Some health issues, try as doctors might, cannot be fixed within the walls of a health care facility — especially for children or other vulnerable populations.
Recognizing this, some hospitals in Northeast Ohio are adding attorneys to their care teams through medical-legal partnerships, or MLPs.
A child with asthma may be living in an apartment infested with mold. A struggling family may be losing access to food stamps. Or a young student with a learning disability isn't getting the support he or she needs.
"The idea is that so much of what helps us be healthy happens outside of the doctor's office. We think that maybe 20% happens within clinical care and the other 80% is not clinical care," said Marie B. Curry, managing attorney of the Health, Education, Advocacy and Law (HEAL) project at Community Legal Aid in Akron. "So when doctors and nurses and health care providers are trying to provide medical care that's going to gain some traction, sometimes it's helpful for them to have a lawyer as part of the health care team."
The HEAL project, which partners with various health care facilities to offer legal support to patients, has been in place for several years. MetroHealth and the Legal Aid Society of Cleveland have been in partnership for such work for 15 years.
But others are popping up more recently.
St. Vincent Charity Medical Center and the Legal Aid Society of Cleveland have teamed up and are starting a MLP this month focusing on the needs of those in treatment for behavioral health and addiction diseases.
In collaboration with Case Western Reserve University School of Law, University Hospitals Rainbow Babies & Children's Hospital recently announced an MLP that will guide families and pediatric patient caregivers on legal issues beyond the scope of clinical care that affect children's health. It's one of various programs UH is piloting ahead of the opening next year of its $24 million Rainbow Center for Women and Children, a three-story, 40,000-square-foot outpatient health care center at the corner of Euclid Avenue and East 59th Street that is largely being funded by philanthropy.
Nearly 300 health care institutions in 41 states have developed these partnerships, according to the National Center for Medical-Legal Partnership.
"There's only so much that we in medicine can do to help with patients' real concerns," said Dr. Marie Clark, medical director of the UH-Rainbow medical-legal partnership and an assistant professor of pediatrics at CWRU.
Cleveland Clinic and Legal Aid signed a memorandum of understanding several years ago to bring free-advice clinics to the community. The Clinic recently applied for a grant to fund the establishment of a medical-legal partnership between the two, and is still waiting to hear if the grant will be approved.
MetroHealth was one of the first in the country to start an MLP after the idea began at Boston Medical Center in the early '90s (then called Boston City Hospital).
Dr. Robert Needlman, a pediatric physician at MetroHealth with a background at the Boston hospital, was a cheerleader from the very beginning.
"We're in the business of taking care of the most disadvantaged kids, and those are the kids who have medical problems that are a direct consequence of their legal issues," he said.
The program at MetroHealth began focused on pediatrics, but has grown since, now involving some adult medicine and other programs.
Needlman, who refers a couple of patients every week for legal advice, sees a handful of issues in which the MLP has been most valuable to his work in pediatrics: children with learning disabilities, children with a cognitive or developmental disability, and families with housing issues.
A lawyer works with the family to figure out what they need and offers advice and information on what the family is entitled to. The attorney then continues to work with them in various capacities, be it representation, letter writing, advocacy or more, until the problem is resolved.
In starting the program at UH Rainbow, Needlman offered advice to Clark, who trained at Boston Medical Center and later developed a MLP in a previous position in Pittsburgh.
"It really made an impression on me, and I don't really know how to process medicine any other way," she said.
Clark teamed up with Laura McNally-Levine, law professor and director of the Kramer Law Clinic Center at CWRU. McNally-Levine has also had a long interest in participating in an MLP, which will offer training, education, advocacy and individual representation on non-medical legal issues.
Through the Kramer Clinic's Health Law Clinic, third-year law students can, under faculty supervision, represent children and adults in administrative and court proceedings. MLPs also work to train doctors on what the signs of issues that may be rooted in legal problems.
At St. Vincent, rather than focusing on children, the MLP will be the first of its kind in Ohio to focus solely on behavioral health and addiction diseases. St. Vincent estimates that 40% of the nearly 4,000 patients treated within its geriatric and adult psychiatric units need immediate legal help to remove barriers to improved health.
"We feel like when we just do what we do every day, unfortunately it's like putting a Band-Aid on this thing," said Dr. Albana Dreshaj, medical director of the psychiatric emergency room at St. Vincent. "But then the patients, when they're released, they kind of just go into the community, suffer the same results and then come back."
The MLP can help people with issues like eviction, guardianship issues, health insurance, homelessness, custody issues and more, she said. A two-year, $280,000 grant from the Jones Day Foundation will support a full-time Legal Aid attorney to partner with St. Vincent Charity clinicians, case workers, patient navigators and other caregivers. The hospital estimates that in the first year, the program will assist 175 patients and family members through 75 legal cases.
Many involved in MLPs are looking for ways to address systemic legal issues or greater policy decisions that impact health.
"We know that we only even meet a small fraction of the people who would be eligible and need our help, and of those, we can only help a very small number, because we're not a big shop," said Curry, of the HEAL project.
Clark is hoping that work will be down the line for the program at UH as people from different disciplines work together to address legal determinants of health.
"Coming together, we can kind of think about some systemic changes that could happen or how we could better work within the system to support families," she said. "So instead of working on an individual level, you can work on a more broad level and hopefully impact more families that way."
"Hospitals team up with lawyers to aid healing" originally appeared in Crain's Cleveland Business.