By: David Hymel, Fall 2018 HeLP Legal Services Clinic Intern
Know your limits. Law students, like everyone else, have many limits. One limit is time, another is patience, and another—which we often do not care to admit—is knowledge. When we run into knowledge limitations, our instincts tell us to make something up that sounds a lot like knowledge, but is in fact smoke in the wind. In the HeLP Clinic, law students handle cases involving complex medical conditions, symptoms, and terminology. Personally, when I run into a medical term I do not understand, I usually convince myself that I can put on a cape and become a medical expert. I hop on google, read WebMD, and conclude that “Ah yes, that is a classic Hematological Malignancy.” Smoke in the wind. Meanwhile, there are walking, talking encyclopedias of medical knowledge in the room next door from the Morehouse School of Medicine. Here’s what I‘ve learned: when you don’t know, ask. It works!
I’ll give you an example. The HeLP Clinic takes in a lot of cases involving Supplemental Security Income (SSI). To qualify for SSI, the Social Security Administration (SSA) states that the applicant must be disabled. In order to be disabled, a person must have a legitimate physical or mental disability that causes serious limitations in his or her life.
In many of the HeLP Clinic’s SSI cases, we represent children with Sickle Cell Disease. Sickle Cell Disease is a blood disorder characterized by episodes of extreme pain. Due to its severity, children with the disease commonly qualify as having a “disability” for SSI purposes. However, just because a child has a diagnosis of Sickle Cell Disease does not mean that the child will automatically satisfy the legal criteria for disability. The Sickle Cell Disease must also cause serious limitations in the child’s life. In a situation where a child has been to the hospital 5 or 6 times in one year because of a disability, for example, SSA may consider that an open-and-shut case because it’s clear that the child experiences serious limitations. But sometimes the line looks fuzzy. Some Sickle Cell patients do not need to go the hospital often, and experience limitations in other ways.
To prove serious limitations in situations where a child does not frequently visit the hospital, evidence must be presented that the child struggles to function compared to other kids at the same age. “Functioning” includes learning, completing tasks, and taking care of one’s self. The catch is that the limitations in the child’s ability to function must be caused by the Sickle Cell Disease, which can involve medical research that I, a law student, know nothing about.
Showing that a child’s limitations are caused by Sickle Cell Disease can get especially tricky because Sickle Cell Disease is not fully understood. Sickle Cell Disease is characterized by episodes of extreme pain, but the triggers for that pain are not always clear. In some cases, our clients explain to us that they believe cold temperatures and cold water are the causes of their child’s severe pain. If this were true, then the child would be experiencing serious limitations because he or she could not swim with friends, play outside in the colder months, or remain inside if the A/C was set too low. In other Sickle Cell cases, a child may struggle with nocturnal enuresis, or bedwetting, which certainly would limit the child’s functioning. In researching this topic, I needed to prove that Sickle Cell Disease caused sensitivity to cold and nocturnal enuresis from a medical standpoint. I performed a quick google search using the terms “cold and sickle cell disease,” and could not find medical authority other than WebMD that could establish the causal connection. I did find a few articles that seemed legitimate, but I could not understand most of the words on the page. I tried to fudge a medical explanation based on my questionable resources, but eventually gave up.
Finally, admitting that I knew nothing, I turned to the nearest walking, talking encyclopedias of medical knowledge: the medical students from Morehouse School of Medicine. Within a matter of minutes, they found peer-reviewed research articles establishing the two causal connections, explained the confusing medical jargon to me in plain English, and helped me formulate an answer. As a result, two members of the medical profession, using their medical expertise, firmly established a legal connection that I could not establish on my own. When you don’t know, ask!