By BETSY TAYLOR
Sometimes, it takes more than a doctor or nurse to help patients improve their health. Sometimes, it takes a lawyer.
Franciscan Missionaries of Our Lady Health System in Baton Rouge, La., has partnered with other community organizations to begin a medical-legal partnership to aid low-income patients who may need legal assistance to address factors harming their health or impeding their recovery.
Now patients can be referred to legal professionals who help resolve problems related to food or housing insecurity, family matters, immigration status, disability benefits and more. Among the services provided by lawyers doing pro bono volunteer or legal aid work are help navigating the application process to receive public benefits or set up a payment plan to keep the patient's utilities on. Legal advocates may spur a landlord to do mold abatement in an apartment occupied by an asthma patient or assist a patient in getting approved for Social Security disability.
Shown here with her children, Tracie Jackson is one of the first clients to be assisted by a new medical-legal partnership in Baton Rouge, La.
In an Innovation Forum at the Catholic Health Assembly in Washington, D.C., Ellen Lawton, the co-principal investigator of the National Center for Medical-Legal Partnership, and Jolee Bollinger, vice president for corporate integrity and general counsel for Franciscan Missionaries of Our Lady Health System, will discuss the purpose of medical-legal partnerships, how to establish a medical-legal partnership, the connection between civil legal aid services and population health and how savings can be achieved in health care expenditures through the work of the partnerships.
Justice and mission
The National Center for Medical-Legal Partnership is based at the Milken Institute School of Public Health at George Washington University in Washington, D.C. It works to make an integrated medical-legal approach to health and health care mainstream. The national center provides resources to organizations trying to establish new medical-legal partnerships, like the one in Baton Rouge. Currently, medical-legal partnerships are active in 262 hospitals and health centers in more than 35 states.
Information from the center says one in six people need legal assistance to be healthy. It says the social determinants of health — "the circumstances in which people are born, grow up in, live, work, play and age, as well as the systems designed to improve health and treat illness — have a significant impact on the health and well-being of individuals and communities." The center says many injurious social conditions can be traced to laws that are unfairly applied or under-enforced.
Lawton said assembly participants strike her as "a natural audience" for more information about medical-legal partnerships. The work of such partnerships in assisting the poor and vulnerable "aligns really closely with the mission of Catholic hospitals, in general," she said.
Bollinger summed up the mission of Franciscan Missionaries of Our Lady Health System by saying, "We care for those most in need." She said clinicians treat the sick and promote population health, "but there are other problems in (patients') homes, or in their families or in their communities that they do not have an effective way of resolving, so that they can be at their highest health status." Lawyers taking part in the medical-legal partnership can directly assist poor and vulnerable patients with legal and safety net access issues, leading to improvements in factors that impact patients' health and well-being.
Bollinger
Lawton
Breathing easy
Franciscan Missionaries of Our Lady Health System operates five hospitals, including Our Lady of the Lake Regional Medical Center in Baton Rouge, clinics and housing for the elderly. Bollinger said a community organization brought the idea for a medical-legal partnership to the health system, and the first organizational meeting was in the fall of 2012. Representatives of the health system and other interested organizations including Southeast Louisiana Legal Services and the Baton Rouge Bar Foundation Pro Bono Project created the Capital Area Med-LAW Partnership out of that joint effort.
The Baton Rouge partnership's initial focus is on assisting asthmatic patients and families with asthmatic children, because that ties with work already being done in the region to try to mitigate conditions that aggravate asthma.
Medical-legal partnership organizers began educating groups of clinicians last year about the partnership, advising clinicians to ask patients about environmental factors and social determinants that may be harming their health, and providing clinicians with forms — which the lawyers said they later had to simplify so that busy clinicians would fill them out — to refer patients to the Capital Area Med-LAW Partnership. When organizers of the medical-legal partnership spoke with Catholic Health World in March, they had assisted five clients with 30 separate legal matters including, but not limited to, helping a client complete a will, assisting a parent seeking child support and guiding others through the application process for government programs that provide assistance.
Fresh eyes on challenges
Sarah J. Campbell, directing attorney for Southeast Louisiana Legal Services in Baton Rouge, said when the partnership reviewed its first application for legal assistance, someone commented that it didn't seem there was much the partnership could do to aid that client. "I said, 'No, she's got three kids, and nobody else in the household. Why isn't she getting child support? Why is she paying so much out in utility bills?' These are the things you home in on, because that's what we do, day in and day out."
Laura Tuggle, the executive director of Southeast Louisiana Legal Services, is a fellow in "Where Health Meets Justice," a program of the National Center for Medical-Legal Partnership. She explained how lawyers can advocate for clients hobbled by medical bills. A client of the New Orleans office of Southeast Louisiana Legal Services had no health insurance and about $200,000 in unpaid medical bills. An attorney worked with that client to get the person disability benefits and Medicaid, which included a retroactive coverage period. As a result, most of the patient's unpaid medical bills could be paid, she said. Tuggle, who is based out of New Orleans, said the hope is that, in time, a medical-legal partnership will be established in the New Orleans region, too.
Lawton said she recommends medical-legal partnerships set their priorities based on input from the health care team or teams they're working with, and from health data about the area. From there, many of the partnerships focus on an area of need, such as the work to improve housing conditions for asthmatics in Baton Rouge.
Bollinger said at the assembly she'll discuss practicalities including funding. The partnership probably should have pursued seed funding, she said. It can't afford to employ a full-time staff lawyer. And it probably should not have waited until now to seek the assistance of the health system's grant writers, she said, then laughed, "We're lawyers, and we thought, 'we can figure this out.'"