Doctors And Lawyers Work Together
To Solve Problems That Harm Health
October 4, 2005
By HILARY WALDMAN, Courant Staff Writer
Dr. Monique Deveaux went to medical school at Yale and spent
years in a suburban private practice, but when this seasoned
pediatrician hung out her shingle in one of Hartford's poorest
neighborhoods she encountered problems she felt completely ill-equipped
She knew from her training to suspect that one of her patients had
a brain tumor. But how could she persuade a recalcitrant insurance
company to pay for his care?
She knew the rodent droppings in one family's mouse-infested apartment
were bad for the children's health. But how could she push the landlord
to clean up?
"They don't teach it to you in medical school and they don't
teach it to you in residency," said Deveaux, a pediatrician
at Community Health Services, a clinic in Hartford's North End. "I
came here to do things for the community, but I don't know what to
do except lobby on the Capitol steps."
But in the past year, Deveaux has been able to leave her soapbox
behind and concentrate on medical treatment that is delivered with
a stethoscope. Now, when issues arise that require more than a medical
diagnosis, Deveaux calls a specialist: Jay Sicklick.
Sicklick, a former legal aid lawyer, set up an office at Connecticut
Children's Medical Center in 2000 to help families and pediatricians
address legal and community issues affecting health care.
His program, known as the Family Advocacy Project and funded by
private foundation grants, has spread into every public pediatric
clinic in Hartford. As a result, virtually every low-income family
in the city now has access to free legal help.
The idea that doctors need lawyers to make meaningful improvements
to the health of low-income children was a pretty radical concept
when Dr. Barry Zuckerman suggested it in Boston more than a decade
Zuckerman, chairman of pediatrics at Boston Medical Center, was
tired of sending asthmatic children home to apartments that were
moldy and infested with roaches only to have them return to his clinic
wheezing a few hours or days later.
He realized that all the inhalers and steroids he could prescribe
for children wouldn't do much good until, for example, a landlord
fixed the leaky pipe that was soaking the carpet and causing asthma-inducing
mold to grow in the room where a child slept or watched TV.
He could spend fruitless hours on the phone dealing with landlords
while patients with earaches and sore throats piled up in his waiting
room. But when he hired the hospital's first lawyer in 1993, things
started to change.
"The data shows you're denied food stamps, you have bad asthma,
there are mold and mites - a lawyer contacts the landlord and the
problem gets fixed," Zuckerman said.
By 1999, articles about Zuckerman's pioneering project began to
appear in legal journals. The idea intrigued Martha Stone, director
of the Center for Children's Advocacy, a project based at the University
of Connecticut Law School that promotes children's legal rights.
About the same time, Dr. Paul Dworkin, vice president and chief
medical officer at Connecticut Children's Medical Center, began to
wonder if his old friend Barry Zuckerman's idea could be applied
A year later, Jay Sicklick, who was teaching first-year students
at UConn Law School and looking to get back into practice, opened
his office at Connecticut Children's Medical Center.
His program, funded by a $260,000 grant from the Hartford Foundation
for Public Giving, became the nation's second medical-legal advocacy
program using the Boston model. There are now 25 similar programs
across the country and that number is expected to grow.
The Kellogg Foundation last month approved a $2.5 million grant
to Zuckerman's Family Advocacy Center in Boston, which will allow
creation of similar programs at 15 new locations. Zuckerman said
he also planned to use a portion of the money to lobby for changes
in lopsided social policies.
For example, he said, fuel subsidies in New England are so low that
low-income families can be forced to choose between food and heat.
In the winter, clinics begin to see incidents of growth retardation
in children whose families scrimp on food to pay fuel bills.
"We'd like to set up a national network to deal with policies
so we're not just putting our fingers in the dike," Zuckerman
Like the lawyers in Boston, Sicklick started out working with the
kind of cases that confront most legal aid lawyers: landlord-tenant
disputes, denial of food stamps, battles to get special-education
One client he remembers especially is Damaris Pedraza, who was a
freshman at Hartford Public High School when a lawyer in the school
referred her to Sicklick.
