The Plaintiff

The Plaintiff

Angel Raich found a ‘miracle’ in medical marijuana. Now she’s asking the Supreme Court to uphold her right to smoke it.

Angel Raich flicks a butane lighter at the bowl of a small glass pipe, inhales deeply, then, in deference to a guest, blows the pungent smoke out the window of the sitting room in her three-story Oakland home. “Without cannabis, I would not survive,” she says.

The room is pale blue and filled with ceramic angels. Beside the lavender couch on which Raich sits, a table holds 11 small glass jars of medicalquality marijuana–strains that growers have named Juicy Fruit and Haze. Alas, her favorite, Romulen, “which is really strong,” is all used up.

Raich, 39 years old, 5 feet, 4 inches tall, just 100 pounds, with skin thecolor and translucence of skim milk, is smoking with her physician’s blessing. According to the doctor, she suffers from a staggering array of ailments, including chronic severe pain (from scoliosis, temporomandibular joint dysfunction and endometriosis), nausea, life-threatening weight loss, seizures, fibromyalgia and an inoperable brain tumor. “I hurt–every second of every day,” she says. “I wouldn’t wish my body on my worst enemy.” The lighter flares again.

Marijuana doesn’t get Raich high–it hasn’t in a long time–and it doesn’t kill her pain, but it blunts it, loosens her muscles and joints and gives her some appetite. She goes through some 9 pounds of the drug a year. She smokes or vaporizes about every two hours, and eats marijuana-laced food. She also massages herself with cannabis oils and balms. In her words, she is “medicating,” in accordance with California’s Proposition 215, which passed in 1996 and allows marijuana use if recommended by a doctor. According to federal law, however, she’s committing a crime. The U.S. government doesn’t recognize any legitimate use of marijuana, so it remains a Schedule I drug, along with heroin and Ecstasy.

This clash of laws, for eight years the cause of much friction between California and federal authorities, will now be resolved by the U.S. Supreme Court–because Raich forced the issue.

In October 2002, Raich, two growers who supply her with marijuana free of charge, and Diane Monson, another medical cannabis patient, filed suit against U.S. Atty. Gen. John Ashcroft and Asa Hutchinson, then head of the Drug Enforcement Administration. They asked for a court injunction to stop federal government arrests and prosecutions of those who grow, possess or use marijuana for medical reasons. They lost in District Court, but the U.S. 9th Circuit Court of Appeals reversed the decision in December 2003, ruling that states could adopt medical marijuana laws if the drug wasn’t sold, transported across state lines or used for nonmedicinal purposes. The federal government then filed its appeal, and the Supreme Court agreed to hear the case. Oral arguments are scheduled for Nov. 29.

The court’s decision will have national implications. California was thefirst state to allow the medical use of marijuana, but Arkansas, Arizona, Colorado, Hawaii, Maine, Maryland, Nevada, Oregon and Washington now have similar laws. California likely has the most medical cannabis patients– surprisingly, no one keeps official records, but estimates run from 30,000 to 100,000–as well as an organized and angry pro-cannabis movement. The result has been an ongoing fight that has included busts of patients and pot “dispensaries,” and sometimes bizarre law enforcement clashes. An August 2002 raid on Monson’s Butte County, Calif., home, for instance, featured a three-hour standoff between DEA agents, who wanted to destroy six marijuana plants, and the county district attorney, who ordered local deputies to protect the weed, at gunpoint if necessary. Ultimately, he was overruled by the U.S. attorney’s office in Washington, D.C., and agents chopped down the plants with axes while Monson stood nearby reading aloud the complete text of Proposition 215.

Acting Solicitor General Paul D. Clement, who is arguing Ashcroft vs. Raich for the attorney general, won’t comment on the case. His legal brief, however, maintains that exempting medical marijuana from federal drug law would increase drug trafficking, decrease “the incentives for research and development into new legitimate drugs” and “undermine Congress’ intent to regulate the drug market to protect public health and safety.”

Raich sees the potential loss of the case–and her drugs–in even starker terms. Without marijuana, she says, she will be in constant, excruciating pain, unable to eat and in real danger of death through malnutrition or starvation. “It will mean that the federal government can execute me,” she says flatly. “I will have to the leave the country, because I will not be safe here.”

