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On this page: What is the MLPP?,
Mission Statement, Case Examples,
Learn More, Important
Resources, Documents, Presentations,
MLPP Contacts
The Medical-Legal Partnership Project (MLPP) is a
medical-legal collaborative designed to improve the health and welfare
of low-income children and their families. Proactive legal assistance
is provided in a health care setting to make legal services easily
accessible.
The MLPP provides traditional legal representation
with a comprehensive approach to the health care needs of an individual
child, and advocates for children's health on a systemic level.
Center for Children's Advocacy established the Medical-Legal
Partnership Project in 2000. The first office opened on-site at
Connecticut Children's Medical Center (CCMC) and services quickly
expanded to the Charter Oak Health Center and Community Health Services,
federally qualified health clinics serving two of Hartford's poorest
neighborhoods. An additional office is on-site at Saint Francis
Hospital & Medical Center, and legal services are provided at The
Hospital of Central Connecticut and the Burgdorf/Bank of America
Health Center. Together, these primary care centers provide health
care to the great majority of the poor children who receive pediatric
services in the Greater Hartford area.
MLPP is a joint medical-legal collaboration between
the Center for Children’s Advocacy, Connecticut Children’s Medical
Center, Charter Oak Health Center, Community Health Services, Inc.,
Saint Francis Hospital and Medical Center, and The Hospital of Central
Connecticut.
Project activities are funded through generous grants
from American Savings Foundation, Connecticut Bar Foundation, Connecticut
Health Foundation, Fisher Foundation, Hartford Courant Foundation,
Hartford Foundation for Public Giving, Maximillian E. & Marion O.Hoffman
Foundation, The New Alliance Foundation, Robert Wood Johnson Foundation,
and Universal Health Care Foundation of Connecticut.
An Overview of the
Medical-Legal Partnership Project
MLPP
Brochure
History
of Medical Legal Partnership Project
It is the mission of the Center for Children's
Advocacy's Medical Legal Partnership Project (MLPP) to improve low
income children's health outcomes through interdisciplinary medical-legal
collaboration in the health care/clinical setting.
1. The MLPP will utilize an interdisciplinary
approach to legal advocacy by forging partnerships with medical
providers to collaborate on addressing medical and legal issues
discovered and treated in the clinical setting.
2. The MLPP will address medical-legal issues
on behalf of children at risk by representing children and families
to address health issues that are identified by its clinical partners
that impact health and well-being. Representation will be based
on the family's need to address health and safety related legal
issues, such as housing, disability, access to quality healthcare,
education, and discrimination.
3. The MLPP and its clinical partners will collaborate
on education and training material to provide a greater ability
for the team to address children's health issues by improving advocacy
and changing the culture of pediatric health care delivery. Education
and training opportunities will occur in the clinical, academic
and legal environments.
4. The MLPP, working with its health care partners,
will work to change systems and policies that affect children's
health by engaging in collaborative advocacy.
5. The MLPP will work with regional and national
partners to replicate and proliferate medical-legal collaborations
by engaging in partnerships and producing materials and data to
enhance medical-legal collaborations throughout the country.
The MLPP represents clients in matters relating to
housing (habitability and conditions as well as disability
discrimination), disability benefits, including Supplemental
Security Income ("SSI") appeals, public benefits and entitlements
(public assistance and food stamp eligibility), Medicaid advocacy
(coverage denials for medically necessary care and treatment), educational
rights (special education and related services for children
with disabilities), immigration, civil rights (children's
confidentiality and emancipation rights) and access to appropriate
services for children with disabilities.
When Alina first looks at you, you see a quiet teenager
with soft brown eyes. When you look more closely, her eyes reveal
a lack of focus that gives pause for great concern.
Alina’s family moved from Puerto Rico to Massachusetts
two years ago. Her stepfather had been offered work and the family
found housing close to his job. After a very short time, the extreme
domestic violence the family had suffered in Puerto Rico began again;
Alina’s stepfather beat both the girls and their mother. Alina was
raped repeatedly, and her mother finally took action, escaping with
the girls to Hartford to seek refuge with a cousin's family.
Alina’s history of abuse at the hands of her stepfather,
and the domestic violence she continually witnessed as a young girl,
contributed to problems that had begun to manifest years earlier.
She suffered from ongoing seizures and began to experience auditory
hallucinations that directed her to harm herself and her family.
