INTRODUCTION Jennifer S. Bard, J.D., M.P.H.* I. BACKGROUND: HOW A PANEL BECAME A SYMPOSIUM .•.•............ 391 II. THE PANELISTS ..................................... : ......................................... 391 A. Wendy Parmet ........................................................................... 391 B. Charity Scott ............................................................................. 392 C. Marshall Kapp .......................................................................... 393 D. JoNel Newman .......................................................................... 394 E. Sallie Thieme Sanford ............................................................... 395 III. PROPOSALS ..................................................................................... 395 A. Michele Mekel ........................................................................... 395 B. Emily Berifer .................................. ............................................ 395 C. Christine Nero Coughlin ........................................................... 396 D. Dea. C. Lott .............................................................................. 397 E. Kathleen Noonan and Sarah Davis ........................................... 398 The essays printed here reflect the work of ten health law professors and are important to all law professors working to integrate experiential learning in their curriculums. The essays originated from a panel presenta­ tion I designed for the Section of Law, Medicine, and Health Care at the 2012 meeting of the American Association of Law Schools. It was entitled, "Health Law Professors Engaging in the Real World," and my goal as in- . coming chair was to inform not just those who heard it live in Washington, D.C., but to a broader readership of teachers who wanted to reach out be­ yond the classroom without taking on the daunting task of running a live­ client clinic. Having myself come into academe after a career in private practice and government service followed by two years teaching at a medi­ cal school, I knew how much contact with the real world of health care and health law could benefit both students and faculty. I have written elsewhere of the lessons legal and medical education can learn from each other, but * Chair of the American Association of Law School's section on Law, Medicine, and Health Care; Alvin R. Allison Professor of Law and Associate Dean for Faculty Research and De­ velopment; Director, Health Law and J.D./M.D. Programs at Texas Tech School of Law; Associate Professor (adjunct), Department of Psychiatry, TTU School of Medicine. Thank you to all the panelists and all those who responded to the call for papers. Thank you also to the Executive Board and Members of the AALS Section on Law, Medicine and Health Care and especially to Joan H. Krause, Associate Dean for Faculty Development and Dan K. Moore Distinguished Professor of Law, who was chair of the Section, at the time this panel was developed. Thank you also to Jane La Barbara, Managing Director of AALS, and Tracie Thomas, Senior Meetings Manage, whose hard work, flexibility, and ability to solve all problems, large and small, were much appreciated. Finally thank you to Charles Blevins, Texas Tech University School of Law '12, for his substantial help in organizing the panel. 390 INDIANA HEALTH LAW REviEW [Vol. 9:2 the primary difference betWeen the tWo is that medical students benefit from an extended apprenticeship which allows them to turn the knowledge they learned in.the classroom into the skills they need for reallife.1 This is possible because medical graduate education is funded by the federal gov­ ernment.2 Lacking this kind of training subsidy, we in legal education must make the best use possible of the three years we have to help students be­ come competent, compassionate and ethical lawyers. This cannot be achieved by· sitting in a lecture hall. . . Although the Panel was a terrific 8ucce8s,3 its lasting legacy will be the writings of these innovative health law professors. In reading their work you will be inspired, as I am, to see new possibilities for bringing into your classes the real world where health care law is not just studied, but where it is practiced. In looking for ways that health law professors are engaging with (again broadly defined) the people who face the legal issues we teach, I re­ alized that on the one hand there were many existing models and on the other that it was a project far beyond the Sc<>pe of a single AALS panel. I also realized that identifying the activities of a "health lawyer" were as dif­ ficult as defining "health law.',4 Health lawyers practice in many different areas including mental and physical disability, family, non-profit taxation and antitrust.5 So given the impossibility of giving any kind of comprehen­ sive overview of the subject matter, I toOk a step back and looked for pro­ grams which could engage those of us teaching health law, and our students, in many different ways. The essays in this issue reflect only a fraction of the creativity in health law teaching today. They take us from food insecure neighborhoods in Chicago and Indianapolis to rural villages in Eastern Ethiopia. They are written by both clinicians and doctrinal scholars. They span the gamut from some of the most experienced and respected health law professors in the United States to law professors only a few years out of school. What they l. See Jennifer S. Bard, "Practicing Medicine and Studying Law": How Medical Schools Used to Have the Same Problems We Do and What We Can Learn From Their Ef­ forts to Solve Them, 10 SEA'ITI.EJ.FORSOC.JUST.135 (2011). 