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Salute To Veterans in the War on AIDS
Michigan HIV News, Fall 2004 Issue
Michigan has lost some pioneers this year, veterans in the
war on AIDS who helped shape Michigan as a progressive state in HIV prevention
and care and legal advocacy. Two passed suddenly, stepping off their high-speed
lives, leaving us shocked at their loss. Schawne Parker, former CHOW Executive
Director and Fredie Shay of Wayne State University (see Michigan News) left
behind a legacy of activities that will continue, but their loss is deeply felt
and both are dearly missed.
In addition, this fall two more individuals have moved on to
other states. Each has done groundbreaking legal advocacy work for persons
living with HIV here in Michigan.
Kendra Kleber, JD, founded Michigan Advocates Exchange (MAX) in 2000 as a
non-profit organization to provide a unique approach to legal advocacy for
persons living with HIV/AIDS. David Piontkowsky, MD, JD – recognized for
his early legal advocacy activities – was appointed in the late 80’s to then
Governor Blanchard’s expert task force on HIV/AIDS. While he was president of
Michigan’s main Gay rights group, Michigan Organization for Human Rights, the
group lobbied for the first money from the State to do HIV prevention in the gay
community in l985.
Kleber made a bold move for her personal life, closed MAX and
moved to Rochester, New York, setting up a new private practice; Piontkowsky,
MD, JD, left his residency program at WSU Detroit Medical Center to head up a
unique HIV medical clinic in Pittsburg treating people with HIV as an infectious
disease specialist.
Kendra Kleber, JD many of you know from her participation on the
Michigan HIV/AIDS Council and SHACC (Statewide HIV/AIDS Care Council) before
that. She doesn’t let anything slide. Kleber was always quick on her feet to
point out the legal problems with any suggestions or proposals that were made at
these council meetings. She could be blunt, but she has always had a great sense
of humor.
Kleber recognized that the legal, direct approach was not
always the best for her clients in her work for the Michigan Protection and
Advocacy Services’ HIV/AIDS Advocacy Program (MPAS-HAAP) during the 1990’s. This
is why after a couple of years consulting with case workers around the state,
Kleber realized there had to be a better approach to advocacy for her
HIV-positive clients, rather than a strictly legal response to their problems.
With the help of Christina Tabaczka, CPA, MSW, who was at the
time a case manager with the HIV/AIDS Resource Center in Ypsilanti, and
consultation with other case managers around the state (“the three Marys” as
Kleber refers to them), MAX was incorporated in May of 2000.
“We invented this therapeutic advocacy which focuses on the
most important thing for the client is to preserve their relationships,” said
Kleber. When lawyers get involved and take over a case, afterward the individual
is left to deal with the fallout. Clients would say, “‘No one will treat me,
nobody will hire me, nobody will baby-sit my kids, people look at me funny in
the grocery store, how has this made my life better?’ And the answer is, ‘It’s
not.’ For a client to have to leave town after a legal matter is not a
successful resolution,” said Kleber.
The idea for MAX came for Kleber working with a core group of
case managers (Tabaczka, Mary Byers at McClees Clinic in Muskegon, Mary Breedon
at BASIS in Bay City and Mary Dillinger at Thomas Judd Clinic in Traverse City)
“that I turned to to help me solve problems. And it was so apparent to me that
often times clients got embroiled in problems that a lawyer could not solve, but
when a case manager or a social worker called….a lot of times people who had
done dumb things were a lot more amenable to the notion of negotiating some sort
of a solution …solving the problem,” she said. Kleber began to see that case
managers could advocate for their clients in a way that she couldn’t and
realized that the best people to be working with lawyers were social workers.
So MAX was developed as a way for advocates to work together
with legal guidance to solve problems before litigation was necessary
“absolutely acting with the client’s best interest and letting the client
describe what that is….MAX was formed with the idea that empowering people to
take control, regain authority over their own lives, and solve their problems in
a way that made sense and preserved their relationships in their communities was
absolutely the best way to go.”
“There is a doctrine of analysis that’s called therapeutic
jurisprudence, which evaluates how to use the law and the courts as a healing
mechanism for clients…But generally speaking it’s not proactive enough for my
taste, so we invented therapeutic advocacy,” which is all about the client and
preserving relationships.
Everything was going well at MAX. Kleber and Client Advocate
Debra Wright were usually opening 30-40 new cases a month. But when the
opportunity came to open up her life to a new family, Kleber decided it was
worth the move and the change in her career. But change is not new to Kleber;
law was her fourth career at age 32. (For more on the career evolution of Kendra
Kleber, see www.mipwa.org/newsletter)
Kleber gave plenty of notice to her Board of Directors last
winter. Then after careful consideration and involvement of the funder,
(MDCH-DHAS-HAPIS), the board decided candidly that they would not be able to
replace the expertise and experience of Kleber with the funding they had
available. So prior to the new fiscal year the MAX Board decided not to accept
HAPIS funding for the agency, and MAX closed at the end of September. HAPIS has
funded MPAS-HAAP (1.800.288-5923) for FY ’04-‘05 to provide legal and advocacy
coverage outstate. The Detroit Department of Health and Wellness Promotion has
been and continues to support MPAS-HAAP to provide these services to the Detroit
(Eligible Metropolitan Area) EMA.
“I’m sad about MAX closing,” said Kleber. Working at the
non-profit agency gave “a license to dream up creative solutions to very
important problems.” “It’s been an extraordinary honor.” At the September
meeting, MHAC recognized Kleber for serving vulnerable populations “respectfully
so as to empower, preserve and protect self-esteem, and minimize stigma in a
creative, least intrusive and efficient manner.”
