Medical-legal partnerships receive boost in new bills

Washington -- A bipartisan group of lawmakers has introduced bills that would allocate $10 million to test the value of medical-legal partnerships.

MLPs integrate legal assistance into the medical setting in an effort to improve the well-being of patients. They seek to eliminate barriers to a healthy lifestyle that often prevent vulnerable populations from getting the care they need.

"Assistance in navigating our legal system is sometimes all it takes to prevent individuals and their families from making repeated trips to the doctor or hospital for a reoccurring condition," said Sen. Tom Harkin (D, Iowa), chair of the Health, Education, Labor and Pensions Committee.

On July 29, Harkin, along with Sens. Evan Bayh (D, Ind.) and Kit Bond (R, Mo.), introduced the bill -- the Medical-Legal Partnerships for Health Act. Reps. Daniel Maffei (D, N.Y.) and Christopher Murphy (D, Conn.) introduced companion legislation in the House.

"MLPs help people obtain legal aid necessary to ensure that they receive the care and benefits they deserve to lead healthier lives and to avoid future injuries and illnesses," Harkin said. "Through making investments in MLPs, we also save money by addressing preventable health conditions. It is my hope that we can get the support needed in Congress for this important service."

The lawmakers said the legislation would:

• Provide federal support to hospitals and attorneys to establish MLPs and encourage local buy-in by requiring each MLP to match at least 10% of federal grant funding.
• Help cut health care costs by reducing emergency department visits.
• Support a healthier work force by reducing the rate at which employees are absent from work or show up despite being ill.

A growing concept

Attorneys and paralegals are partnered with physicians and nurses at more than 200 hospitals, health centers and group practices nationwide, according to the National Center for Medical-Legal Partnership, founded at Boston Medical Center's Dept. of Pediatrics in 1993.

According to BMC, nearly 70% of its patients are poor, making them particularly vulnerable to environmental and social stressors that impact health.

Barry Zuckerman, MD, said he founded the center after becoming frustrated with continuously having to send sick children home to apartments that were in substandard condition, often unheated and with unhealthy levels of mold.

He said he recognized that an attorney could help patients navigate complex legal problems so patients could avoid situations that lead to medical problems, such as a lack of food or heat.

"We can treat the health problem with medication, but the point is the cause of it frequently is a legal one, and we're going right to the root cause," said Dr. Zuckerman, who is also professor and chair of pediatrics at the Boston University School of Medicine. "It's amazing how many people get their utilities shut off in the winter when it need not happen. These are things that our lawyers can help us prevent."

Initially, the center helped provide legal services exclusively on behalf of children, but it expanded the effort in January 2009 to assist all individuals.

For the past year, the center has been monitoring the progress of a pilot study examining the impact of MLPs. Preliminary data have shown a 50% decrease in ED visits after medical-legal interventions.

Dr. Zuckerman hopes that the new bills in Congress will help launch a more cohesive national program that would build on the resources started by his center and others.

In New York, for instance, the Syracuse Medical Legal Partnership links training programs in a pediatrics department with a clinical program at the Syracuse University College of Law. At the University of Kansas, law students work at the Family Health Care Legal Services Clinic to assist poor clients who have been referred to them through Southwest Boulevard Family Health Care in Kansas City, Kan.

Physician support

The concept of MLPs has received the backing of several physician organizations, including the American Medical Association.

At the AMA Annual Meeting in Chicago in June, the Board of Trustees recommended that the Association "should encourage physicians to develop MLPs to help identify and resolve diverse legal issues that affect patients' health and well-being."

"Through this partnership, the unmet legal or environmental needs of patients can be addressed before they reach crisis proportions," said AMA board member David O. Barbe, MD. "The AMA encourages physicians to develop medical-legal partnerships, and we will help them do this by creating a model agreement and working with key stakeholders on education."

MLPs also have received support or endorsement from other groups, including the American Academy of Pediatrics, the American Hospital Assn. and the American Bar Assn.