Legal advice as a determinant of health

When Christine Crawford, 57, began discussing gender transition surgery with her hormone specialist at a clinic for Mount Sinai Hospital in New York, she expressed concern over the process of legally changing her name to Christine.

The process, which can take three to six months, was one more stressful item on a "to-do" list that included surgery.

But an attorney at the Mount Sinai Medical-Legal Partnership was able to take the stress out of the name change. The attorney drafted a petition to change Crawford's name, expedited the process and got a court date on the calendar. In just about a month, Crawford’s name was legally changed quickly enough for her new name to appear on her recently completed master’s degree in social work.

“It took a lot of stress off me and a lot of worry,” says Crawford, who was MSMLP’s first client. “My attorney cared about me as a human being and really wanted things to turn out well for me,” she added.

Less than a year old, MSMLP has no central office or employees but rather operates on a case-by-case basis to provide volunteer, pro bono legal aid to patients.

The MSMLP provides dedicated programs for specific hospitals and clinics within the New York system. These include child and family services at Mount Sinai St. Luke’s Roosevelt, which was awarded a $1.33 million grant from the Manhattan District Attorney’s Criminal Justice Investment Initiative to provide free legal services for patients at risk of poor life outcomes. It focuses on representation in youth suspension hearings, legal screenings and other services.

At the Mount Sinai Palliative Care Institute, the MSMLP has a program to provide standby guardianship for minor children of dying patients. The partnership also works with volunteer legal organizations for services involving domestic issues and housing discrimination and hopes to have two or three more programs started by the end of the year, including one associated with Mount Sinai’s Medicare Shared Savings Program Accountable Care Organization, says Beth Essig, executive vice president and general counsel of Mount Sinai Health System.

Roughly 300 hospitals, health systems and clinics are now part of medical-legal partnerships, as the field begins to realize how closely the social determinants of health are linked to the law, says Joel Teitelbaum, co-director of the National Center for Medical Legal Partnerships.

Though positive stories are plentiful, when it comes to showing the measurable effect of medical-legal partnerships on health outcomes, "it’s very much in the early stages," says Teitelbaum.

This shouldn’t make health care leaders hesitant to consider incorporating legal advice into care, though, as long as they consider their patient base, Teitelbaum says. Other factors to consider are the level of integration that can be achieved and sustained along with the best partners in the community, he says. And like many large undertakings, take your time.

“Don’t move too fast — don’t take on too much in the beginning, because that’s when we’ve seen a lot of these topple over," Teitelbaum  says. “You think you can address all your patient’s legal needs from the outset, but that oftentimes will lead to failure.”