Health and Medicine

Free legal help for those who need it most

At a time and place where they have little control over their lives, the cancer patients appreciate the opportunity to put in writing how their health care and finances should be handled when they can no longer make those decisions.

Second-year law student Kristi Nickodem, left, confers with cancer patient Chanda Holst at UNC Hospitals at the University of North Carolina at Chapel Hill.
Second-year law student Kristi Nickodem, left, confers with cancer patient Chanda Holst at UNC Hospitals at the University of North Carolina at Chapel Hill.

Chanda Holst of Autryville, a part-time special needs teacher, wife and mother of two, has enough to worry about.

The cancer diagnosed in her breast two years ago spread to her lymph nodes and then to her bones and her brain. She comes to Chapel Hill every two weeks for life-saving therapy at the UNC Lineberger Comprehensive Cancer Center, on this day sporting a pink head wrap decorated with the pink ribbons representing breast cancer awareness.

The last thing she needed was the hassle of going to a lawyer’s office to draw up a power of attorney or a living will, although she knew she should. She and her husband had been carrying around the paperwork ever since her first diagnosis.

Then one day in the waiting area outside the chemotherapy clinic, Holst saw a brochure for the UNC Cancer Pro Bono Project, a program that allows law students, working under the supervision of volunteer attorneys, to draw up advance directives for cancer patients, for free.

“Here, with it being so readily available, you can’t run away,” she said. So she contacted the students.

The law student who prepared Holst’s papers came right into the infusion room where she was hooked up to the tubes for chemotherapy, pulled the bed curtain shut for privacy and got started.

“I wonder how many people who sat around us were encouraged to complete their paperwork,” Holst said.

The law students and volunteer attorneys process about 30 documents a month at clinics held the second and fourth Fridays outside of the Patient and Family Resource Center within the N.C. Cancer Hospital. They meet with cancer patients and their families there to talk about legal documents the patients often need: financial powers of attorney, health-care powers of attorney and living wills.

The patients provide instructions about how they want their financial and health care affairs to be handled, the law students draft the legal documents and the volunteer lawyers review the work. The papers are signed and notarized on site, and the patients leave the hospital with legal documents, but no bill for them.

“When you’re finished, you don’t have to worry about it any more,” said Brandon Holst, Chanda’s husband.

From left, Sylvia Novinsky, assistant dean for public service programs; Kimberly Ann Bart, assistant dean for public interest and pro bono at Duke Law School; and Jodi Schur ’14 accept the 2014 Law Student Group Pro Bono Award from Alan W. Duncan, president, N.C. Bar Association.

An immediate success

The cancer project began in February 2013, led by Jodi Schur, a second-year law student at the time, with help from Sylvia Novinsky, assistant dean for public service programs at Carolina’s School of Law, and their counterparts at Duke.

In the UNC-Duke Cancer Pro Bono Project, modeled after a program that Novinsky had discovered at George Washington School of Law, Duke and Carolina law students alternated the weeks they ran clinics at their respective hospitals.

The program took off immediately. In the 2013–14 academic year, students executed 182 documents and served 281 patients. As of fall 2014, 114 law students had been trained for the clinics. Carolina’s student-run program has grown so much that it operates separately from Duke’s now, with the help of Legal Aid of North Carolina Inc. and about 35 volunteer attorneys.

The program has become the impetus for many other law schools in the state and across the country to begin their own cancer projects, and earlier this year, received the 2014 Law Student Group Pro Bono Award from the North Carolina Bar Association.

“What impresses me most,” said Schur, “is the cohesiveness as the project matures.”

At a time and place where they have little control over their lives, the cancer patients appreciate the opportunity to put in writing how their health care and finances should be handled when they can no longer make those decisions. The students’ expertise in advance directives allows the patients to face the future and make it a little less scary.

“Very often, people in this situation can’t afford these services, so it’s a huge comfort to them,” Novinsky said.

Helping both patients and students

As much as the project benefits the cancer patients and their families, it also provides valuable real-world experience to the law students.

“The clinic gives hands-on client counseling experience to students who have not had live interactions with clients before,” said Jennifer Little, a third-year student and part of the group’s 10-member leadership team.

But before students can meet with patients, they must go through an intensive weekend training program, where they not only study the laws related to advance directives, they also learn interviewing skills, professional ethics and sensitivity issues regarding working with the chronically ill.

“The population that we help is very uplifting,” Little said. “It sounds crazy, but they have a great outlook on life.”

The training session ends with students role playing both patients and interviewers.

“It’s a very odd dynamic for a student because of the intimacy of the setting and the vulnerability of the client,” said Jason Jones, also a member of the leadership team. “It very innately brings out the compassionate part of the student.”

While the law students offer very helpful services, they are still students and not able to provide everything a licensed attorney can. That’s where the partnership with Legal Aid of North Carolina Inc. comes in.

Madlyn Morreale is the firm’s supervising attorney for the Medical Legal Partnership Program, which operates statewide to help clients whose health is affected by factors that are often beyond the scope of medical care.

Legal Aid of North Carolina began working with the cancer pro bono project this past July. “It really is a great fit between the students and pro bono attorneys to be able to provide valuable services to this distinct patient population,” Morreale said.

Right now, student volunteers outnumber attorney volunteers 53 to 35. The American Bar Association recommends that lawyers devote at least 50 hours a year to pro bono work. The cancer pro bono project is always looking for attorneys who can devote some of those hours for the services students can’t provide, like drawing up wills.

Chanda Holst has her advance directives in order, thanks to the cancer pro bono project, but she still doesn’t have a will. “I’ve got to get that done,” she said.

“You never want to think about the end,” said Brandon Holst, a National Guard member who didn’t make his own will until he was deployed to Iraq for 10 months and the military required him to. “But it’s going to happen to us all sooner or later.”