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Lawyers, doctors team up to reduce health disparities

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On Kate Marr’s first day practicing law at The Children’s Clinic in Long Beach last week, she met with the mother of an asthmatic 7-year-old. Health clinic workers sent the woman, a Mexican immigrant, to Marr's office because they suspected there was a connection between the boy’s asthma and the family's apartment – where paint peels from the walls, cockroaches inhabit the floorboards and only one electrical outlet functions.

An attorney who has practiced with the Legal Aid Foundation of Los Angeles for more than a decade, Marr is now seeing clients at the clinic two days a week as part of a new medical-legal program that seeks to address the issues underlying patient treatment.

“We can treat a child with asthma and give them the right medications, but if they live in a rental house that has mold growing on the ceiling, we won’t be able to control the asthma until we address the housing issue,” says Dr. Elisa Nicholas, CEO of The Children’s Clinic. “So many issues that impact health are legal issues.”

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“The medical-legal partnership model is about bringing legal services into the health care setting to address patient legal needs in order to improve health and well-being,” says Dr. Megan Sandel, interim executive director of the National Center for Medical-Legal Partnership and an associate professor of pediatrics at the Boston University School of Medicine. Dr. Barry Zuckerman, a physician at Boston University, developed the model in 1993.

These partnerships have become increasingly popular nationwide. There are more than 90 programs in 235 clinics or hospitals across the country, and California has developed the most medical-legal partnerships of any state. There are more than two dozen of these arrangements in community clinics and hospitals spanning the state, from Chico to Oakland and San Diego.

“Medical-legal partnerships are the wave of the future in legal and medical services, at least in the low-income context,” Marr says.

In addition to the Long Beach program, a similar project was started in the Boyle Heights neighborhood of Los Angeles this fall. A partnership is in development in San Bernardino, and next year, a medical-legal program will open in San Francisco that will work specifically with elderly patients through a partnership between UC San Francisco and the UC Hastings College of the Law.

Physicians say the housing case that attorney Marr encountered at The Children's Clinic is a prime example of why these partnerships are necessary.

“There are reasons why a family comes in for medical care that can result from issues that lawyers or social workers are able to help with,” says Dr. Dana Weintraub, assistant professor of pediatrics at the Stanford University School of Medicine and co-founder of the Peninsula Family Advocacy Program, the state's oldest legal-medical partnership. "Doctors do see the impact of these many issues on families, but we don’t have the resources to address these issues, and it seems like a natural partnership to work with like-minded attorneys.”

There also are financial benefits and cost savings associated with these partnerships. One study found a 50 percent reduction in emergency room visits after medical-legal partnerships were established. Another study [PDF] found that one partnership was able to recover $923,188 in Medicare and insurance reimbursements for 17 patients over a 45-month period, thanks to legal advocacy from the partnership.

Marr says working from the Long Beach health clinic allows her to work with clients who don’t know that free legal help is available to them. The client with the asthmatic son, for example, also was facing problems related to domestic violence, immigration and access to food stamps.

“There are so many barriers for low-income people to having good health,” Marr says. “There is a huge crossover between their legal needs and their medical needs.”

Legislation was introduced in September to provide funding to support these partnerships nationwide.

“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,” U.S. Sen. Tom Harkin, D-Iowa, who co-sponsored the bill, said in a statement. “Coordinating preventive health care with preventive law will help ensure that families receive the care and benefits they need and live in conditions that promote their well-being.”

Correction: An earlier version of the story misstated the title of Dr. Elisa Nicholas of The Children's Clinic. She is its CEO.

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