By Lauren M. Darisse, Esq.
Associate Vice President, Compliance & Legal Affairs
Greater Lawrence Family Health Center

Greater Lawrence Family Health Center has recently started a new Medical-Legal Partnership (MLP) with Northeast Legal Aid. The partnership is funded through the generosity of the Cummings Foundation. As part of the MLP, a Northeast Legal Aid Staff Attorney has an office at GLFHC’s Haverhill Street facility but will provide free legal assistance to patients from all GLFHC locations. This article provides background on the important benefits that can arise from the partnership.

MLP Definition

MLPs marry the clinical expertise of healthcare staff with the legal knowledge of attorneys to create solutions to various Social Determinants of Health (SDOH) issues. SDOH are largely subjective issues to tackle; however it is crucial that patients are asked questions about these conditions to paint a complete picture of their overall wellbeing. If the right questions are asked and tracked over a period of time it can help determine quality metrics, success of SDOH initiatives and give on-site counsel sufficient data to hone in on issues that matter the most to the health of the population. In a MLP setting patients that screen “positive” for these issues will be offered legal services to assist. On-location legal support is key because it closes the access gap and allows for a warm handoff.

MLP History

Although the MLP sounds like a new and innovative approach to health it has been in motion for fifty years. In 1967 Dr. Jack Geiger brought an attorney on board at the Delta Health Center to help patients with food and housing issues.[1] A decade later the AIDS epidemic prompted other healthcare organizations to partner with legal counsel to address end-of-life needs for this population.[2] The first “official” MLP was established right in our own back yard at Boston Medical Center in 1993.[3] Thirteen years later the National Center for Medical-Legal Partnership was formed to serve as a platform for program awareness and development across the country.[4] Today there are 333 participating health organizations in 46 states.[5]

Relevance to Health Outcomes

Any SDOH can be addressed using the MLP model. Issues such as housing, wrongful public benefit denial, immigration and domestic violence play a large role in the health of our communities and should be considered in the healthcare setting.

Lack of adequate housing and/or homelessness contributes to health in several ways. In the Federally Qualified Health Center (“FQHC”) setting clinical staff often indicate that homelessness directly impacts medication adherence. Often this is tied to transportation issues and patients literally can’t get to the pharmacy location; however it should be noted that self-esteem also plays a role here. Think for a moment about the questions that are typically asked when picking up a prescription. Certainly pharmacy staff will want to verify identification. This can be done by asking for the patient’s name, date of birth, address and government-issued identification. On countless occasions patients have expressed to GLFHC pharmacy staff that they are embarrassed to come in to pick up medication because they do not have an address or their address is a shelter. As such, medication adherence is in jeopardy when housing issues arise. Lead exposure/poisoning and asthma can also be attributed to poor housing.

Patients who are victims of domestic violence are, with good reason, often scared to document their whereabouts. It is unfortunately all too common that patients who are dealing with safety concerns choose not to attend necessary medical visits due to the crippling fear of being located. Immigration concerns are very similar to the healthcare avoidance seen in domestic violence victims. While physical safety might not be an obvious concern in this instance it is very likely a real one. If a patient is in the country illegally and faces deportation to his/her country of origin (s)he could be very fearful to be discovered in the clinic. In light of the increased media attention to immigration enforcement this is a very real concern for many. An MLP could educate undocumented persons as to their rights as well as assist with the citizenship process.

Food insecurity is the classic SDOH example. It is no secret that poor eating habits result in issues such as obesity, diabetes, high blood pressure and a laundry list of related medical problems. Many are left with processed and unhealthy foods as their sole source of nutrition. A few years ago, GLFHC collaborated with Greater Boston Food Bank and Project Bread to introduce a “Mobile Market” to Lawrence residents. Participants receive fresh produce at no cost on a monthly basis. This is certainly a major improvement, but issues still remain. An MLP could address problems like difficulty accessing food stamps or baby formula and would create a stronger case for financial support of food insecurity initiatives like the Mobile Market.

Education, or lack thereof, has already been clearly defined as a SDOH. An MLP could educate patients and staff about important rights which are granted by local, state and/or federal laws and regulations. Know your rights” information sessions are but one example of the positive reinforcement an on-site attorney could provide to patients and staff alike. MLP support will also help prevent the denial of much needed public benefits where they are needed and deserved.

Studies have shown that patients assisted by a MLP are more likely to take medications as prescribed, report less stress and improved mental health and are admitted to the hospital less often.[6] MLPs have a positive impact on the bottom line as well. As a direct result of MLP initiative there is a reduced spend on total healthcare costs.[7]

Barriers

One might be hard-pressed to ascertain why MLPs don’t exist at all healthcare facilities. Surely the benefits are worth the time and money, so why is it such a rarity? Unfortunately the answer to these questions is lack of funding. There are few grants available and it has proven to be a difficult task to secure them. Fortunately, Northeast Legal Aid has procured a grant from the Cummings Foundation which will support a full-time attorney for the MLP for a two year period. More information about the GLFHC MLP is to come!

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[1] Lawton, E. (2015, January). The Medical-Legal Partnership. Community Health Forum- National Association of Community Health Centers. Retrieved December 2, 2018, from https://medical-legalpartnership.org/wp-content/uploads/2015/01/NACHC-Magazine-A-History-of-the-Medical-Legal-Partnership-Movement.pdf. 1-3. Retrieved from https://medical-legalpartnership.org.

[2] Id.

[3] Zuckerman B, Sandel M, Lawton E, Morton S. Medical-legal partnerships: transforming health care. Lancet. 2008;372:1615–1617. doi: 10.1016/S0140-6736(08)61670-0.

[4] National Center for Medical-Legal Partnership. Available at: http://www.medical-legalpartnership.org/. Accessed June 30, 2009.

[5] Id.

[6] National Center for Medical Legal Partnership. (n.d.). Retrieved December 2, 2018, from https://medical-legalpartnership.org/impact/

[7] Id.