Colorado Health Equity Project
2013-2014 Supervising Attorney Handbook
Colorado Health Equity Project
Supervising Attorney Handbook
2013-2014
Nancy Elkind, Esq.
Health Equity Project
Supervising Attorney Handbook
Table of Contents
1. Welcome 3
2. About the Colorado Health Equity Project 5
3. CHEP Vision and Mission 5
4. Medical Partners and Community Based Sites 7
5. The Role of the CHEP Supervising Attorney 9
6. Miscellaneous Practicum Requirements and Expectations 14
a. Public Policy 14
b. Work Product, Formatting & Storage 14
c. Correspondence 14
d. Student Transfers of a Case 15
e. Closing a Case 15
7. Appendix Contents 16
1. Welcome
It is our pleasure to welcome you to the Colorado Health Equity Project. As Supervising Attorneys, you will serve as educators, role models, and essential contributors to solving the health and health care obstacles faced by the poor in Colorado. Together, we will teach Colorado Law Students to provide excellent legal services, work collaboratively with medical and public health professionals, and make a tangible difference in the lives of low income and vulnerable people in Colorado. In the process, we hope to bring lasting change to both the health care and legal services delivery model for poor Coloradans.
The Colorado Health Equity Project (CHEP) brings together faculty and students from the University of Colorado Law and Medical Schools, as well as the Colorado School of Public Health, to collaborate with Colorado’s finest attorneys.
During the 2013-2014 academic year, the ten Supervising Attorneys who participate in the Poverty, Health & Law Practicum will stand at the core of our educational and service mission. Without your generosity and expertise, we could not hope to fulfill our pedagogical mission to prepare the best health lawyers in the state of Colorado and beyond. The market for legal services is changing dramatically. Nowhere are these changes more dramatic or challenging than in the market for health law attorneys. We thank you for being willing to help us prepare our students to meet these challenges with excellence!
Dayna Bowen Matthew
Pia Dean
Co-Directors, The Colorado Equity Project
2. About the Colorado Health Equity Project
The Colorado Health Equity Project (CHEP) is a collaboration of student, faculty, public interest, and pro bono attorneys, public health advocates, and physicians dedicated to improving health outcomes for vulnerable Coloradans by integrating the delivery of legal and medical services in hospital and community health care settings. CHEP will help to reduce health disparities by addressing the legal barriers to good health that poor populations face. In short, CHEP will help to reduce health disparities in Colorado by increasing health justice.
In Colorado, as elsewhere, the social determinants of health are the conditions in the places where people live, work, learn, play, and age that directly affect their health. These include the availability of preventative health care, safe housing, healthy food, safe educational and work environments, job opportunities, public safety, freedom from discrimination, and access to social support. To the extent that these social determinants are inequitably distributed, Colorado’s vulnerable populations suffer the fundamental injustice of disparately poor health outcomes.[1] State and federal laws including the Patient Protection and Affordable Care Act (ACA) contain provisions that directly address these social inequities associated with poor health. However, poor patients often do not have legal representation to avail themselves of the protections and benefits for their health that the law affords. The project is based on the core belief that improving legal services will improve the health and wellbeing of Colorado’s poor.
For more information on the work of the Health Equity Project in the community, visit: http://.
3. CHEP Vision and Mission
Colorado Health Equity Project Vision
To remove legal barriers to equal health access and health outcomes for Colorado’s vulnerable populations.
CHEP Four-Fold Mission Statement
The four-fold mission of the Colorado Health Equity Project:
1. Education – To train health care, legal, and public health professionals in an interdisciplinary, integrated clinical system of learning to address the social determinants of poor health and disparities
2. Service – To join law school, legal aid, and private sector pro bono attorneys in collaboration with health care providers serving Colorado’s vulnerable populations
by addressing unmet legal needs and removing legal barriers that impede good health
3. Research – To provide social science research and data that supports innovation in developing population-based, health care delivery systems focused on prevention and wellness among Colorado’s underserved populations
4. Policy – To provide qualitative and quantitative information to promote the development of public policy that advances health equality
4. Medical Partners and Community-Based Sites
During AY 2013-2014, CHEP will provide direct legal services through medical legal partnerships for selected patients at three clinic locations (see Appendix C for maps).
