Hand in hand
With an emphasis on integration, the Legal Advocacy for People with Cancer Clinic serves as a model for handling cases with care.
“We’re representing people in preventive law,” Kathryn Smolinski ’11 says. She’s referring to the work she and her students do in the Law School’s Legal Advocacy for People with Cancer Clinic (LAPC), where they tirelessly focus on five areas of law: insurance, housing, employee benefits, life planning and public benefits.
“In other words,” Smolinski continues, “it’s a whole model.”
It’s a model that is rooted in law, but its reach extends beyond legality. “Think about what a lawyer needs to do: A lawyer needs to solve a problem. To solve a problem, you have to know the law. To know which law to apply, you need to know the facts. To know the facts, you’ve got to get them from your client. To get facts from your client, you’ve got to interview them. To get them to interview, you’ve got to build trust,” Smolinski observes. “That is so similar to working with a patient in an oncology social work perspective.”
Seeing a need
And Smolinski would know. She spent 20 years as an oncology social worker — a defining role. “There is so much rich living when somebody is facing a chronic illness,” she observes. “Everything gets richer: Their view of their relationships, their view of life, their view of their job.”
But during her time as a senior oncology social worker at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, she realized something was missing.
“I always had this desire to go to law school,” she reflects, “and part of it stemmed from the fact that sometimes the law was very helpful when we were trying to help people come to a decision in a health care setting, and sometimes the law was an obstacle.” Keep in mind that, all too often, these decisions were already heart wrenching in that they centered on life-sustaining therapies.
“I really felt honored to do that type of work, which was working with families and patients addressing whatever stresses were going on in their life and helping them breathe a little bit easier on their journey,” says Smolinski, who went on to become the executive director of the Association of Oncology Social Work.
Still, she says, “it frustrated me when there were legal obstacles in place for us to really provide what felt like the ethical solution.”
Running a nonprofit organization was rewarding for Smolinski, but her grant-funded role at the Association of Oncology Social Work had a time limit — something she viewed as an opportunity. So, in 2008, she enrolled at Wayne State University Law School to pursue a new passion.
“I knew I wanted to learn and think about law interfacing with health,” says Smolinski, who began working in the Disability Law Clinic as a 2L. “We helped a lot of people who had been denied Social Security and disability, and it was such a comfortable place for me to be because I was reading medical records.”
After three semesters working in the Disability Law Clinic, Smolinski was approached by Associate Professor (Clinical) David Moss, who had been looking to expand the Law School’s clinic offerings and observed her keen interest in collaborating with other disciplines outside of law. They discussed a unique opportunity for a medical-legal partnership between the Law School and the Barbara Ann Karmanos Cancer Institute to provide free legal services to low-income cancer patients. Right away, Smolinski was intrigued.
“I always said, ‘I have to wake up every day knowing that I’m doing something that’s making a difference.’ That’s why social work meant so much to me, so when I became a lawyer, I knew that couldn’t change.” She continues, “I had a fabulous experience working with cancer patients who are so open and willing to teach that sense of resiliency, and I thought, wouldn’t it be cool to have law students experience that?”
Connecting the dots
Once Smolinski secured funding from Equal Justice Works, the LAPC took on its first client in January 2012. Law students work in the clinic for 21 hours a week, with four hours devoted to seminars. Smolinski always designates the second class of the semester to touring Karmanos and meeting staff members.
“Sitting in the Law School, it’s a bubble,” she explains. “Students need to see the people that they’re helping.” Often, the people they’re helping are dressed in jeans and blouses or T-shirts and by all accounts look healthy — and that’s the point. “I need them to see that,” Smolinski says.
But beyond dispelling the myth that everyone with cancer is terminally ill, these seminars allow LAPC students to start making critical connections between the practice of law, social work and medicine.
Smolinski explains that sometimes law students may be successful in getting an appeal overturned for their client’s Social Security disability, which the client will receive in a couple months — but during that time, the client is at-risk of losing their apartment. A social worker might have access to a patient access fund that, based on a needs assessment, could be allocated to fund those two months of rent.
“It’s a smooth transition of care,” Smolinski says. “It’s wonderful: This person never needs to leave their home while they’re getting treatment, but it’s because the social workers and the law students work together to make that happen.”
In fact, Smolinski is so committed to the complementary relationship between lawyers and social workers that she hosts a master of social work student in the LAPC every year. Jessica Lennon, M.S.W. ’19, worked in the clinic from August 2018 through April 2019, where she focused on two capstone projects: Winter Wishes, a holiday fundraiser similar to adopt-a-family programs, and an interdisciplinary workshop for law, social work and nursing students in the winter.
“The clinic is almost entirely law students, so I enjoyed learning more about legal work,” says Lennon. “I was constantly learning new things and getting experience I don’t think a lot of other social work students get.”