Raich is very much the public face of the case that bears her name. For understandable reasons, the marijuana growers involved aren’t interested in speaking out–in fact, both sued as John Doe, with their real names kept under seal. Monson, 47, an accountant who has used cannabis to treat back spasms since 1999, says she only wants “to be left alone to pursue my health and happiness. I feel very much forced into my legal actions by the federal government. I led a very private life until the raid on my house.”

Raich not only wants to talk, she also has a publicist and courts the press. The “why” is complex. Certainly she’s a true believer. Medical marijuana, she says, eased her pain, freed her from the disability that trapped her in a wheelchair, literally saved her life. She calls it “my miracle.” She also says she found “a new family” in the medical cannabis community, and recognized its fight as the life mission she’d long been searching for. “I’m on the front lines,” she declares repeatedly. “I’ve been a warrior all my life. I fully comprehend the gravity of what I’m doing. I’m trying to save us all.” As Raich tells it, most of her life was a gothic horror. She was born and raised in working-class Stockton. Her parents divorced when she was 4. In need of day care, her mother, a dental assistant, asked her parents to watch Angel and a younger sibling. Soon after and until she finished fifth grade, “my grandfather molested me, threatened me, locked me in closets, held me down, forced me to do things I don’t want to go into and you wouldn’t print if I did,” she says. “It was constant.” Relations with her mother, who had remarried twice, deteriorated, and two weeks before her 16th birthday, Raich left home.

She married her high school boyfriend at 18; it was a relationship she describes as violent. The couple worked as apartment managers, moving from Stockton to Sacramento to Lodi. By 24, Angel had two children; by 25, she had left her husband. With her kids, she moved again, worked briefly as a massage therapist for a chiropractor, remarried and found an accounting job with a firm that handled billing for trucking companies.

Meanwhile, her health was disintegrating. She’d always been sickly–at 12, scoliosis (curvature of the spine) had required a full-body brace, and during her teens she’d had several surgeries for endometriosis. She also suffered from asthma. An accident during a brief stint at a lumber mill had left her with a rotator cuff injury in one shoulder, and two car accidents and a fall had further damaged her back. Then in 1995, when she was 30, her endometriosis flared up, and a doctor prescribed birth control pills. She’d had a bad reaction to the pill once before, but agreed to try it again. It was a disaster. “By the second day, my right leg was starting to swell. By the third, it was getting bright red. Over a period of days, it became purple, and it was burning hot. When I tried to walk, I had to drag it. The doctors couldn’t figure out what it was.”

Before long, the paralysis had spread to the whole right side of her body. Fully disabled and in a wheelchair, she was in constant pain, but every drug physicians prescribed–acetominophen with codeine, Vicodin, Hydrocodone, methadone and Fentanyl–brought horrendous side effects or allergic reactions such as shakes, hot flashes, itching and intense, continual vomiting. At one point, “angry at God,” she tried to cut her wrists. Unfortunately, she says wryly, “I could only use one arm.” Then a nurse at a hospital where she was being treated quietly suggested that she try cannabis.

Raich says she opposed recreational drug use, and the suggestion initially offended her. But what happened next is recounted almost as myth. “My daughter would cry at night. ‘Mommy, why can’t you do the things that other mommies do? Why can’t you play with me?’ The suffering I saw in her eyes broke my heart. I had to stop it. I got on the computer and started researching.” The pot that “a family member” bought for her on the street eased the pain a bit and gave Raich the push to ask her doctor for a recommendation. (Proposition 215 had passed the year before.) Her husband drove her to a medical marijuana “dispensary,” the Oakland Cannabis Buyers’ Cooperative. With its better-quality product, she says, “I started getting surges through my legs. I began to move my fingers a little bit. I knew I had found a miracle.”

