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“Improving Patient Care by Sustaining MLPs” by Professor Sylvia Caley

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Medical-legal partnership (MLP), a health care model that adds lawyers to the health care team to enhance the team’s ocaley finalverall ability to improve health outcomes, has been in existence for over two decades. While the MLP movement originated in the Department of Pediatrics at Boston Medical Center with the founding of the Family Advocacy Program, the concept of associating lawyers, particularly legal services lawyers, to address legal problems affecting health and stemming from poverty, has spread, not only nationwide, but internationally.  The model has expanded beyond pediatrics to include adults, seniors, disease-specific groups, and veterans.

According to the National Center for Medical-Legal Partnership, the MLP network boasts membership of 135 hospitals, 127 health centers, 35 health schools, 127 legal services organizations, 46 law schools, and 70 pro bono partners. While these numbers are impressive, they represent the tip of the iceberg. The National Center for Medical-Legal Partnership reports that in the U.S., one in six people live in poverty and experience at least one civil legal problem negatively affecting their health and well-being. The problems are well known—substandard rental housing conditions exacerbating health conditions, lack of appropriate legal decision-makers and caretakers for patients lacking capacity due to minority status or disease processes, inability to access the broad array of public benefits for which the patients are legally entitled, and, in the case of children, the inability to access a free and appropriate public education because the need for special education services goes unidentified and unaddressed. The MLP movement works to remedy these barriers to health by making legal care readily accessible to both the healthcare team and the patient.

The existing MLP network believes that adding specially trained lawyers, well-versed in the laws, regulations, and policies dealing with poverty and access and culturally prepared to interface effectively with the health care team, benefits not only patients and overall patient care, but also providers and health care institutions. The American Academy of Pediatrics, American Bar Association, American Medical Association, Equal Justice Works, Legal Services Corporation, and the U. S. Department of Veterans Affairs, among others, agree. So, why doesn’t every hospital and health center have a MLP? While some vestiges of concern remain about permitting lawyers not employed by the health care institution to have access to patients and providers, the main barrier to proliferation of MLPs is lack of resources.

Currently, the vast majority of MLPs include a legal services organization as the legal partner. These organizations overwhelmingly address the legal needs of the poor in America. They also raise the funds and deploy the lawyers to provide the necessary legal care within the integrated health care setting. Many health care entities provide designated space within their walls for MLPs and encourage and support referral of patients to the MLP, but in most instances skin in the game does not include a commitment to generating funds to finance the provision of legal care. Sustainable MLPs require dependable, predictable, year-in, year-out funding.

Many MLPs are collecting data on the benefits of their work to the healthcare entity. MLP successes translate to costs avoided by the hospital or health center. Anecdotally, providers report that their collaborations with a MLP provide them with more time to focus on patient care, increased efficiency, and reduced stress. All of these are sound reasons to invest in MLP. Health care entities should spur the growth of MLP by contributing to the financial support of the lawyers delivering the legal care. These institutions should require their foundations to actively fundraise for the creation and ongoing support of a MLP and also should identify and fund a physician to serve as medical director for the MLP. Today’s health care problems are too complex to operate in silos. Integrating lawyers into the team is the model for 21st Century health care delivery. The health care system needs to fund this necessary integration.

Sylvia Caley is the director of Health Law Partnership, and associate clinical professor and co-director of HeLP Legal Services at Georgia State University College of Law, focusing on the intersection of health and poverty, particularly the devastating effect that serious illness of a child can have on families. The Health Law Partnership (HeLP) Legal Services Clinic is part of the Health Law Partnership, a medical-legal collaboration among Georgia State Law, Children’s Healthcare of Atlanta and the Atlanta Legal Aid Society.

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One thought on ““Improving Patient Care by Sustaining MLPs” by Professor Sylvia Caley

  1. As Professor Caley highlights, medical-legal partnerships can produce a range of positive outcomes. One notable benefit is that legal advocacy that addresses the root causes of poor health (e.g., the impact of substandard housing on asthma in children) can help prevent adverse health outcomes. Beyond cost savings over the long-term, “moving upstream” to address issues that trigger illness enables children to stay healthier and miss fewer days of school. Lower absenteeism rates give children a better chance of reaping the benefits of education. The other benefits of MLP are significant, and Caley is correct that we need to ensure MLPs have the funding they need to be successful in improving health outcomes.

    Last, just as a footnote, we all should take note of Caley’s use of the term “legal care.” If we all thought of legal services as “legal care” (just as we talk of receiving health care not merely health services), we might develop more supportive, client-centered approaches to the law.

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