2. Id at 136. · 3. Frank Pasquale, AALS Panel on Teaching Health Law: A Tour de Force, HEALTH: REFORMWATCH(Jan. 14, 2012), http://www.healtbreformwatch.com/2012/01/14/aals-panel­ on-teaching-health-law-a-tour-de:-forcel (reviewing the panel and. concluding that "[t]he health law section at AALS put on a truly outstanding program"). · 4. See generally M. Gregg Blocbe, The Emergent Logic of Health Law, 82 S. CAL. L. REv. 389, 396 (2009) ("[T)he law of health care provision and the health care system itself are best understood and acted on as emergent systems.''). . S. These essays do not reflect the growing interest in. providing experiential learning for health law students in transactional work. See Jonathan Todres, Beyond the Case Meth­ od: Teaching Transactional Law Skills in the Classroom, 37 J.L. MED. & Ennes 375 (2009) (pointing out that health law cla8ses, like moSt law School Classes, are· overly weighted to­ wards litigation). 2012] INTRODUCTION 391 share is a passion for teaching and for using law to solve the difficult legal issues which arise when people seek to deliver and receive health care. My hope is that these essays will inspire you to develop your own programs to interact with the real world outside of our classrooms and will give you strong tools with which to do so. I. BACKGROUND: HOW A PANEL BECAME A SYMPOSIUM These essays are both from law professors who spoke on the panel in Washington, D.C. and those who responded to a call for papers but were not on the panel. Because. the response to the call for papers generated three times as many proposals as there were slots on the panel, I approached the editors of the Indiana Health Law Review, who had already agreed to publish the proceedings of the panel, if they would extend their offer to in­ clude papers by those who submitted proposals describing a program fittin~ the panel's theme of bringing health law teaching outside of the classroom .. They graciously agreed, although it doubled their workload, and this vol­ ume is the result. All of us in the AALS Section on Law, Medicine and Health Care owe a debt of gratitude to the generous and skillful help of the editors of the In­ diana Health Law Review, especially its editor-in-chief Courtney Campbell, in bringing this project to publication. Each of the essays below represents the distillation of considerable creativity and hard work. They are arranged in two groups. The first group includes those who spoke at the panel in Washington, D.C., on January 7, 2012. The second comes from a class of papers that generated three times as many proposals as could be accommodated on a single panel. ll. THE P ANEI,JSTS A. Wendy Parmet The oldest and most comprehensive program of involving law stu­ dents and law professors with the world of their clients is the Co-op Pro­ gram · at Northeastern University in Boston, Massachusetts. Professor Wendy Parmet, Associate Dean for· Academic Affairs and George J. and Kathleen Waters Matthews Distinguished University Professor of Law, not only has taught health law at Northeastern for more than twenty-five years, she herself has been directly involved in landmark health law litigation while at the same time carrying on her duties as a professional. Professor 6. There were many excellent submissions that did not directly describe a program. Each deserves to be. the subject of a presentation or law review article. Moreover, not all of those proposing to speak about their proiram on the panel chose to write an essay for this issue. 392 INDIANA HEALTH LAW REVIEW [Vol. 9:2 Parmet writes about the particular benefits of a co-op program for health law students noting that "Perhaps because many students in a health law course will have either just finished working on a health law co-op or are in the process of looking for one, our health law students tend to be extremely engaged participants in classroom discussions." In addition to writing about her students' experiences with co-op, 7 she also writes about how co­ op has enriched her experiences as a faculty member. Recounting how she became co-counsel in the landmark civil rights case Bragdon v. Abbott,8 she writes that she became involved "after a student who had worked on the early stages of the case on a co-op with the AIDS Law Project at Gay and Lesbian Advocates and Defenders" introduced her to his supervisor, Ben­ nett Klein, with whom she went on to bring the case to the Supreme Court of the United States.9 B. Charity Scott Charity Scott, Catherine C. Henson Professor of Law and Director for the Center for Law, Health & Society, at Georgia State University's College of Law in Atlanta, Georgia, created and is the director of the Center for Law, Health & Society. Because in 2009 it hosted a conference titled "In­ terdisciplinary Collaborative Education: Partnerships Between Law Schools and the Health Professions," I knew she would serve as a rich resource. In fact, her presentation consisted of outlining ten separate categories of en­ gagement. The article Professor Scott has written expanding on her talk, Collaborating with the Real World: Opportunities for Developing Skills and Values in Law Teaching, is a wonderful resource for those who seek to step out of the classroom. 