Alina’s doctor, a pediatrician at Connecticut Children’s Medical
Center (CCMC), was very concerned about her physical and mental
health status. She was looking for a way to help the family get
assistance from the Department of Social Services (DSS). The mother’s
application to DSS for cash assistance had been denied and Alina’s
application for disability from the Social Security Administration
(SSA) had been rejected. Alina’s pediatrician called CCA attorney
Bonnie Roswig of the Center’s Medical Legal Partnership Project
for help. Attorney Roswig contacted DSS and explained the family’s
need for assistance. Years of violence had left the mother with
disabling trauma, making it very difficult for her to find full
time work. Alina was so emotionally disabled that she could not
attend school on a regular basis and needed her mother’s constant
care.
Attorney Roswig’s successful legal advocacy led to
Alina’s family receiving emergency financial assistance from DSS.
At Alina’s SSA disability hearing, Attorney Roswig submitted a brief
that included evidence of Alina’s psychiatric impairments, including
records from medical and psychiatric facilities in Connecticut and
Massachusetts. CCA also obtained Alina’s educational records, which
documented significant learning disabilities exacerbated by her
psychiatric condition.
As the day of the SSA hearing approached, Attorney
Roswig was concerned about the stress Alina’s mother would suffer
when she testified to the domestic violence, sexual abuse and psychotic
episodes that led to the application for disability. Fortunately,
the Court contacted CCA the morning of the hearing to say that the
Judge had ruled in favor of Alina’s appeal based on submitted documentation.
Alina’s physical and emotional challenges continue,
but she is moving in a positive direction. Attorney Roswig recently
helped Alina secure an appropriate educational setting and she continues
to carefully monitor the family’s progress.
Marco eyed the pile of rocks just down the road. With
the bravado only an eleven year old can muster, he decided his wheels
could navigate the obstacle and he sped up as he approached. Careening
forward, Marco’s wheels flew out from under him when he hit the
rocks and he was dumped onto the roadway. The story would have a
simpler resolution if Marco had been on a bicycle, but Marco navigates
in a power wheel chair. He suffers from Spinal Muscular Atrophy
Type II – he has no lower body strength and only limited motion
in the top half of his body. A broken wheelchair was only the latest
problem for Marco and his mother Millie.
Marco’s medical problems meant that Millie had to
carry him when he had to use the bathroom or the shower. While not
a perfect system, this worked when Marco was little, but he now
weighs almost 100 pounds. This past summer, Millie fell when lifting
Marco and they both wound up in the emergency room. Based on his
medical needs, Marco receives ongoing care and support from the
Connecticut Children’s Medical Center Orthopedic Department. Clinicians
determined that installation of a lift system in the house – a track
installed on the ceiling that allows the user to sit in a sling
and navigate through relevant rooms – would prevent further danger
to Marco and Millie.
To the dismay of the family and CCMC’s Orthopedic
Department, the request for the lift system (durable medical equipment)
was denied by Millie’s Medicaid/HMO insurance carrier. Marco’s orthopedist
called CCA’s Medical-Legal Partnership Attorney Bonnie Roswig for
guidance. Attorney Roswig spoke extensively with the clinicians
and the family to assess the insurance denial and secure this important
equipment for the family. Connecticut’s legal standard for such
equipment is medical necessity, which is defined as “health care
provided to correct or diminish the adverse effects of a medical
condition.”
A picture is worth a thousand words.
Assisted by law student Jennifer Pomales, Attorney
Roswig visited Marco at home. After taking pictures, making diagrams
and gaining a new appreciation for the practical as well as legal
definition of medical necessity, Attorney Roswig Filed an Appeal
of Denial with the State of Connecticut Department of Social Services.
Within days, an attorney from the Medicaid HMO called Attorney Roswig
and agreed to discuss a resolution for the family.
Marco has many hurdles to face, including a spinal
fusion in the very near future. Some challenges will be eased with
the installation of the newly approved lift equipment that will
make his life, and his mother’s, easier and much safer.
The MLPP provides multidisciplinary training to the
medical, social work, and legal providers at its health care partners
and in the community on issues affecting children's health outcomes.
In addition, the multidisciplinary nature of the training program
provides "cross training" by medical experts on issues concerning
child health to legal advocates. The MLPP conducts the following
training opportunities:
- large group, plenary
training sessions, such as "grand rounds", hospital-wide trainings
and legal advocacy seminars for legal practitioners;
- small group training
sessions, such as "in-service" trainings to pediatric departments;
individual consultations to medical and social work staff involving
medical-legal issues that directly affect children's care and
health outcomes;
- conference presentations
to medical, social work and legal providers involving medical-legal
issues; and
- residency training programs
in pediatric medicine and psychiatry through the University of
Connecticut School of Medicine.
