Professor Guernsey and Dr. Lynch highlight why collaboration between law and medicine is critical, especially when defending clients with severe mental health conditions or substance use disorders.
Tuesday, August 15, 2023

Professor Alison K. Guernsey recently presented at a continuing legal education (CLE) seminar focused on improving federal criminal defense practices, alongside Dr. Alison Lynch, a psychiatrist at the University of Iowa Hospital and Clinics. 

Professor Guernsey is director of Iowa Law's Federal Criminal Defense Clinic, where law students have the opportunity to act as real attorneys and handle federal criminal cases under Guernsey's supervision. Students represent indigent people charged with federal crimes at the district court level, as well as in post-conviction and sentence-reduction proceedings, including compassionate release. Before coming to Iowa, Guernsey was the supervising attorney for the Federal Defenders of Eastern Washington and Idaho.

Dr. Lynch is a psychiatrist with the University of Iowa Hospital and Clinics and serves as a clinical professor and the director of the Opioid Addiction Clinic and Addiction Medicine at Carver College of Medicine. 

We spoke with Professor Guernsey and Dr. Lynch about the importance of bringing law and medicine together to better serve clients facing serious health challenges. 

What is the Federal Defender seminar? 

Professor Guernsey stated, "Each spring, the Federal Defenders of Iowa host a CLE for members of the federal criminal bar in Iowa. The goal is to help ensure Iowa defenders continue to provide high-quality representation by educating practitioners on emerging legal issues and providing insight into how to hone and develop core defense skills.

This year, Nova Janssen, the organization’s chief of training and CJA Resource Counsel, decided to tackle an ever-present concern for defense lawyers across the country: What are defenders’ ethical obligations as we navigate relationships with clients who present with symptoms of severe mental health or substance use disorders and how do those ethical obligations play out in everyday practice?

To kick off the event, I provided an overview of relevant Iowa Rules of Professional Conduct, and then joined a roundtable discussion to talk about how those rules “applied.” The roundtable included a wonderful and diverse group of stakeholders:

  • Hon. Helen Adams, Chief United States Magistrate Judge, SDIA
  • Alison Guernsey, Director, U. of Iowa Fed. Criminal Defense Clinic
  • Alison Lynch, Doctor of Psychiatry & Addiction Medicine Specialist, U. of Iowa
  • Ashley Knight, United States Probation Officer, SDIA
  • Joe Herrold, Assistant Federal Defender, SDIA
  • Melanie Keiper, Assistant Federal Defender, SDIA
  • Pam Nelson, Supervising United States Probation Officer, SDIA
  • Moderator: Mackenzi Nash, Assistant Federal Defender, SDIA"


How do health professionals play a role in law?

"Collaborating with medical experts like Dr. Alison Lynch is a key part of ensuring that defenders provide the best representation possible. The Rules of Professional Conduct don’t provide us with much information on how to counsel, communicate, and “deal” with clients who are suffering from mental health conditions or substance use disorders.

We know that we are required to maintain as “normal” an attorney-client relationship as possible and can take protective measures if we believe our clients are suffering from “diminished capacity.” But there are very few lawyers who are unilaterally qualified to determine whether a client’s “capacity” has been impacted and to what degree.

Medical experts and other health professionals help provide us (and the courts) with guidance as we navigate medical concerns all the while trying to honor our clients’ values and wishes, protect their interests, and limit our intrusions on their decisional autonomy," said Guernsey.


Why is collaboration between judges, probation officers, federal defenders, and mental health providers beneficial?
Doctor Alison Lynch Headshot
Alison Lynch, MD, MS, psychiatrist and addiction medicine specialist at the University of Iowa.

Dr. Lynch shared that "For a variety of reasons, health care providers who work in mental health and/or addiction take care of patients who are incarcerated, have been incarcerated, or are on probation/parole.

However, medical training does not include information or skills needed to understand or help patients navigate these systems, so there is a total lack of coordinated care and support.

Often, health care providers don’t even know if a patient of theirs is on probation/parole or has been incarcerated, and most of the time, a person’s doctor and lawyer have no contact and work in isolation from each other. These are missed opportunities to align efforts and best help the people we serve.

The ethics panel provided a unique and important opportunity to break down these barriers, establish communication and collaborations, so ultimately we can bridge some of the current gaps and ensure that people with mental illness and/or addiction get the care and treatment they need to most effectively participate in the legal process."