Fixing America's Health and Legal Services Safety Net

Charity healthcare and pro bono legal services create a vital safety net for poor and vulnerable populations. Legal issues often impact the health of those living in poverty, and health challenges can lead to legal problems including housing discrimination and employment issues. Tragically, economic pressures are reducing or eliminating these services despite the rising need. Health and legal professions have the opportunity – and responsibility – to work together to bolster the medical-legal safety net and ensure it is available to those in need.

Disparities demand action

Disadvantaged and underserved communities have extensive unmet needs for health and legal services. For example, last year the University of California, Davis, Medical Center provided more than $50 million in free services to impoverished patients and more than $135 million in unreimbursed care.

Similar challenges exist in legal services. New York's Legal Aid Society, for instance, turns away eight of every nine people who seek assistance. Since 2008, requests have increased 40 percent for healthcare issues and 54 percent for unemployment insurance and work-related problems. In response, New York has become the first state to require pro bono services for those seeking admission to the bar, potentially creating nearly 500,000 hours of legal services for low-income New Yorkers every year.

Educational initiatives establish sustainable foundation

Securing a national medical-legal safety net begins with education. I hear compelling stories of appreciation, excitement and personal fulfillment from University of California, Davis, School of Medicine students who participate in programs that connect them to populations experiencing health disparities and healthcare injustices.

For example, UC Davis medical students provide free primary care clinics in disadvantaged communities. The pioneering PRIME (Programs in Medical Education) program prepares physician leaders who are committed to rural communities. An additional special training program is available to students interested in underserved urban areas. The demand from students is substantial – and inspiring – nearly 60 percent of the School of Medicine class of 2016 expressed interest in these programs.

Medical-legal partnerships improve low-income health

People's health and their legal needs are interrelated. Substandard housing may exacerbate children's asthma, yet their health cannot be adequately addressed until parents receive legal help in tenant-landlord disputes that remedy living conditions. Unexpected medical bills can lead to liens, utility shut off and bankruptcy – all requiring legal assistance. People in these situations must receive coordinated services from health and legal professionals if they are to truly achieve improved health.

Barry Zuckerman, a pediatrician at Boston Medical Center and chair of pediatrics at Boston University School of Medicine, is a leader in developing medical-legal partnerships. He began in 1993 by hiring a lawyer for the pediatrics department who helped parents navigate government programs and judicial procedures. His idea has become a successful model in which healthcare professionals identify legal issues that are causing or worsening a child's health status and lawyers provide the legal solutions.

Medical-legal relationships are now being established around the country, including Sacramento. For example, UC Davis School of Medicine and Pacific McGeorge School of Law are developing multi-sector solutions. Medical students and Elder and Health Law students participate in joint classes that address health and legal issues in the senior community. Law and medical students worked together at a citizenship fair held at the School of Law Student Center. Law students and attorneys from the law school's Immigration Law Clinic provided free assistance to people applying for U.S. citizenship. UC Davis medical students offered free blood pressure and vision screening services.

UC Davis School of Medicine, UC Davis Medical Center and Legal Services of Northern California (LSNC, a legal rights organization for low-income people) are piloting a project that brings together medical students, resident physicians and lawyers to collaboratively identify and address factors that adversely affect a patient's health. The project is expected to lead to medical-legal partnerships for the emergency department and family and internal medicine clinics. 

UC Davis School of Medicine and UC Davis Law School students work together at a UC Davis student-run free health clinic that serves the homeless population of Sacramento. Law students help patients access public services and provide legal counsel referrals to LSNC lawyers. Through these programs, students learn from real-life situations in an environment that fosters interprofessional understanding and teamwork.

We can do more

Now is the time for the health and legal professions to come together to weave a more effective safety net.

  1. Mandate safety net services. All states should join the pro bono legal services momentum started in New York, and all hospitals and health professionals should provide and document uncompensated services.
  2. Create more joint clinics. Legal and health professions should increase the number of medical-legal clinics, which serve vulnerable patients more effectively and create additional venues to provide required pro bono legal services.
  3. Integrate students' passion into curriculum. Health and legal educational institutions – individually and collaboratively – should develop more educational experiences that celebrate, harness and satisfy students' altruistic spirit – the heart of the safety net.

Failure to provide an adequate safety net of health and legal services places the health, economic well-being and civil rights of all of us at risk. It is time to make a lasting difference. As Sir Winston Churchill said, "We make a living by what we get, we make a life by what we give."

Claire Pomeroy is vice chancellor for human health sciences and dean of the School of Medicine at the University of California, Davis. She chairs the Board of Directors of the Association of Academic Health Centers and the Council of Deans of the Association of American Medical Colleges.

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