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Week of 1 November 2002 · Vol. VI, No. 10

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Docs and lawyers team up to safeguard kids’ health

By Tim Stoddard

Barry Zuckerman was so tired of sending asthmatic children home to apartments full of roaches and mold and of seeing babies who live in unheated homes return to his clinic again and again with lung ailments that he decided to do an undoctorly thing: he enlisted the help of lawyers. In 1993, Zuckerman, a MED associate professor of pediatrics and chairman of the department, hired three attorneys and launched the Family Advocacy Program (FAP) at Boston Medical Center. Its mission has been to augment pediatric care with legal services to meet the basic needs of low-income families.

Vicky Bennet (from left), FAP’s outreach coordinator, and staff attorneys Pamela Tames, Thuy Wagner, and Ellen Lawton, who directs the program. Photo courtesy of the Family Advocacy Program
  Vicky Bennet (from left), FAP’s outreach coordinator, and staff attorneys Pamela Tames, Thuy Wagner, and Ellen Lawton, who directs the program. Photo courtesy of the Family Advocacy Program

The lawyers provide a range of services to the 600 families referred to their clinic every year, services that go beyond the standard social work provided by hospitals. In a typical week, FAP lawyers and student interns pressure recalcitrant landlords to comply with sanitary codes, negotiate delinquent bills with utility companies, and help low-income families apply for food stamps.

When six-year old Raymond recently came to BMC with trouble breathing, his pediatrician treated his severe asthma with steroids and sent a visiting nurse to inspect his home for asthma triggers. The nurse discovered the usual suspects: mold from a leaky pipe and wall-to-wall carpeting, which is prime real estate for dust mites. Raymond’s mother had asked the landlord repeatedly to fix the pipe and remove the carpeting, which were exacerbating her son’s asthma, but he refused to do anything.

“Normally, that’s the point where the doctor says, ‘I don’t know what to do to help you,’” says Ellen Lawton, a staff lawyer and director of the program. “Part of our role as attorneys is to train the doctors that there is something they can do.”

Raymond’s pediatrician referred his mother to FAP, and an attorney called the landlord to inform him of his legal obligations to remove the carpeting and fix the pipe, explaining that his inaction was severely impairing the child’s health. The landlord promptly complied and six weeks later Raymond was back in school and no longer on steroids.

In situations like this, Zuckerman says, “pediatricians and social workers can’t be effective on their own, because rules and regulations change. And those agencies or landlords really don’t care what pediatricians say. But when a lawyer calls, they take the matter seriously.”

Today’s physicians may be well versed in the complexities of reimbursement through managed care, but many of the legal issues affecting poor families are beyond their ken, says Lawton. “We don’t want doctors to handle a housing case, because that’s not their job,” she says. “They’re not trained in understanding the rules and regulations that pertain to housing, or food stamps, or disability payments, or any of the myriad agencies that poor families have to interact with. But they do need to know enough to recognize when there’s a problem and to make a good referral.”

Doctors have been traditionally reluctant to ask patients if they’re getting enough to eat, because in the past, there was virtually nothing they could do about it. “Working with lawyers allows us to ask the important questions about the social context of a child’s life in terms of adequacy of housing and food,” Zuckerman says. “I think we’d all been reluctant to ask before because we didn’t feel like we could do anything about it.”

FAP has inspired similar programs in four Dorchester clinics and at hospitals in Chicago, New York, Rhode Island, Connecticut, and Washington, D.C. Now, its directors are trying to spread its reach even further. In October, FAP sponsored a conference at BMC entitled Fostering Medical-Legal Collaborations: How to Bring Legal Advocacy into the Clinical Setting. Drawing upon the successes and setbacks of the BMC program, the conference was designed to support well-established advocacy programs, and also to help a number of start-ups to get off the ground.

One of the issues under discussion was how best to make use of pro bono services from interested law firms. For the past 18 months, the firm of Mintz, Levin, Cohn, Ferris, Glovsky, & Popeo in Boston has helped tackle FAP’s difficult cases. Lawton says it’s important for would-be family advocates to act as filters between the client and the pro bono attorneys. “Many clients come to us with a slew of problems,” she says, “and we try to save the most resource-intensive ones for Mintz, Levin and hang on to the easier ones that we can solve ourselves.” In some cases, the firm had agreed to represent a client expecting the case to take 100 hours, when in fact it required a much larger investment of time.

If Zuckerman’s track record is any indication, the Family Advocacy Program will soon be a national phenomenon. He founded Reach Out and Read, a program hailed by both the Clinton and Bush administrations, which gives children a new book at each checkup. “Just like Reach Out and Read, I think this is ready to take off all over the country,” he says. “We’re going to follow the same steps we did before, because both doctors and lawyers have responded like librarians and pediatricians did with Reach Out and Read.”

It’s a shame that legal remedies are needed to safeguard the health of children, Zuckerman says, but in the short term, it appears that lawyers partnering with pediatricians will be a growth industry. “It’s the only way that I know to level the playing field for low-income minority children. They have to have their basic needs met. Medicine can’t do it alone.”

For more information about the Family Advocacy Program, please visit www.bostonchildhealth.org/special/FAP.


1 November 2002
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