But in 1998, the federal government sued to close the cannabis cooperative, saying that by distributing marijuana, it was violating the1970 Controlled Substances Act (which makes marijuana illegal to manufacture, distribute, dispense or possess with intent to manufacture, distribute or dispense), and a protracted legal battle began. Raich was infuriated. She found her own sources, continued to “medicate,” and her health continued to improve. By August 1999 she was out of her wheelchair, single again, living in the Bay Area and reborn as a medical cannabis activist.

“The night I tried to kill myself, when I asked God why I had to suffer, I got an answer: ‘You can’t end suffering if you don’t know what suffering is.’ The OCBC was like a world opening up to me–I realized that it was where I belonged. This was part of my destiny, to try to help other patients.” Raich volunteered to talk to media, and joined the Medical Cannabis Working Group, which helped the city develop guidelines for the dispensaries and police. When the cooperative’s attorneys took their legal fight to the U.S. Supreme Court in 2001, arguing that the cooperative was distributing marijuana on the basis of medical necessity, Raich became a “spokespatient.” By then, cannabis had even given her a new relationship- -she and one of the cooperative’s lead attorneys, Robert Raich, had fallen in love. They married the next year; Angel’s children, now 16 and 18, live with them.

The Supreme Court ruled against the cooperative, and though the court explicitly noted that it was deciding only whether it was legal to dispense marijuana to others, not the legality of possession for personal medical use, raids on patients soon began. Since September 2001, “about half thefederal government’s marijuana prosecutions in Northern California have focused on medical cannabis,” says Robert Raich. Activists in particular felt targeted, and Angel Raich, who had declared on national television that she wouldn’t obey any law that kept her from using cannabis, says she “always wondered when I’d be woken up by my door getting kicked in.” In October 2002, Robert Raich, along with David M. Michael, a San Francisco criminal defense attorney, and Randy E. Barnett, an attorney specializing in constitutional law and professor at Boston University School of Law, filed the current suit.

“Angel’s effort to enjoin the federal government has to be one of the most courageous steps taken in our movement,” says Jeff Jones, co-founder and executive director of the cooperative. He compares the case to Roe vs. Wade.

The strictly legal conflict of Ashcroft vs. Raich is hardly the stuff of drama. In essence, it concerns whether applying the Controlled Substances Act to marijuana grown and possessed within a state, and for which no money changes hands, is unconstitutional under the Commerce Clause of the U.S. Constitution, which regulates interstate trade. The cannabis activists assert that states have the right to regulate conduct that occurs solely within their borders; the federal government says it must regulate controlled substances within states in order to combat national drug trafficking.

But underlying the dispute is a more basic–and controversial– question: Is or isn’t marijuana legitimate medicine? Activists such as Angel Raich call cannabis a wonder drug that has been vilified by both Democratic and Republican administrations for political reasons and to protect pharmaceutical industry profits. (There are no patents on marijuana plants.) The federal government and those involved in anti-drug efforts vehemently disagree. In his brief, Solicitor General Clement argues that the Federal Drug Administration “has never approved marijuana as safe and effective for any medical use.” A brief filed on behalf of Ashcroft by a coalition of groups including the Drug Free America Foundation Inc., theDrug Free Schools Coalition and Save Our Society From Drugs calls the idea “a step backward to the times of potions and herbal remedies” and claims that sanctioning medical marijuana use would make the drug appear less harmful to the public–and thus lead to its increased abuse.

“Patients who have been misled into believing smoked marijuana provides a safe and effective therapeutic benefit have been misled and exploited by those in the drug legalization movement who know emotional appeals– based on faulty scientific claims–can best achieve their end goals,” says Rep. Mark E. Souder (R-Ind.), chair of the House Subcommittee on Criminal Justice, Drug Policy and Human Resources, who with six other representatives also submitted a brief. “If proponents of ‘medical’ marijuana truly believed that smoking the drug was safe and effective, they would have submitted their data to the FDA.”

Scientific examination of these competing claims has failed to issue the definitive blessing or curse both sides would like. Beginning in the 1980s, researchers identified brain and immune system receptors for cannabinoids, the active compounds found in marijuana, which seem to have a natural role in pain moderation. A synthetic version of the cannabinoid THC became available in the late ’80s to treat chemotherapyinduced nausea. Medical cannabis activists claim that these singlecannabinoid synthetics are poor substitutes for the marijuana plant, which contains hundreds of compounds, and are needlessly expensive. (One synthetic, Marinol, currently sells for about $17 a pill.)

