Medical-Legal Partnerships

Photo by Waldo Jaquith via Flickr

Sometimes gesturing toward a good idea is worse than ignoring it.  Section 2537 of the House reform bill (HR 3967) would create a demonstration project supporting medical-legal partnerships.  Medical-legal partnerships are a great thing.  So why is Section 2537 bad?

Medical-legal partnerships (”MLPs”) help the poor and ignored get well.  Look at a couple of examples.

Refnely Jaime.   Refnely was a 3-year old who kept getting sick — pneumonia, rashes, and weight loss.  Her doctors realized that her problems related to her poorly maintained, vermin-infested housing, and referred her and her mother to the Medical-Legal Partnership in Providence, Rhode Island.  The attorney there, with the law on her side, prevailed on the landlord to bring the building up to code. Refnely’s health was restored through enforcement of sanitary laws.

Norris Nicholson.   Norris’s diabetes, coronary artery disease, arthritis, and other chronic conditions kept him from working.  His doctors prescribed medication to keep him well, but he couldn’t afford them.  Uninsured, it was either food or medicine; he had applied for disability-based Medicaid coverage, but was denied.  He was referred to the Southern Illinois Law and Health Project.  After another denial, his attorney filed a legal action, and the court found Norris disabled and ordered Medicaid coverage.  He can now both eat and take his medicine.

Photo by Chicago Man via Flickr

MLPs were the 1993 brainchild of Dr. Barry Zuckerman, a pediatrician at Boston Medical Center.  He recognized that some debilitating and expensive illnesses persist notwithstanding the smart, compassionate work of doctors, due to the crushing disadvantages of socioeconomic circumstance.  He partnered with an attorney to address the legal needs of his patients that stood in the way of their good health.  The idea became a movement, and there are now over 180 such partnerships around the country — a great achievement, but a drop in the bucket compared to the need.

So why is Section 2537 bad?  It provides for funding of MLPs to “assist patients and their families” to improve health outcomes, and enhance the treatment and prevention of chronic conditions.  The problem lies in Section 2537(c)(1), which prohibits using the funding “for any medical malpractice or other civil action or proceeding.“ The malpractice prohibition makes some sense — but no other civil action or proceeding?  Norris’s attorney asked very nicely that he be approved for Medicaid coverage, but the government said no.  Without resort to litigation, Norris would still be choosing between drugs and medicine.  And if Refnely’s attorney had not been able to threaten enforcement of sanitary codes, her landlord would still be content to see her dodging rats and mice.

MLPs can save lives and money.  On many occasions, a lawyer or paralegal can achieve these goals without litigation by helping a patient understand a government program, or by explaining the law to a landlord.  But on occasion it is necessary to enforce the law — something for which non-poor people routinely seek legal advice.  Section 2537 gestures to MLPs, but ties their hands.  Leave in the malpractice bar — MLPs often steer clear of these matters in any case — but let the advocates to their jobs.