Putting lawyers on the case

Medical-Legal Partnership|Boston gives patients support from attorneys

By Karen Weintraub
Globe Correspondent / May 10, 2010

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The letter cut right to the point: Hawah Jackson’s lights would be turned off by the end of the month if she didn’t pay overdue utility bills totaling hundred of dollars. Jackson, a nurse at a rehabilitation hospital, said she didn’t have the money and worried how her 22-year-old severely disabled daughter, Binah, would cope if the power in their Dorchester home was shut off.

“She can’t stay in the darkness,’’ Jackson said. Binah, who has autism and doesn’t speak, often calms herself by switching on all the lights in the middle of the night, her mother said.

Jackson told Binah’s pediatrician about the impending crisis. He called a lawyer and within days, Jackson had sent a partial payment to the electric company, which acknowledged that because of her daughter’s disability it couldn’t legally stop providing electricity.

Jackson’s predicament is evidence that good health — particularly for people with modest financial resources — can be as much about legal issues as medical ones.

Dr. Barry Zuckerman, head of Boston Medical Center’s pediatric department, says he realized that years ago. In 1993, he hired a lawyer for the department to deal with legal issues associated with patients’ medical problems. The medical-legal partnership that resulted from his idea is now a national phenomenon, used in nearly 200 hospitals and clinics, with 15 participating law firms.

The partnership can help in various ways. For instance, lawyers connected to a hospital or clinic might write a letter encouraging a landlord to replace moldy carpeting that’s triggering asthma attacks, assist families in getting food stamps and other government benefits, and obtain power of attorney for the parents of a severely disabled child who is turning 18.

Locally, Medical-Legal Partnership|Boston involves a handful of the area’s largest law firms, including Ropes & Gray, LLP, and McDermott Will & Emery, and helps about 1,300 families a year. It has just started working with Children’s Hospital Boston, bringing its model into the hospital’s primary care service, according to Joshua Greenberg, director of government relations at Children’s Hospital, the lawyer Zuckerman hired 17 years ago.

“In my 35 years of practicing pediatrics in Boston, the lawyers have been the missing link to really improve the health and well-being of the children,’’ said Zuckerman, who is also a professor of pediatrics at the Boston University School of Medicine.

The partnership is now expanding into cancer care and geriatrics, areas that involve extremely vulnerable patients. For instance, cancer patients are legally entitled to less strenuous jobs when they are receiving and recuperating from treatment, but many are still forced to choose between their workday and their appointment for radiation, said Dr. Megan Sandel, medical director at the National Center for Medical-Legal Partnership.

Older people may be subject to abuse in nursing homes or by family members, she said.

Training doctors to look for potential abuse and providing easy access to lawyers will ideally stop such problems before they become crises, she said.

“Though the [medical-legal partnership] model started in pediatrics, where it may have its biggest impact is in geriatrics,’’ Sandel said.

In addition to helping individuals, like the Jacksons, the partnership promotes policy changes that help a much larger group.

“The front-line physicians who are seeing vulnerable families and adults every day get insights into what the policy tools might be,’’ said Ellen M. Lawton, executive director of the National Center for Medical-Legal Partnership.

Lawton’s group is now lobbying the federal government for funds to study whether its approach to health care saves money in the long run, by keeping patients healthier.

The power of the program is that it can address problems while they’re still relatively easy — and inexpensive — to fix, said Samantha J. Morton, executive director of Medical-Legal Partnership|Boston.

“When they become legal emergencies, they often become health emergencies,’’ Morton said.

The program is good for law firms, too. It gives young lawyers practice in client care, case management, and health care law, said Melissa Nott Davis, a partner at McDermott Will & Emery in Boston, and cochair of the firm’s pro-bono committee.

“It allows folks at a younger place in their career to really take the lead on different matters,’’ said Davis, adding that nearly 70 lawyers, staff, and summer associates at the firm have devoted more than 1,400 hours to the partnership over the last five years, often helping it deal with ethical and administrative issues.

For its part, Ropes & Gray last year devoted 6,000 hours to the health clinic at the Dorchester House Multi-Service Center , said Michele M. Garvin, a partner in the firm’s Health Care Group. Ropes & Gray has helped more than 50 Dorchester House patients with their legal matters over the last 20 months, Garvin said, including Hawah and Binah Jackson.

Dr. Peter Loewinthan, Binah’s pediatrician at Dorchester House, said he used to send letters to landlords or a school district on behalf of patients. But when Ropes & Gray sends out a letter, it gets more attention.

“If you’re some landlord who isn’t fixing up your apartment and get a letter on Ropes & Gray stationery, you know that one of the major law firms in Boston is going to stick it to you if you don’t clean up,’’ he said.

Loewinthan, who has been Binah’s doctor since birth, referred Jackson to the partnership last year: Binah’s 21st birthday was approaching, meaning she would be too old to attend a specialized school.

A Ropes & Gray lawyer helped educate Jackson about her options, and ensured Binah a smooth transition to a day program for disabled adults.

“She needs a program where she can get more activities and not somewhere where she’s just sitting at a table drawing pictures,’’ Jackson said.

Jackson said she was touched when her lawyer, Kathryn Beaumont Murphy, came to the rehabilitation center where she works to deliver paperwork.

“You would think I was someone so important,’’ she said with a broad smile. “I never had nothing done like this for me.’’