In 1988, after the DEA held two years of public hearings on pot’s medicinal value, the agency’s chief administrative law judge concluded that marijuana, in its natural form, “is one of the safest therapeutically active substances known to man,” and recommended its reclassification to Schedule II, which would allow doctors to prescribe it. (The DEA declined the advice.) In 1997, the White House Office of National Drug Control Policy asked the Institute of Medicine, a component of the National Academy of Sciences, to review scientific literature on the drug. Its eventual conclusion was that “the accumulated data indicate a potential therapeutic value for cannabinoid drugs,” and that while many conditions could be treated more effectively with other medications, “there will likely always be a subpopulation of patients who do not respond well to [them].” There was “no conclusive evidence” that smoking marijuana was linked to using other illicit drugs and “no convincing data” that sanctioning medical marijuana would increase its use in the general population. The Institute of Medicine did condemn smoking as inherently dangerous and specified the need for a smoke-free way to ingest cannabinoids–but also noted that until one was developed, “there is no clear alternative for people suffering from chronic conditions that might be relieved by smoking marijuana, such as pain or AIDS wasting.”

It seems fair to say that whatever happens in Ashcroft vs. Raich in court, the federal government has lost the marijuana PR war. According to its legal brief, 25.8 million Americans–about 1 in 11- -use marijuana. A 2002 Time/CNN poll found that 80% of Americans thought adults should be able to use cannabis legally for medical purposes. In July 2003, Medscape, a website for medical professionals, reported that according to its poll, 3 of 4 doctors and 9 of 10 nurses said they favored decriminalization of marijuana for medical use.

Angel Raich plans to be in Washington when the Supreme Court hears her case. It will be her moment. At home, her poor health keeps her from doing much, but what energy she has goes to the medical cannabis movement. For three years, she’s headed a nonprofit organization, Angel Wings Patient OutReach, which advocates for the rights of medical cannabis users–and has partly funded her legal battle. Though it’s clear that she’s deeply invested in the fight and in her “warrior” identity, she says that all she really wants is for it to end. “Look, I had a really hard life,” she says. “I want more than anything to be happy. To feel safe. To spend time with my children and give them what I never had.

“I don’t like using cannabis. Sometimes I feel like it’s taken over my life–if I wasn’t using it, I wouldn’t be going through all this. But I have the right to be free of pain, and it’s not like I have a choice how. Believe me, if I could just take a pill, I would.”

The Veterinarian Brings His Healing Presence to Pets of the Unhoused



The man standing outside the tent on Skid Row in downtown Los Angeles clearly doesn’t live in the neighborhood. Tall and fit, he’s dressed in jeans and a doctor’s blue scrub shirt and carries a medical bag. The tent, one of many rough structures on the stained sidewalk, sits amid heaped wooden pallets, old furniture and trash. But the man’s eyes are fixed on the dog lounging nearby.

“Hi, how are you?” he says when the tent flap opens. “I’m a veterinarian, Dr. Kwane Stewart, and I offer free pet care to people experiencing homelessness.” He gestures at the dog. “Can I examine your pet?” 

First comes confused silence—you’re who?—then suspicion: Is this animal control, here to take my dog? Finally, a slow nod. Stewart, who calls himself the Street Vet, kneels, pulls out his stethoscope and goes to work.

These Skid Row streets hold the nation’s largest concentration of homeless people who are not staying in a shelter, and at first glance it’s an unrelieved landscape of despair: mental illness, poverty, addiction. But love exists, too, including the love of pets. Across the nation, 10 to 25 percent of the people who are homeless keep pets, and there’s no reason to think the number is lower in sunny Los Angeles. Cats sit on sleeping bags, pit bulls, scruffy terriers and mutts trot alongside filled shopping carts, and chihuahuas ride in bicycle baskets and the laps of people who themselves are in wheelchairs. Various local groups and volunteers help the owners of these animals care for them, with weekly and monthly clinics, mobile spay and neuter vans, handouts of flea meds and food. 

