asked for “detailed” responses. Evans answered with a few short sentences each:

PLEASE EXPLAIN IN DETAIL WHAT LIFE EVENTS HAVE CAUSED YOU STRESS: I recently broke up with my boyfriend and have had a really hard time recovering. I have a stressful job and am facing a lot of uncertainty in my life.

PLEASE EXPLAIN IN DETAIL HOW YOUR ESA HELPS YOU: My cat is a calming influence on me. She makes me feel needed and loved. It cheers me up to see her when I wake up and when I come home from work.

Evans never talked to the social worker in New Mexico. But the letter she received said Evans has an “emotional and mental disability” and qualifies for protections under the Americans with Disabilities Act, the Fair Housing Act and the Rehabilitation Act.

Neither health provider responded to a request for comment on this story.

While the Deseret News applied for and got letters from two online sites, a search for "ESA letter" brought up several dozen vendors — as well as articles about how vendors are "flooding" college campuses and rentals with "bogus" claims.

The ability to get letters online without forming a relationship with a therapist has made landlords leery and prompted laws like the one just adopted in Utah, Smith said. Landlords hope people who might be tempted to abuse rules allowing emotional support animals will take note of laws and other efforts to curb misuse.

But he warns that for landlords, the issue isn’t going away. If criminalizing misrepresentation of the animals isn’t enough, he said landlords may eventually support efforts to target doctors who “prescribe” animals that aren’t medically necessary.

“We don’t want to make it impossible for the legitimately disabled,” said Smith. “The problem is when someone abuses it, it hurts the people you’re really trying to help.”