Every Friday, Christine Crawford has a counseling session at a clinic at New York City’s Mount Sinai Health System as she moves ahead with plans for gender transition surgery later this year. In addition to the many medical and psychosocial issues, there are practical ones as well. So, Crawford was thrilled when a Mount Sinai representative said they would assign a lawyer to help her legally change her name to Christine.
The lawyer filed her name-change petition with the court and helped Crawford, 56, with other steps, such as notifying her former spouse and publishing the name change in the newspaper. She gave Crawford information about what she needed to do to make the change official with organizations such as the Social Security Administration and the Department of Motor Vehicles.
Perhaps best of all, when Crawford graduated with a master’s degree in social work last month, her diploma had her new name on it.
“[The lawyer] was able to expedite the petition and the court date,” Crawford said. “She was a godsend.”
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 have set up these programs, said Ellen Lawton, co-director of the National Center for Medical-Legal Partnership at George Washington University in Washington, D.C.
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.
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.
With that in mind, 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.
Mount Sinai, whose program is just getting off the ground, is taking a hybrid approach. In addition to a grant from the Manhattan District Attorney’s Office to provide child and family law services, the hospital partnered with law firms and other organizations to provide transgender and end-of-life legal services on a pro bono basis.
Sena Kim-Reuter, president of the Mount Sinai Medical Legal Partnership, said she’s focused on identifying gaps in patients’ needs where she can offer assistance. “There’s no way to handle all of it,” she said.
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