The MLPP, in collaboration with its health care partners,
works to identify certain health related issues that require systemic
intervention to improve children's health and quality of life outcomes.
Case #1: The Team Approach and Emmett's Case
Emmett is a one-year-old boy who suffers from numerous
physical and cognitive impairments as a result of premature birth,
including developmental delays, failure-to-thrive, digestive disorder,
hearing loss and neuro-motor limitations. Upon evaluating Emmett,
the pediatric primary care provider ("PCP") immediately called the
MLPP for a consultation regarding public assistance and disability
benefits. After initial consultation, the MLPP worked with the child's
mother to ensure that all eligible benefits were accessed, and commenced
an investigation of an outstanding application for Supplemental
Security Income ("SSI") benefits.
The MLPP initiated an advocacy plan on Emmett's behalf
for disability benefits, but then worked with the PCP to engage
a multidisciplinary team to address his complex medical and social
needs. Taking the lead, Emmett's pediatric primary care provider,
and the CCMC Primary Care Center's ("PCC") clinical social worker
convened a multidisciplinary meeting that consisted of Emmett's
PCP, the department's clinical social worker, the PCC's nutritionist,
Emmett's managed care Medicaid insurer's case manager, a state Department
of Mental Retardation caseworker, the MLPP Director, and Emmett's
mother, father and grandmother. As a result of the meeting, the
team established a comprehensive plan to improve the family's access
to accessible state and federal benefits (including cash, disability
and nutritional benefits), health care services (including shift
nursing and home health aides), nutritional services, respite allocations,
and educational opportunities for Emmett's mother and father.
Case Outcome:
As a result of the meeting, the family was able to
achieve the following goals:
- Reestablish a legal claim for SSI with the
Social Security Administration
- Provide the household with nursing and home
health assistance on a regular basis
- Coordinate nutritional services with other
CCMC departments that provide Emmett with ongoing care
- Coordinate agency services between Medicaid
and DMR providers to ensure that the household is augmented to
meet Emmett's complex medical needs
- Bolster social support services to include
household education, and access adult educational services for
Emmett's parents
Case #2 – Disability Advocacy for a Child at Risk
KJ is a seven-year-old boy who was diagnosed with
sickle cell anemia since birth. In December 2003, a CCMC specialty
provider and social worker contacted the MLPP to assist the family
in appealing the denial of SSI benefits. At the time of the referral,
the Social Security Administration (SSA) had twice denied KJ's claim,
once during the initial application process, and the second time
during KJ's initial appeal. After assisting KJ's mother in filing
for a hearing with an SSA judge, the MLPP began the investigation
and document collection tasks necessary to evaluate his case. It
soon became apparent that KJ had suffered considerably over the
years due to his sickle cell disease, including requiring several
hospitalizations and ongoing treatment for anemia. After consulting
with his treating specialist, the MLPP agreed to represent KJ's
mother in an appeal with a Social Security Administration Administrative
Law Judge. After securing a retainer agreement with the family,
the MLPP initiated a three-point approach to KJ's SSI case.
First, the MLPP analyzed all of the evidence obtained
from KJ's primary care and specialty pediatric providers. Specifically,
the MLPP consulted with KJ's treating nurse practitioner who provides
KJ ongoing specialty care for his sickle cell anemia. After a strategy
meeting, the provider drafted a comprehensive report detailing KJ's
sickle cell symptoms, care and treatment, as well as the repercussions
suffered by KJ as a sickle cell patient. Of significant note was
the specialist's attention to detail as to how KJ's condition can
flare up at any time, and the chronic pain he suffers as a result
of his impairment.
Second, the MLPP staff assembled a package of documents,
including preschool records and home health reports, to support
the family's contention that KJ's condition causes him to miss preschool,
and causes significant chronic pain and discomfort.
Third, the MLPP attorney submitted a legal brief,
replete with multiple pages of supporting exhibits, documenting
how KJ's condition met the criteria for disability as defined under
the federal statute and the Social Security Administration's ("SSA")
regulations. The crux of the argument was that KJ's chronic anemia,
as referenced by hematocrit levels that hovered around and under
"25", rendered him categorically eligible for benefits under the
regulatory "listings" of medical impairments.
Case Result
The legal argument, coupled with the strong presentation
of evidence, provided sufficient support to convince the SSA judge
that KJ's condition met the criteria for children's SSI benefits.
