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So, how difficult is it to have a legitimate medical reason to not wear a face mask?
Most states now have mandatory face-covering orders in place to help reduce the spread of the coronavirus, and most (if not all) of these orders include language about medical exemptions.
Here, for instance, is how Minnesota defines those who might qualify for an exemption: “Individuals with a medical condition, mental health condition, or disability that makes it unreasonable for the individual to maintain a face covering."
That sounds clear enough. But what, exactly, are the conditions that would qualify for an exemption? The Centers for Disease Control and Prevention provides no specific guidance and neither do the state and city mask orders.
The apparent consensus among doctors, however, is that very few people can claim that masks are a health risk.
Dr. Raymond Casciari, a pulmonologist at St. Joseph Hospital in Orange, California, told Prevention.com that people with severe lung disease or people with panic disorders might qualify. But, he said, “(M)ost people can breathe just fine with a mask on. People who can't wear a mask are a very rare segment of the population."
Dr. David Kaufman, a pulmonologist and director of the Medical Intensive Care Unit at Tisch Hospital in New York, told Health.com, “There are no known medical conditions aside from a severe skin condition (like a very severe burn that needs medical attention) on your face that would prevent a person from wearing this type of mask. If you can wear a scarf to keep your face warm in the winter, you can wear a mask to prevent the spread of disease."
Still, many people are trying to get medical documentation for exemptions, and apparently they're not having much luck. WebMD is reporting that doctors now are dealing with queries from patients who are asking them to provide written excuses for them to not wear masks. These doctors, WebMD said, generally turn them down as unwarranted.
Meanwhile, most airlines are now requiring all passengers to wear masks. Most are not giving medical exemptions.
With all this frustrated demand, it's probably not surprising that fraudulent enterprises have arisen to make a quick buck. For instance, an outfit called the “Freedom to Breathe Agency" (FTBA) is selling laminated “exemption cards" that can look somewhat official if it wasn't for some sloppy spelling. The Justice Department and other agencies warn that these cards, which cost $9.99 each, are bogus.
“Wearing a face mask posses (sic) a mental and/or physical risk to me," the cards state. “Under the Americans With Disabilities Act (ADA), I am not required to disclose my condition to you."
Apparently, people believe that merely citing the existence of a “medical condition" provides automatic protection under the ADA.
It's not so simple, as professor Jessica Roberts, the director of the Health Law & Policy Institute at the University of Houston, told USA Today. “A person must have a legally recognized disability to enjoy the protections of the ADA," she said. “So, the individual would have to establish that she is a person with a disability under the law, which has specific legal standards and is not always an easy or straightforward thing to do."
However, the ADA also requires businesses to provide "reasonable modifications" of policies to accommodate people with medical needs. When it comes to face-mask policies, this can mean allowing the customer to wear a loose scarf, pick up ordered goods curbside, or wait in the car for scheduled appointments.
During a pandemic, the government has emergency powers to require people to wear face masks. And businesses have the right to require that their customers wear masks as well. But other than requesting accommodation by the "reasonable modification" standard, citizens in the states and cities with mask mandates have limited legal rights of refusal to comply.
Still, it's very much an honor system. The City of San Francisco has probably come the closest to requiring proof, saying, “If you have a chronic respiratory condition, you should get documentation from a medical professional." But other mask-mandate orders typically state that people who claim a medical exemption don't need to provide proof.
All they must deal with is their conscience.