On this page: What is the MLPP?, Mission Statement, Case Examples, Learn More, Important Resources, Documents, Presentations, MLPP Contacts

 

What is the Medical Legal Partnership Project?

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

 

Mission Statement

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.

 

MLPP Goals:

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.

 

Direct Legal Representation

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.

 

MLPP in The News: Important Articles on Medical-Legal Issues

 

Important Resources

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.