In 2006, Pisgah Legal Services (PLS) in Asheville proposed to NC IOLTA the initiation of an innovative new program—a medical-legal partnership (MLP) to ensure that patients could meet basic needs that would improve their health. When patients’ housing, educational, safety, and financial needs are met, medical interventions can have optimal impact, and the need for ongoing and crisis-driven medical care may be decreased. Such medical-legal collaborations were being implemented in many urban communities around the country, and PLS and Mission Hospital were eager to demonstrate the impact of this model in rural western North Carolina. Today, this partnership (the Health Education and Legal Support Project or HEALS) is thriving, and Legal Aid of NC (LANC), our statewide legal aid program, is expanding the model throughout the state.

Now endorsed by both the American Medical Association and the American Bar Association, the first such collaboration (the Family Advocacy Program at the Boston Medical Center) was founded by Barry Zuckerman, MD, chair of pediatrics at the Boston University School of Medicine. He said he founded the program after becoming frustrated with continuously having to send sick children home to apartments that were in substandard condition, often unheated and with unhealthy levels of mold. He recognized that an attorney could help patients navigate complex legal problems so patients could avoid situations that lead to medical problems, such as a lack of food or heat.

"We can treat the health problem with medication, but the point is, the cause of it frequently is a legal one, and we’re going right to the root cause," said Dr. Zuckerman.

In many situations, an attorney is uniquely qualified to assist patients to:

• escape an abusive relationship;
• defend their rights with a disreputable landlord; 
• preserve their housing and avoid homelessness; 
• avoid predatory creditors; or
• navigate the bureaucracy to secure Medicaid or disability benefits.

A True Collaboration

Through medical-legal partnerships, health care professionals and attorneys work together to form a safety network for their most vulnerable patients/clients. Legal experts are on site at hospitals and medical clinics to help physicians, nurses, social workers, discharge planners, and patients tackle the complex socio-economic issues that impact health. MLPs train healthcare staff to screen for potential legal issues that have a negative impact on health—such as substandard housing conditions that lead to chronic asthma—and try to intervene before a legal emergency arises. After a potential legal problem has been identified, the healthcare provider refers the patient to the MLP lawyer just as a patient would be referred to a cardiologist for a heart problem.

Kristoffer B. Shepard, senior associate general counsel at Carolinas HealthCare System and member of the LANC Board of Directors sees this collaboration from both sides. "One of our medical providers, Dr. Daniel R. Neuspiel, has been instrumental in helping us understand the critical role that lawyers can play in improving our patients' health. Sometimes we reach the limits of what we can do clinically for someone whose health is being affected by things that are outside of the traditional role of medicine."

Health care providers are more likely to screen patients for such problems when they know that they can refer patients for services to address those concerns. Lawyers can often get better results for a client when a medical professional is on the team. By collaborating with lawyers, medical professionals are gratified to see that they can often improve the health of their shared patients/clients.

Volunteer Lawyers Increase the Benefits

Charles R. Holton has seen the value of the MLP first-hand. A partner with Womble Carlyle Sandridge & Rice, Holton currently serves as vice-chair and chair-elect of the LANC Board of Directors. And, in October 2012, Mr. Holton was one of five North Carolina attorneys honored by the national Legal Services Corporation (LSC) Board of Directors for volunteer work with LANC.

"Legal services attorneys have overwhelming case loads. Private attorneys, particularly litigators, can play an important role in assisting legal services attorneys to bring these claims forward and litigating them in court, if necessary," says Holton. "I’ve had the opportunity to work with MLP attorneys on several matters that have evolved to litigation, including mold and insect infestation problems in rental housing units. Without a doubt, these cases would not have come to light without the involvement of members of the medical community who have observed the connections between their patients’ health and the environmental conditions where they live."

And, those benefits can flow to the lawyers as well, acknowledges Holton. "These cases also present excellent opportunities for our newer lawyers to gain litigation skills and in-court experience, which they may not get any other way."

Benefits to the Community Extend Beyond the Individual Clients Involved

Holton feels particularly pleased when results can benefit a larger number of people. "As it turns out, many of these cases can be satisfactorily resolved not only to help the individual client, but also to help other residents of the same dwelling units or apartment communities. This opportunity for impact work represents a terrific investment for the broader legal community."

Kris Shepard sums it up nicely, "In a time of limited resources, LANC has to make choices about how to allocate our resources. If LANC can serve someone in a way that has a ripple effect on his or her life in a way that is broader than what health care providers or lawyers can do alone, that’s a bigger win."

Click here to view a list of medical-legal partnership programs in North Carolina.