“Toddler mauled by service dog” – the cost of thoughtless disability letters.

By Richard Hunt on June 9, 2025

The headline was all too familiar, “Toddler mauled by service dog.” We have seen it before when untrained animals were allowed on airlines or in other public places.(6) When it is passenger passing off a peacock as an emotional support bird it is funny. When it is a child who may be disfigured for life nobody’s laughing. But all these stories share two things in common: First, of course, some adult who should have known better decided to take advantage of federal law, usually the ADA, FHA or Air Carrier Access Act. They thought it would be nice if they could take their pet everywhere, and so they claimed to have anxiety, depression or some other mental condition, claimed to have trained service dog, and then found a medical professional willing to write a letter. The second thing these stories have in common is the medical professional or healthcare provider; maybe a doctor, but more likely a therapist or social worker willing to write a letter certifying the animal as a service animal without bothering to properly diagnose the existence of a disabling mental disorder or asking about the supposed training of the “service dog.”

In the recent case of Leibman v. Waldroup, No. 23-0317, 2025 WL 1610583. (Tex. June 6, 2025) the doctor was a gynecologist. The holding from the Texas Supreme Court was narrow, but very important for anyone, including landlords, business owners and individuals who have been victimized by service animal or ESA verifications that never should have been written in the first place.

The case began when the defendant, Dr. Maurice Leibman, wrote a letter for his patient Julia Romano, certifying that she was disabled by anxiety and that her dog was a service dog. With that letter any restaurant or other public place would be required by the ADA to allow her to bring her dog. That included the restaurant where the Waldroups were dining with their infant daughter. The dog attacked the infant, severely injuring her. The Waldroups sued the restaurant, the owner and, importantly, Dr. Leibman, but it is only Dr. Liebman’s case that came to the Supreme Court. The Texas Supreme Court addressed two questions. First, was there a sufficient connection between Dr. Liebman’s letter and the attack for there to be any claim at all. The second was whether the claim against Dr. Liebman was a medical malpractice claim; that is, a claim that Dr. Liebman failed to meet the appropriate standard of care for a doctor engaged in medical practice. Under Texas law claims of medical malpractice cannot be filed without a timely file expert report stating that the doctor failed to meet his standard of care. The Waldroups did not file such a report and their claims against Dr. Liebman had been dismissed in lower courts. To sue Dr. Liebman they had to show he did something other than medical malpractice.

The Supreme Court’s answer to the first question was “yes,” because the injury to the Waldroup’s daughter might be fairly traced to Dr. Liebman’s letter. The Court observed that the Waldroups will still be required to prove the letter was in fact a cause of their daughter’s injury. Nonetheless, the holding opens to door and allows them to try to prove the letter caused the injury.

The Supreme Court’s second holding requires more discussion. Deciding whether the Texas law requiring an expert report applies in this case depends, according to the court, on whether when he wrote the letter Dr. Liebman was engaged in the diagnosis or treatment of a mental disease or physical disorder. The Supreme Court says this about the Waldroups’ claims:

Their claims focus solely on Dr. Leibman’s letters and his alleged failure to determine whether Romano’s dog really was a properly trained service animal with appropriate public behavior.

Equally important is what their claims were not. The Waldroups did not claim that Dr. Liebman had misdiagnosed Ms. Romano or that he had mistakenly said a service dog would help help. What he had done was tell the world, through his letter, that the dog had the characteristics of a service dog, including being trained to behave in public places.¹ The letter was not wrong because of failure of medical diagnosis, but because it implicitly said something Dr. Liebman did not know; that is, that the dog was safe around strangers.

The Supreme Court emphasized that the Waldroups have a long way to go before they can tie Dr. Liebman’s letter to their daughter’s injuries, but the holding is still important.² It should remind medical professionals that just doing what their client or patient asks may not just be doing them a harmless favor, because the letter they right amounts to claiming they know something they probably do not know; that is, that the dog is not dangerous. A health care provider that writes a letter knowing it will allow their patient to take a dog into stores and restaurants has assumed some responsibility of the behavior of that dog. This gives businesses, landlords and direct victims of fake service dog letters a possible remedy and creates a threat that might make medical professionals think twice about carelessly writing an ESA or service dog letter.

