Sometimes It Takes a Village: Health Rights Clinic Battles for Cancer Patient


Carmen Nuñez with her son CarlosCarlos Nuñez sits in the waiting room with his mother at Sylvester Comprehensive Cancer Center’s pediatric oncology clinic, alex’s place, at the University of Miami Miller School of Medicine. The walls of the pediatric hospital are covered with children’s drawings, happy messages, and photographs of grateful children. The 22-year-old is here because he has a type of brain cancer that is more common in children than adults.

In early April, Carlos Nuñez, a junior college student at Indian River State College in Fort Pierce, Florida and part-time janitorial worker, was suffering from migraines, dizziness, and vertigo. His doctor thought Nuñez might have an ear infection but, being thorough, also ordered a MRI.

Between the time of the office visit and the scheduled MRI, Nuñez’s mother, Carmen, became concerned — her son, and first born, was having lots of problems with his balance. She took him to the local emergency room, where a CAT scan revealed a sizable mass. He was soon diagnosed with a cancerous brain tumor.

Nuñez was referred to Sylvester, part of UHealth, the University of Miami Health Care System, for surgery and follow up. He has had laser surgery to remove the tumor, completed thirty treatments of radiation; chemotherapy is ongoing.

Mrs. Nuñez quit her janitorial job to care for her oldest son, bringing him to Miami for treatment and caring for him at home. Carlos is still too sick to be left alone. The loss of both her and Carlos's income caused the family (Carlos has two sisters) to fall into financial hardship; their father’s support from his construction job in Orlando was not enough to keep the family solvent.
Nuñez applied for Social Security Disability payments — which would automatically kick in Medicaid as well — and was denied. He reapplied and again was denied.

“I couldn’t believe when the doctor told me I had to stop working and going to school, and then my mother had to stop working to help me,” Nuñez said. “Luckily our van is doing okay, but the driving up and back is a lot more than we usually drive. We started falling behind very quickly on rent and food and things we need.”

Fortuitous timing

The School of Law’s Associate Director of the Health Rights Clinic Melissa Swain makes presentations about securing benefits to medical groups.

“We had just presented to the medical providers at alex's place a few days earlier,” said Swain. “We give presentations to groups at the medical school several times a year as a way to keep the Medical-Legal Partnership active. Since we started in 2005 we have assisted over 1,000 patients obtain their rightful government disability payments and health insurance.”

In the audience that day was Ida Rodriguez, a clinical social worker at alex’s place. Minutes after Rodriguez placed a call to the Health Rights Clinic about Nuñez’s case, a team was en route to the medical campus.

“Things like this always take forever, even with groups like Legal Aid, where there is a lot of red tape,” said Rodriguez. “The people from the clinic were here the same day I called.”
Second-year law student Princess Manasseh, a 6’1” Los Angeles native, and 6'4 Gulliver High School junior Alaz Sengul, who was in a summer program at the law clinic, met with Carlos and his mother that afternoon. Manasseh speaks Spanish fluently and was able to communicate with Mrs. Nuñez, who is from Puerto Rico and has a limited understanding of English. Sengul’s mother is a professor and cancer researcher at UM’s Miller School of Medicine; and Sengul has a strong interest in science.
From the start, supervising attorneys at the clinic felt that Social Security had not even done a cursory examination of the application and they pushed, through Manasseh and Sengul, to have the case reviewed without sending it to hearing.

"From the first time I met Carlos, I could tell he had a resilient spirit,” Manasseh said. “Once I heard his story and understood how unfair his denial was, I was extremely angered. I was mad at the system and I became determined not to let Carlos be a victim of that system. It made me fight that much harder to secure disability payments for this client that was truly in need of, and entitled to, these benefits."
Sengul helped by creating a simple one-page form for Nuñez’s doctor that simplified the Social Security disability criteria to a series of boxes to check and a line for a signature – it is already becoming a standard document in brain cancer cases – a figurative smoking gun record.

"The Carlos Nuñez case was a truly moving case because it exemplified the influence a lawyer can have in ensuring basic necessities to those who desperately need it,” said Sengul. “I pushed myself for this case because it was not a matter of Social Security acting within the law, but instead a matter of life and death. Carlos needed aid as soon as possible, and he was counting on us at the clinic to help him receive necessary treatment. This situation helped me understand the impact my work can have on our community."

Manasseh worked the file and worked the phones pushing Nuñez’s case up the bureaucratic ladder. In less than a month of pleading, threatening, cajoling, and being very, very pushy, they got Carlos’s case reopened and awarded monthly disability payments. The Social Security award also triggered Medicaid.

“We are pleasantly stunned by the outcome Princess and Alaz were able to secure for Carlos,” Swain said. “It is unheard of to have a denied case reopened and approved, and never in 30-days. The best we can usually hope for is to maybe get a case expedited through the hearing process. Florida is the slowest region in the country hearing cases — most as long as two years — with final decisions judgments nearing the four-year mark from application. Princess seemed to have been deaf to the word no. Every time she heard it, she asked for the next supervisor until she got her way.”

Nuñez is still in a long battle with cancer, but his burden is lightened somewhat by not having to fight on the financial front as well. He only has cancer to worry about.

“Now I can focus all of my attention on getting better. I am getting Medicaid, and the social security payments so we are able to catch up on rent, and buy food and necessities,” Nuñez said. “I so appreciate Princess’ and Alaz’s help. When I told my mom I was getting the payments, she said, ‘Gracias a Dios!’”

“So much of best outcomes are tied to the patient’s mental state; having a positive frame of mind is half the battle. Being freed of some of the worry for the family’s well-being helps any patient’s recovery,” said Rodriguez. “And Carlos is such a likeable person; he has goals, he is organized, he takes his treatment very seriously. And he is so generous.”