4 Tips for Managing Staff and Patients Who Won’t Comply with Mask Mandates

At this point, most of us have witnessed someone refusing to comply with a mask requirement—whether that’s in a video, a social media post, or good ol’ real life. Unfortunately, it’s become a controversial issue, but the numbers indicate that widespread—and proper—mask use reduces the spread of viruses, including COVID-19. Furthermore, whether or not you personally feel masks are effective or that people should have to wear them, taking recommended precautions significantly minimizes the risk that a patient—or any other individual—will bring a claim against your practice for exposing them to the novel coronavirus. It also protects your—and your practice’s—reputation and eases patient anxieties over contracting the virus, which in turn helps with patient retention.

In response, many states and private businesses—including rehab therapy practices—have instituted mask requirements of their own. But, what can a PT, OT, or SLP do when a patient or staff member refuses to comply? To help answer that question, we put together a quick guide to handling disputes over mask mandates.

1. Share any and all precautionary policies in advance.

Any time you update your clinic’s policies and procedures, it’s essential that you communicate those updates to every individual who will be impacted—from patients and visitors to providers and vendors. This is especially critical in a situation involving public health. So, be sure to take the following steps when implementing a mask mandate in your practice: 

• Post clear information about mask requirements and other safety protocols on your practice’s website.
• Notify patients of any updates to your policies via email, text message, or phone call—before their next appointment. This is a good opportunity to remind patients to bring a mask from home if possible.
• Place signage on your front door that alerts patients to mask requirements before they enter the facility. Be sure to specify that patients must wear masks covering both their nose and mouth at all times.
• Enforce this policy uniformly among all patients, staff members, and anyone else who enters the clinic. This ensures you’re not held liable for any discrimination claims.
• Communicate the consequences of failing to follow these mandates. That way, patients have the opportunity to cancel or reschedule their appointments if they cannot agree to your terms.

Getting Your Team On Board

Meet with your staff before implementing the policy and explain the reasoning behind it. There is a lot of conflicting information out there regarding mask use during the coronavirus pandemic. (Some information is outdated, and some is patently untrue.) Fortunately, we now have a better understanding of the effectiveness of masks than we did in March 2020, and providing this information—or even pointing to useful infographics such as this one—can do a lot to reassure your team.

That said, you are well within your rights as an employer to send staff members home when they refuse to comply with practice policy. 

2. Provide masks at the front door.

Of course, even patients and staff members who fully intend to comply with mask requirements may forget their mask at home. For that reason, practices should provide disposable masks free of charge. In this article for Physicians Practice, healthcare attorney Ericka L. Adler, JD, offers this advice: “I recommend to my practices that this interaction with patients occur outside the front door of the practice or within an inner lobby, if possible. Some practices even go to the patient’s car outside. While the goal is to prevent patient congregation, this also helps prevent a patient from creating a scene in the waiting area where others are present.”

Depending on your location, your state might actually require you to provide masks to your team if you enforce a mask mandate. It’s important to check your state and local legislation or consult with your attorney to see if this is the case for you.

3. Train your staff on how to respond to non-compliant individuals.

This is where things can get a little tricky. After all, your team might not be comfortable enforcing policies—or know how to respond when patients offer seemingly-valid excuses for not wearing a mask. In these instances, providing a script that your team can fall back on during these conversations can help minimize any awkwardness or potential confrontation. We’ve provided a sample script below:

We appreciate that you’ve taken the time to come see us today. Just so you know, our office/practice/clinic has instituted a mask policy, which means all patients and staff must wear a mask that covers both their nose and mouth while inside the clinic. (Offer a disposable mask if you’ve made them available.)

We understand masks aren’t necessarily comfortable, but we’ve made this decision to ensure the health and safety of our patients and our team, which is why we’ve made every effort to notify you of this policy beforehand. But if you’re unable to wear a mask today, I’d be happy to reschedule your appointment to a time when it’d be possible for you to do so.

Planning Ahead

Here are a few other considerations when training your staff on how to handle these situations:

• Remind non-compliant patients that they were informed about the mask policy prior to the visit.
• Offer to reschedule the appointment for a time when the patient would be willing to wear a mask.
• Do not allow non-compliant patients to receive services that day simply to avoid making a scene. In other words, remain firm with all individuals when it comes to your mask policy.
• If a patient believes wearing a mask is not necessary for any reason—whether that be first amendment rights, HIPAA, or a specific health concern—calmly explain the reason for the policy (i.e., that it is in accordance with guidance from the CDC, OSHA, and local governance) and reiterate that compliance is a condition of service in your practice.
• Do you not allow your staff or any other patients to engage in an argument with a non-compliant individual.
• Keep an eye out for false exemption claims or fake documentation. According to Adler, “Be aware that there are laminated cards being presented from a non-existent government organization that would ‘exempt’ people from wearing masks due to claims of HIPAA and/or ADA violations. These are not real cards, and these are not real legal violations.”
• If a patient is particularly adamant about receiving services that day and refuses to leave the premises, inform the patient that this constitutes trespassing and that you will contact the appropriate authorities to have the patient removed.
• Consider designating a specific point person staff can call in the event that a patient becomes combative or refuses to leave.
• Don’t be afraid to lose a single patient’s business in order to preserve the health and safety of your team and other patients.
• Create a policy around recording these encounters (i.e., whether or not recording non-compliant or combative patients is acceptable). As Adler writes, “if the practice does record the events, the patient’s identity is considered protected by HIPAA and thus it should not be shared on social media. Based on events that occur, it may be needed for law enforcement.”

4. Collect information if patients or staff attempt to invalidate the legality of your mask requirement.

At some point, you may come upon a situation where a patient or staff member claims to have spoken with a lawyer who advised that not wearing a mask is not illegal. If this happens, collect the contact information for the patient or staff member’s legal representation and let them know you—or your legal counsel—will reach out to their attorney. Alternatively, you can direct the patient or staff member to your practice’s attorney to discuss the matter further.

According to Adler, “a lawyer who has done their research will know that a business is well within its rights to generally set the standards under which it will provide services, and to deny services to those who do not comply with reasonable accommodations.” In other words, you are well within your rights to refuse service to individuals who will not comply with your mask mandate.

We know these types of scenarios can be incredibly uncomfortable. But ultimately, enforcing mask mandates in your practice is better for everyone. Hopefully, you now feel better equipped to handle these types of situations should they arise in your clinic. And as always, if you have any questions, drop us a line in the comment section below.