Monthly Archives: December 2009

A Link to the Hearing World

This piece, by Health Justice Director Nisha Agarwal, will appear in the upcoming issue of NYLPI’s Pro Bono Clearinghouse newsletter.  It discusses a case that the Health Justice team worked on in conjunction with NYLPI’s Disability Law Center and advocates from around the country.

Imagine going to a hospital for heart surgery and not being able to communicate with your doctor or any of the nursing staff.  Imagine that your 13- and 9-year old children are made to serve as your voice instead: to ask questions for you, to explain the procedures to you, to tell you that post-surgery you had a stroke.  Imagine that your children are given pagers and pulled out of school whenever hospital staff need to speak with you, and that the younger child later attempts suicide because he thinks the problems you suffered in the hospital were his fault.  After all, his 9-year old vocabulary couldn’t find the right words to describe what was happening — to you, to himself or to others.

These are, roughly, the facts of Loeffler v. Staten Island University Hospital, a case decided by the Second Circuit Court of Appeals on October 6, 2009.  Robert Loeffler was a man who was profoundly deaf and sued Staten Island University Hospital for failure to provide him with a qualified sign language interpreter, as required under the Americans with Disabilities Act and the Rehabilitation Act.  NYLPI became involved with the case at the appeals level, organizing a broad national coalition of disability and language rights groups to provide amicus support to the plaintiffs.  Our brief highlighted two issues: (1) the proper legal standard to apply in “deliberate indifference” cases of this kind under disability law and (2) the importance of having competent, qualified medical interpreters in the health care setting, not just for people who are deaf but also for individuals with limited English proficiency and other communication barriers.  Our coalition of amici wanted the members of the court to understand not only the legal right they were being asked to clarify but also, more importantly, its significance.

And understand they did.  Oral arguments took place in March and were notable for the impassioned questioning of one judge on the panel, who described as “inhumane” the use of the Loeffler children as interpreters.  The court’s eventual decision found for the Loefflers on all points of law and remanded to the district court for trial.  In the concurrence, the court concluded, powerfully, by recognizing that the case is “not the dawn of never-ending liability for the Hospital, it is what Congress required – a link to the hearing world.”  For NYLPI, the case was an important opportunity to bridge the disability and language access communities and take part in an important victory for many of the communities we serve.

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2010 Health Justice Spring Internships!

New York Lawyers for the Public Interest pioneered the practice of community lawyering in the five boroughs of New York City.  With every case and every campaign, we continue to elaborate an approach to working with marginalized communities that is ambitious, participatory, and dynamic.

In our health justice program, a community organizer and a team of attorneys challenge racial and ethnic disparities in the health care system in New York.  For us, health justice is achieved when racism, language barriers and anti-immigrant bias no longer infect the design and delivery of health care in the United States. Our work is rooted in the low-income communities of color and immigrant communities of New York City.  Sometimes we use the courts to make sure health care providers and others within the health care system play by the rules.  Sometimes we go to the legislature to change the rules of the game so that they are more fair and equitable.  But we always do these things in a way that fosters and supports grassroots organizing and activism within the communities where we work.

NYLPI seeks highly accomplished, progressive, community-minded law students to advance the goals of the health justice program.   Students interested in part-time spring internships with our program should submit a resume and writing sample as soon as possible to Peggy Germain at healthjustice@nylpi.org.

NYLPI is an affirmative action employer.  We actively recruit people of color and people with disabilities.

We dare you to find a better spring internship.

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DOJ Civil Rights: Back in Business?

Yesterday afternoon advocates from civil rights organizations across the country were invited to a meeting with Tom Perez, the newly confirmed Assistant Attorney General for the Civil Rights Division at the U.S. Department of Justice (DOJ).  The purpose of the meeting was to discuss enforcement of Title VI of the Civil Rights Act of 1964 — a law that has been called the sleeping giant of the civil rights legal pantheon.  The fact that the meeting was happening was symbolic of the change in attitude at the Civil Rights Division of DOJ after the 8 years of the Bush Administration.   Earlier in the week, there was a meeting with language access advocates from across the country as well.  “DOJ is back in the civil rights business,” according to Tom Perez.

What exactly this will look like remains to be seen, but here in the Health Justice program we are cautiously optimistic.  For our work, having the federal government willing to engage in a little bit of oversight and enforcement, or simply issue guidance on critical issues related to health disparities, could have a ripple effect across the health care industry.  It also opens up an entirely new venue of advocacy–the federal government–which had been effectively closed off to us for the past 8 years.  We’ll be working with our community partners to figure out what to do and how – stay tuned!

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Reading Between the Lines: Kids of Color & Mental Health Care

This post, by Health Justice Director, Nisha Agarwal, originally appeared on the Race-Talk.org blog of the Kirwan Institute for the Study of Race & Ethnicity and in the Huffington Post.

This weekend the New York Times reported on a new study which finds that kids on Medicaid are four times more likely to be prescribed antipsychotic drugs than their privately insured counterparts, and often for conditions for which the drugs are not FDA approved such as A.D.H.D. and conduct disorders. These drugs may not only have significant psychological impacts on the children who take them, but they also cause long-term physical harm. This is terrible no matter what, of course, but let us be very clear about what we are talking about here. In places like New York City, where African-Americans and Latinos are 3.5 times more likely to be on Medicaid than whites, the kids we are talking about are black and brown.

The children who are being systematically over-medicated and denied high quality mental and behavioral health services are disproportionately young people of color. What we are talking about, then, is race even if all but the most oblique reference to it has been scrubbed from the lines of the mainstream media coverage.

Let us also be clear about how this may be happening. The Times piece implies that certain problems with the Medicaid program, such as low reimbursement rates for therapy, contribute to the over-medication of children by creating incentives for doctors to prescribe antipsychotics or by reducing the availability of psychiatrists who accept Medicaid, thus funneling low-income kids to non-specialists who are more likely to provide treatment through drugs. This may very well be true, but let us unpack these dynamics as well from the racial justice tip.

In New York City, where I work, there are large, well-respected institutions providing high quality mental health services for children that refuse to accept Medicaid patients ostensibly because they don’t pay that well. This can be viewed as a rational dollars-and-cents reaction to an inadequate Medicaid system, but when you consider the close relationship between insurance and race, it starts to look like a modern version of Whites Only. Such policies become all the more difficult to swallow when you compare them to the approach of some community-based health care providers that also exist in the city and manage to make mental health services available effectively and equitably.

The directors of clinical services at these community health centers will tell you about how they’ve figured out their administrative and billing infrastructure so they can work around some of Medicaid’s challenges to provide high quality mental health care to all patients, regardless of their insurance. Providers like these fight alongside consumer advocates to preserve Medicaid and make it better because they recognize how critical it is to the lives of their patients. They don’t retreat from the system or take shortcuts, hoping that poor kids of color and their mental health problems will just go somewhere else. Indeed, they bear responsibility for their colleagues at other institutions, who disguise their discrimination in the form of a “rational” economic calculus.

You can expect to hear more about the doping of America’s children in the coming year, as more studies are released and blue-ribbon policy panels convened to address the problem. What you probably won’t see are many efforts to write race into the story or the solution. That is our job as racial justice advocates: to read between the lines and move in from the margins.

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