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School of Law Graduates Instrumental in Creating
National Center for Medical-Legal Collaboration
By Maura King Scully
http://www.slaw.neu.edu/magazine/06summer/trends.html
Summer, 2006
SHE HAD TO CHOOSE BETWEEN HEAT AND FOOD.
So Marla (not her real name), a single mother
of two, chose food. Marla works full time, but when her child support
payments stopped abruptly, she couldn't make ends meet. She got
behind on utility payments, and her power was shut off. Marla tried
working out a payment plan with the electric company, but was unsuccessful
in navigating the bureaucracy. That was June. It's now September,
and with the cold weather's approach, she confesses to her pediatrician
at Boston Medical Center that she's concerned for the health of
her daughters, one of whom is blind.
Her pediatrician immediately refers her to a
specialist who contacts the utility, and within days, restores Marla's
power and arranges an appropriate payment plan. That specialist
is a staff lawyer at the Boston Medical Center's Family Advocacy
Program (FAP). And the call made to turn back on Marla's electricity
is all in a day's work for the program's six attorneys, including
Director Ellen Lawton '93, Anne Gillespie '91 and George-Marie Jasmin
'04.
"We work on a case consultation model, similar
to how clinicians operate," says Lawton of the path-breaking program.
"If a pediatrician hears an irregular heartbeat, she can page a
cardiologist to come, listen and advise. FAP does the same thing
with lawyers," she notes, allowing them to act preventively in the
delivery of legal services.
TRACK RECORD
Established in 1993, FAP has helped more than
4,000 families since its inception, providing legal remedies for
social problems such as substandard housing, inappropriate special
education placements and loss of benefits, like food stamps and
SSI. It has also been replicated across the country, with nearly
30 programs springing up over the past decade, from California to
Connecticut. Throughout that time, FAP directors, including Lawton
and her predecessors, Josh Greenberg '93 and Jean Zotter '95, have
served as unofficial consultants to these programs, offering practical
advice and sharing resources.
In April, this informal arrangement became
official with the launch of the National Center for Medical-Legal
Collaboration at Boston Medical Center. Made possible by $3 million
in grants from the W.K. Kellogg Foundation and the Robert Wood Johnson
Foundation, the center will develop and disseminate best practices
in medical-legal collaborations as well as consolidate national
and local policy advocacy. Josh Greenberg, FAP's inaugural director,
now director of state and federal relations at Children's Hospital
Boston, calls the national center "terrific." "Practicing law in
a medical setting is like a cross-cultural experience. How do you
read medical records? How do you bridge issues of confidentiality?"
he asks. Creating a national center devoted to answering these questions
for doctors and lawyers, he notes, "is tremendously important. This
has the ability to infiltrate the medical delivery system in substantial
ways."
THE HEALTH-LAW CONNECTION
It's precisely this promise that drew the Kellogg
Foundation to commit $2.4 million over five years, according to
Program Director Dr. Albert Yee. "What intrigued us was how medical
care could impact social and economic factors affecting child health,"
he says. "The [FAP] model is one of collaboration, with the medical
and legal professions coming together to learn, contribute, collaborate.
If the medical side pursued it alone, it would be overly medicalized;
with legal alone, you'd miss out on medial impacts, outcomes. Here,
the partnership informs better policy. The whole really is much
greater than the sum of its parts."
"Medical-legal collaborations just make sense,"
notes Mallory Curran, director of the medical-legal collaboration
program at MetroHealth Medical Center in Cleveland, Ohio. "Where
are children going to be? At the pediatrician. With this model,
we're able to benefit from the trust relationship with the health
care provider and go where people who really need our help are already."
Curran credits Boston's FAP with helping her
launch such a collaboration at MetroHealth. "In May 2001, I was
in law school and read an article in The New York Timesabout the
Boston Medical Center program. It was like reading about my dream
job," she recalls. "I contacted Ellen [Lawton] right away and told
her I wanted to start a program like this in Cleveland." Through
FAP's medical founder, Dr. Barry Zuckerman, Lawton put Curran in
touch with MetroHealth, Cleveland's safety net hospital. "When can
you start?' was their first question," Curran recounts.
"FAP shared everything they had-types of trainings,
resource sheets. They encouraged me and provided lots of technical
support over bumps in the road," she says. "I can't overstate the
role that Boston played. They've been tireless in bringing word
to places all over the country, organizing conferences, long before
they were regarded as a national model. They're an inspiration in
what they've been able to achieve."
Jay Sicklick, director of the medical-legal
partnership project at the Center for Children's Advocacy in Hartford,
Conn., tells a similar story of launching the programs he now oversees
at St. Francis Hospital and Medical Center and the Connecticut Children's
Medical Center. "Between Josh Greenberg and Jean Zotter, I absorbed
a significant amount of information: subtle common sense, suggestions,
concrete materials to help us get started," he explains. "I was
a poverty lawyer-I wouldn't have approached it the same way without
their guidance. I would have approached it like a traditional legal
services office; put up a sign, had referrals. It would have worked,
but I wouldn't have been accepted into the medical fabric." Following
Greenberg's and Zotter's advice, Sicklick learned to "speak doctor":
he developed a case-based presentation style, with lots of take-home
bullet points and a laminated resource list. "We wouldn't have had
nearly the impact on the culture without the integrated model we
picked up from Boston," he says.
FORWARD THINKING
Hopes for the National Center for Medical-Legal
Collaboration are high. "Through the center, we can link sites together
so they can learn from each other, and provide more thorough technical
assistance," says Lawton. "We think this will dramatically, positively
shift how services are provided." Yee at Kellogg agrees. "The center
has the potential to transform how pediatric care is provided to
children from lowincome families. That's what's really exciting
about all of this. If I could dream, it would become a new national
standard for children's health."
And if Yee has his way, the next time a pediatrician
at a safety-net hospital comes across a social problem with a legal
remedy, she'll ask, "Is there a lawyer in the house?" The answer
will be a resounding, "Yes!"
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