Medical-legal partnerships are fueled by the desire to address social needs through an integrated healthcare system with an understanding that health means more than just good medicine. This guiding principle of medical-legal partnership practice models leverages the expertise of lawyers in a healthcare setting to work with partners in different disciplines, such as social workers, clinicians, and case managers, to address structural problems at the root of numerous health inequities.
According to the National Center for Medical-Legal Partnerships, many studies have found that when legal services are brought into medical clinics to address patients’ social needs, people are admitted to the hospital less frequently, more likely to take their medications as prescribed, and report lower levels of stress. Medical-legal partnerships may, for example, address a health issue an asthma patient faces by recognizing the connection to a social issue like poor housing conditions. In 2023, over 75,000 patients resolved a legal issue linked to their health, such as housing, through the assistance of a medical-legal partnership. Today, medical-legal partnerships are present in 49 states and across 450 organizations.
Many American law schools, including the University of Maryland Francis King Carey School of Law, offer clinical opportunities for students to gain practical lawyering skills. The University of Maryland Francis King Carey School of Law is unique in the sense that it requires full–time day students to participate in the school’s clinical law program as a prerequisite to graduation. The Maryland Carey School of Law has 18 clinics under the umbrella of the clinical law program, covering a wide range of legal practice areas. Students in the Medical-Legal Partnership (MLP) Clinic spend their second or third year of law school providing direct client representation primarily to patients at the University of Maryland Medical Center, Midtown Campus’ THRIVE Program. Law students practice law pursuant to MD Rule 19-220 under the faculty supervision of Professor Sara Gold. The MLP Clinic students are exposed to a wide range of legal issues and engage in interprofessional work with other students and providers in the social work and healthcare fields. The range of matters includes SSI/Social Security disability benefits, custody, employment discrimination, advance care planning, and medical decision-making (preparing medical advance directives, simple wills, and powers of attorney), and legal name change for transgender clients.
Medical care is, of course, a critical component of attaining and maintaining good health. But many clients experience significant non-medical conditions that contribute to their physical and/or mental health that also need to be addressed. These social determinants of health (SDoH) are the conditions in which people live, work, and play that impact overall health and wellness, oftentimes before the symptoms appear in a healthcare provider's office. For example, a patient with asthma symptoms may go to their treating medical provider and be prescribed an inhaler. If the patient returns to their apartment that is infested with mold due to a neglectful landlord, the inhaler will likely not provide sufficient relief and does not address the root of the problem. The partnership between the MLP Clinic and THRIVE Program allows student attorneys to conduct informative training for the social workers and healthcare providers educating them on how to screen a patient for a possible legal issue. Upon identifying a potential legal issue, social workers and/or providers refer the patient to the MLP Clinic for legal services. Matters referred may be litigation, non-litigation, or a quick-hit “brief advice” meeting where the patient is able to have their questions or issues addressed in one meeting. The MLP Clinic provides preventative legal advice and counsel to address “upstream” issues before an acute legal dispute arises, as well as ongoing legal representation in cases where a legal conflict exists.
The Medical-Legal Partnership Clinic represents clients in a broad range of case types, from SSI/Social Security disability benefits to legal name changes. This reflects the many legal issues impacting clients’ abilities to maintain a healthy lifestyle. The MLP Clinic operates on the overarching awareness that clients’ health and wellbeing may be impacted by factors—SDoH—outside their control. These SDoH include housing instability, financial instability, and family instability. Keeping these factors in mind, student attorneys collaborate with healthcare and social work partners who are trained to screen for various legal issues. Together, student attorneys in the MLP Clinic provide holistic representation through the continuum of care.
In medicine, the continuum of care describes the delivery of healthcare services to a patient through collaboration to ensure the quality of that healthcare. The Medical-Legal Partnership Clinic reinforces this concept and fits within it. By partnering with healthcare providers and social workers to address health disparities affecting vulnerable clients, specifically those living with HIV, student attorneys maximize the quality of both legal representation and healthcare provided. These efforts provide the best possible care and work towards increasing the healthcare provider’s capacity to address social and environmental threats to a patient’s health.
During the course of representation, student attorneys are given the opportunity to make a positive impact on the lives of their clients. This may come in the form of “brief advice” or may be an ongoing relationship throughout the school year. The following client stories highlight the impact of student attorney work with various clients and the importance of interprofessional collaboration, as well as the role of the MLP in the student attorneys’ law education.