10 It also, however, gives her an opportunity not just to describe ways that health law professors can step outside of the classroom into the real world, but why they should. She writes, [R]eal-world collaborations can mix up the law class­ room routine and get students' attention, a first step in improving their learning. When students see real problems or real people, their motivation to engage with them constructively is significantly enhanced. Real-world collaborations also offer authentic learn­ ing opportunities, which can deepen learning and make it lasting. Students are not the only ones who 7. Wendy Parmet, Beyond Externships: Health Law Co-ops, 9 IND. HEALTH L. REv. 399,400 (20 12). 8. Bragdon v. Abbott, 524 U.S. 624 (1998). 9. Parmet, supra note 4, at 406. 10. Charity Scott, Collaborating with the Real World: Opportunities for Developing Skills and Values in Law Teaching, 91ND. HEALTHL. REv. 409(2012). 2012] INTRODUCTION benefit from such collaborations: they can promote your own professional engagement and development and may even :further your law school's mission. 11 393 Professor Scott also addresses directly the reluctance that some of us may feel in stepping past the podium: Classroom professors do not need to become clinical professors or start teaching lawyering skills courses. Instead, they can collaborate with clinical professors, practicing lawyers, and other professionals outside their classrooms in settings that relate to their doctri­ nal fields. Such collaborations can effectively draw on others • expertise and skills to extend and deepen their students' learning and thereby better prepare them for real-world practice.12 C. Marshall Kapp Marshall K.app, Director, Florida State University Center for Innova­ tive Collaboration in Medicine & Law; Professor, FSU College of Medicine Department of Geriatrics; Courtesy Faculty, FSU College of Law in Talla­ hassee, Florida, approaches engagement between the legal and medical community not as an issue incorporated into the curriculum but as a cur­ riculum in itself. Professor Kapp bridges the fields of legal and medical education. Before being hired by FSU to start the Center he was the Gar,. win Distinguished Professor of Law and Medicine at Southern Illinois Uni­ versity Schools of Law and Medicine. He also is professor emeritus from Wright State University School of Medicine and served for more than twen­ ty years as a member of the adjunct faculty at the University of Dayton School of Law. He writes in A Collaborative Center in Medicine and Law: Lessons from a Disruptive Innovation, 13 that ''the Medicine-Law Center has since its inception tried to operationalize its mission by slowly developing, on a trial-and-error basis, a portfolio of activities with real world connota­ tions that is intended to capitalize on potential areas of shared interests and values between physicians and attomeys."14 In describing the programs he has launched he provides an inspirational model for law professors interest­ ed in building meaningful ties with the health care community. Although, as he points out, an effort on the scale of his center requires a substantial 11. ld at 454. 12. ld. at414. 13. Marshall Kapp, A Collaborative Center in Medicine and Law: Lessons from a Disruptive Innovation, 91ND. HEALmL. REv. 455 {2012). 14. ld. at458. 394 INDIANA HEALTH LAW REVIEW [Vol. 9:2 financial endowment, "[ o ]perationalizing within an academic center an ac­ tive, ongoing, synergistic interaction between the medical and legal profes­ sions is a challenge, but one whose ultimate objectives-for both the public and members of the respective professions-are well worth the necessary investment of time, treasure, and energy." While few of us have the re­ sources to build a center as he has, all of us can learn how to reach out to our colleagues in health care. D. JoNel Newman My initial inspiration for the panel came from attending the impres­ sive presentation by Professors JoNel Newman and Melissa Swain ·at the 2011 SALT Teaching Conference in which they described the Health and Elder Law Clinic which is a Medical Legal Partnership with the Miller School of Medicine. Professor Newman is the director of this clinic, and Professor Swain the deputy director at the University of Miami School of Law in Coral Gables, Florida. Professor Newman, who is currently an as­ sociate professor of clinical legal education, brought with her to academe a distinguished record as a civil rights attorney, so her teaching is always in­ formed by her own real world experience. Newman's article Miami's Med­ ical-Legal Partnership: Preparing Lawyers and Physicians for Holistic Practice15 describes how their clinic's clients are patients facing a panoply of legal problems related either to their efforts to pay for health care or for the hurdles of daily living for those living well under the poverty line such as land lord tenant disputes. The growing number of medical legal partnerships at law schools across the country presents an opportunity for collaboration between col­ leagues who identify themselves primarily as clinical professors who are supervising a health law clinic and for lack of a better word, non-clinical professors whose work so far has not involved this task.16 In addition to representing clients, Prof. Newman has developed a program where law students and medical students work in a team with the law students accompanying the medical students on rounds and the medical students attending client meetings. Both benefit from getting a greater un­ derstanding of the clients and patients for whom they will be working, but just as important they learn more about each other. 