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Lawyers as Part of Health Care

Posted May 12 2010 4:36am
March 23, 2010
NY Times

When Doctor Visits Lead to Legal Help

By ERIK ECKHOLM

It was not the normal stuff of a pediatric exam. As a doctor checked the growth of Davon Cade’s 2-month-old son, he also probed about conditions at home, and what he heard raised red flags.

Ms. Cade’s apartment had leaky windows and plumbing and was infested with roaches and mold, but the city, she said, had not responded to her complaints. On top of that, the landlord was evicting her for falling behind on the rent.

Help came through an unexpected route. The doctor referred Ms. Cade to the legal aid office right inside the pediatric clinic at Cincinnati Children’s Hospital.

Within days, a paralegal had secured an inspection that finally forced the landlord to make repairs, and also got the rent reduced temporarily while Ms. Cade searched for less expensive housing.

“It got done when the lawyers got involved,” Ms. Cade said.

Doctors and social workers have long said that medical care alone is not enough to address the health woes of the poor, which are often related to diet, living conditions and stress.

The pediatric clinic in Cincinnati is one of 180 medical sites around the country that now seek to address at least some of these broader issues by bringing lawyers and doctors — so often foes in the courtroom — together into a close partnership.

In a process being duplicated nationally — the latest partnership started in West Virginia in the fall — the doctors at Children’s Hospital, using a protocol that started 18 months ago, referred 500 patients for legal aid last year. Some needed help getting food stamps, heating aid or cash welfare that had been wrongfully denied; some received help with evictions or home repairs; others got legally mandated help for children with learning disabilities.

The idea was developed in the 1990s by Dr. Barry Zuckerman , chief of pediatrics at the Boston Medical Center. In recent years it has taken off, mainly in pediatric centers, although the technique is being tried with cancer and geriatric patients as well.

“This has transformed the way we think about giving care,” said Dr. Robert S. Kahn , a pediatrician at Children’s Hospital who helped start the collaboration with the Legal Aid Society of Greater Cincinnati .

A survey of patients in Dr. Kahn’s clinic, where nearly all are on Medicaid , found that 28 percent of families had their gas or electricity cut off in the previous year and that 23 percent had doubled up in housing or had to move to a cheaper residence. One in seven mothers with infants said they had diluted their formula to make it last, and one in three said they had sometimes run out of formula without money to buy more.

The partnerships do more than provide quick access to legal aid, Dr. Zuckerman said. They alter perspectives for both the medical and legal professions, as physicians become better at spotting underlying threats to health, and lawyers engage in what he called “preventive law.” The concept has been officially endorsed by the American Bar Association and the American Academy of Pediatrics .

A recurring concern of hospital executives has been that patients might try to draw the lawyers into malpractice suits. Dr. Zuckerman said that had not happened, and the legal aid groups involved say that malpractice was not their mandate and that they would tell complaining patients to seek advice elsewhere.

A vital first step is teaching doctors how to ask the right questions, said Elaine Fink , a senior lawyer with the Legal Aid Society who founded the partnership with Dr. Kahn of Children’s Hospital.

“What can a doctor feel comfortable asking in a few seconds that will identify a legal issue?” Ms. Fink said. “It’s quite different from an attorney questioning a client.”

The society helped develop a two-week course that teaches medical interns how to ask about home life, school and finances during routine exams.

Diana A. of Cincinnati took her prematurely born daughter for her first checkup in the fall. (She spoke on condition she not be identified because she did not want her relatives to know of her hardships.) Diana said she had been working as a home-health aide and had received no paid maternity leave. Her application for food stamps had inexplicably languished. “Pretty much all I was eating was oatmeal,” she said.

The baby was not gaining the expected weight. Doctors introduced her to Deanna White, a paralegal who got Diana baby formula and other aid on the spot, and food stamps and temporary cash assistance within days. Her daughter is now doing fine.

Felisa Tremble’s 16-year-old son was flunking out of school and she had been unable to get his learning disabilities properly diagnosed until she took him to Children’s Hospital. A psychiatric nurse called in legal aid and with that help, Ms. Tremble said, Medicaid paid for a costly neuropsychological exam and the school developed an individual learning program for her son.

“He likes school now,” Ms. Tremble said. “If we hadn’t seen the lawyers, maybe he wouldn’t be in school at all.”

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