There is, of course, more to be said about this case, and that requires a diversion to a recent decision from the Louisiana State Board of Social Work Examiners. In File #2024-33 concerning Melissa Montrose, a licensed clinical social worker, the Board issued (by consent) a reprimand, fines amounting to more than $2000, requirements for additional professional education, and reporting requirements to the Board. What did Ms. Montrose do to deserve this? She wrote a letter certifying that her client was disabled and needed an emotional support dog. She did this on the basis of a 15 minute telehealth consultation and answers to some screening questions. She did not try to gather any information about her client’s background, family, work, or medical history. She did not prescribe any treatment other than an emotional support dog. Even social workers have to do more than that before they give their professional opinion that their client needs something. By failing to fulfill her professional responsibilities Montrose violated Louisiana laws concerning the standards of practice for social workers.

There is a pretty large gap in training and qualifications between a social worker who sells ESA letters in Louisiana and a licensed MD in Texas, but the similarity is clear. Even though it was not an issue in Liebman, when a healthcare provider writes a service dog letter or ESA letter they are engaged in professional practice and obligated to meet the standards of that practice. It is worth asking whether before writing Ms. Romano’s service dog letter Dr. Liebman do what a professional would ordinarily do. Did he conduct a proper forensic examination to determine that Ms. Romano suffered from anxiety that met the statutory definition of “disability” under the ADA or FHA?³ Did he ask whether the dog had been individually trained to perform a specific task related to Ms. Romano’s anxiety and if so just what that task might have been? Did he do any research in the effectiveness of psychiatric service animals for helping those suffering from a disabling level of anxiety? In short, did he do any of the things he would have done before trying to diagnose and treat any gynecological disorder? We don’t know, but I would be surprised if he did.(4)

The specific legal posture of this case means we will probably never learn whether Dr. Liebman engaged in medical malpractice when he wrote the letter for Ms. Romano, but the Montrose case from Louisiana is a reminder that for every kind of healthcare provider from MD to social worker that writing letters claiming their client or patient has a disabling level of some mental disorder and that requires a service dog or emotional support animal must be approached with the same level of care that they approach any other part of their practice. A healthcare provider who diagnoses a disability has a duty to conduct a professional examination to determine whether their patient suffers from a mental health disorder, to understand the legal definition of “disability” before claiming their client meets that definition, and to understand the use of service animals and emotional support animals in exactly the same way they understand the use of any drug or surgical treatment before they recommend it. A doctor should not prescribe a service dog any more lightly than they would prescribe a narcotic, because both can be dangerous to the patient and others. A therapist should not prescribe a service dog any more lightly than they would prescribe any course of treatment for a serious mental illness because prescriptions of this kind have effects in the real world that can include anything from a child disfigured by an dog’s attack to loss of a license to practice.(5) ESA and service dog letters are not just good business, they are also serious business.

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¹ There is no explicit requirement in the Americans with Disabilities Act that service dogs have such training. The relevant regulation, 28 CFR §36.104 requires that a service dog be “individually trained to do work or perform tasks for the benefit of an individual with a disability.” It says nothing about behavior. However, a service dog could not do its job, whatever that might be, if it were constantly reacting to, let alone attacking, strangers. Thus, all genuine service dogs are trained to behave well around other people.

² The published opinion is still not final and four of the nine judges dissented, so the outcome remains a little uncertain.

³ Ms Romano originally sought the letter from Dr. Liebman because she wanted to keep her dog in her apartment. For this the applicable law is Section 3604(f)(3)(B) of the Fair Housing Act. Taking the dog into a public place like a restaurant is the domain of Section 12182(b)(2)(A)(ii) of the Americans with Disabilities Act. The definitions of “handicap” under the FHA and “disability” under the ADA are not the same, and by writing the letter Dr. Liebman claimed, implicitly if not explicitly, that he was familiar with these statutory definitions and the related regulations.

(4) If Dr. Liebman did the research he might have found the 2022 study finding no significant difference in mental well being between patients who had a psychiatric service dog and those who did not. Katlyn Morales, The Differences in Mental Well-Being for Individuals With and Without Service Dogs, August 2022, available at service dog article. There do not appear to be any peer reviewed studies that demonstrate the effectiveness of psychiatric service dogs, and if anyone who reads this knows of any I would love to hear more about them. What we seem to have instead is many studies where people who already own dogs tell the researchers how much they like them. These all suggest that people who like their dogs feel better when their dogs are around. What a surprise.

(5) It is worth asking whether Ms. Montrose would have gotten off with a reprimand and fine if the ESA she prescribed had severely injured a child.

(6) I first learned of the case discussed below from William Goren’s 2023 blog about the court of appeals opinion, which you can read at “Goren Blog.” My earlier blogs on related topics can be found at – Science v. HUD – science and business are the losers., HUD’s new Guidance on assistance animals will encourage emotional support animal fraud., and HUD gets it wrong again on emotional support animals – two is one too many.