BMC to go national with legal aid program
Lawyers, doctors team up for health
Sometimes lawyers, not doctors, can be the key to good health.
That principle drives a Boston Medical Center program that relies on attorneys, in partnership with physicians and social workers, to help low-income children stay healthy. The lawyers ensure that houses are heated in the winter, help undernourished families apply for food stamps, work to eliminate rodent infestation, and prod landlords to clean up moldy apartments that can trigger asthma, among other tasks.
Now, in a national project backed by $2.7 million in grants, BMC today will launch an ambitious effort to replicate its program in every state. By using lawyers to solve legal problems that can cause illness -- from fixing faulty furnaces to navigating immigration rules that may make patients afraid to apply for food or housing assistance -- doctors believe they can prevent more serious health crises, such as malnutrition, job loss, and domestic violence.
''This is a way of changing pediatric care for low-income families," said Dr. Barry S. Zuckerman, chief of pediatrics at BMC and founder of its Family Advocacy Program, which will be renamed the Medical-Legal Partnership for Children. ''It's an opportunity, in a pediatric setting, to pick up legal problems before they reach their natural unfortunate outcome, such as homelessness or child abuse."
Driven by studies and first-hand experience showing that poor children suffer more health problems than their wealthier peers, the program will encourage doctors nationwide to diagnose not only medical issues in impoverished children, but also barriers to good health that the law can remove. They can range from relatively simple problems like eliminating indoor pollution caused by cigarette smoke from neighboring apartments to more complex matters, such as accessing safe and affordable housing and education.
The program also will match law firms and legal aid organizations with health centers nationwide so that families unable to afford private legal services can work with attorneys free of charge. In Boston, Day, Berry & Howard LLP works with BMC by staffing weekly legal clinics for low-income families at East Boston Community Health Center. Seven other local law firms, as well as local bar associations, also do pro bono work for BMC, which has six in-house attorneys that work on patient advocacy issues.
The goal, said Dr. Lauren A. Smith, a BMC pediatrician and medical director of the program, which has assisted more than 4,000 families since its founding in 1993, is to ''uncouple poverty and the effects that poverty has on kids' health."
When the mother of one of BMC pediatrician Jack Maypole's autistic patients died, lawyers helped the girl's father, who lived in another country, stay in the United States to care for her. ''Had she gone back to her father's country, there may not have been services to care for her very complicated behavioral and neurologic problems, including seizures," Maypole said, ''and her life prospects would have been a lot different."
Similar programs, modeled after Boston's, are underway in more than 30 communities nationwide. To further nationalize the effort, BMC officials will develop curriculum and training materials; travel around the country to educate pediatric staffs, lawyers, social workers, government officials, and community agencies; host national conferences; develop a more comprehensive website; and provide on-site consultations, technical assistance, and evaluations to a network of hospitals and health centers.
Legal services are provided at no cost to patients, and the national effort will be funded by $2.7 million over five years from several philanthropic groups, including the W.K. Kellogg Foundation and Robert Wood Johnson Foundation, according to the program's executive director, Ellen M. Lawton, who is a lawyer. Kellogg alone has committed $2.3 million.
BMC officials concede that doctors initially may feel awkward involving lawyers in patient care. But several physicians who have referred patients to the hospital's legal team said they have been elated with the results.
BMC pediatrician Maypole and his colleague Suzanne Steinbach, like many doctors, frequently write letters for their patients that vouch for their eligibility for medical, mental health or educational services, or that ask landlords to correct housing conditions like mold that can aggravate asthma. But particularly in landlord disputes, said Steinbach, director of BMC's pediatric asthma-allergy clinic, they ''very rarely" got results -- until lawyers stepped in.
By bringing attorneys into the mix, many doctors realized that ''issues we were concerned about and seeing only as health issues were actually also legal issues," Steinbach said. ''Our prior approach didn't work and didn't help our patients and made us feel powerless, while with the lawyer as our colleague we felt empowered." Added Maypole, who is also director of pediatrics at the South End Community Health Center: ''A doctor can write a good letter, or a lawyer can help a doctor write a great letter."
BMC's program helped Roxbury resident Selena Rankin when the suburban school system in Newton where her 10-year-old daughter, Kenya Williams, was a Metco student said it could not accommodate Williams's behavioral problems and wanted to transfer her back to Boston public schools, Rankin said.
''Things like school success are one of the most important elements in our pediatric group," said Williams's pediatrician, Dr. Sean Palfrey, a professor of pediatrics and public health at the Boston University School of Medicine. ''In this case, Kenya had been placed in a special program that wasn't the right one for her . . . and she had behavioral and attentional problems because she was in the wrong setting, so we had to get advocacy to help get her the services she needs."
At BMC's request, a lawyer at Holland & Knight LLP negotiated with the Newton school system, which paid for Williams to attend summer school and also paid for her transportation there. Williams now attends a Boston public school in Jamaica Plain, where her mother said she is ''making tremendous progress." Williams also has the option of returning to Newton or another suburban school system that participates in the Metco program, according to her lawyer, Kwamina Thomas Williford.
''I was at my wit's end," said Rankin, ''and they were like guardian angels that came in and were able to interpret all the paperwork."
Sacha Pfeiffer can be reached at pfeiffer@globe.com. 