Kendra Kleber chose love but she hasn’t severed her ties
completely with Michigan. She incorporated her new law practice (which she
intends to go national with), Kendra S. Kleber & Associates PLLC, “focusing on
HIV/AIDS-based Social Security disability claims, and developing legal
strategies and policy to enhance the self-sufficiency, independence and quality
of life of people living with HIV/AIDS”, in Michigan.
She will be living New York State, which has a community
planning system that includes 3 EMA’s (eligible metro areas). “They are a really
good example of collaboration without territoriality,” said Kleber. For example,
all services at the western end of the state are housed in one building, so the
convenience of the client was the priority.
And though she doesn’t plan on getting involved with
community planning right away, she looks forward to working with a system where
the “emphasis is solve the problems and be done with it.” It was in 1998 that
Laura Anderson, at the time also at MPAS-HAAP “dragged me to my first SHACC
(Statewide HIV/AIDS Care Council) meeting.”
You can still reach her at
kkleber@positiveoutlook.org or call 888-629-3660. Her plans are to
move back with her partner, Jenni, when their son, Alec, graduates high school.
She’d like to get married and is holding out for when they can do that legally.
David Piontkowsky, JD, MD left several chapters in Michigan HIV history
before leaving the state in October, first in his career as a lawyer, human
rights advocate and educator. And then, with a mid-life career change, he became
a physician in AIDS care.
In the early 1980’s Piontkowsky worked on employment discrimination of all
kinds, including handicap and sexual orientation discrimination which led him
into HIV discrimination. During that time he was also president of the Michigan
Organization for Human Rights (MOHR). “He helped get the first Michigan Special
Office for AIDS Prevention (SOAP) started and ran MOHR until 1986, hiring me
then as their Executive Director,” said Craig Covey, CEO of the Midwest AIDS
Prevention Project.
In the late 80’s Piontkowsky was appointed to the Governor’s
expert task force on HIV/AIDS. Along with Evelyn Fisher he and other task force
members helped draft the original HIV laws that were passed in 1988. “From that
I developed a generalized interest in HIV and started doing a lot more with it,”
Piontkowsky said.
Piontkowsky then taught at the University of Michigan Law
School focusing on HIV issues, a year long course he taught with a colleague for
two years and then on his own for one. The first semester was a generalized
symposium on AIDS legal issues covering different topics such as discrimination,
health insurance and hospital visitation issues. In the second semester
Piontkowsky had his students working one-on-one with a PLWH/A, writing a will
and durable power of attorney. His clientele were referred from the Ann Arbor
Veteran’s Administration (VA) hospital. Piontkowsky and his students worked on a
couple of significant cases in those three years.
One major case dealt with a health policy issue. It involved
an incarcerated woman who was put into a 23 hour lockup because she had been
involved in a fight and she was HIV positive, but there was no process to get
her out. Piontkowsky had a few students working on that case and within three
days they had her out of lockup. The students then went on to help write rules
for this process.
Piontkowsky’s U of M Law students wrote a brief to the
Supreme Court on a health insurance case for a young man living in Texas whose
health insurance was limited to $100,000 lifetime coverage after his diagnosis.
“For any other disease the limit is for one million lifetime, so we argued that
was discriminatory and filed an Amicus brief in the US Supreme Court under the
ERISA (Employee Retirement Insurance Security Act) statute,” said Piontkowsky.
While the Supreme Court eventually ruled against their case, this led to
additional policy issues and discrimination cases.
After teaching, he did some private work representing
physicians through the law firm Frimet, Michaelsen and Piontkowsky. During that
time he continued to represent a number of people with HIV, balancing medical
treatment and discrimination issues. Piontkowsky then helped to write some
guidelines for healthcare workers in the State of Michigan, as part of a task
force.
One of the issues was, “What do you do if the healthcare
worker is positive?” They took a very broad approach and reviewed on a “case by
case basis to determine if there was any actual potential for someone to spread
infection. If not then there should no limitation on their ability to work and
to care for people.
“Through all of that work I got to know a number of dedicated
physicians in Michigan and was inspired by them,” said Piontkowsky. He decided
at that point to go back to school for medicine. This meant two years of
prerequisite undergraduate work before med school in 1995 at Ross University in
the Caribbean. He did his clinical rotations at Wayne State and then accepted a
residency at Wayne State in Internal Medicine. He stayed there for a two-year
Infectious Disease fellowship at the Detroit Medical Center (DMC). His primary
interest in infectious disease has been HIV, along with hepatitis C.
During this training period, he worked at the DMC clinic that
has about 1300 patients with HIV and also saw patients in the hospital setting
at Detroit Receiving, Harper Hospital or the Detroit VA Center. Early this fall
he completed a HIV/hepatitis C co-infection study at Wayne State. “Looking at
our population there…about 20 % are co-infected with HIV and hepatitis
C…nationally the figures range as low as 10-15 percent, to a high of about 30
percent…It’s an area that really needs a lot of attention in terms of treatment
issues,” said Dr. Piontkowsky. They are starting to treat patients for hepatitis
C through the infectious disease clinic at Wayne State he said.
Dr. Piontkowsky’s interest and expertise in co-infection will
serve him well in his new position. In October he left Michigan to become an
attending physician at Alleghany General Hospital in Pittsburg, PA., in the
Positive Health Clinic for people with HIV, which sees about 300 patients.
Running the Clinic and teaching the medical residents who rotate through the
Clinic for HIV care will keep him busy for a while. However, down the road Dr.
Piontkowsky sees himself getting more involved in policy issues again. He
belongs to the HIV Medical Association, “a national organization that helps to
formulate policy and has discussion around political issues as well as medical
issues.”
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