Starting in 1993 Barry Zuckerman MD and Ellen Lawton JD partnered to create an innovative partnership between two professions that traditionally encountered each other in the courtroom. Tired and frustrated of seeing pediatric patient after patient come in with new or worse diseases from substandard housing, food insecurity and other social determinants of health, Zuckerman worked with Lawton to create a Medical-Legal Partnership at Boston Medical Center to use an inter-professional approach to produce health and legal outcomes that were not possible alone (http://www.mlpboston.org). Rather than suing doctors, these lawyers partnered with them to address the social, economic, legal and even neglect or abuse threats that people face every day that often lead to the diseases I see in the clinic and hospital. In one seminal paper in the Journal of the American Academy of Pediatrics titled “Why Pediatricians Need Lawyers to Keep Children Healthy”, Zuckerman and Lawton describe a case of how legal research on local and state sanitary and housing code regulations helped encourage a landlord to fix a pipe, clean up mold and replace unsanitary carpeting to help significantly improve a 6 year old boy who was suffering from severe asthma symptoms. Studies have shown that 1 in 6 people need legal care in order to be healthy. And since 1993 there are now 294 Medical-Legal Partnerships in 41 states! (http://medical-legalpartnership.org/) Traditional medicine often thinks about disease and patients in a vacuum. However, the emerging field of public health has encouraged physicians, lawyers and society to take a wholistic view of health paying specific attention to upstream determinants of health in order to care for individuals in the context of their communities and environment.
This past month I have had the incredible opportunity to work with patient advocate lawyers at the Medical Legal Community Partnerships of Neighborhood Legal Services of Los Angeles County (http://www.nlsla.org/projects/medical-legal-community-partnerships-mlcps/). I have learned to work and partner with lawyers to assist patients with housing eviction, physical abuse, domestic violence, parental custody, divorce dissolution, supportive services, immigration, medical insurance exemptions, safe house planning and so much more! I witnessed the power of a MLP when I helped work with a client whose life was acutely in danger from biological, financial and social threats simultaneously.
However, no size fits all communities well and there are variations and differences in best practices for communities based on size, culture, politics, resources, etc. And the partnership often struggles to efficiently integrate electronic record processes while maintaining HIPPA compliance. Perhaps the greatest need for growth is in data collection and evaluation programs in order to create a better evidence-based MLP culture and practice of objectively proven best practices. That said the new partnership is one of many new collaborations in both health and law.
As I move to Hilo to start my Family Medicine Residency Program, I will be working to implement a new MLP in the community of Hilo with local partners. I will first start by listening and learning from the community and stakeholders how exactly such a partnership could best meet their needs! I often say that this world is getting crazier by the minute, and often news can be more discouraging. However, I am encouraged and inspired by this emerging community-based MLP model of whole person care!
