Medical-Legal Partnership: Integrating court-related advocacy into complex care

Consulting Attorney Jeremy Spiegel (right) smiles with Camden Coalition program graduate Charlie Vazquez (left) and Community Health Worker Brian Thompson at Putting Care at the Center 2018 conference
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Consulting attorney Jeremy Spiegel (right) with Camden Coalition program graduate Charlie Vazquez (left) and Community Health Worker Brian Thompson (center) at the Putting Care at the Center 2018 conference.

By Amy Yuen

Legal issues like a threatened eviction, a benefits denial, or a utility shut-off have often kept healthcare consumers from meeting their basic needs and staying healthy and stable. That’s why our medical-legal partnership pilot program is playing such an important role in our care coordination work with patients. We’ve achieved some exciting legal successes on a broad range of civil and criminal issues since launching the program with Rutgers Law School in November 2017. It’s also given us insight into how we can enhance the program to provide better care.

One way our medical-legal partnership is helping us provide better care is by providing our staff with greater insight into Camden’s municipal court system. Since June, consulting attorney Jeremy Spiegel has led group visits to the city’s municipal courtrooms to view court proceedings and become familiar with the way our local municipal courts work. Through courtroom observation sessions and debriefs, our clinical and non-clinical staff are familiarizing themselves with the legal intricacies that many of our patients have to navigate. This insight is helping them more effectively advocate for the people we serve.

“Many of our patients — and thousands of Camden residents — have regular involvement with the municipal court system,” said Jeremy. “It’s valuable for the care teams and other Coalition staff to develop a deeper understanding of the court system.”

Entering any municipal court proceeding can be intimidating and confusing, particularly for people with complex health and social needs who are addressing complicated legal issues. “A lot of our patients enter a hearing not expecting it to go well, and often it doesn’t go as well as it could,” said Jeremy. “These trainings are helping our care team better understand how the court system works so that they can more effectively prepare patients for hearings and advocate for them in court.”

An imperfect system

During a visit to Camden’s municipal courts last October, our staff visited three courtrooms to watch legal proceedings for a variety of cases — among them, driving with improperly tinted windows (dismissed), driving with a suspended or expired license (a $200 fine), and driving while obstructing traffic ($50 fine, plus $33 for court costs and $6 surcharge). A few defendants were asked if they wanted a public defender ($50 application fee). One case for a loitering charge was dismissed after the defendant’s probation officer testified about the progress she’s made in a drug treatment program.

After the observation session, staff regrouped at the Camden Coalition office to debrief. Many said the case of the defendant enrolled in a drug treatment program shared clear similarities with some of our participants. The group was also struck by how the court’s emphasis on penalty fines and fees overburdens vulnerable community members.

“Our patients struggle with payment of fines and fees that represent a disproportionate amount of their limited, and often fixed, incomes,” said Jeremy. “They suffer from a system that demands payment of significant sums as a penalty, yet at the same time deprives them of their driving license, which is often necessary for them to earn money to make payment. They also struggle with a system that often requires multiple court appearances during work hours, and that penalizes their failure to appear with an arrest warrant and possible incarceration.”

Traditionally siloed sectors also complicate matters for many of our patients with legal issues. “The systems don’t talk to each other,” said Jeremy. “For example, we sometimes hear from our patients, ‘I was locked up and couldn’t make the hearing.’” To foster a partnership across silos and lay the groundwork for addressing the needs of vulnerable residents, the Coalition is engaging with municipal court officials about many of these obstacles.

Law in action

Clinical Manager for Innovation Operations Michelle Adyniec was already doing court-related advocacy for our patients before participating in the first court observation training last June. But she said the training was key in building her comfort level around being in court.

“I’m a nurse, and I had never stepped into a courtroom until I started doing this with our patients,” she said. “It’s not like I knew what the normal flow of the court was. Hearing Jeremy’s perspective as a lawyer helped me understand what to expect and what information is useful to provide to the public defender to help them advocate for the patient,” she said.

“A lot of people are afraid to go to court. People often will ignore court dates because they’re scared to go,” she added. “The first step is that we offer to go with our patients, and that makes them feel more comfortable and more likely to show up to court.” Michelle then speaks with the public defender about the progress the patient has made in the Camden Coalition care intervention, and explains how much it would help them continue their progress if they weren’t burdened with court fines. Sometimes, the judge asks her to speak on record in court. “We have had varied outcomes. We haven’t had anyone say ‘No, we’re not willing to do anything to help.’ Usually they’ll at least reduce the fines.

“At first, I was intimidated by the idea of going into court and talking to the public defender, but it’s actually very similar to the work we do on a daily basis meeting with many providers in the community. Just because it’s in a court setting, it shouldn’t be as intimidating. It can help people a lot.”

This year, Jeremy plans to continue offering court observation trainings to Coalition staff every few months so that more can participate. He is also working with members of our policy team to determine how the Coalition can advocate for municipal court reforms.

“There are ongoing efforts to restructure the municipal court system so it’s not operated as a profit engine, and to provide alternatives to paying fines,” said Jeremy. “For patients, paying a few hundred dollars for a fine is a big deal. It’s harder for them to pay it off, and it’s a barrier that prevents them from addressing their chronic health and social challenges. We have had some interesting municipal court experiences that should be shared with New Jersey policymakers working on reforms.”

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