*This fictional Newspaper article was written to incorporate my Multi-Genre Research Project. The article leads into an interview with Mercedes Lopez, SLP, who is fighting to receive funding for her client, Zoe Mackinroe.

The San Diego Sun Times
08.21.02

Communication is the Key
by Eliza Hudson

The controversial court case centered around funding for an Alternative Augmentative Communication (AAC) Device is set to go before a judge on August 26. Zoe Mackinroe was born with Cerebral Palsy, and has been unable to communicate through speech since birth. An Augmentative Communication device will produce synthesized speech, and is the best way to help her communicate. Medicare covers the cost of some AAC devices, but not all. The AAC device recommended for Zoe is one that Medicare has refused to pay for in past years.

One of the guidelines set up by Medicare states that they will not cover devices which are "convenience items, and not medical in nature." (Moore, 2000). In Zoe's case, the device recommended for her is run through a laptop computer. Medicare classifies a laptop as a "convenience item", and refuses to cover the cost. It is for this reason that her family has decided to take her case before a judge.

I recently had the opportunity to discuss the case with Zoe's Speech-Language Pathologist, Mercedes Lopez.

Eliza Hudson (EH): Hi, Mercedes. Thank you so much for taking time out of your busy schedule to meet with me.

Mercedes Lopez (ML): Oh, you are quite welcome. I am very pleased to have the opportunity to share Zoe's case with you and the public.

EH: I am equally delighted. I won't waste any precious time, though. How did you first meet Zoe and her family?

ML: I first met Zoe in May. She was referred to me by her Family Physician, who was interested in seeing her acquire some sort of communication device.

EH: How old is Zoe?

ML: Zoe is 13 years old. She is at that prime time in her life when communication is the bridge to the world.

EH: There has been a great deal of speculation about the AAC device that was recommended for Zoe. If I understand correctly, the device is generated through a laptop computer. Did you recommend that device?

ML: Yes, the device is generated through a laptop. I was also responsible for the recommendation of the device. As an SLP, researching devices and helping the families choose one, is a main part of my job description.

EH: Why did you recommend a device that is programmed through a laptop computer?

ML: I spent countless hours researching the thousands of devices available. I didn't choose the laptop because it was the most expensive, or because it was a laptop. I chose it because it is the best device for Zoe. Given her age, and her needs, the laptop is the most appropriate device.

EH: Some have said that "beggars can't be choosers", meaning wouldn't it have been easier to pick another device knowing that Medicare would have covered it without any questions?

ML: Sure, I could have picked any number of devices for Zoe. But her family and I decided upfront that we weren't going to take the "easy" road. Both her parents and I want what is best for her. I firmly believe that the laptop device is best in her situation. Since the device is run through a computer, it is able to "grow" with her so to speak. If I had picked another device, it is very likely that in a few years she would have needed a replacement.

EH: Tell me this. If the laptop is the best device, then why are there so many other devices available on the market?

ML: I don't believe that I stated the laptop device is the "best" overall. I said that the laptop device is best for Zoe. I will readily say that the laptop may not be the best device for my next client. With every new client who needs an AAC device, I do new research. Every client's needs are different.

EH: Thanks for the clarification. Let's talk about what prompted you to take the case before a judge. Was it your decision or her family's decision?

ML: It was absolutely a joint decision. Zoe's family is very involved in her therapy. My job is to educate them, and help them in any way I can. In this case it means doing the research, making the recommendations, and giving guidance. After I had decided which device was best for Zoe, I sat down with her family for a conference. I knew where Medicare stood on the issue, and I knew that we would have to fight for funding. I gave them the option of court case, or choosing another device.

EH: Why did they choose to take the case to court?

ML: Honestly, this all about Zoe and her needs. They want the best for her. If the best for her means going to court, then they are willing to do that.

EH: Do you believe that you have given her family any false hope about the outcome of the court case?

ML: No, I don't. I have always been very upfront with her family. I explained that there were no guarantees. I don't know what the outcome will be. Obviously, I hope it's in our favor, but I realize that it may not be.