Salud Family Health Center – Commerce City Clinic
6255 North Quebec Parkway Commerce City, Colorado 80022
Medical Director: Tillman Farley, M.D. ()
Salud operates nine community health care clinics and a mobile unit. Salud provides primary care to low-income patients throughout Colorado, including migrant and seasonal farmworkers. University medical students collected survey information from over six hundred patients at the Salud clinic in Commerce City. The results revealed the extent of unmet legal needs among these patients. Over 400 patients (66.9%) reported they had at least one legal problem during the past year, and 42% of those patients reported their legal problems caused or exacerbated their poor health. The three most frequently cited legal issues these patients faced were the inability to access public health and disability benefits ( %), immigration status issues ( %), and landlord-tenant disputes ( %).
Children’s Hospital Colorado
Anschutz Medical Campus, Aurora, Colorado
Medical Directors: David Fox, M.D. ( ) and Shale Wong, M.D. ()
Founded in 1908, the Children’s Hospital, Colorado is consistently ranked among the nation’s top 10 children’s hospitals. The mission of Children’s Hospital Colorado is “to improve the health of children through the provision of high-quality coordinated programs of patient care, education, research, and advocacy.” In July 2009, the University of Colorado Children’s Hospital, the University of Colorado Health Sciences Center, and Colorado Legal Services formed Colorado’s Medical Legal Partnership[2] (MLP). Since its inception, the Colorado MLP has screened over 8,000 patients and served over 1,600 patients in two of the Hospital’s 40+ clinics.
Colorado Refugee Wellness Center
1666 Elmira Street, Aurora, Colorado
Medical Director: Jamal Moloo, M.D. ()
Approximately 3 million of the world’s refugees are settled in the United States annually; The Colorado Refugee Wellness Center (CRWC) serves approximately 2,000 each year. Colorado began its program in 1980 and has resettled over 39,000 individuals since that time, from over 25 different countries including Eritrea, Somalia, Iraq, Bhutan, and Burma. Most of these individuals are settled in the Denver Metropolitan region.
The CRWC will provide services to these refugees including immediate health evaluation upon entry to the United States for conditions such as tuberculosis, syphilis, and risk of suicide; early follow-up within 30 – 90 days for significant mental and physical illness; long term physical and behavioral health services as a primary care, medical home; support in identifying medical experts for evaluation in support of asylum applications, and social services support for counseling and benefits.
5. The Role of The CHEP Supervising Attorney
Your role as Supervising Attorney in CHEP is essential not only to the success of the Poverty, Health, & Law Practicum, but also to the Law School’s overall pedagogical mission. As we seek to equip students to meet the challenges of a rapidly changing legal and health care market, we rely on your willingness to become collaborators with the Law School faculty in every way. You will find a background and overview of the Colorado Law School and its educational mission in Appendix A.
As Supervising Attorneys, you are at the core of the CHEP educational and service missions. During the year, we ask you to fulfill three roles: 1) Accept the responsibility of serving as attorney of record on one case matter referred to you by CHEP; 2) Supervise and mentor two law students assigned to work with you on the case; and 3) Work collaboratively as an integral member of the health care delivery team that serves the patient referred to you as a client.
The Supervising Attorney is at the core of the educational and service mission of the Colorado Health Equity Project.
The legal system can force open doors and sometimes even knock down walls.
But it cannot build bridges. That job belongs to you and me.
Supreme Court Justice Thurgood Marshall Speech at the National Constitution Center, 1992
a. Attorney of Record on One Case
You will assume primary responsibility as the pro bono attorney of record for the case you accept through the Colorado Health Equity Project. You will have the support of two Colorado Law students acting as your externs, through the Poverty, Health and Law Practicum, on this case. While you will serve as counsel of record on the case, the law students will be permitted to practice under C.R.C.P. 226.5, Colorado’s Student Practice Rules. (See Appendix A.) Under this Rule, the Practicum is a "legal aid dispensary." For every case, each client must sign a Student Retainer (see Appendix B), which includes the client’s consent to being represented by the law student under a supervising attorney. In any case in which the student will appear in court or an administrative hearing, the Supervising Attorney will submit a notice of appearance on behalf of the student, or otherwise obtain the consent of the tribunal.