Ms. E was a patient who was referred to the Medical-Legal Partnership Clinic for advance care planning, meaning she wanted clinic staff to prepare a will, financial power of attorney, and advance medical directives. Ms. E’s physician referred her to the clinic due to her dementia diagnosis, which would soon prevent her from being able to make decisions on her own. The physician’s biggest goal was making sure his patient legally documented her medical wishes before the dementia progressed too quickly, while Ms. E just wanted to have some “peace” about the process. While working with Ms. E, the student attorney discovered other issues that needed to be addressed before finishing her documents, including mortgage bills, benefit payments, and family disagreements that were competing for her attention and energy. These were all non-legal problems that would create serious barriers to her ability to maintain a healthy lifestyle and were concerns for her will preparation.
Ms. E needed a care team to address her needs, and the student attorney needed more context about her situation from her physician and social worker. During a quick phone call, Ms. E’s physician was able to offer insight into her diagnosis, and her social worker assisted in making recommendations about how to reduce the expensive bills she was juggling. Through collaboration, the team was able to clear Ms. E’s mortgage debt and provide her with additional resources, and the student learned how to trust the client’s judgment despite her diagnosis so that she could prepare her legal documents. The interprofessional collaboration provided Ms. E with medical, legal, and social services on her care team to address underlying issues that could not be resolved by physicians alone. She also felt comforted knowing that she could trust the care team to consult with each other and that she did not have to seek outside assistance for several different issues. The most important part of this is that Ms. E was happy, her goals were met, and she is still maintaining her lifestyle today thanks to the clinic’s assistance.
Working with clients to draft advance directives to name a healthcare agent are often “pretty straightforward” cases. Some of the clients, however, do not want anyone, including their appointed healthcare agents, to know their HIV status. While HIV is now a chronic, manageable disease, HIV-related stigma still remains. Student attorneys often work with clients on creative solutions to maximize their privacy while also ensuring that their healthcare agents are authorized to make informed future medical decisions.
When working with one client, Mr. B., what the student thought would be a “pretty simple” case of filling out forms reminded her of the importance of client-centered lawyering. By tailoring the advance directive form and other documents, the student attorney was able to ensure the patient named a healthcare agent, while also protecting information they wished to keep private. This solution was reached after thoughtful collaboration by the student attorney with the patient’s social worker and the student’s supervising professor. A creative approach to completing these documents strengthened the student attorney’s critical thinking and creative problem-solving skills and allowed her to also take on the role of counselor too.
One of the main ways the clinic achieves the goal of interdisciplinary collaboration is through its participation in the Preparing the Future (PTF) HIV Educational Program at the University of Maryland, Baltimore campus, which is funded by the MidAtlantic AIDS Education and Training Center (AETC). The PTF Program brings together students from the schools of law, nursing, social work, dentistry, medicine, and pharmacy to achieve an interdisciplinary approach. Through the PTF program, students work together across different disciplines to improve patient health outcomes and reduce health disparities related to HIV. This collaborative approach teaches future healthcare professionals the best practices to ensure quality of care, including how to practice as part of an interdisciplinary healthcare team. The core competencies were created by a panel of experts from each discipline and the courses in the program are taught by faculty across the six disciplines.
The first session each student attends is HIV 101 Through an Interprofessional Lens, where students learn about the gaps in the continuum of care for people living with HIV, and the role each profession plays in improving health outcomes. Some of the other interdisciplinary courses offered in the PTF program include Implicit Bias in the Medical Setting, Patient Experience in an Interprofessional Clinic, HIV Criminalization and the Law, LGBTQ+ Cultural Competency, HIV and Stigma, and Social Justice Perspective through a Trauma Lens.
The final course each student is required to take to receive a certificate of completion at the end of the program is the Standardized Patient class. The Standardized Patient is an interprofessional experiential learning opportunity where students from each of the six discipline areas come together in a clinical setting to identify and articulate the importance of interprofessional care. For example, public benefit issues are commonly where clinicians and lawyers come together to address patient needs. A patient who recently stopped receiving public benefits or was evicted from their home may visit the emergency room or communicate this issue to their social worker due to the impact it has on their emotional, mental, and physical health. The Standardized Patient course allows each student to see where and how their discipline can assist the patient along the continuum of care.
Lawyers working in healthcare settings have a unique opportunity to leverage their understanding of relevant policies, laws, and systems to resolve problems for patients, while also helping clinical staff identify health-related legal needs. Student attorneys receive invaluable experience by working in MLP clinics, because they are engaging in interprofessional problem-solving while developing and strengthening their legal problem-solving skills. Lawyers who use their knowledge and expertise to address patients’ SDoH can make a tremendous impact on all areas of a patient’s life by offering a holistic approach to healthcare. The ABA Health Law Section has a Medical-Legal Partnership Educational Outreach Interest Group aimed at assisting and supporting partnerships between physicians, social services, and attorneys at hospitals and other healthcare facilities. If medical-legal partnerships are something you might be interested in or if you have any further questions, please do not hesitate to reach out.
