Partners in Care
Medical, legal teams combine to improve key areas of a patient’s life
At the UF Health Severe Asthma Center, there’s a new twist on an old medical office saying: The lawyer will see you now.
The attorney is Chelsea Dunn, who spends two days each month working on legal issues with pediatric patients and their families. UF Health’s pediatric medical-legal partnership launched in early November, joining a program that offers free legal services for seniors.
At their core, medical-legal partnerships have a holistic goal: Patients can’t heal or stay healthy if other aspects of their lives are unhealthy or in turmoil. For children, that could mean getting relief from a mold-infested apartment. For seniors, it might involve getting some help caring for a child with a disability who is now an adult.
Rachel Coleman, M.D., served as medical director of a pediatric medical-legal partnership, or MLP, at the University of Massachusetts health system in Worcester, Massachusetts. Coleman, a UF Health pediatrician since 2012, jumped at the chance to launch a similar effort here. After a few years of planning and grant-seeking, she’s excited to see the nascent project take off. Through late February, the pediatric MLP had served 19 families.
“Having a medical-legal partnership makes me feel like I can provide much more complete care to my patients. Without it, I don’t feel like I have all of the tools I need to provide good care,” said Coleman, an assistant professor in the UF College of Medicine’s pediatrics department.
For now, the UF Healthy Kids MLP is limited to Severe Asthma Center patients but Coleman sees a need among other pediatric patients. Every week, Coleman said, she sees general pediatrics patients who need legal assistance with housing concerns, government benefits, and individualized education plans among other issues.
From clinic to court
Dunn, who works for Southern Legal Counsel in Gainesville, has already taken on some challenging MLP cases. She moves fluidly between clinic and court pleadings: One moment, she is intensely focused on a case’s facts and legal arguments. In the asthma center, her softer side emerges as she explains to parents how the free legal services can help their child.
Ask Dunn why she does MLP work and her passion bubbles up quickly. Landlords shouldn’t be ignoring a moldy apartment and a school can’t refuse to let a child use an asthma inhaler — but they do. It’s Dunn’s job to keep the scales of justice balanced so that medical treatments can be as effective as possible.
Tamora Alston only recently started bringing her 7-year-old daughter Daziyah Bacon to the Severe Asthma Center. In December, she met Dunn and revealed a problem: The management at Alston’s Ocala apartment complex was demanding more than $3,000 in back rent and trying to evict her.
Alston doesn’t believe she owes the money because her rent is federally subsidized. Dunn dug into the case, arguing in court documents that management never notified Alston about a rent increase and didn’t take the proper steps to end her lease.
Without help from the pediatric MLP, Alston said she would have just represented herself. Losing the case would probably leave Alston and Daziyah homeless, Dunn said in court documents.
“The day I met Chelsea, she took on the stress and the burdens of my legal case. She gave me her word that she would fight and has been faithful to that,” Alston said. “She’s not only had my back but also my baby’s back.”
As of early April, Alston’s eviction case was still pending in mid-May, though she and her children have since moved into a new apartment. The legal representation provided by the MLP bought crucial time that allowed Alston to find other housing, Dunn said.
Challenges at school
Dunn’s first MLP case for a UF Health patient involved a 9-year-old girl in The Panhandle who wasn’t being given access to an asthma inhaler by a charter school instructor. She was having asthma symptoms in physical education class, but school officials insisted on keeping her inhaler at the front desk. The inhaler wasn’t made available during PE class, and a teacher sometimes refused to let her go get it, Dunn said. The UF Health Severe Asthma Clinic even sent a letter telling the school about the child’s need.
Dunn worked with the child’s mother, giving her advice on her rights, the school’s obligations and other educational options. Ultimately, the mother decided to move her daughter to a public school where a nurse would oversee the inhaler use.
Alston’s case and the others taken on by Dunn are exactly why MLPs are needed, said Jodi Siegel, executive director of the not-for-profit Southern Legal Counsel. Her firm uses grant money to provide free legal services through the UF Healthy Kids MLP.
“For a child who has both legal and medical needs, you’re not going to see improvements in their health if you just address one of those issues,” Siegel said.
Siegel’s point is underscored by studies and demographic trends. Sixty percent of a person’s health is determined by Social factors such as income, housing and family stability determine 60% of a person’s health, according to research cited by the National Center for Medical-Legal Partnership. Other first-world countries with better health outcomes such as life expectancy and birth weight spend nearly twice as much on social services as the United States.
