Politics Feature

In 1993, San Antonio lawyer Susan Zinn sued the state of Texas on behalf of a class of more than 1.5 million children she claimed were not getting adequate medical care that should have been provided through Medicaid -- the federal indigent health care program administered by the state.

Zinn works for Texas Rural Legal Aid, a federally funded law office that represents clients unable to afford legal counsel. (She is now handling the lawsuit in her part-time private practice.) She became involved in the issue when conducting an informal health care survey on the Texas-Mexico border. "One of the most common problems they would mention were these horrible toothaches. The child was up at night, crying, nobody else could sleep, the child couldn't eat, couldn't go to school. I'd say ŒDoes the child have Medicaid?' They would say ŒYes.' I'd say ŒDo you know you can use your Medicaid card to take the child to the dentist?' And they never did."

Several years later, in 1993, Zinn filed suit in Paris, Texas, on behalf of an East Texas child who was not getting adequate Medicaid services. In 1996, the state settled with Zinn and her clients and signed an extensive consent decree, supervised by federal Judge William Wayne Justice. In the decree, the state agreed to meet certain specific requirements concerning Medicaid. Last year, Zinn returned to Justice's courtroom (he has moved to Austin), alleged that the state had failed to make the required improvements, and asked the judge to compel the state to comply with the agreement made in 1996.

The judge agreed, and early in his 173-page opinion, he returned the issue that drew Zinn into the lawsuit. "Abundant evidence was presented that clearly demonstrated that class members do not get adequate medical care. They crowd emergency rooms in hospitals, suffering from acute dental diseases that, while easily preventable, often lead to such complications as infections, dehydration, fever and malnourishment stemming from the inability to eat," the judge wrote in his August 14 opinion.

In it, he found that the state has failed to inform parents of children that medical, and, in particular, dental services, are available to them. He found that the state inflated its numbers concerning caseload and its outreach program. He found evidence that the transportation system intended to get children to doctor and dental appointments often fails, and that the managed-care programs in which some children are enrolled by Medicaid are often barriers to children in need of health care.