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Scaling Back 

During the past 35 years, the New Orleans Legal Assistance Corp. has argued thousands of civil cases on behalf of poor people. Now, they're facing budget cuts that could prove devastating to their clients.

When her family got together, Linda Dumas would arrive with her own bench. She was too heavy for regular furniture.

"I was always on the chubby side," she says. But by the time she turned 18, she had topped 300 pounds. Household scales stop measuring at 350, she says, but her problems kept increasing with her weight gain. "At 475, I couldn't sit in the bathtub."

Whenever Dumas left her apartment in the St. Bernard housing project, she had to have a companion, to help her go to the bathroom. Once she outgrew her bathtub, she had a shower installed, but she couldn't bathe alone because she wasn't able to reach her entire body on her own. In no way could she touch her toes or tie her shoes.

"I couldn't walk from here to the porch without gasping for air," she says now. It's a distance of maybe 12 feet.

At one point, her friends threw her a birthday party complete with a cake shaped like a bed, since that's where Dumas spent most of her time. She took it with good humor. But even going to bed was difficult. "I'd gotten so big that my lungs wouldn't work on their own," she says. She had to prop herself up on four or five pillows and then strap on an oxygenated face mask in order to make it through each night.

It seemed like Dumas would never stop gaining weight. She reached 530 pounds. "I couldn't walk; I couldn't do anything," she says. "I was just a body on earth."

By 1999, Dumas had been examined by two separate doctors. Both recommended a $20,000 surgery called gastric bypass, commonly called "stomach stapling" because the procedure uses surgical staples to reduce the stomach to a small pouch. But Medicaid, which provides coverage to low-income people like Dumas, refused to cover the procedure, saying that it would have cosmetic effects and thus wasn't medically necessary.

After the initial Medicaid refusal, the first doctor "wouldn't fool with me," she says. So she went to the second physician, Wagih Mando, whose office assisted Dumas as she submitted and re-submitted her case to Medicaid.

For two years, Dumas tried her best to get the surgery. She secured affidavits about her condition. She had friends take photos of her, her head barely visible behind her stomach. Still, Medicaid refused to cover the procedure. "They turned me down three or four times," she says. She talked to attorneys, but they wanted all sorts of money up front, she says.

A friend suggested that she call legal aid. And so, in August 2000, Dumas phoned the New Orleans Legal Assistance Corp. (NOLAC) and spoke with staff attorney John Keeling. By March, her surgery had been approved. "They gave me my life back," says Dumas.

NOLAC was established in 1967 to be "a law firm for the poor." In New Orleans, where nearly one in three residents lives in poverty, this is no small task. In 2001 alone, the organization's 23 attorneys helped 28,000 people.

"I view NOLAC the main point of entry into the legal community for poor people," says Rachel Piercey, director of the Pro Bono Project, which partners with NOLAC to assist low-income people. The Project, through its roster of volunteer private attorneys, handled 1,200 cases in 2001.

For NOLAC, family law -- divorce, child custody, protective orders -- has always been a priority. But NOLAC attorneys are more than just low-rent lawyers. Many of the organization's attorneys have years of specialized experience in areas that specifically affect the poor, such as welfare, food stamps, public housing and Medicaid.

"It shouldn't take a lawyer to negotiate the system, but it often does," says Larry Lavin, director of the Los Angeles-based National Health Law Program, which gives technical assistance to lawyers on health-related issues and publishes a highly regarded reference manual called An Advocate's Guide to the Medicaid Program. When lawyers are needed, they're most often found in places like NOLAC, says Lavin. "Traditionally, the only people who represent Medicaid beneficiaries are legal-services lawyers," he says.

Yet for NOLAC, the year ahead looks rocky. Due to funding changes tied to census data, NOLAC stands to lose $300,000 in federal funding for the next year alone. Other significant cuts seem inevitable.

Legal-aid agencies across the country are bracing for cuts, says Erik Kleiman, spokesperson for the D.C.-based Legal Services Corp. (LSC), which makes grants to local-legal services agencies such as NOLAC. Kleiman goes to his computer and pulls up the charts showing funding losses and gains by state.

"Oh wow," he says. "Louisiana loses more than just about anybody."

Since 1992, thousands of Louisiana children have benefited from a single NOLAC victory, a Medicaid case brought on behalf of Karen Divinity and her daughter. In the early 1980s, Divinity's 3-year-old daughter had been diagnosed as an insulin-dependent diabetic. Her condition resulted in long hospital stays and Divinity spent so much time with her in the hospital that she lost her job as a welfare caseworker for the state of Louisiana.

Divinity was able to secure Social Security Income (SSI) disability benefits for her daughter Rennell, but money was still very tight. And Louisiana's Medicaid program did not cover the supplies that Rennell needed for her condition. "They wouldn't pay for syringes for the insulin, for the glucometer or the strips to test her blood," Divinity says.

"The strips cost $10 for 50, and she went through at least four of those daily. They'd give you the insulin, but not the syringes -- the excuse was that they considered it drug paraphernalia." Typically, Rennell's supplies totaled $300 a month, and Divinity tried to pay for them first but then often found herself putting off the light bill or the phone bill.

Finally, one weekend, Rennell ran out of syringes and blood-testing strips. Divinity had just paid the rent and had no money to spare. As a result, Rennell got sick enough that she was admitted into the hospital. Before she was discharged, Divinity went through the neighborhood begging for money so that she could pay for $50 worth of supplies.