MLPs have flourished since the first one was formed in Boston in 1993: Health organizations have formed 333 partnerships in 46 states, including nine in Florida.
One of these is the UF Health Senior MLP, a collaboration between the nonprofit Three Rivers Legal Services and UF Health Shands Hospital that started in September 2017. Referrals come primarily from UF Health social workers or case managers. Funding is provided by a two-year grant from the Florida Department of Elder Affairs.
It didn’t take long for referrals to start flowing in, said Nancy Wright, the senior MLP’s director. Some seniors were spending all their time and energy caring for disabled adult children, causing their own health to fray. The MLP helped them find government-funded programs that can help care for people with developmental disabilities.
Like its pediatric counterpart, the senior MLP cases can be as different as the clients they serve. When Hurricane Michael ravaged The Panhandle in October, a ventilator-dependent man’s rental house was wrecked by a fallen tree. The local hospitals were heavily damaged, so he was flown to UF Health Shands Hospital.
Back at home, a Federal Emergency Management Agency inspector denied the man’s claim for assistance because the man wasn’t home during a damage assessment. Wright swung into action, working with the advocacy group Disability Rights Florida and battling her way up the FEMA chain of command. The agency decided the inspector had erred. Within days, another damage inspection was done and a check was delivered. Aided by UF Health Shands social workers, the man used the money to find a home in Gainesville, Wright said.
Battling red tape
A persistent MLP attorney can help overwhelmed clients knock on — or knock down — bureaucratic doors, Wright added. When seniors are exploited financially by a relative or caregiver, they sometimes can’t pay for their medications anymore. That starts a vicious, downward cycle that can land a person in the hospital.
“They’re often ashamed to even talk about what happened,” Wright said.
In other cases, Wright has battled arcane rules: A state agency once refused to do an assessment for home care or a nursing home because the patient was still hospitalized. Wright contacted the agency’s attorney and got the policy changed.
For Wright, an MLP harnesses collective power of dedicated physicians and determined lawyers.
“Ultimately, we have been able to accomplish so much for clients by being part of a team,” she said.
By the Numbers
Lawyers can ‘make a difference’
When the UF Health pediatric MLP was being discussed, pediatric pulmonologist Sreekala Prabhakaran, M.D., was initially hesitant: Who else was going to be involved with her patients, and to what degree?
But she also saw an upside. Many of her severe asthma patients face socioeconomic challenges that can complicate their medical treatment. Schools don’t always handle access to asthma inhalers like they should. Insurance issues can hinder access to inhalers. Dust mites in old carpeting aggravate children’s asthma.
“There are a lot of problems that medical providers cannot handle by ourselves. The family can talk to the landlord and they probably won’t listen. As medical providers, we can send an email or letter to the landlord. Sometimes they listen, but if it comes from a lawyer, that makes a difference,” said Prabhakaran, the medical director of the UF Health Severe Asthma Center and a clinical associate professor in the UF College of Medicine’s pediatrics department.
The UF Healthy Kids MLP is about more than just legal advice. Alicia Hardy, R.N. a coordinator and certified asthma educator who works with Prabhakaran, has seen the MLP help in other ways.
For patients’ families, navigating the complex system for getting federal Supplemental Security Income can be challenging, Hardy said. Some people aren’t even aware they’re eligible. Like the senior MLP, the UF Healthy Kids MLP has helped families with their application and renewal eligibility, including determining which documents they need out of a lengthy medical record. SSI can help patients pay for medical expenses that aren’t otherwise covered.
“It helps them pay for medications that insurance won’t cover. It helps with their expenses for traveling to the clinic. Some of our patients travel quite a distance. The supplemental income can help their general well-being,” Hardy said.
While the UF Healthy Kids MLP is off to a busy start, its physician leaders are already thinking ahead. Coleman, its medical director, would like to see it expanded into general pediatrics and primary care. Ideally, she said, that would mean having an embedded attorney, just as Dunn is with the Severe Asthma Clinic.
“If I see a patient and identify a legal need, they can meet with the attorney directly and find out about getting the help they need before problems get worse,” said Coleman, who also serves as the medical ambassador for the senior MLP.
For Prabhakaran, the UF Healthy Kids MLP is a valuable way to help treat the entire patient — not just their medical symptoms. Before the MLP, certain details about how a patient’s living environment affected their medical condition were much more elusive.
“As health care providers, we would never find out certain things about our patients without the MLP,” she said. “Some important details that affect a patient just wouldn’t be known to us.”