15. JoNel Newman, Miami's Medical-Legal Partnership: Preparing Lawyers and Physicians for Holistic Practice, 91ND. HBALm L. REv. 471 (2012). 16. Jane R. Wettach, The Law School Clinic as a Partner in a Medical-Legal Partner­ ship, 15 TENN. L. REv. 305 (2008); Amy Ken, Helping Clients at the Intersection of Law and Medicine, 33 PA.LAW. 38 (2011). 2012] INTRODUCTION 395 E. Sallie Thieme Sanford Professor Sallie Thieme Sanford of the University of Washing­ ton School of Law in Seattle, Washington, who recently came into academe after a distinguished career as an assistant attorney general representing the University ofWashington's Medical Center, has brought health law not just out of the classroom, but out of the country. In her talk, Teaching Health Law in Rural Ethiopia: Using a PEPFAR Partnership Framework and In­ dia's Shanbaug Decision to Shape a Course, Professor Sanford describes a month-long intensive health law and policy course she taught at Haramaya University College of Law in Eastern Ethiopia. In her essay, she offers as­ sistance to others who would like to offer a similar course by providing an outline as well as suggested source material for teaching in what she de­ scribes as "in low-income countries with rapidly expanding health sys­ tems."17 III. PROPOSALS A. Michele Mekel In Putting Theory into Practice: Thoughts from the Trenches on De­ veloping, a Doctrinally Integrated Semester-in-Practice Program in Health Law and Policy, 18 Professor Michele Mekel of Southern lllinois School of Law in Carbondale, Illinois, describes how she and her colleagues em­ braced experiential learning by developing the SIU Health Law & Policy Semester-in-Practice Program, which is a full-time, semester-long student immersion in a designated health law and policy practice setting. The pro­ gram is remarkable because it follows the advice of the Carnegie Report to not merely teach mechanical skills but also merges both the hands-on expe­ rience of a full-time externship with the in-class components of a doctrinal course. As. she describes it, "the Program features a full-time health law and policy field placement coupled with a robust classroom component and concurrent courses in substantive health law." B. Emily Benfer Emily Benfer, a Clinical Professor of Law at Loyola University of Chicago School of Law and the founder and Director of the Health Justice 17. Sallie Sanford. Teaching Health Law in Rural Ethiopia: Using a PEP FAR Part­ nership Framework and India's Shanbaug Decision to Shape a Course, 9 IND. HEALTH L. REv. 485, 499 (2012). 18. Michelle Mekel, Putting Theory into Practice: Thoughts from the Trenches on Developing, a Doctrinally Integrated Semester-in-Practice Program in Health Law and Policy, 9 IND. HEALTH L. REv. 503 (2012). 396 INDIANA HEALTH LAW REVIEW [Vol. 9:2 Project, writes in The Health Justice Project: A Collaborative Commitment To Solving Real World Problems19 about taking a holistic, rather than pure­ ly legalistic, approach to confronting the issues of poverty, food insecurity and ill health of the Chicago community in which the law school is located. The project, which grew from a single clinic, ''united the surrounding com­ munity, attracting partners from the medical, social work, public health and legal professions, including Erie Family Health Center, Northwestern Uni­ versity Family Medicine Residency Program, Equip for Equality, Lawyers Committee for Better Housing, and AIDS Legal Council of Chicago" with Loyola's own School of Law's Beazley Institute for Health Law and Policy legal clinic (named, Health Justice Project) and the School of Social Works' Institute on Aging and Intergenerational Study and Practice. In addition, the Health Justice Project hosts Loyola University Masters of Public Health students "who study the effect of the partnership on patient health and Schweitzer Fellows who select a discrete public health project in the com­ munity and collaborate with partners to develop solutions." Together they have joined forces to pool their skills and talents of a community to address that community's most pressing problems. She writes that Since taking its first patient/client in 2010, the Health Justice Project has served over 400 patients of Erie Family Health Center, contributed pro bono hours that are the equivalent of over $2 million in attorneys' fees, and obtained reimbursement of medical expens­ es to Erie Family Health Center after winning Medi­ caid denial appeals. In the case of just one patient, the reimbursement was valued at over $25,000. To further the. interdisciplinary partnership, students reg­ ularly train over seventy health care providers in the social determinants of health and work on interdisci­ plinary teams to address policy issues. Together, they have commented on federal and local rulemaking re­ lated to public health, met with local policy makers and board of education members, worked with na­ tional non-profits, and visited Capitol Hill to educate legislators on the collaborative model.20 C. Christine Nero Coughlin Christine Nero Coughlin, Director, Legal Analysis, Research & Writ- 19. Emily Benfer, The Health Justice Project: A Collaborative Commitment To Solv­ ing Real World Problems, 91ND. HEALTH L. REv. 521 (2012). 