Some doctors may ‘prescribe’ an attorney for their patient
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| Barry Pfundt has helped Spokane develop the Health and Justice Initiative through Gonzaga University’s Law School. |
Spokane’s Health and Justice Initiative, a medical-legal partnership program at Gonzaga School of Law, is designed to integrate legal advocacy into health care, training doctors, medical residents and other health-care staff to identify patients’ legal needs and refer them to lawyers and legal interns.
For example, if a physician’s assistant (PA) asks a few questions about the home environment of a girl with asthma symptoms, she may learn that mold and lack of heat may contribute to the problem. The PA refers her to an attorney who contacts the landlord to let him know he is legally responsible to make repairs.
Then, instead of regular nebulizer treatments, the girl’s symptoms can be managed with infrequent use of an inhaler. The cost of care goes down and her quality of life goes up.
Barry Pfundt learned about such partnerships at a Northwest Justice Project conference in the Tri-Cities and thought it would work in Spokane where there is much poverty and a large medical community.
“For example, I have been in Spokane homes where mushrooms grow in the carpet, there is raw sewage in the basement, weatherization is poor and there is no heat, said Barry.
“Instead of prescribing a nebulizer, a doctor can ‘prescribe’ an attorney to investigate the home and compel a landlord to make repairs or help a family relocate.”
Rather than treating just symptoms, a doctor, working with an attorney, gains power to treat the root cause of an illness. Studies show that health care providers’ job satisfaction rises as they are involved in addressing the root causes of poor health, he said.
Barry works with social workers, nurses and doctors who provide evidence to address issues before legal proceedings begin, keeping cases out of court, which is expensive and time consuming.
“We look for solutions through better relationships,” said Barry, who grew up in Bellingham.
A fifth generation commercial fisherman, he was a commercial salmon fisherman in Southeast Alaska for five years. A second-generation U.S. Navy veteran, he spent six years as an electrician on nuclear-powered surface ships.
“In the Navy, I felt like a pawn in a larger game I had no say in and I was upset by the trash thrown over the back of the vessel. I wanted to help make the world a better place,” Barry said.
After his honorable discharge in 1999, he finished undergraduate studies at Evergreen State College in 2000 and worked with a U.S. Congressman, a Washington State Senator and two governors.
“I thought I could help people through politics, but found it lacking,” Barry said. “I realized many people who called the governor about safety or housing issues needed legal aid.”
So he applied to Gonzaga’s Law School and was wait-listed.
For a year, he worked in Spokane with Climate Solutions, a nonprofit working on global warming and modernizing the power grid with alternate energy.
Then he was accepted at the law school. During his studies, Barry did work-study with the Center for Justice on veterans’ advocacy. He graduated in 2009. After Barry passed the bar exam in Bellevue, the Northwest Justice Project, Washington’s publicly funded legal aid program, hired him to work in Spokane as a staff attorney, helping low-income people stay in their homes, secure benefits due them and advocate for consumer protection.
After learning about the medical-legal partnership model, he left the Northwest Justice Project in 2012 and started the Health and Justice Initiative in 2013 through the Center for Justice. In 2015, a community collaborative effort of Empire Health Foundation, Providence Family Medicine Residency Clinic, Providence Internal Medicine Residency Clinic, Gonzaga University School of Law, Spokane Teaching Health Center (STHC) and the Center for Justice began the multidisciplinary effort to train future doctors and lawyers about the impact social determinants of health have on the cycle of poverty.
For a while, he had offices at the Center for Justice, the STHC and Gonzaga Law School. Now his office is at the Gonzaga Law School, where he is an adjunct professor and director of the Health and Justice Clinic for University Legal Assistance.
Barry teaches up to 10 second- and third-year students a semester to improve access to justice for low-income and marginalized people with health concerns. Students have case loads they manage under his supervision.
Gonzaga’s Center for Law and Justice runs University Legal Assistance, a nonprofit clinical law program, through which law students practice law while in school.
The clinical law program, which began in 1974, also has clinics in Business Law, Environmental Law and Land Use, Elder Law, Federal Tax Law, General Practice Law and Indian Law. The elder and tax programs take walk-ins, but others require referrals.
Barry and students work with health care professionals at the Spokane Teaching Health Clinic (STHC) and Eastern State Hospital, where there are also social work students from Eastern Washington University. The medical students are majoring in pharmacy, nursing, medical and physical therapy, psychiatry, internal or family medicine.
Barry said the medical-legal partnership model 1) advocates for patients, 2) looks at systems that affect patients and 3) looks at policy issues.
• It addresses issues such as landlord-tenant relations, housing discrimination, translation for patients, health care access, refugee concerns, public benefits, and mental health hospitalization and discharge experiences.
• The interdisciplinary approach helps people deal with systems. For example, HIPAA, the Health Insurance Portability and Accountability Act designed to protect patient information, may inhibit health care coordination. Lawyers can help patients sign releases to improve their care.
• A policy issue they identified involved the city improperly interpreting its chronic nuisance law and compelling landlords to evict tenants who were victims of domestic violence, because they were part of an assault.
Students helped the city draft a notice informing landlords of tenants’ rights as domestic violence victims. Under state law, a victim cannot be evicted, but a perpetrator can, Barry said.
“We have saved tax money and improved patients’ lives, while teaching law students about complexities of patients’ situations,” said Barry.
Students also work with Hotspotters, a community action organization at Volunteers of America. The program works with “super users” of emergency medical services and first responders.
“We provided consultation to help start the program and advocate for clients,” Barry said. “The program collaborates with Community Court to protect clients’ safety and assets.”
Barry counsels students not to judge people who are experiencing poverty, but to take direction from their clients, because they know what they need.
Throughout his life, Barry has found there is not equal access to services in America or in the world. Some are held back by social determinants of health, the conditions in the places where people live, learn, work and play.
For instance, Spokane Health District’s study: “Odds Against Tomorrow” reports that people living at the top of the South Hill live 18 years longer than those living downtown.
Barry believes the Health and Justice Initiative works in Spokane because it’s small enough that all the players can meet to discuss cases— prosecutors, public defenders, fire fighters, nurses, engineers, police, emergency room doctors, primary care providers, mental health providers, social workers, housing providers, homeless advocates and substance abuse servicers.
“We help people regain their lives and health,” he said.
For information, call 313-5791 or email pfundt@gonzaga.edu.
Copyright © February 2018 - The Fig Tree