Born with spina bifida, Pedraza has no use of her legs. She was
having trouble getting to school because, although the school bus
stopped at the curb every morning, there was often no one to help
her down the four or five porch steps from the apartment where she
lived with her grandmother on Sigourney Street.
Instead of offering an aide to get Pedraza and her wheelchair on
and off the bus, the school system offered to send books home so
she could keep up on the days her uncle was not available to carry
her to the bus.
Sicklick stepped in and Pedraza, who has since graduated and attends
Capitol Community College with dreams of becoming a lawyer, got the
aide she needed to put her on the school bus. Later, Sicklick also
helped her family file and win a fair housing case against the Sigourney
In his first five years, Sicklick has helped a lot of clients like
Pedraza. And it quickly became clear that many of the problems families
faced fit similar patterns.
Unfair denials of Social Security benefits, illogical state policies
that denied payment for life-saving but non-prescription items such
as nutritional supplements to families covered by Medicaid, and refusal
by private managed-care plans to pay for certain procedures topped
If doctors were educated about these and other issues, an army of
professionals might work together, rather than just one lawyer trying
to repair the crumbling social foundation of people's lives one family
at a time.
So Sicklick hired another lawyer to represent families at the children's
hospital and he offered his services to four other clinics that treat
low-income children in the city. Then he started teaching doctors
how to use the law to improve their patients' health.
In addition to serving individual clients, the Family Advocacy Project
has evolved into an integral part of training for resident physicians
learning to become pediatricians in Hartford.
Sicklick and his colleague, Gladys Nieves, regularly give lectures
to residents and practicing physicians on housing and education law,
adolescent privacy rights, Social Security and Medicaid regulations,
insurance rules and policies, food stamp eligibility and other aspects
of social welfare law.
"This program has a major impact on the training of future
pediatricians," said Dworkin, who supervises residents at the
children's hospital. "We have a case management conference every
Friday. Prior to this, it would be unusual to discuss psychosocial
or legal problems in dealing with a patient."
Now it is routine.
The goal, Sicklick said, is to change the way pediatricians think.
Doctors are very good at treating organ systems, but they are completely
unprepared to take on the social systems that can make people sick
or interfere with recovery.
His latest venture is to add six questions to those that doctors
ask during their standard medical history and physical. None of the
questions addresses anything that a well-educated doctor is prepared
Do you have enough food?
What are your housing conditions like?
Do you have enough money in the house to pay for necessities?
Have you had any problems with your medical insurance?
Do you believe your child is being properly educated?
Do you feel safe in your house?
In the past there was no reason for a doctor to ask those questions.
What could the doctor, already behind schedule with five minutes
to see each patient, 10 patients backlogged in the waiting room and
a list of phone messages to return, do to help?
But with training, a physician may be able to make the one necessary
phone call and have a hungry family's food stamps re-instated. And
if not, the doctor can always refer the patient to one of the lawyers.
Deveaux said her clients light up when they learn there's a lawyer
down the hall at the Albany Avenue clinic who will help them without
charge. But with Sicklick's training, she also has been able to handle
some issues herself.
The other day the mother of a patient called Deveaux to complain
that her apartment was infested with mice and she was planning to
withhold the rent. After a brief consultation with Sicklick, Deveaux
learned that the mother could pay her rent to the housing court instead
of the landlord until the apartment was cleaned.
Deveaux told the mother the steps she would have to take to protect
her rights. The brief telephone conversation empowered the mother
to take action and spared Deveaux the need to write a letter to the
landlord. Deveaux said the process empowered her as well.
"I'm talking to the patient,
I'm not [just] holding their hand saying we'll get through this.
I know what the laws are."
Reprinted with permission of the Hartford Courant.
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