A new model for treating population health issues and their attendant social needs leverages legal resources in civil cases. In these partnerships a lawyer in-residence at a hospital provides legal advice to patients while also participating in those clinical meetings related to them.  These partnerships are present at hundreds of hospitals around the nation, including children hospitals and VA Medical Centers.  Funding for these efforts stems from federal and state subsidies (legal aid appropriations), academic research grants, and private/corporate philanthropy.  Those interested in learning more about Medical-Legal Partnerships (MLP) can access useful information at: https://medical-legalpartnership.org/need/.

I have always found it surprising that criminal cases have legal representation readily provided by the government but not so for civil cases.  In a criminal case, a person is charged with an offense by a prosecutor or district attorney. By way of contrast, civil cases are those where a person or entity fails to carry legal duties with respect to a plaintiff.  Costs in civil cases can be substantial, including: attorney’s fees, transcripts, expert witnesses, copying fees, and filing fees. Furthermore, according to Lawyers.com, “Awardable costs could be capped under an applicable state law, and that limit may not come close to making the prevailing party whole in terms of what was expended to successfully litigate the case”. Medical Legal Partnerships integrate free legal services in the healthcare setting.

In many medical conditions, health problems are just the tip of the iceberg.  There are social determinants of health and their additive effects provides toxic stress.  Conditions of prolonged adversity early in life, including physical and emotional injuries, are risk factors leading to behavioral, learning and health related deterioration across the lifespan of the individual. This toxic stress is most prevalent among low-income families and vulnerable community members because of inequities ingrained within our health and social system.  Poverty affects life choices and is the seed of life burnouts.  This is a vicious cycle wherein physical and emotional exhaustion caused by chronic/toxic stress leads to cynicism and detachment, as well as feelings of worthlessness.  The end result is chronic fatigue, insomnia, forgetfulness, and an increased likelihood for developing comorbidities.

Figure: Adverse Childhood Experiences Pyramid.

Some MLPs focus on a vulnerable population (e.g., veterans) but others do so on a particular medical condition.  With limited resources, a focus on a particular patient population (e.g., pediatrics) or a particular condition (e.g., autism) can achieve health related changes within a community and bypass the strenuous work required in pursuing many individual efforts.

Legal services may be necessary to:

• Help acquire resources (income to meet daily basic needs)
• Access to jobs
• Improve quality education and advance job opportunities
• Acquire proper housing and utilities: a healthy physical environment
• Provide personal and family stability through safe homes and social support
• Prevent or stop illegal evictions and improper terminations of housing subsidies
• Prevent mortgage foreclosure
• Ensure that repairs and services are made to unsafe rental houses
• Challenge discrimination through fair housing claims

Medical-Legal Partnerships may also help gain access to social support services, health screening, and connect patients to adequate governmental resources. Remember that everyone has a fair and just opportunity to be as healthy as possible. This requires removing obstacles to health, such as poverty, discrimination, lack of access to good jobs with fair pay, quality education, housing, safe environment, and health care (Health Equity Report 2017).