Lennon led Winter Wishes to its most successful event in 2018, working with law students to double the initial goal by raising nearly $14,000 worth of items (professionally wrapped, no less) for a dozen families. She also helped restructure the interdisciplinary workshop — a collaboration between the Law School, the School of Social Work and the College of Nursing that invites students from each discipline for a day of seminars where they team up to interview a mock client.
“The benefit is that these students realize they’re not in it alone — that other people bring fabulous skills that can help the client and help them in helping the client,” says Smolinski. “They realize that sometimes it gets exhausting for people to tell their story; sometimes, what a client tells the nurse might be different from what they tell the social worker versus what they tell a lawyer.”
Leaving no stone unturned
Students in the LAPC devote the majority of their time to representing clients — and sometimes this means making hourslong phone calls to third parties like Social Security Administration, the state of Michigan and insurance companies to advocate for a client’s needs.
“The students are amazing,” says Smolinski. “Students have argued about bills from collection agencies and gotten $2,000 wiped off because they hold them accountable and say, ‘This isn’t fair to this cancer patient who thought he was doing everything correctly, was paying his premiums and his insurance, and somebody didn’t file something.’”
She recalls one client, Lisa*, whose chemotherapies caused her to have three strokes, eradicating her cancer but resulting in her requiring a wheelchair. “Financially, she was struggling, so one of my students was successfully able to get her Social Security disability, which was wonderful,” Smolinski says.
But Lisa, who had gone back to school later in life to complete training as a nurse’s aid, was distressed by her student loans, which struck a nerve with another student working in the LAPC. He poured himself into the case, working tirelessly until he found a caveat in the Department of Education that forgives student loans for those who are permanently disabled and haven’t worked for five years continuously.
“Lisa had already been not working for two years,” Smolinski says. “So the student did his homework, got her medical records, and for the next three years the client just needed to confirm — if she wasn’t able to go back to work — the paperwork, and at the end of those five years, those student loans would be gone. That was a huge win and such a relief for Lisa.”
That kind of persistence is something that students like Craigen Oster, who began working in the LAPC in winter 2019, develop day in and day out. “To be an effective advocate, one needs to constantly be chipping away and refining their work and capacity for empathy,” says Oster, who considers his time in the clinic “a legitimately life-affirming experience that helped me realize my calling and dedication to the service of others.”
Now an advanced student in the LAPC, Oster continues to focus on cases, meet with clients, and provide walk-up legal aid during Ask the Attorney office hours at Karmanos while also producing instructional videos to help train other students whose work in the clinic is just beginning.
Granted, no two cases are the same. “It’s very much client-centered lawyering,” Smolinski notes. “I have my students learn all the facts, learn the law and then counsel the client: ‘So here’s everything we could do. What makes sense?’ Because while we know the law, they know their life, and what is a solution for one client isn’t a solution for another client.”
She adds that students are typically able to open and close cases over the course of a semester, though some cases might take longer than others. Still, Smolinski says, “students usually can make an impact on at least three to four individuals while they are here that semester — and even if they don’t solve it, they’ve moved it further down the line.”
And that impact is seen by Kay Carolin, chief nursing officer at Karmanos. “This just makes you want to cry,” she says as she recalls the story of a patient — a single father of a 16-year-old daughter — who was entering hospice. “He had very limited time, but the students were able to arrange for the patient’s sister to become the daughter’s guardian just before the patient died. If they had not stepped in, the daughter could have ended up in foster care. Can you imagine? We don’t have the wherewithal to help with all of that.”
Just as students embrace the opportunity to go above and beyond for each client, the partnership between the Law School and Karmanos Cancer Institute is similarly extraordinary. “I don’t think anyone but Wayne State does this,” Carolin says of the LAPC, which was recognized among the nation’s top 15 most innovative law school clinics by preLaw magazine in 2014.
As Smolinski puts it, “Everybody wins: The hospital wins because their clients have a better quality of life, the Law School wins because it’s able to provide a real-life client situation for students, and the clients win because they receive free legal services.”
Looking ahead, Smolinski has ambitious plans for the LAPC, which will soon mark eight years of working with clients. “I want the students to be a more boots-on-the-ground in the community because lawyers especially can sometimes have a narrow view of the world,” she says, adding that she hopes to offer more outreach programs as well as presentations for staff members at the hospital. “I think we can all have our own view of a society — who we hang out with, who we see on a daily basis — and I want my students to keep broadening their minds.”
It’s this kind of comprehensive, compassionate approach that Smolinski believes will help future jurists become leaders in their field.
“Nobody works in a silo. You have to learn to not only know that other professionals are touching your client’s lives, but appreciate what role they have,” she says. “It’s not about turf wars. It’s about locking arms and working toward the same goal.”
* Name has been changed.