Medical-Legal Partnership: When legal issues are barriers to care

Care management & redesign Legal & criminal justice

In many cases, legal issues — like a threatened eviction, a benefits denial, or a utility shut-off — become a barrier to better health. The Camden Coalition partners with Rutgers Law School to pilot a medical-legal partnership to better address the health-related social needs of community members involved in our complex care intervention. Attorney Jeremy Spiegel writes about a few of the cases that best illustrate the need for legal assistance among participants in our care intervention.

By Jeremy Spiegel

I first met M.T. at a home for men in recovery from mental health crisis. His wife had died three weeks prior from cancer. I was visiting at the request of his Camden Coalition community health worker, who informed me that M.T. was facing eviction. M.T. was hoping that the Rutgers Law/Camden Coalition Medical-Legal Partnership (MLP) could assist with his situation.

M.T. explained that he and his wife had failed to pay rent for a few months in their government-subsidized apartment as they battled their medical issues. The property management company had commenced eviction proceedings and changed the locks. M.T. was facing homelessness at a moment when stable housing was critical.

I engaged M.T. as an MLP client and immediately contacted the landlord and property management company to ensure that the property was not leased to another tenant. I negotiated a resolution to the foreclosure matter and assisted the Camden Coalition in obtaining emergency county funds to pay back-rent. Within two weeks, just as M.T.’s time expired at his recovery house, he signed the paperwork to return to his apartment. He has since obtained a renewal of his lease — and is experiencing improved mental health — thanks, in part, to his stable housing situation.

M.T.’s case is one of many that I have handled as the consulting attorney for our newly-created MLP in Camden, New Jersey. Medical-legal partnerships like ours generally seek to provide legal assistance to people who are facing ongoing medical issues. The logic is that legal issues often interfere with a patient’s medical care — whether by undermining a physician’s care or creating a barrier to recovery and stability for the patient. By having a medical-legal partnership address a patient’s legal issues, the patient and their medical team are able to more effectively focus on medical issues.

Some MLPs focus on specific patient populations or specific legal issues. Our program provides quality representation for as many Camden Coalition patients as possible, regarding nearly every legal issue facing those patients. We have assisted over 30 patients to date on matters concerning housing, disability benefits, employment, municipal court fees and warrants, child support, domestic violence, and even a contractor dispute. For patients with pre-trial criminal issues, like C.V., we have engaged with public defenders to supplement their advocacy.

Rutgers Law and the Camden Coalition launched the MLP in November 2017 with grant funding for one part-time attorney for around a year. Our goal was to turn those modest funds into a powerful narrative about the value of a medical-legal partnership in Camden. Reflecting on our first nine months, we have made great progress toward this objective. We have achieved some exciting legal successes, including M.T.’s case, while learning a tremendous amount about the ways we can enhance our MLP services.

G.J. is another patient we engaged with through the MLP. G.J., who speaks only Spanish, is suffering from diabetes-related blindness and renal failure. At our first meeting, in the living room of his rooming house, G.J. described for me and his Coalition care team how he had proudly worked for two decades at a prominent grocery chain. When he could no longer perform his job, he left work and sought the proceeds from short- and long-term disability policies for which he had responsibly paid premiums. After a few months of disability insurance payments, however, G.J.’s checks stopped coming. Meanwhile, he needed the money for rent and to support his family.

We engaged with G.J. to pursue his missing funds and quickly contacted the disability insurers. To G.J.’s shock, his former employer had informed the short-term insurer that he had resigned from his job for a reason unrelated to his disability, thus terminating his payments. The long-term insurer, for its part, had miscalculated the patient’s benefits and was wrongfully withholding funds each month. G.J., hindered by his visual impairment and language barrier, had struggled for months to obtain his rightful payments. With the MLP involved, the employer promptly agreed to pay the thousands of dollars in missing payments, and the long-term insurer corrected G.J.’s payments going forward.

We have represented numerous patients before New Jersey municipal courts regarding outstanding fines and related warrants. For many patients, these looming fines — and the accompanying threat of incarceration for failure to appear in court — represent a barrier to medical stabilization. The MLP has succeeded in vacating over $6,000 in fines and negotiating community service in lieu of payment for several other patients.

We have also worked with Camden Coalition patients participating in the Camden Delivers program for women of reproductive age. Many of these patients, including two MLP clients, obtain medical care from Cooper Hospital’s Addiction Medicine Program. As these patients pursue treatment for addiction and underlying mental illness, the MLP seeks to address anxiety-inducing legal matters and other issues that stand in the way of recovery. One patient suffered increasing anxiety over outstanding child support. We addressed outstanding warrants for the support payments and obtained a significant reduction in the monthly support obligation on account of her demonstrated mental illness. Another patient, who has already made great strides through treatment, was limited in her job search because of an old arrest. We are pursuing expungement of that charge to improve her career options.

In all of these cases — and many others in which the MLP has been engaged — the common thread has been a glaring need for legal representation. Patients facing challenging medical issues are often not equipped to address complicated legal issues. We see small issues snowball into larger problems due to a lack of attention, and we see issues of all sizes becoming a source of great stress for patients. By inserting the MLP into the equation, we have been able to address many of these issues, achieve positive outcomes, and allow patients to focus on their recovery and stabilization.

I attribute much of our early success to an excellent synergy with the Camden Coalition care management structure. When I engage with a patient, it is through an introduction from a Coalition care team member who has established a trusting relationship with the patient. As a result, I have instant credibility with the patient, and can quickly evaluate potential areas for MLP involvement. In addition, the care team members maintain weekly contact with their patients. So, for example, when we need documents for an ongoing matter, the care team is able to obtain the necessary papers without my direct involvement. And when a patient has a court appearance, the care team can ensure that transportation is in place. This model creates tremendous efficiency in the provision of legal services by allowing the attorney to focus on substantive legal issues and by increasing the responsiveness and participation of the clients.

We feel confident, based on our success thus far, that we are laying the groundwork for what will become an established MLP serving a city whose residents benefit greatly from the additional legal resources. As we look to the future, we plan to join with additional medical partners in order to serve many more Camden patients. We have formalized our relationship with the Cooper Addiction Medicine Clinic and are finalizing our relationship with the Cooper Medical School at Rowan University. We are hopeful that the compelling success stories generated from our initial efforts will lead to sustained financial support necessary to enable this growth, so that a medical-legal intervention eventually becomes standard-of-care for Camden patients.

To learn more about medical-legal partnerships, visit The National Center for Medical-Legal Partnership. Resources and tools are available on their website, including this recent brief on the role of MLPs in addressing the opioid crisis.

The National Center for Medical-Legal Partnership will host a pre-conference workshop on December 5 addressing social determinants through MLPs, prior to the opening of Putting Care at the Center 2018. Visit the pre-conferences page to learn more.

The MLP is supported by the Holman Auto Group and the Rowan/Rutgers Board of Governors