Stewart, 50, has usually worked solo, walking the streets and looking for animals and people in need. “Maybe it’s because when I began this work, it wasn’t uncommon to find a pet that had never received care,” he says. “Everyone I met looked at me as if I’d just dropped out of the sky.”

Stewart grew up with dogs, loved them and science, and by the time he was 10 knew he would become a veterinarian. It was an unusual ambition for a Black track star in Albuquerque. Once, a coach asked about his future plans and laughed with disbelief when Kwane told him. “I’ve never met a Black vet,” the coach said. Stewart goes on, “At the time I didn’t think much about it. But here’s the thing: He was Black himself.” Decades later the number of African American veterinarians is still so small the Bureau of Labor Statistics has reported that it might as well be zero. 

Stewart graduated from the University of New Mexico, got his DVM degree from Colorado State University College of Veterinary Medicine and Biomedical Sciences, and headed to San Diego. He spent a decade there treating a suburban clientele with “bottomless bank accounts.” Then, in 2008, he relocated to Modesto, in California’s Central Valley, for a job as the veterinarian for Stanislaus County. And everything changed. 

The Great Recession flattened Modesto, a city of around 200,000, with plummeting home prices and 17 percent unemployment. And when humans go broke, animals often pay the price. Pet surrenders surged until the area’s aging shelter, built for 200 animals, held twice as many, and its euthanasia rate became one of the nation’s highest.

“I was destroying 30 to 50 animals every morning,” Stewart says softly. “Healthy dogs and cats. It was killing my soul. I felt like God was keeping score and I was losing. I didn’t go to school all those years to destroy animals. I wanted to help and save them.”

At first that meant he helped a homeless man he encountered almost daily by treating the man’s dog, which suffered from a bad flea bite allergy. Then he held a free clinic at a local soup kitchen. And then, on his own time, he began to walk around Modesto and some Bay Area sites looking for pets to help. He moved to Los Angeles to serve as chief veterinary officer for the American Humane Association, which makes sure animals are treated well on film sets, and his ramblings shifted to San Diego and Los Angeles. He wore scrubs to identify himself, carried a bag filled with meds, vaccines and syringes, nail trimmers, and he did what he could, free of charge. 

He was stunned by what he found. Like many people, he questioned why homeless people had animals to begin with—if humans couldn’t take care of themselves, how could they be responsible for pets? And yet they were. In fact, numerous academic studies over the years have revealed the vital role pets play in the lives of unhoused men and women—providing structure, purpose, meaning and love. “Researchers have consistently found very high levels of attachments to pets among the homeless,” Leslie Irvine, a sociologist, writes in her 2012 book about the phenomenon, My Dog Always Eats First.

Stewart agrees. “Pets were a lifeline to the people I met,” he says. “Most of them were great pet owners. They did remarkably well with the resources they had, and made sacrifices for them well beyond what you or I would. The bond between them was on a completely different level. They needed each other.”


For five years, his efforts were a kind of secret hobby that he says even his family—he has three children—didn’t know about. Then, in 2017, he and his brother, Ian, produced “The Street Vet” as a reality TV series­—it has aired on broadcast TV in Scandinavia and Eastern Europe and in the States on a Utah cable channel­—and Stewart acknowledges he’s now a “media personality.” These days he’s founding a new veterinary practice in San Diego and writing a book about his experiences on the street.

Last September he started a nonprofit, Project StreetVet, raising money on GoFundMe to cover the cost of treating pet medical problems beyond the scope of a sidewalk exam. He has occasionally volunteered with larger organizations assisting people who are homeless. Though he says “there are probably more efficient ways I could spend my time,” he likes doing it his way. 

“The wound is healing well,” he reassures a man named Ben, whose pet rat had been attacked by a cat. (“I’ve seen birds and snakes, but this was my first rat.”)

“The puppies look great,” he tells Julian, a tattooed man who has lived on the same stretch of pavement for two years and whose dog recently gave birth. (He also vaccinates the pups.) 