EH: What will you do if the judge rules against you?

ML: There are several options available, one being an appeal. Another option is to choose a different device for Zoe. Neither of these options are ones that we are entertaining at this point and time. We have nothing but optimistic thoughts.

EH: Let's get more specific. How do you intend to win this case for Zoe and her family?

ML: I intend to present very compelling evidence as to why Zoe needs this device. This whole issue is connected to the "quality of life" issues that we often hear people talk about. If Zoe gets the device she needs, it will increase her quality of life beyond what we will ever know. That's the point I want to prove in court.

EH: Can you give us any specifics on what items you plan to present in court?

ML: As of right now, everything is tentatively set. I do have a gameplan, though. I have spent many hours preparing, and I believe that we are almost ready.

EH: Can you give us any insight into that "gameplan" of yours?

ML: I would be happy to share some of it with you. One of the very first things I want to present is a Powerpoint

(application/octet-stream, 174 KB)

Presentation. I do not know which judge will be hearing our case, nor how much knowledge he has about AAC devices. The Powerpoint will be an excellent learning tool.

EH: Wow! That sounds great! What else do you have in mind?

ML: Actually, I have another information tool that I want to use. I was asked to be an editor for the P.A.C.F (Pushing Augmentative Communication Further) Newsletter

(application/octet-stream, 56 KB)

. It is a brand new newsletter specifically centered around Augmentative Communication. I believe that P.A.C.F is an amazing way to create a community of AAC users in the San Diego area. By presenting it in court, I hope to place an impact on how important AAC devices are to individuals and to the community.

EH: Very exciting, Mercedes. I was just thinking how ironic it is that Zoe can't even plead her case before the judge. This whole controversy is about the issue of speech, yet she can't stand in court and tell the judge why she needs one. Is there anyway for her to be involved?

ML: I am so glad that you asked that. I was very intent on making sure that Zoe was involved in this case. Not too long ago, Zoe told me that she started writing in a Journal the day that she and I first met. She had never let anybody read the journal until recently when she let me read portions of it. After reading it, I decided that it was a great piece to present in court.

EH: What impact do you think her journal will have?

ML: I think it will have a profound impact. I was amazed at her writing abilities. She may not be able to speak, but she makes up for her loss through her writing ability. Her journal entries give a real glimpse into her heart.

EH: Is that the only way Zoe will be involved?

ML: Actually, no. One day in therapy, I asked her to write an "I AM" Poem about herself. The "I AM" poem is designed to describe Zoe's life as she sees it. Again, a little piece of her heart shines through. Trust me, it will pull at your heartstrings.

EH: I would love to read that. It sounds amazing. But so far we have a Powerpoint presentation, Newsletter, journal entries, and a poem. From what you have told me, it sounds like you have a pretty solid case. Anything else you wish to share?

ML: There is one other solid piece that I would like to present. Zoe's father, Simon, wrote a Guest Editorial in the San Diego Star Times. It is a very compelling piece that presents Zoe's case from a fatherly perspective. I wanted to make sure that I covered all of the bases by including my voice, her family's voice, and most importantly, Zoe's voice.

EH: Excellent! I wish you the best of luck in this case. I am so glad that I had the opportunity to talk with you today. You have really enlightened me, and I know the public will appreciate your voice. Please tell Zoe that I would love to meet her someday. She sounds like an incredible girl. I wish both her and her family the best.

ML: Thank you!! It has been a true pleasure. If anyone wants more information about Augmentative Communication and AAC devices, my Webliography contains various links to sites that will be beneficial and insightful. We can always use another advocate for our cause!

EH: I truly hope that this interview will heighten awareness about AAC devices. I think AAC is an area that people are unfamiliar with, but you have definitely been instrumental in bringing the subject to light. Again, I thank you.

*Mercedes Lopez is an SLP who owns her own private practice in San Diego. She is also an editor of the P.A.C.F Newsletter. If you would like to contact her via email, her address is:
MLopez@pacfnewsletter.org