Medical-Legal Partnership: Lessons from Five Diverse MLPs in New Haven,Connecticut

Abstract

This article examines five different Medical-Legal Partnerships (MLPs) associated with Yale Law School in New Haven, Connecticut to illustrate how MLP addresses the social determinants of poor health. These MLPs address varied and distinct health and legal needs of unique patient populations, including: 1) children; 2) immigrants; 3) formerly incarcerated individuals; 4) patients with cancer in palliative care; and 5) veterans. The article charts a research agenda to create the evidence base for quality and evaluation metrics, capacity building, sustainability, and best practices; it also focuses specifically on a research agenda that identifies the value of the lawyers in MLP. Such a focus on the “L” has been lacking and is overdue.

Get full access to this article

View all access options for this article.

References

Farmer

, Infections and Inequalities: The Modern Plagues (University of California Press, 1999): 10 (quoting

Eisenberg

, “Rudolf Ludwig Karl Virchow, Where Are You Now That We Need You?” American Journal of Medicine 77, no. 3 (1984): 524–532).

NCHHSTP Social Determinants of Health, Centers for Disease Control and Prevention, available at <https://www.cdc.gov/nchhstp/socialdeterminants/faq.html> (last visited July 9, 2018).

E. A.

Benfer

, “Health Justice: A Framework (and Call to Action) for the Elimination of Health Inequity and Social Injustice,” American University Law Review 65, no. 2 (2015): 278-302.

Utility Access and Health: A Medical-Legal Partnership Patients-to-Policy Case Study, MEDICAL-LEGAL PARTNERSHIP BOSTON (June 2010), available at <http://www.kidscounsel.org/Utility%20Access%20and%20Health%20An%20MLPPatients-to-Policy%20Case%20Study.pdf> (last visited July 9, 2018).

Engaging Legal Services in Community Efforts to Prevent and End Homelessness, U.S. Interagency Council on Homelessness, available at <https://www.usich.gov/resources/uploads/asset_library/Engaging_Legal_Services.pdf> (last visited April 20, 2018).

National Center for Medical Legal Partnership, available at <http://www.medical-legalpartnership.org> (last visited July 9, 2018).

Id.

M. D.

Klein

et al ., “Doctors and Lawyers Collaborating to HeLP Children — Outcomes from a Successful Partnership between Professions,” Journal Health Care for the Poor and Underserved 24, no. 3 (2013): 1063–1073;

M. M.

O'Sullivan

et al ., “Environmental Improvements Brought by the Legal Interventions in the Homes of Poorly Controlled Inner-city Adult Asthmatic Patients: A Proof-of-Concept Study,” Journal of Asthma 49, no. 9 (2012): 911–917;

Weintraub

, “Pilot Study of Medical-Legal Partnership to Address Social and Legal Needs of Patients,” Journal of Health Care for the Poor and Underserved 21, no. 2 (2010): 157-168, available at <https://pdfs.semanticscholar.org/ed0a/13cd12a56341dbb61a90ae056ba6d0923eaf.pdf> (last visited September 13, 2018).

10.

Regenstein

et al ., The State of the Medical-Legal Partnership Field, National Center for Medical-Legal Partnership (August 2017), available at <http://medical-legalpartnership.org/wp-content/uploads/2017/07/2016-MLP-Survey-Report.pdf> (last visited July 9, 2018).

11.

Martin

et al ., “Embedding Civil Legal Aid Services in Care for High-Utilizing Patients Using Medical-Legal Partnership,” Health Affairs, available at <https://www.healthaffairs.org/do/10.1377/hblog20150422.047143/full/> (last visited April 20, 2018);

J. A.

Teufel

et al ., “Rural Medical-Legal Partnership and Advocacy: A Three-Year Follow-Up Study,” Journal of Health Care for the Poor and Underserved 23, no. 2 (2012): 705–714.

12.

O'Connor

, “Legal Advice as a Determinant of Health,” Hospitals & Health Networks, available at <https://www.hhnmag.com/articles/8532-legal-advice-as-a-determinant-of-health> (last visited July 9, 2018).

13.

26 C.F.R. §1 (2017); 26 C.F.R. §53 (2017); 6 U.S.C. §501(r) (3) (2012).

14.

Abraham and

Buchanan , Greater New Haven Community Index 2016, DataHaven (2016): at 18, available at <http://www.milfordhospital.org/about/community-health-needs-assessment/2016-CHNA-with-Plan.pdf> (last visited July 9, 2018).

15.

Kolko

, “‘Normal America’ is not a Small Town of White People,” FiveThirtyEight, April 28, 2016.

16.

A. N.

Nepaul

et al ., The Burden of Asthma in Connecticut: 2012 Surveillance Report, Connecticut Department of Public Health (2012): at 124, available at <http://portal.ct.gov/-/media/Departments-and-Agencies/DPH/dph/hems/asthma/pdf/Fullreportwithcoverpdf.pdf?la=en> (last visited July 9, 2018).

17.

Abraham, supra note 14, at 33.

18.

Stajduhar and

Mollison , “How the Social Determinants of Health Shape End-of-Life Experiences for Vulnerable Population and Their Care Providers,” paper presented at the European Association of Palliative Care 15th World Congress, Victoria, BC, Canada (May 20, 2017), available at <https://www.uvic.ca/research/groups/peol/home/news/current/presentation-at-the-european-association-of-palliative-care-2017.php> (last visited July 9, 2018).