In addition, Colorado Law faculty will oversee support for you from your client’s physician, a student physician, a behavioral health specialist, and a public health student through the Practicum. You are not permitted to compensate law students, nor can you charge any client or collect any fee for the student’s time.
Your representation will be limited to the matter described in the Referral Memo provided to you by CHEP faculty, and should be reflected in the retainer you sign with the client in accordance with CRCP 11(b) and Col. RPC 1.2(c). You will also sign a Retainer Agreement with the Client and your Student Attorneys. (See Appendix C.)
b. Supervisor For Two Student Attorneys
As Supervising Attorney, you agree to supervise the law students’ work product, provide substantive feedback, and meet with the students on a regular basis. We invite Supervising Attorneys to take a hands-on approach, providing learner-centered instruction and individual feedback. Students are expected to think critically about their case decisions and to dissect their process with supervisors in order to create habits of practice for the future. This level of interaction is rarely available to students or attorneys engaged in pressing litigation, where the focus must necessarily be on getting the job done within tightly prescribed deadlines and large case loads.
1. Schedule
Client Meeting - We ask that you meet with your students and client at least once during the semester, and that this meeting occur at the medical clinic where your client is a patient. Maps to each clinic location are provided in Appendix D. Please schedule your client meetings well in advance by emailing the Medical Director listed for each clinic.
Case Meeting - We ask that you meet with your students on a bi-weekly basis to discuss the status of your case and its progress, and give students feedback. At a minimum, your students should be prepared to discuss the case history, relevant law and legal analysis, case deadlines and their action plan. Case meetings last approximately one hour. After the case meeting, students should record any decisions made during the meeting in a new SOAP Note to be submitted to CHEP Faculty. Please note: case meetings should be supplemented by individual meetings with your student and client as needed. CHEP Faculty will contact you to schedule one case meeting per semester for you to attend as an observer.
Self-Evaluation and Reflection - A key component of participation in this course is student self-reflection and self-evaluation of their performance, on a regular basis. Self-evaluation and reflection is critical to becoming a life-long learner and critical thinker. Frequently, taking the time to analyze and critique performance will allow students to constantly improve their approach, skill set, and technique. Students will be given formal opportunities to reflect and evaluate themselves at the beginning, mid-point, and end of the semester. They will use the Critical Assessment Evaluation form provided in Appendix J. We ask that you review these self-evaluations during a case meeting with your students, in order to assess their strengths and challenges and to agree on a plan for improving and maintaining particular skills. PROOFED TO HERE
Practicum Class/Case Rounds – You are welcome to attend any class session of the Poverty, Health, & Law Practicum but this is absolutely not expected. Class sessions will be led by CHEP Faculty and are dedicated to substantive legal instruction and case rounds. The Practicum Faculty will meet weekly with Student Attorneys to instruct in substantive law and theory as well as discuss student casework in class sessions devoted to “Case Rounds.” We ask that you meet for case planning purposes with the law students, medical professional, and public health student once monthly at the clinic site.
2. Educational Content -
• Please give your students every reasonable opportunity to do the research, writing, and client communication on each case, as is appropriate to reach an excellent result for the client. Special emphasis should be placed on the quality of students’ writing; the opportunity to receive feedback from you about the content, organization, and clarity of written communication is invaluable. For this reason, we will stress that students are not to send any written communication to clients that you have not reviewed. All e-mail correspondence must be copied to you. We also ask that you partner with Practicum Faculty to help students meet the CHEP Learning Objective (Appendix E) and develop the Lawyering and Professionalism Skills described in Appendix F.
• Examples of Substantive Legal Work For Students - Working under your supervision, your law student attorneys should perform the legal “legwork” on your case including
· Client interviews and intake
· Investigation and interviewing for clients and witnesses
· Writing correspondence to and on behalf of clients