Hello readers, we are pleased to announce that the peer-reviewed journal, Progress in Community Health Partnerships, has published a piece about our campaign with Bronx Health REACH to end segregation in the delivery of health care services by teaching hospitals in New York. You can download a copy of the piece here. Feedback welcome! We are using every avenue at our disposal to get the word out about this urgent issue, including the very types of publications that health care providers and policy decision-makers are likely to peruse.
Tag Archives: public interest law
Like many New Yorkers did this summer, I boarded a Hampton Jitney from the east side of Manhattan in late August and made my way to the finger tips of Long Island. Instead of landing on the beach, however, I found myself in the crowded office of a small community-based organization bursting with children and parents, canned goods and clothing swaps, and the bilingual chatter of Latino immigrants seeking help for any number of different problems. I was with a colleague, and we were there to meet a client. Here is her story:
In late July, Laura was rushed to the emergency room of a local Hamptons hospital due to severe stomach pains. She is only a teenager, undocumented, uninsured, and uncomfortable speaking anything but Spanish to discuss complicated health matters. After some ten hours spent unattended on a hospital gurney, Laura was finally seen by a surgeon the following morning. No one explained to her, in a language she could understand, why her stomach was on fire or why she was about to receive an operation. Turns out it was appendicitis.
Laura was admitted to the hospital for 24 hours after her surgery and then summarily discharged, even though she was still in pain. No one talked to her about a discharge plan or explained self-care strategies to use in the wake of her operation. All she knew, through the help of family members advocating on her behalf, was that there was still a drainage tube in her body, and she would have to go to her surgeon’s private office to have it removed.
At this private office, Laura was told that she would have to pay $1500 upfront to extricate the tube, and if she didn’t pay it they couldn’t do the procedure for her. The emergency room of the hospital where she was originally treated, and to which she returned after this extortionate demand, also refused to remove the tube, insisting again that she go to the surgeon’s private office. Her fear mounting, Laura turned to her primary care physician and the local community group for help. Together they advocated with the hospital and the surgeon to have the fee for the tube removal reduced to $300.
Sitting in the surgeon’s waiting for the second time, Laura and her family were subjected to a verbal assault by the physician who initially treated her. She was the reason he and his assistant had to get up in the middle of the night to come to the ER and operate, he shouted. She was ungrateful for the fact that he wasn’t getting paid for the services he was providing to her. Oh, and he also wanted to know—in front of all of the other patients in the waiting room—was she in the country legally or illegally? Only after his anger was vented did the surgeon remove the drainage tube from Laura’s body, but as a parting gift, he also reneged on their payment arrangement and billed her $5000.
As a civil rights-oriented health care lawyer in New York City, I thought I knew what racial and ethnic disparities in health care looked like, and how they manifested themselves. But Laura’s case surprised even me. Here we had potential violations of federal and state discharge planning laws, language access regulations, patient dumping statutes and financial assistance laws, not to mention flagrant disregard for the medical profession’s codes of conduct and a whiff of fraud and consumer protection violations.
What is more, hers is potentially not the only story of its kind. In our interview, Laura’s sister mentioned another family member who had been turned away from the emergency room of the same Hamptons-area hospital. The director of the community-based group where we were conducting the interview also knew of a similar case. To her, the mistreatment was targeted toward a specific patient population. As an Irish-Catholic nun, she noted, she had little problem accessing high-quality, respectful care from the same surgeon who treated Laura. However, the same was not true for the low-income Latino/a residents of the community whom she served.
Since meeting with Laura, I have wondered how cases like her come into being. What are the factors that allow doctors—people who have pledged to do no harm—to exhibit openly hate and bias, to take actions that actually threaten the lives and well-being of some category of their patients? What are the dynamics that make it acceptable for immigrant patients seeking relief from pain and illness to be turned away from their local houses of healing? How does this happen in a place known to be the summer playground of New York’s financial and cultural elite? Do the Haves not have enough?
