Rx for lawyers

PEDIATRICIANS AT Boston Medical Center provide aggressive care for children, and that can mean calling in a lawyer. It's a team approach that protects children from society's more complex health threats -- from poor nutrition to poorly maintained apartments.

Now, with $2.7 million in foundation grants, BMC is going national, taking this 13-year-old model of medical and legal services to other states under a new name, the Medical Legal Partnership for Children.

It shouldn't be necessary, but lawyers can make the system work better for low-income clients. Take the case of a single Boston mother of two teenage daughters, one of whom is partially blind. The mother had a part-time administrative job, but when her child support payments abruptly stopped, she fell behind on her electric bill and her power was turned off for several months, according to Ellen Lawton, executive director of MLPC. The mother had been told that to set up a payment plan, she had to pay half the arrearages. MLPC's lawyers negotiated a deal that restored electrical power and set up a payment plan.

Training is one secret to success. Doctors learn to handle sensitive issues in a routine manner and to look for what Lawton calls ''legal red flags." Open-ended questions such as: How are you making ends meet? or What are some of the stresses in your life? are a first step. Doctors, knowing they're backed up by lawyers and social workers, are more willing to screen for malnutrition, domestic violence, and school troubles that could indicate learning disabilities. The lawyers carry pagers so they can respond quickly.

The BMC program often gets to families early, solving problems such as possible evictions before they become health-compromising disasters, such as homelessness.

BMC has existing or emerging collaborations in more than 20 states, and more outreach will be done at a national conference in California at the end of the month.

A national challenge is finding lawyers who have the skills to help families. The Boston Bar Association has helped with recruitment and large Boston firms have donated many hours of pro bono work. But Lawton says the demand for such lawyers always outstrips the supply. The hospital reaches out to law students with its annual conference on child health and the law. But this is a shortage that law schools, law firms, and bar associations across the country should address.

Over the next five years, the program's funding from the W.K. Kellogg and Robert Wood Johnson foundations and others will end. During this time doctors and lawyers have to turn an innovative idea into standard practice so that whether children live in Boston or Bismarck, they have equal access to sound, legally enhanced medical care.