The judge's office contacted the MLPP to indicate that based solely
on the documentary evidence, SSA's denial of benefits would be reversed
and he granted the SSI benefits retroactive to March 2003, the date
of application. The case is illustrative of how the on-site presence
of the MLPP allowed for direct access to the medical provider, whose
expertise and evidentiary production resulted in a positive result
for a family at risk.
-
Utility
Access and Health: MLP Patients-to-Policy Case Study, Medical
Legal Partnership, Boston, June, 2010.
-
Poverty
Grown Up: How Childhood Socioeconomic Status Impacts Adult Health
ABSTRACT: Socioeconomic status and health
status are directly related across the world
Kathleen Conroy, MD, Megan Sandel, MD, MPH, Barry Zuckerman,
MD,
Journal of Developmental & Behavioral Pediatrics, 2010
www.jdbp.org
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Medical-Legal
Partnerships Practicing Preventative Law, ABA Health
eSource
July 2009
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CCA
& Hospital of Central Connecticut Receive Grant to Expand MLPP
February 14, 2008
-
Medical
Legal Partnership Insight and Passion Change Culture
& Practice
-
CCA's
Medical Legal Partership: Doctors And Lawyers Work Together
To Solve Problems That Harm Health
- School
of Law Graduates Instrumental in Creating National Center for
Medical-Legal Collaboration
Northeastern Law Magazine
Summer, 2006
She had to choose between heat and food...
-
What’s
so Interesting about Medical Necessity? Jay E. Sicklick,
Esq., October, 2009
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Judicial
Intervention for Morbidly Obese Children Jay E. Sicklick,
Esq., October 26, 2007
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Adolescent
Confidentiality and Teenage Legal Rights: A Primer on Reproductive
Health Issues
- "CCMC
Grand Rounds - The Social Determinants of Health" by Lauren
Smith, M.D., M.P.H., June 6, 2006.
Project Director
Jay E. Sicklick, Esq.
Center for Children's Advocacy
65 Elizabeth Street
Hartford, Connecticut 06106
(860) 714-1412
Fax: (860) 570-5256
Staff Attorney
Bonnie
Roswig, Esq.
Staff Attorney, MLPP
Center for Children's Advocacy
Connecticut Children's Medical Center
282 Washington Street
Hartford, Connecticut 06106
(860) 714-1412
Fax: (860) 545-9234
Medical Director
Dr. Sarah Schlegel
MLPP Legal Intern
Vanessa Chabrier-Davis
Alyssa Norwood
Attorney Alison Mohr Devoted to Helping CCA Clients
Patent Attorney Alison Mohr had recently moved to Connecticut
when she learned about CCA's Medical Legal Partnership Project (MLPP).
She was looking for a volunteer opportunity and has devoted extraordinary
energy and resources to the Center's work.
Attorney Mohr has devoted extraordinary energy and
resources to the Center's work. "She's been doing a fabulous job,"
says Bonnie Roswig, Senior Staff Attorney for the MLPP. "She's committed
to the work of the Center on an ongoing basis. She understands the
issues and the medical and legal complications that poverty imposes
on the families we serve."
Mohr has been volunteering with Center since the fall
of 2009, both with MLPP cases and at the weekly clinic at The Hospital
of Central Connecticut in New Britain. She has also been actively
involved in the MLPP's "Keep the Power On" utility clinics which
help low income families maintain utility service.
At a meeting last fall, Attorney Mohr overheard a
hospital social worker lament that their annual toy drive was suffering
because of the recession. "Ali was a bystander to this conversation,"
Roswig says. "Three days later I got a phone call saying, "We are
raising some money to buy holiday presents for the Center's kids."
Starting with her neighbors, news of the gift drive spread and within
a short period of time Mohr had secured $1300 in donations. In addition,
Beth Israel Synagogue in West Hartford heard about her efforts and
dedicated the proceeds of their Chanukah party toy drive to CCA.
Mohr coordinated child-client "wish lists" and personally
purchased many of the gifts, enlisting her children and husband
to help wrap. She and her family "adopted" one of the families she
had met through her CCA work, providing them with a wish list's
worth of household essentials.
Beyond this immediate help, Mohr's work and generosity
have had an incalculable positive effect on the Center's future.
Her word-of-mouth campaign for toy drive donations introduced many
new donors to CCA's work. "Through the toy drive, a whole new group
of people has been introduced to the work of the Center and the
needs of Connecticut's most vulnerable children," explained Roswig.
If you would like to help the children and families
served by Center for Children's Advocacy, please contact mknight@kidscounsel.org.
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