As has been mentioned previously on this blog, this has been a long, hot summer of hate and injustice against Latinos and immigrants, and I can’t help but think that the vitriol spewed into our airwaves is creating a space—a social sanction—for overt acts of harm. After all, Long Island is the place that anti-immigrant provocateur Steve Levy calls home, and whose blistering comments against the undocumented are only the most public example of the kind of anger that led to Marcelo Lucero’s brutal murder two years ago this fall. Levy and others like him have also complained that Mexican “anchor babies” are the reasons hospitals on Long Island are in financial distress. It should come as little surprise to us, then, that some physicians at these very hospitals have adopted a hostile attitude toward those patients that they see as a threat.
As a health care advocate, I have to be attuned to these broader dynamics around race and immigration, for they are directly impacting the clients I serve. And, as racial justice activists, we all have to be vigilant of the many manifestations of hate – not only in the extreme examples of violent crimes and assaults, but also the quiet, painful attacks that take place in our schools, workplaces and hospitals.
Below is a press release we just issued, announcing a major campaign victory!
FOR IMMEDIATE RELEASE
After advocacy groups’ campaign on behalf of parents of kids with special needs, NYU designates providers who will accept Medicaid and,Child Health Plus
New York, NY, June 1, 2010 – New York Lawyers for the Public Interest (NYLPI), a civil rights law firm whose practice includes health justice and disability rights, along with co-counsel, Cleary Gottlieb Steen & Hamilton LLP and LatinoJustice/PRLDEF, announced today that they successfully campaigned for the Child Study Center of the New York University Medical Center to designate certain doctors who will accept Medicaid and other health insurance. Previously, NYU’s Child Study Center had a cash-only policy for patients, which meant that they did not accept any insurance at all.
As part of the advocacy campaign, which included threats of litigation, a group of parents represented by NYLPI and co-counsel met with NYU leadership and explained how the cash only policy impacted them and the thousands of other families who were unable to access the Center’s state-of-the-art evaluations and medical services for children with disabilities. These services are in extremely short supply across New York City, and without access to the facility at NYU’s Child Study Center, many low-income and minority children were unable to obtain the medical attention they needed.
“NYU has taken a step in the right direction towards eradicating a few of the many institutional barriers keeping low-income New Yorkers from accessing quality health care,” said Nisha Agarwal, director of NYLPI’s Health Justice program. “We still have a long way to go to ensure that all children, regardless of their financial circumstance or background, have equal access to high-quality mental and behavioral health services, but this is one step forward.”
As a result of NYLPI’s action, the Child Study Center has announced that it will designate certain providers who will begin accepting fee-for-service Medicaid and Child Health Plus. Before this change, children and their parents who could not afford to pay cash for evaluations and medical services often went without necessary and recommended medical treatment for serious illnesses.
According to Lorraine Ali, “No mother wants to be told she can’t provide her child with the medical attention he needs. Now I can finally get my son to a doctor who can treat him. It’s the best news we’ve gotten in a long time.”
Although NYU’s Child Study Center has agreed to take the important step of accepting fee-for-service Medicaid and Child Health Plus, it does not have plans to accept any Medicaid managed care plans. “There continues to be an acute shortage of evaluative and medical services for children with psychiatric disabilities in New York City,” said Kelly McAnnany, director of the Opportunity & Access Program at NYLPI. “We will continue to work with providers and with state agencies to open the doors to quality health care and educational opportunity for low-income children with disabilities.”
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 firstname.lastname@example.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.
For the past two years, we have been representing a community coalition in the Bronx in a case about insurance- and race-based segregation in New York City hospitals. This Monday night, our campaign is going to be featured in an investigative news piece by Dr. Sanjay Gupta on CNN! The piece will air during the Anderson Cooper 360, between 10pm and midnight; not sure yet which hour. Please tune in and show your support! (Or for those of you with more new-fangled technology, be sure to DVR it.)
Better yet, tune in with a group and use the story as an opportunity to talk about institutional racism in the health care system, and what can be done about it. Check out our Community Discussion Guide to help you facilitate the conversation. If you’re a health care provider, you get your own Provider Discussion Guide.
And please spread the word. There’s been a lot of talk about the health reform proposals coming out of Washington these days. Well, we’re offering a plan rooted in community activism, South Bronx style.