19.

McInturff and

Harrington , 2011 Public Opinion Research on Palliative Care, Center to Advance Palliative Care (2011), available at <https://media.capc.org/filer_public/18/ab/18ab708c-f835-4380-921d-fbf729702e36/2011-public-opinion-research-on-palliative-care.pdf> (Last visited September 13, 2018);

Hallarman

et al ., “Blueprint for Success: Translating Innovations from the Field of Palliative Medicine to the Medical-Legal Partnership,” Journal of Legal Medicine 35, no. 1 (2014): 179-194.

20.

Stajduhar and

Mollison , “How the Social Determinants of Health Shape End-of-Life Experiences for Vulnerable Population and Their Care Providers,” paper presented at the European Association of Palliative Care 15th World Congress, Victoria, BC, Canada, May 20, 2017, available at <https://www.uvic.ca/research/groups/peol/home/news/current/presentation-at-the-european-association-of-palliative-care-2017.php> (last visited July 9, 2018)

21.

M. A.

Zevon

et al ., “Medically Related Legal Needs and Quality of Life in Cancer Care,” Cancer 109, no. 12 (2007): 2600–2006.

22.

Id.

23.

K.J.

Rodabaugh

et al ., “A Medical-Legal Partnership as a Component of a Palliative Care Model,” Journal Palliative Medicine 13, no. 1 (2010): 15–18.

24.

Shavit

et al ., “Transitions Clinic Network: Challenges and Lessons In Primary Care for People Released From Prison,” Health Affairs 36, no. 6 (2017): 1006-1015;

Puglisi

, “What Does Health Justice Look Like for People Returning from Incarceration?” AMA Journal of Ethics 19, no. 9 (2017): 903-910.

25.

Shavit , et al., “Transitions Clinic Network: Challenges and Lessons in Primary Care for People Released From Prison,” Health Affairs 36, no. 6 (2017): 1006–1015.

26.

Id.

27.

Id.

28.

D.M.

Dumont

et al ., “Sesame Street Goes to Jail: Physicians Should Follow,” Annals of Internal Medicine 161, no. 7 (2014): 522-524.

29.

S.A.

Kinner

et al ., “Service Brokerage for Improving Health Outcomes in Ex-Prisoners,” Cochrane Database of Systematic Reviews, no. 2 (2013), doi: 10.1002/14651858.CD010343.

30.

Transitions Clinic Network, GiveGreater.org, available at <http://givegreater.guidestar.org/profile/1147475/transitions-clinic-network.aspx> (last visited July 9, 2018).

31.

Id.

32.

Maschi and

R.H.

Aday , “The Social Determinants of Health and Justice and the Aging in Prison Crisis: A Call for Human Rights Action,” International Journal of Social Work 1, no. 1 (2014): 15-33, at 19; see also Dumont, supra note 528.

33.

Shavit, supra note 25.

34.

Id.

35.

Yale Law School, “Finding a Cure Through Law,” available at <https://law.yale.edu/yls-today/news/finding-cure-through-law> (last visited July 9, 2018).

36.

Manchanda

et al ., Veterans Facing Health-Harming Legal Needs in Civilian Life, National Center for Medical-Legal Partnership (June 2016), available at <http://medical-legal-partnership.org/wp-content/uploads/2016/06/The-Invisible-Battlefield.pdf> (last visited July 9, 2018).

37.

Tsai

et al ., “Partnerships Between Health Care and Legal Providers in the Veterans Health Administration,” Psychiatric Services 68, no. 4 (2017): 321–323.

38.

Id.

39.

Community Homelessness Assessment, Local Education and Networking Groups (CHALENG), U.S. Department of Veterans Affairs (June 2016), available at <https://www.va.gov/HOMELESS/docs/CHALENG-2016-fact-sheet-508-2017-07-29.pdf> (last visited July 9, 2018).

40.

Tsai, supra note 37;

Tsai

et al ., “Medical-Legal Partnerships at Veterans Affairs Medical Centers Improved Housing and Psychological Outcomes for Vets,” Health Affairs 36, no. 12 (2017): 2195–2203.

41.

Id.

42.

How CVLC Works, Connecticut Veterans Legal Center, available at <https://ctveteranslegal.org/how-cvlc-works/> (last visited April 20, 2018).

43.

Veterans Discharge Upgrade Manual, Connecticut Veterans Legal Center (2011); see also Applying for a Discharge Upgrade When You Have PTSD, The Jerome N. Frank Legal Services Organization – Veterans Legal Services Clinic (2014).

44.

About the Clinic, HAVEN Free Clinic, available at <https://www.havenfreeclinic.com/aboutus> (last visited April 20, 2018).

45.

Id.

46.

Teufel, supra note 11;

Pettignano

et al ., “The Health Law Partnership: Adding a Lawyer to the Health Care Team Reduces System Costs and Improves Provider Satisfaction,” Journal Public Health Management & Practice 18, no. 4 (2012): E1;

Knight

, “Health Care Recovery Dollars: A Sustainable Strategy for Medical-Legal Partnerships?,” The Medical Legal Partnership for Children, April 3, 2008, available at <https://static1.squarespace.com/static/5373b088e4b02899e91e9392/t/53cd59cae4b02facb9407e39/1405966794425/Medical-Legal+Partnership+Health+Care+Recovery+Dollars.pdf> (last visited April 20, 2018).