A Dose of Law and Medicine
October 13, 2016
Robert M Reynolds
Laura Russell J.D. ’16 spearheads Oregon’s first medical-legal partnership (MLP) to address the social determinants of health.
by Genevieve J. Long
Almost 50 million Americans—nearly one in six—live in poverty.
And studies show that most of them have at least one legal problem that affects their health. A landlord won’t clean up a moldy building? Tenants develop asthma. A woman comes to the emergency room with bruises and broken bones? She needs treatment—and a restraining order against her abusive spouse.
Health care providers know that social factors harm patients’ health. But it was only two decades ago that a frustrated Boston pediatrician created the first medical-legal partnership, enlisting the local legal aid office to look into patients’ housing conditions. Although more than 40 states have established MLPs, until recently, Oregon was not among them. But now, thanks in large part to the leadership of Laura Russell J.D. ’16, many of Oregon’s most vulnerable citizens will soon have access to both medical and legal resources to improve their overall well-being.
What Is a Medical-Legal Partnership?
Medical-legal partnerships, or MLPs, put attorneys in hospitals and clinics to help low-income patients with legal issues that exacerbate or cause their health problems. Attorneys—and, in some cases, paralegals or law students—train health care providers to identify social and legal issues in their patients’ lives. Then the health care team connects patients to legal services. The only legal issues MLPs do not cover are criminal law, medical malpractice, and HIPAA (patient privacy and confidentiality) issues.
Beginning this fall, Oregon will pilot its first medical-legal partnership at Oregon Health & Science University’s Richmond Clinic, a community health center in Southeast Portland that focuses on helping patients with complex medical needs. The one-year pilot brings together OHSU and the nonprofit Health Share of Oregon, which aims to maximize care for members of the state’s low-income health plan, the Oregon Health Plan.
Russell has been a key player in working with each of these organizations—and in ensuring that Lewis & Clark law students will have an avenue for involvement. For the pilot project, law students will take in clients, consult with pro bono attorneys on case management, and gain other practical experience under the guidance of a supervising attorney jointly funded by Health Share of Oregon and the Richmond Clinic.
A Passion for Patients
Russell became fascinated by health policy when the Affordable Care Act passed in 2010. “My parents both work in health care, and I wanted to find my own path to helping people,” she says. After earning a health policy degree from Washington State University and completing a postgraduate fellowship at the University of Michigan, she chose Lewis & Clark Law School as the best place to combine her policy interests with her passion for helping those in need.
Russell began exploring the legal requirements for establishing an Oregon MLP in a health law and policy seminar taught by Barbara Safriet, visiting professor of law. “Laura and others were convinced that social and economic factors—such as housing, transportation, nutrition, violence, poverty —affect an individual’s health status, both in the origin of health problems and often in the effectiveness of any medical intervention or treatment,” recalls Safriet.
A Spark Ignites a Movement
When Russell started law school, her now fiancé was a medical resident at Oregon Health & Science University. His supervisor, Ken Gatter, who holds both a J.D and an M.D., knew of the medical-legal partnership movement and mentioned it in passing. Though Oregon has historically been a pioneer in health care, including developing the Oregon Health Plan in 1993 to ensure health care access for all working Oregonians, the state was one of a handful without a medical-legal partnership.
Discussions with Gatter piqued Russell’s interest. In 2014, she and Gatter attended the annual conference of the National Center for Medical-Legal Partnership, and Gatter introduced Russell to Rachel Arnold of Health Share. Happily, Health Share’s CEO had just read a New York Times article on medical-legal partnerships and was enthusiastic about starting one in Oregon. From there, Gatter says, “Through hard work, networking, perseverance, and intelligence, Laura took the idea from a spark to a working MLP. Her leadership and understanding of how MLPs can affect the social determinants of health has been impressive.”
Solving legal problems for a few, says Russell, can improve health for many. “About 60 percent of health outcomes are determined by socioeconomic status,” she says. “The American Health Care Paradox, by Bradley, Taylor, and Fineberg, was the first major work to show that health outcomes are only marginally controlled by medical intervention, and poverty makes you sick.”
She points to the health care movement, incorporated into the Affordable Care Act, as a way to move from “sick care” toward preventive care. “As lawyers in medical-legal partnerships, we are trying to get justice for our clients,” says Russell. “And we want that justice to translate into a healthier person, family, and community.”
Bringing Experts Together for Health
In Oregon’s MLP pilot, Health Share and the Richmond Clinic are the medical partners; Lewis & Clark law students, the attorney hired to supervise, and pro bono attorneys have the legal side covered. Russell, Arnold, and Gatter remain on the organization’s board. Team members will spend the one-year pilot studying whether legal interventions improve patient outcomes and lower health care costs. Russell hopes the partnership will show cost efficiencies and warrant further funding, leading to expansion in the Portland area and across the state.
It can be a challenge to bring busy professionals together for a medical-legal partnership, but Oregon’s group came together eagerly. Gatter began shopping the idea around to OHSU colleagues, and the team spoke with OHSU’s Richmond Clinic early in the process. “The staff is an exceptional group of physicians and leaders,” Russell says. “We hardly had to explain the MLP concept—they already know how these issues affect patients. The MLP began getting referrals a year ago, way before we were ready.”
A Promising Future Lewis & Clark Law School Associate Dean Libby Davis, a member of the MLP board, says working with Laura has been inspiring. “She understands what this program can bring to people suffering health issues tied to a legal issue,” says Davis.
Genevieve J. Long is a Portland writer specializing in medical communications.
Problem: When medical and legal issues collide
Teresa is a single mother of two who works two jobs. She lives in an apartment that the landlord is allowing to deteriorate. Teresa’s doctor diagnoses her with high blood pressure and prescribes medication, regular checkups, and a nutritious diet and exercise. But Teresa can’t afford the prescription or time off work for appointments. Plus, the kids need new school clothes. So Teresa takes half the prescribed dose of medication and puts off checkups. The result? Her blood pressure stays high,and the stress of managing one more expense worsens her cardiovascular health.
Solution: A medical-legal partnership (MLP)
During a rare checkup, Teresa explains her problems getting medication and time off work. The doctor connects her with the clinic attorney, who tells Teresa about a low-cost prescription program. The attorney also helps her get a reduced-fare bus pass and writes a letter to the landlord about Teresa’s living conditions. Now, Teresa takes the prescribed dose of medication and, with the low-cost bus pass, gets to appointments more often. When her health improves, she is promoted at one job and quits the second. This means she can walk with her neighbor several evenings a week and afford to buy more healthful food, which benefits her and her children.