Stewart marvels at the generosity of a young man named Reggie, who lives in a school bus and uses his own cash to make lemonade that he gives away to his neighbors. Stewart vaccinates the man’s dog, Daisy. “You’re doing a good job,” Stewart says.

“Oh, this is such a blessing,” the young man replies. 

Most Americans Have Pets. Almost One Third Can’t Afford Their Vet Care

Since mid-2020, more than a thousand low-income families have brought their sick and suffering pets to the nonprofit Pet Support Space, housed in a tiny Los Angeles storefront. One 14-year-old dog had a tumor that a veterinarian had quoted $5,000 to remove. A four-year-old pit bull had been vomiting for days, a cat’s painful bladder stones required surgery, a pug limped from the foxtail embedded in its paw. Skin and ear infections abounded. Neither the animals’ problems nor their owners’ inability to afford help for them was a surprise.

recent nationwide study found almost 28 percent of households with pets experienced barriers to veterinary care, with finances being the most common reason. In low-income households, the researchers found, financial and housing insecurity can increase the risks that animals will not receive the care they need. Sociologist Arnold Arluke, author of Underdogs: Pets, People and Poverty estimates that 66 percent of pets in poverty have never seen a vet at all.

The “why” behind those numbers is complex. Of course, money is the primary problem. Veterinary care is expensive. A majority of practitioners work in for-profit clinics, consolidation in the industry has increased emphasis on profit margins, and vet prices have risen faster than the overall rate of inflation. That has checkups starting at $50, dental cleaning going for $70-$400, and blood work and x-rays at $80-$250. If a dog breaks a leg or eats a sock, surgery costs begin at four figures.

High prices aren’t necessarily about greed. Michael Blackwell, a former Deputy Director of the Center for Veterinary Medicine at the FDA, is the chair of the Access to Veterinary Care Coalition (AVCC) that was formed in 2016 to study this very problem. Veterinary training, he said, teaches vets to practice a “gold standard” of care, which means running every possible diagnostic test and pursuing every treatment option, even when a client’s budget is limited. (Many pet owners don’t know they can decline a recommended procedure, such as blood work, and even fewer are willing to decline care for fear of looking heartless.)

Some private vets offer struggling clients discounts, added Jeremy Prupas, DVM, Chief Veterinarian for the City of Los Angeles, but they themselves carry an average of $150,000 in student loan debt, so they simply “can’t carry the immense existing need on their own.” Telling clients you can’t help them because they have no money is one of the leading causes of burnout in the veterinary profession, according to Prupas. Pet insurance might help defray costs but requires monthly premiums and comes with such a complicated array of deductibles, co-pays, caps, and exclusions that one how-to guide recommends hiring an attorney to review the policy. Credit cards designed for medical care financing, if one can qualify, can carry punishing interest rates as high as 26.99 percent.

Equally critical is a long-term failure on the part of the animal welfare movement to consider, much less prioritize, the needs of low-income pet owners. Since the 1990s, the rescue/humane world has poured vast amounts of funding and energy into cutting shelter euthanasia through adoption, but far less into helping those without money take care of the pets they have. “If you can’t afford an animal,” the thinking went, “then you shouldn’t have one.”

“Until recently, we focused on shelter-centric challenges,” acknowledged Amanda Arrington, senior director of the Humane Society of the United States’s Pets for Life Program, which assists low-income pet owners. “There was a lot of judgment and making determinations on who was or wasn’t deserving of support and resources that was influenced by what I think a lot of society is influenced by, which is classism and racism. We conflated a lack of financial means and access with how much someone loves their pet or desires to care for it.”

In fact, owners can be punished because they can’t afford veterinary care — “most humane neglect cases stem from an inability to get care for a pet,” said Prupas. In Michigan, for example, failing to provide an animal with adequate care, including medical attention, is a misdemeanor that can carry 93 days in jail and/or a fine of up to $1,000. With a second violation, it becomes a felony.

The distorted belief that ‘those people’ don’t care about their pets has never been true.

