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SourcesAnn E. Dibble, senior staff attorney Ellen M. Lawton, executive director Kate Mewhinney, managing attorney Barry Zuckerman, M.D., founder News stories
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by Eileen Beal, M.A.
What do you get when you put a doctor and a lawyer on the same medical case?
When they team up in a medical-legal partnership (MLP), you get healthier patients.
In an MLP, the doctor zeroes in on the socioeconomic factors – roach-infested housing, poor nutrition, etc. – that negatively impact his/her patient's health. The lawyer provides legal services – suing landlords to clean up apartments where roach droppings trigger children's asthma attacks, filling out food stamp applications, etc. – that enable patients to optimize the benefits of the doctor's care.
The first medical-legal partnership was set up in Boston in 1993 by Barry Zuckerman, M.D., chair of Boston Medical Center's pediatric department. Frustrated by the non-medical issues, such as poverty or the parents' inability to figure out the health care system, that exacerbated his tiny patients' problems, he brought in a lawyer to help parents get the financial aid and state and federal benefits and services they and their children were eligible for.
In 2005, Zuckerman and lawyer Ellen M. Lawton spearheaded the creation of the National Center for Medical-Legal Partnership.
Today, there are MLPs in more than 230 hospitals and health centers in 38 states, said Lawton, the Center's executive director, in a telephone interview. "Typically," she explained, "an MLP's clients are referred for legal services by a physician or hospital social worker, though some partnerships also accept referrals from community-based organizations."
MLPs can provide a number of services:
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resolving insurance disputes
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securing local, state and federal benefits
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drawing up and notarizing advance planning/end-of-life documents
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addressing credit problems
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fixing housing problems
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negotiating workplace accommodations (including assisting with application for Family Medical Leave Act protection)
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accessing special education services
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referring clients to social service agencies that provide psychosocial support and counseling
"This is a program primarily for low-income people, so legal needs are pervasive. … [T]here will never be enough lawyers to address need," Lawton said.
MLPs have the endorsement of the American Bar Association (see the Medical-Legal Pro Bono Support Project) and the American Medical Association.
While partnerships draw expertise from legal aid agencies, law schools, firms doing pro bono work, hospitals, health centers, medical schools and residency programs, "MLPs always represent the client, not the facility," said Ann Dibble, senior staff attorney at New York City-based LegalHealth, at the National Aging and Law Conference in December.
"Though most [MLPs] are nonprofits, they vary widely in size, approach, focus and sources of funding," she added. Dibble's firm, which serves 17 New York City hospitals, is the largest MLP in the United States
Although MLPs were "born" in pediatrics, the number of MLPs focused on the elderly is growing, a phenomenon which can be explained by the growing number of elderly citizens and increased life expectancy, explained Kate Mewhinney. Mewhinney is the managing attorney for the medical-legal partnership between Wake Forest University's School of Law and the School of Medicine's Internal Medicine/Gerontology and Geriatrics Medicine Section. She also spoke at the National Aging and Law Conference.
While MLPs are set up to do good, their numbers wouldn't be growing at the rate they are if they weren't also financially viable. "Because MLPs help patients find financial aid and benefits that they are entitled to – often through insurance or state or local programs – patients get the [health care] services they need and better quality of life. Doctors and hospitals get increased reimbursements and decreased social and preventable admissions and re-admissions," Dibble said.
Background reading
"Medical-Legal Partnership: Collaborating with Lawyers to Identify and Address Health Disparities (PDF)," J Gen Intern Med 25 (supl 2): 136-9
"Medical-Legal Partnerships: Transforming Primary Care By Addressing The Legal Needs of Vulnerable Populations (PDF)," J Health Affairs, 29, no. 9 (2010): 1697-1705
(Remember: AHCJ members have free access to Health Affairs.) [Alternative link]
Medical-Legal Partnerships: Addressing the Unmet Legal Needs of Health Center Patients (PDF), Geiger Gibson / RCHN Community Health Foundation Research
Collaborative, George Washington University; May 4, 2010
CME event: Medical-Legal Partnership: A New Standard of Care, March 24 & 25, Baltimore
New AMA Backing of Medical-Legal Partnerships Wins ABA Praise, American Bar Association press release; June 15, 2010
Harkin, Bayh, Bond Introduce Bipartisan Bill to Improve Health and Lower Health Care Costs through Medical-Legal Partnerships, Sen. Harkin press release; July 29, 2010
Eileen Beal is a Cleveland-based independent journalist who specializes in covering aging and consumer-focused health and wellness issues.
