Diabetes Forecast

Removing Legal Obstacles to Good Health

By Katie Bunker ,

A good diet, regular exercise, and appropriate medication sometimes aren't the only things needed to maintain the health of someone with diabetes. The biggest barriers to successful control may have much to do with problems that a doctor can't treat, including unemployment, workplace discrimination, and housing problems.

That's why Jessa Barnard (pictured at left), a member of the American Diabetes Association's Advocacy Attorney Network, cofounded what she calls the nation's first medical-legal partnership specifically for people with diabetes. Known as the Diabetes Law Collaborative (DLC), it is housed at Santa Clara Valley Medical Center in San Jose, Calif., where doctors may refer patients to a lawyer or social worker under the same roof. People with diabetes whose income is under 400 percent of the federal poverty level, or about $43,000 a year for one person, may get legal help with any obstacle to their staying healthy. The collaborative's attorneys help clients with disputes, educate health care providers about legal issues, and advocate for the rights of people with diabetes in conjunction with medical professionals.

"One of the reasons for partnering with a medical provider is because a lot of people don't even know they have a legal issue," says Barnard, 29, a graduate of Stanford Law School who was diagnosed with type 1 diabetes as a 9-year-old. "So, medical providers who are already seeing a patient every three to six months or every year can help screen [for problems] and refer patients to legal services."

ADA's Advocacy Attorney Network is a group of lawyers across the country who are specially trained to help people with diabetes fight discrimination. To inquire about joining the network, send an e-mail to attorneynetwork@diabetes.org.

ADA is also seeking people for its Health Care Professionals Legal Advocacy Network. To inquire about joining, send an e-mail to hcpnetwork@diabetes.org.

Attorneys in the collaborative may negotiate on behalf of a tenant who needs more time to pay rent to avoid an eviction, Barnard says. Having a stable place to live is crucial to maintaining good health. Or a lawyer may call an employer to explain the right of a person with diabetes to accommodations such as extra breaks at work or permission to keep snacks at a desk to help manage blood glucose levels. ADA legal advocates and network attorneys provide similar services for people with diabetes. The difference with a collaborative like Barnard's, though, is that the legal help is available in the same place where medical care is provided, allowing doctors to spot legal problems and make quick attorney referrals. In some cases, prospective clients may contact the collaborative directly for legal help. Since the Diabetes Law Collaborative, a program of the Law Foundation of Silicon Valley, began operating in March 2009, it has handled about 120 cases, Barnard says.

Leah (not her real name), a woman with type 2 diabetes who had been employed by Santa Clara County as an in-home worker caring for her father, called the DLC after he died earlier this year. Trying to cope not only with his death but also with the loss of her livelihood, Leah found she couldn't afford the $472 per month it would have cost her to continue her health insurance coverage under the federal COBRA law. The DLC learned that Leah was eligible for a federal subsidy to lower her premium to an affordable $165 per month and helped get her policy reinstated.

A DLC attorney also found that Leah lacked reliable transportation to her medical appointments and aided her in applying to a local transit service for people with disabilities and the elderly. When that application was rejected, the DLC helped Leah file a successful appeal. With insurance and transportation secured, she could keep her appointments with her primary care physician, diabetes specialists, and mental health services, all central to her successfully managing her diabetes and depression.

From working with people like Leah to fighting her own battles, Barnard knows how much people with diabetes have to advocate for themselves. As a student, she learned how to get accommodations for standardized testing so that she wouldn't have to take exams when her blood glucose was very high or very low. As an adult, she's often had to straighten out insurance billing mistakes. Such problems may be common for someone with diabetes, Barnard says, but not everyone has the resources or knowledge to deal with them effectively.

"Seeing how much self-advocacy you need to be able to do on a day-to-day basis—if you can't do that or don't speak the language or don't have the time, I know how hard it can be for people, and I'm happy to be able to help," Barnard says. "These programs are a great way to serve people with diabetes."

If you believe you have been discriminated against because of your diabetes, call the American Diabetes Association at 1-800-DIABETES (1-800-342-2383) to request a free packet of information and to ask to speak with a legal advocate.



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