Legal issues can often cascade into problems with bad medical outcomes
By Anamika Roy
BridgeTower Media Newswires
BALTIMORE — As health care systems continue to shift toward becoming comprehensive medical homes for patients, health care providers are increasingly incorporating lawyers into the team of professionals who are on hand to help people at no additional charge to patients.
Roughly 300 health care systems, children’s hospitals and federally qualified health centers across the country have set up these programs, said Ellen Lawton, co-director of the National Center for Medical-Legal Partnership at The George Washington University in Washington, D.C.
A long-standing program in Maryland is Project HEAL, an effort of the Maryland Center for Developmental Disabilities at the Kennedy Krieger Institute. Project HEAL provides legal services for children with both intellectual and developmental disabilities and their families. The program partners with several area law firms, including Baker Donelson, Offit Kurman, DLA Piper and Ballard Spahr LLP.
Baker Donelson, formerly Ober|Kaler, has been involved with Project HEAL for at least 12 years, offering pro bono assistance with special education matters, said Paul Sugar, senior counsel in the firm’s Baltimore office.
Since 2014, DLA Piper’s Baltimore office has been offering similar services to Project HEAL as part of its nationwide pro bono effort, “Advancing Education’s Promise.”
“Nowhere is the promise of education more at risk than when economically disadvantaged disabled children are denied the services that the law requires schools to provide for them,” said Ray Earnest, senior pro bono attorney at DLA Piper.
Ballard Spahr attorneys in Baltimore also take on pro bono cases with Project HEAL, including immigration, lead paint, and future planning issues to help families once their special needs child becomes an adult, said Mary Gay Scanlon, the firm’s pro bono counsel.
The firm usually has three or four attorneys working with Project HEAL, along with support staff.
“We staff them just like we would staff any other case,” Scanlon said.
Offit Kurman started working with Project HEAL earlier this year after firm principal Rajiv Goel, who is on a committee at Kennedy Krieger, saw a presentation on the program. Another firm attorney, Sara N. Cimino was a law clerk with the program as a law student.
“I was blown away by the what they’re doing and their mission and that’s when we had a conversation with Project Heal about what we as a firm could do help them,” Goel said.
Other medical-legal partnerships in Maryland are also in the works at Health Care for the Homeless in Baltimore and Holy Cross Health Network in Montgomery County, said Lawton, from the National Center for Medical-Legal Partnership.
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Natural pairing
The pairing makes sense in many ways. Legal issues all too often can cascade into problems with bad medical outcomes. Lawyers might file for an order of protection from a violent spouse, help appeal an insurance claim denial or get involved in child custody, guardianship or power of attorney issues.
For Care Connections at Lancaster General Health/Penn Medicine in Lancaster, Pa., housing problems are a key area that requires legal expertise. The four-year-old program provides comprehensive primary care services for people with complex health and social needs, especially patients who are frequently hospitalized, said Dr. Jeffrey Martin, managing physician for the program.
For someone with severe asthma and other chronic medical conditions, “it’s hard to use inhalers and take 16 other medications if you’re living in the back of a car or on someone’s couch,” he said.
When someone is fighting eviction, has problems with federal housing subsidies, suffers a utility shutoff or has poor housing conditions, Care Connections staff call on Catherine Schultz. She is a legal aid lawyer with MidPenn Legal Services, which has a contract to work on such cases for Lancaster General Hospital.
Martin described the case of one patient, a licensed practical nurse in her mid-30s who was diagnosed with multiple sclerosis. She lost her job because she could no longer work, and then her car was repossessed. She stopped taking her medications and couldn’t make it to her medical appointments.
Schultz worked to get the woman a federal housing subsidy and apply for Social Security disability benefits, then appeal the administration’s denial of benefits. They’re awaiting the results of the appeal.
Value-based care
In fee-for-service medicine, a hospital’s work was considered finished once patients were discharged, Lawton noted.
But health care has shifted toward value-based care that focuses on outcomes and avoiding preventable hospital readmissions. Now, “you are accountable for patients beyond the four walls of the hospital, and you have to think creatively about how to create stability for them,” Lawton said.
Many health care systems are focusing on medical-legal partnerships that target patients who are high users of services.
“Once upon a time, the attitude of the provider was, ‘It’s not my problem that you have mold in your apartment,’” said Emma Kagel, manager of medical-legal partnerships at Denver-based Centura Health System. “‘I’m just going to keep pumping you full of steroids and give you an inhaler.’” That attitude doesn’t work with value-based care, she said.
Funding is always a problem for these programs where demand far outstrips supply. They are frequently staffed by legal aid attorneys under contract to the health care providers. Some programs use private-sector lawyers working on a pro bono basis.