For Divinity, that was enough. The next day, she went to NOLAC and met with attorney David Williams. Williams ended up filing a class-action lawsuit on behalf of Rennell and 200 other diabetic kids in the state of Louisiana. In 1992, the state's Medicaid system was ordered to pay for all necessary supplies for these children. As a result of the ruling, Rennell was able to consistently get her insulin. Her health stabilized, and soon Divinity could go back to work.

In 1998, 41 percent of the babies delivered in Louisiana were born under Medicaid; in this state, like most others, children make up half of the Medicaid rolls. So a court ruling on behalf of Louisiana's Medicaid children can have an enormous impact. "After Ms. Divinity's case, we got thank-you notes from parents all across the state," says Mark Moreau, NOLAC's executive director.

In many ways, this is a typical NOLAC success story. Without proper medical care, low-income people are often hobbled, says Moreau. "You can't move the whole community forward when more than one-third of the community is poor and they have these crises of health," he says. "If you want everyone to be a productive citizen, you have to remove these barriers."

Yet NOLAC itself is facing some daunting barriers. The Louisiana state funding for legal aid is one of the lowest in the nation. The upcoming cuts in federal funding result from 2000 Census data showing that the number of those in poverty in the state has actually decreased. And when federal cuts like these take effect, NOLAC has very little else to fall back on.

The most recent big cuts for NOLAC came in 1996, when the Newt Gingrich-led Congress cut LSC funding by one-third. That congress also outlawed the use of federal legal-aid funds for lobbying the legislature, for suits that yield attorney's fees, for cases on behalf of prison inmates and certain immigrants, and for class-action lawsuits like the one brought on behalf of Karen Divinity.

Some legal-aid organizations, those who had large amounts of state and private funding, ended up splitting their offices into two divisions -- one federally funded, one not -- in order to continue their work without the new federal constraints. The class-action prohibition was particularly contested, and court challenges to this issue continue even today. But the prevailing view is that this restriction is here to stay, says LSC spokesperson Erik Kleiman. "The federal appellate courts have ruled on it and the Supreme Court notably declined to review it. That suggests that this is the law of the land."

Prior to 1996, NOLAC would bring maybe two class-actions a year, Moreau estimates. They were carefully chosen, and so the success rate was high: 90 percent over a 15-year period. It's an impressive list of class-action victories ranging from a 1969 triumph in a "vacuum-cleaner hoax" lawsuit that came out of a door-to-door sales scam, to a 1991 victory that required Section 8 to increase annual tenant utility allowances.

At the time the new federal restrictions took effect, NOLAC was in the midst of an extensive class-action against the Social Security Administration. They conducted a nationwide search to find someone who could take the case, but they couldn't find anyone, and so the case fell by the wayside. "A private firm won't take on a high-risk case like that," says Moreau. "It involves thousands and thousands of pages of documents in discovery. And there's no expectation of a fee at the end."

Moreau says that NOLAC's clients are still affected by the problem addressed in the lawsuit -- overdenial of Social Security claims. But now attorneys have to fight each denial individually.

David Williams, who won Karen Divinity's suit and many others during a 10-year tenure at NOLAC, left the organization as a result of the 1996 federal restrictions. He now works out of his own firm, Williams and Peller, and still takes on a fair share of pro bono cases on behalf of Medicaid clients. Lately, Williams has been working on behalf of several patients who were rejected by Medicaid for gastric bypass surgery.

"I did a public-records request last year," he says, "and they (Medicaid) were turning down 85 percent. My clients say that they can't even get doctors to put in for it, because the doctors know that Medicaid is going to deny."

When he sees something like this, he's reminded of the research they'd done at NOLAC that showed that, in any given area, they were seeing 1 out of 1,000 people. "So when I see something that's a systemic problem," says Williams, "I know that for every client I see there are 999 others that I'm not going to see."

Six months ago, Linda Dumas actually took a bath in her bathtub. She's now working as a nursing assistant and can walk an entire mile without getting tired. She fits in a size 9 shoe, down from a size 12.

A few weeks ago, she nervously set off for the Palace Theater and discovered that she'd passed another milestone -- she once again can fit into movie-theater seats.

Dumas underwent a gastric bypass on July 30 of last year and has been sticking close to her protocol -- protein shakes, lots of water or iced tea with diet sweetener, but no soft drinks and no fried foods. Today, if she has a side of mashed potatoes from Popeye's, she's full. She's lost 200 pounds so far, and is still losing about 10 pounds a month. She hopes to eventually get down to at least 250 pounds.

This fall, when her daughter Brivelle went off to college in Baton Rouge, Dumas could fit behind the wheel of a car to drive her to school. And she was able to carry bags and boxes up to the dorm room. "These are just simple things," she says. "Normal things. But they mean a lot."

She feels so good that she has become an apostle for her surgery -- and for John Keeling, her attorney at NOLAC. Recently, she walked into the Winn Dixie and saw a very large woman leaning on a freezer case. "I immediately got a flashback," she says. "If I was making groceries, I would take an empty grocery cart with me, and then every so often I would flip it over and sit on it. For my back."

"So I went up to this lady and I said, 'My name's Linda,' and I told her about my surgery. She called me a few days later."

Dumas walks up to people like that all the time. The conversations always end the same way, she says. "I give them two things: John Keeling's number and my prayers that what worked for me will work for them."

click to enlarge DONN YOUNG
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