20. Id at529. 2012] INTRODUCTION 397 ing Professor of Legal Writing at Wake Forest University School of Law in Winston Salem, North Carolina, who also has appointments in the Wake Forest University Graduate School of Arts and Sciences and the Wake For­ est University School of Medicine's Translational Science Institute, is di­ rectly confronting the divide between doctors and lawyers, which is making it so difficult for us to join forces in solving the problems of health care de­ livery. She writes in Legal Methods for Medical Professionals Year 2: Shifting Negative Attitudes21 that "Last year, Wake Forest University School of Medicine began offering fourth-year medical students a month­ long rotation in legal education housed at the Wake Forest University School of Law. One primary goal was to shift some of the negative atti­ tudes that may exist between physicians and lawyers. ,,22 Prof. Coughlin addresses the logistical and cultural issues which can make it difficult for law students and medical students to interact in meaningful and sustained dialog. She reports that while only in its first year, the program was suc­ cessful in creating opportunities for engagement and dialog. She writes that "We discussed the fact that with many medico-legal issues there are actual­ ly more than two sides to the story. We had a heated discussion on the role that religion, spiritual beliefs, socioeconomic concerns and political prefer­ ence may play on a political response, or lack thereof.'.23 In the evaluation, one student wrote, [I]t's easy to come into the class having stereotypical thoughts regarding lawyers-ruthless, ambulance­ chasing, etc. Learning more about the law and the in­ tricacies involved, knowing that its very easy to have two, three, four sides to a story gives the [legal] pro­ fession a lot more credibility in my eyes. Things are not always black and white, and ethical and moral di­ lemmas really require lawyers for the public good. 24 D. Dea. C. Lott Dea C. Lott, Clinical Adjunct Professor of Law & Director of Out­ reach Indiana University Robert H. McKinney School of Law Health and Human Rights Clinic in Indianapolis, Indiana, directs the Health and Hu­ man Rights Clinic ("HHRC") which has entered in a Medical:-Legal Part­ nership (MLP) with a specific health care provider, the Wishard Hospital, which "operates Westside Health Center ("Westside") ... and provides the 21. Christine Nero Coughlin, Legal Methods for Medical Professionals Year 2: Shift- ing Negative Attitudes, 91ND. HEAL'IH L. REv. 533 (2012). 22. /d. at 537. 23. /d. at 543. 24. /d. at 544. 398 INDIANA HEALTH LAW REVIEW [Vol. 9:2 HHRC with access to [its facility.]"25 Like Professor Benfer's clinic in Chicago, the HHRC serves primarily the low income area approximately two miles west of the law school's campus. Professor Lott writes that be­ cause the clinic is directly associated with a healthcare setting, "there have been several requests for drafting of advance directives for disabled or ter~ minally ill clients. There has been a consistent stream of uninsured or un­ derinsured patients seeking assistance in determining eligibility for and appealing denials or terminations of government programs that provide health care and disability benefits.',z6 In addition to their own representa­ tion of clients, the clinic has worked to expand access to legal services by launching "a pilot pro bono program ... designed to establish a system of outreach and coordination for pro bono attorneys."27 She writes further that although the "program was created to assist newly admitted attorneys with the transition from law school to practice while providing pro bono repre­ sentation to im~overished and underserved populations throughout the Indi­ anapolis area." 8 E. Kathleen Noonan and Sarah Davis Finally, Professors Kathleen Noonan and Sarah Davis write about two clinical programs at the University of Wisconsin Law School that provide experiences to students interested in health law: the Center for Patient Partnerships ("CPP"), and the Government and Legislative Clinic ("GLC"), which bring law students in direct contact 'with the real world. The CPP is one of a few law school clinics which actively integrates not just law stu­ dents but also medical, pharmacy, public affairs, public health, and other disciplines. Since health care is by its nature multi-disciplinary, they are teaching students within the context that they will practice. The GLC is well-but not uniquely-suited to the law school's location in Wisconsin's capital city. Students get experience working with government clients on legal issues with policy significance. Because most state representatives work with little or no staff, it is likely that this kind of relationship could be arranged even if a law school were not actually in the same city as the capi­ tal. I hope you find the work of these professors as inspiring as I have and wish you all great success in developing your own programs. 25. Dea Lott, Teaching Holistic Justice: Medical-Legal Partnerships in the Clinical Setting, 9 IND. HEALTH L. REV. 547,551-52 (2012). 26. /d. at 553. 27. /d. 28. /d.