Children’s legal eagles

As an attorney, Kristin Small, Esq., specializes in cases where the legal and health care needs of her clients cross paths. She recently worked with the parents of a 5-year-old child with autism.

The father had lost his job and the mother couldn’t work because of the time she needed to devote to her son’s care. Though the Social Security Administration (SSA) agreed that their son qualified for benefits medically, the family was deemed ineligible because they had “too many resources.” With both parents out of work and no means of income, legal counsel was the last option they thought was available to them.

Their pediatrician referred them to Small, a staff attorney for the Medical Legal Partnership | Boston (MLP) and liaison to Children’s for the newest MLP site in the Children’s Hospital Primary Care Center (CHPCC). Providing care for more than 13,000 children—65 percent of whom are covered by Medicaid—the CHPCC is well suited to host the MLP at CHB. “Our medical and social work staff already spend a lot of time advocating for our patients,” says Joanne Cox, MD, medical director for the CHPCC. “They’re writing letters to utility companies, helping families access food stamps and communicating with landlords about poor housing conditions.” Chronic illnesses such as asthma, cerebral palsy and diabetes are often exacerbated by environmental factors like lack of food, housing, education and employment. A child my be falling behind in school due to chronic illness, or a family may be forced to choose between medicine and food. By teaming with the MLP, the CHPCC can now offer their patients direct access to legal information and support to help them make sure their needs are being met.

Josh Greenberg

The MLP’s model of combining medical and legal care was founded at Boston Medical Center (BMC) in 1993, where physicians found themselves calling landlords personally to try and get them to fix housing conditions that were impacting patients’ health. Kids with asthma were being treated in the ER, but treatment could only carry them so far if they were going home to moldy carpets, rodent infested walls or poor air quality. When trying to treat the social or environmental causes of some medical conditions, then pediatrician-in-chief, Barry Zuckerman, MD, found it effective to have a lawyer on his team, and hired attorney Joshua Greenberg—now Children’s vice president of Government Relations.

Since then, the MLP has expanded out of the local arena by creating a National Center to coordinate nationwide research and government policy efforts related to the social impacts of health. They’ve established the MLP Network, consisting of nearly 80 partner sites working with more than 200 health care institutions across the United States and Canada. Now, thanks to efforts led by Greenberg and Children’s Senior Vice President and General Counsel Stuart Novick, Esq., the MLP has a home in the CHPCC.

It’s a natural step that many at Children’s have been eagerly waiting for—all of Children’s pediatric residents spend time at BMC and have at least some exposure to the MLP. With the newly established MLP triage phone line, clinicians and social workers can refer a patient or family they feel needs legal expertise, and expect a response within five minutes. “To be able to place a call for legal assistance and get a response within five minutes is nothing short of amazing,” says Sally Cheek, MSW, who came to Children’s from BMC, and now serves as the MLP’s “Social Worker Champion.” “But we want to use our resources well, which is why we’re training our clinicians to take the first few steps themselves, before making a referral.”

“We need to empower our clinicians to ask difficult questions about other places our patients might be hurting. Things like ‘Do you find yourself running out of food at the end of the month?’”

That’s where Kathleen Conroy, MD, MSc, comes in. Serving as the MLP’s “Medical Champion,” she coordinates training to integrate the legal and medical aspects of health care. “The standard check-up question is ‘Where does it hurt,’” says Conroy. “We need to empower our clinicians to ask difficult questions about other places our patients might be hurting. Things like ‘Do you find yourself running out of food at the end of the month?’” While she’s not trying to make doctors into lawyers, Conroy’s goal is for all clinicians to consider the role of social and environmental factors in achieving the highest quality outcome for their patients.

In addition to the phone line, Small holds legal clinics in the CHPCC every Wednesday and arranges pro-bono consultations through the MLP’s network of Boston law firms, who are called upon to litigate cases when necessary. The emphasis, though, is on preventive measures intended to resolve a situation before it needs to be taken to court. Small offers the example of a tenant who wants to begin withholding rent in a dispute with his landlord over unaddressed housing repairs. “There’s a right and wrong way to do that,” says Small. “We’re here to help with the right steps, since the wrong steps could leave him legally open to eviction.”

It’s not always about shady landlords or dilapidated housing though. In the case of the family that was denied benefits because they “had too many resources,” Small tracked the problem to a simple clerical error. During one of the family’s meetings with the SSA, their caseworker had mistakenly recorded that they owned four cars—the parents actually share one vehicle. An MLP representative accompanied them to their next SSA meeting and the family started receiving their much-needed benefits. “It’s not easy to make it through the legal system without representation,” says Small. “The MLP is here to make sure that families don’t have to do it alone.”