The Unbeaten Path to the Heart of Healthcare
By Charity Kenyon

Whenever we select a practice area to highlight for an issue of Sacramento Lawyer, we try to profile one or two accomplished colleagues off the beaten path, lawyers whose careers probably followed courses that surprised even them, if not their families and friends - who may have seen it all coming.

In the area of healthcare law, Donne Brownsey, Ben Rich and Lilly Spitz stood out. Their work is in the public policy arena and, necessarily and appropriately, controversial. Their focus is on the rights of groups for whom the American public have been unable to agree on either options for care or resources for payment.

Donne Brownsey is a McGeorge Law School grad admitted to practice in 1988. She started her firm, Government Solutions, in 1993 and represents primarily health care and legal interests. Brownsey currently represents the California Nurses Association, two national end-of-life groups: Americans for Death with Dignity and Compassion and Dying Federation, the March of Dimes for the California Birth Defects Monitoring Program, the Breast Cancer Fund, a national advocacy group to eliminate the cause and improve the medical care for patients diagnosed with breast cancer and the California Organization of Methadone Providers (COMP), clinic owners who treat the opiate-addicted population.

Her accomplishments include passage of the first-in-the-nation licensed nurse-to-patient ratios sponsored by the CNA, authored by then-Assemblywoman, now-Senator Sheila Kuehl, and signed by Governor Gray Davis in 2000. Brownsey is working with the CNA to negotiate the Department of Health Services regulatory package to implement the staffing ratios. Brownsey worked with other breast cancer advocates to establish the state-federal matching program to treat indigent women for breast and cervical cancers. The Breast Cancer Fund and Senator Jackie Speier sponsored this effort, which Governor Davis signed into law in the 2001-02 budget. Four years ago, Brownsey worked with COMP and then-Assemblymember Gary Miller to streamline billing practices for the Drug Medical program to ensure medical treatment for the opiate addicted population served under this program.

This year, Brownsey worked with ADD and CIDF to enact legislation authored by Assemblymember Dion Aroner that requires physicians to take 12 hours of continuing education on pain management and end of life care as a condition of licensure.

Brownsey's legal clients include the Academy of California Adoption Lawyers, the California Dispute Resolution Council and the Beverly Hills Bar Association. Before starting her firm, Brownsey served for over a decade as the chief consultant for legislation to then-Senate President ProTem David Roberti. During that time, her major accomplishments included staff work on the legislation banning assault weapons, on various environmental laws and on family law reform.

Ben Rich, JD, PhD, encountered Brownsey, shortly after accepting his new position with the UC Davis Health System, through his great interest in improving the treatment of pain - in this state and across the country. Rich received his BA in history from DePauw University in Indiana, his law degree from Washington University in St. Louis, and his doctorate in philosophy from the University of Colorado at Boulder. Before becoming a full-time academic, Rich practiced law for nearly 20 years, as a litigation partner in a Raleigh, North Carolina health law firm, as an administrative law judge, as legal counsel to the University of North Carolina Hospitals and Clinics, as senior resident counsel at the University of Colorado Health Sciences Center, and as general counsel for the University of Colorado system.

Newly armed with a PhD, in 1995 Rich became assistant director of the program in Health Care Ethics, Humanities and Law and a faculty member of the Department of Preventive Medicine and Biometrics at the University of Colorado Health Sciences Center in Denver. Since the early 1990's Rich has published widely-cited articles about the ethical and legal aspects of the physician-patient relationship and end-of-life care. When the UCD Health System decided to expand its bioethics program, Erich Loewy, who holds the Alumni Association Endowed Chair in Bioethics, recruited Rich to join him in Sacramento. Since February of 2000, Rich has been an associate professor in the bioethics program at the University of California Davis Medical Center in Sacramento and a visiting professor at the University of California Davis School of Law.

Dr. Scott Fishman, medical director of the UC Davis Pain Center, finds that Rich's credentials, many past experiences, and extensive published works "have elevated Dr. Rich to a position of rare credibility in the area of the ethics of pain control. He is an important part of the war on pain at UC Davis and well beyond." Dr. Faith Fitzgerald also praises Rich's contributions to the health system and medical school. She observes that in the world of medicine "lawyers are frequently seen by physicians as the enemy, though the contributions of the law to patients' rights and social justice have been considerable." While "conflict and argument are necessary to lawyers' modus operandi," she finds that Rich's calm, knowledgeable analysis "brings clarity to confusion" and leaves students "the most enduring lesson: In matters of great magnitude touching human lives, ongoing principled and informed argument is salutary and must continue."

Last year Rich published A Prescription for the Pain: The Emerging Standard of Care For Pain Management, 26 Wm. Mitchell L. Rev. 1 (2000). He was active with Donne Brownsey, testifying in support of legislation to improve treatment of pain and prescription practices in California. In March 2001, Rich served as a panelist for the annual Forum on Bioethics, Law and Medicine co-sponsored by the UCD Health System Leadership Council and the Milton L. Schwartz Inn of Court, which explored ethical and legal issues involved in treatment of pain. His book, Strange Bedfellows: How Medical Jurisprudence Has Influenced Medical Ethics and Medical Practice, was released by Kluwer Academic/Plenum Press in October of 2001.

Lilly Spitz, a Golden Gate University School of Law grad admitted in 1977, has been working in the area of health care policy for more than twenty years. Immediately after graduating from UC Irvine, Spitz moved to Sacramento to serve in the state capitol as an Assembly Fellow. She went on to serve as health policy and legal advisor to former Assembly Speaker Willie Brown. After Spitz left the Legislature she served as legal counsel to the California Healthcare Association, and then director of governmental relations to the California Nurses Association.

This background in the policy and politics of healthcare made Spitz the ideal candidate for her dream job: serving as the first chief legal counsel for California Planned Parenthood's statewide non-profit education/public policy arm. This position involves her with issues ranging from community clinic licensure and staffing, to gender equity and reproductive rights. Her responsibilities include participating in litigation, drafting legislation, legal/policy/medical research, analyzing and responding to proposed and current state and federal regulations, and leading workshops and seminars.

Dan Stone, formerly a Deputy Attorney General in the Government Section of the California Department of Justice and now with the Department of Education, worked with Spitz last year on Catholic Charities of Sacramento, Inc. v. Superior Court, a case now pending in the California Supreme Court. The case involves a challenge to the constitutionality of two statutes requiring employers that provide insurance coverage for prescription drugs to include coverage for contraceptives. The State has prevailed in both the Sacramento Superior Court and at the Court of Appeal.

Stone high praised for Spitz's assistance and dedication to her cause. He said that Spitz was both helpful and hardworking, helping Stone to understand a long and elaborate legislative record in a short time frame. He sees Spitz' work as vitally important and a major contribution to the health of women.

Spitz has served on the Boards of California Women Lawyers and Women Lawyers of Sacramento, and currently serves as a Board Member of the CWL Foundation. In 1996 and 97 Spitz received the CWL Presidents Award of Excellence for her work in support of affirmative action and community education regarding domestic violence. She is the editor of the acclaimed and widely distributed Manual on California Domestic Violence Law, published by the CWL Foundation. In addition, Spitz has served on the boards of the Birthing Project and Women In Politics and currently serves on the board of The Capital Unity Council.

Each of these lawyers has found a niche in health law that is overwhelmingly challenging as well as personally satisfying. We like to think that we may be introducing some passionate professionals to lawyers who might not otherwise cross their paths. We might even inspire young lawyers to trust their instincts, when they come to unexpected bends in the road presenting opportunities to redefine the goal of the journey. For Brownsey, Rich and Spitz, it's the heart of healthcare.