Alyssa Noll

It was a typical patient exam at the Stanford Emergency Department (ED), but unusual by most hospital standards. After the attending physician signed off on discharge orders for Johnny, an 8 year old with recurrent asthma attacks, a trained volunteer entered the room to preform an alternative assessment. The routine screening, which is offered to all patients, revealed that Johnny’s home was infested with mold, but the landlord, his father said, kept denying his request to have the problem resolved.That evening, Johnny and his father left the ED with a new inhaler and a letter to hand to their landlord addressing the housing concerns. Soon after, Johnny and his father received keys to new apartment, helping bring Johnny’s asthma under control. Johnny’s family was able to seek help through services offered by Stanford’s ED, but unfortunately, many patients across the country are less fortunate.

Health conditions like Johnny’schronic asthma that stem from the conditions in which people are born, live, and work are surprisingly common. However, treating these social determinants of health lie outside the spectrum of care doctors can feasibly provide. No single drug can cure poverty’s detrimental effects on health. To counter these observed adverse effects, Stanford Emergency Department is one of 260 healthcare centers nationwide that incorporates attorneys as a part of routine care through the creation of Medical Legal Partnerships (MLPs)1.

“Throughout the healthcare system, patients often have legal needs driving their illness or that stand as barriers to the delivery of care”, said Dr. Jennifer Newberry, MD, JD, an attending Emergency Medicine physicianat Stanford, and co-director of Peninsula Family Advocacy Program, Stanford’s MLP. “These are problems that we cannot fix as physicians alone, so to truly provide the care our patients need, we need to have a lawyer on the team.” With a goal to better treat these socioeconomic factors, MLPs seamlessly integrate health care and civil legal aid in order to identify legal needs that threaten the wellbeing of patients2. These collaborations strive to ensure that laws holding the potential to influence health are properly executed, particularly among vulnerable communities.

The need for MLPs is tremendous. In America, one in six families live in poverty3and research demonstrates that on average, these households experience 1.3 to 3.0 unaddressed legal needs that negatively impact their health4. In the Bay Area, 28.5% of residents live below 200% of the poverty line, placing them at major risk for food insecurity and other complications5. In effect, nearly 50 million Americans lack the proper legal assistance required to be healthy2, highlighting the urgent need for new MLPs to be established.

Many of the health issues patients experience result from unenforced laws or erroneous denial of vital services, leading to preventable poor health outcomes1. Being denied disability benefits, food stamps, and health insurance directly bars families from obtaining needed medications or food. Tenants facing utility shut-offs can no longer refrigerate medications or stay cool in summer weather. In addition, Dr. Newberry states that patients “may live in housing infested with insects, rodents, or mold, causing their asthma, allergies, or migraines to recur, but they have no voice.” These social causes of health disparities require legal aid to address. Physicians are often not trained to guide their patients through the necessary legal landscape to connect them to valuable resources.

In 2013, MLPs aided nearly 60,000 patients5 and resolved issues including legal status, income support, domestic violence, and other serious problems. The provided interventions have been statistically proven to help patients gain increased access to health care, food, safe housing and, ultimately help to improve their wellbeing6. “The impact of MLPs goes well beyond the ability to connect patients to direct legal representation”, according to Dr. Newberry. In her experience, “Even without being present, having a lawyer on the team empowers patients”.

Because health is so inherently dependent on socioeconomic influences, addressing these environmental factors that shape health outcomes is just as essential as writing drug prescriptions. Like many others, Dr. Newberry believes that “MLPs must become part of the standard of care across the country.” She states, “I hope that someday, physicians look to an MLP the way they routinely look to social work now. We have a chance to help our patients, their families, and our communities be healthier, to give them a voice, and to reduce injury and illness on a scale beyond our individual practice by leveraging the expertise of MLPs not just for the individual patient encounter, but to affect institutional and governmental policy.”

Despite the countless benefits medical legal partnerships provide, their establishment is not yet standard.Clearly, the unique collaboration between lawyers and physicians effectively treats the socioeconomic issues that create and perpetuate illnesses. After all, doctors, says Dr. Newberry, “…meet people in crisis, whether that’s medical or social, and we[as a society] have to be ready to meet that need.”

References

1. National Center for Medical Legal Partnership Website. Medical-legal partnership overview handout. Available at: http://medical-legalpartnership.org/wp-content/uploads/2014/03/MLP-Overview-August-2014.pdf.
Accessed on October 31, 2014.
2. Sandel, M et al. Medical-Legal Partnerships: Transforming Primary Care
By Addressing The Legal Needs Of Vulnerable Populations. Health Affairs. September 2010;22:1697-1705.
Accessed on October 31, 2014.
3. DeNavas-Walt, C, Proctor B. Income and Poverty in the United States: 2013. United States Census Bureau. Available at: https://www.census.gov/content/dam/Census/library/publications/2014/demo/p60-249.pdf
Accessed on October 31, 2014.
4. Legal Services Corporation. Documenting the justice gap in America: the current unmet civil legal needs of low-income Americans. Available at:
http://www.lsc.gov/pdfs/documenting_the_justice_gap_in_america_2009.pdf.
Accessed on October 31, 2014.
5. San Francisco Food Security Task Force. Assessment of Food Security in San Francisco: 2013. San Francisco, California: San Francisco Department of Public Health; 2013. Available at: https://www.sfdph.org/dph/files/mtgsGrps/FoodSecTaskFrc/docs/FSTF-AssessmentOfFoodSecurityInSF-2013.pdf
Accessed on:
6. National Center for Medical Legal Partnership Website. Impact at a glance. Available at: http://medical-legalpartnership.org/mlp-response/impact/.
Accessed on October 31, 2014