What exists for pet owners in poverty is a patchwork of low-cost care options, ranging from local efforts — such as Emancipet in Texas and the Philadelphia Animal Welfare Society — to well-funded national enterprises such as Pets for Life, which operates in several dozen cities. The great majority, however, offer only basic services like sterilization, vaccination, and flea treatments. “We are not a full-service veterinary clinic and do not treat sick or injured pets,” warns one low-cost option on its website. Another suggests that needy people travel, since “vets in smaller towns may charge lower fees,” or start a GoFundMe. As a result, many types of care are largely unavailable: emergency care (by some estimates one in three pets will have an emergency need each year), management of chronic conditions such as diabetes or kidney disease, medication, dental care (dental disease affects perhaps 80 percent of older dogs), and the mercy of humane euthanasia (which can run $50-$300).

The final piece of the care gap is a practical and cultural disconnect. Because many economically challenged neighborhoods are “vet deserts,” with few if any practitioners, it’s not easy to find care, and reaching it can require wrangling an unhappy animal over distance and/or arranging private transportation. Keeping an appointment at an office with weekday-only business hours or a once a month clinic can mean losing a day’s pay. Paperwork raises the fear of immigration status inquiries. The veterinary profession also remains one of the country’s whitest: Just as people who feel alienated or unwelcome don’t utilize human health care options, pointed out Arluke, they don’t utilize care for their pets.

The result has been suffering: most directly for animals that remain untreated, die from what vets call “economic euthanasia” (putting an animal down because treatment costs too much), or end up in shelters. Fear of a looming vet bill, and the mistaken belief that all shelter animals receive medical care, is a prime cause of owner surrender.

But people pay, too.

Some sick animals can infect their humans. Roundworms, for example, can pass through contact with pet feces and cause lung, heart, and eye problems. Blackwell reports meeting an optometrist who practices in a low-income Florida community who has seen increasing numbers of children with roundworm larvae in their eyes.

The psychic toll is just as real. Families in poverty who love their pets and for whom “they offer an emotional core and possibly one of the only sources of joy” face “mental and emotional” devastation from the unimaginable choice of weighing that love against potential financial ruin, said Blackwell. Professor Katja M. Guenther, author of The Lives and Deaths of Shelter Animals, called the rupture of an animal-human bond “a kind of community violence” in a 2021 webinar.

Change seems increasingly possible. Covid-19 and the country’s recent racial and economic reckoning has prompted humane organizations to examine their assumptions and biases about who has the “right” to a pet’s love, and, said Arrington, there’s increasing recognition that “racial and economic injustice really impacts animal welfare.” Meanwhile, AlignCare, a new program out of Michael Blackwell’s Program for Pet Health Equity, is trying to create a national model of something like Medicaid for domestic animals. Under the program, families already found to be struggling (because they participate in SNAP or a similar program) and who ask for help at a shelter or veterinary clinic will be signed up and paired with a veterinary social worker or support coordinator. They’ll then be directed to a veterinarian who has agreed to offer preventative, dental, and even critical care, for a reduced fee; AlignCare will pay 80 percent of the cost. After three years of pilot programs in 10 disparate communities, it’s taking on its biggest challenge yet, Los Angeles, where one in five people live in poverty.

AlignCare won’t offer “gold standard” care, instead emphasizing preventative, incremental, and cost-saving measures (such as offering telehealth appointments and limiting diagnostics that won’t change treatment options) when possible. But it will expand the human safety net to include the animals most of us now consider part of our families. And while the effort is currently funded by grants from Maddie’s Fund, the Duffield Foundation, and Petsmart Charities, Blackwell’s goal is “community ownership:” The combined involvement of local vets, city animal services departments, social service agencies, rescue and community organizations, pet food and product manufacturers, and affluent pet owner-donors can make the model self-sustaining.

There is no perfect solution for low-income pet owners who need help accessing veterinary care. But growing awareness of the problem is a big step forward. “What we call ‘animal welfare’ is changing,” said Lori Weise, whose nonprofit, Downtown Dog Rescue, runs the Pet Support Space. “The distorted belief that ‘those people’ don’t care about their pets has never been true. People can’t afford care. Sometimes they don’t even know what’s out there; they themselves have never been in a hospital. As more people are brought into the system, we’ll see the first generation to get proper veterinary care.”