If you saw attorneys working with patients while you were waiting to see your doctor, what would you think? Historically, the most common interaction between attorneys and physicians is when there’s a lawsuit either against the facility or the physician.
People’s Community Clinic in Austin, Texas is reversing that perception by modeling a recent trend found in public clinics across the country by establishing an in-house Medical/Legal Partnership (MLP) to address the legal determinants of health.
Making the Case for MLP’s
Keegan Warren-Clem, current Director of People’s Austin MLP, recalled the experience as a legal intern with the Health Law Program at the Texas Legal Services Center (TLSC) that led her to discern her life’s ambition. In 2010, a case was referred to Ms. Warren-Clem for a patient who had been denied coverage for a critical medication to treat a neurological condition. The patient’s physician had appealed the decision and lost. The patient, knowing his condition would worsen without this medication, sought legal aid at TLSC.
In addition to winning the appeal, Ms. Warren-Clem was able to set a precedent for expanded medical coverage to include this drug for future patients in need. Ms. Warren Clem discovered just how mired the process was in Federal Drug Administration regulations, something foreign to most outside the legal profession. The experience made her dig deeper to find a solution which led to the discovery of existing MLP’s in other parts of the country. Upon sharing the information with TLSC leadership, a decision was made to apply for two-year fellowship to establish an MLP in a public clinic in Austin. The fellowship was awarded to TLSC and they decided to approach People’s Community Clinic, known for its holistic approach to public healthcare.
From People’s perspective, they had long been waiting for the opportunity. As a longtime legal advocate for the underserved, Regina Rogoff, JD., currently serves as CEO of People’s Community Clinic. Rogoff knows firsthand how lack of resources for legal advocacy can deeply impact the health and well-being of individuals and their families in low income communities. Rogoff was Executive Director of the Legal Aid of Central Texas for twenty years and a Legal Aid staff attorney for ten years, beginning her career as a VISTA lawyer and tried unsuccessfully to establish an MLP at People’s early on. Funding was the obstacle.
According to Warren-Clem, the seed funding to incubate the program gave both organizations an opportunity to assess the legal needs of the clinic’s patients, prioritize top needs, and educate the medical staff. Warren-Clem described the learning curve to figure out the best way to integrate legal referrals into an already overburdened process without compromising patient care a learning opportunity for both sides. Ultimately, cumbersome paper referrals found their way into the electronic medical records with an automated referral generated to Warren-Clem and her team.
Sadly, at the conclusion of the TLSC fellowship, the program was suspended as People’s Board of Directors felt fundraising efforts should continue to focus on healthcare alone.
Taking A Broader Approach to Funding Public Health
As part of its desire to create systemic change to improve health outcomes for underserved populations, the Episcopal Health Foundation (EHF) developed a new strategic plan based on research around the social determinants of health. The research took them on a deeper dive on the role of nutrition, benefits, education and legal advocacy. Their commitment was to provide funding to “go beyond the walls” of the clinic to eradicate the root cause of chronic illnesses like asthma, diabetes and a host of other repeat illnesses that could be eradicated through a holistic approach.
Anna Steiner, EHF Program Officer, explained how the foundation's broader approach allowed People’s Community Clinic to reestablish the MLP as both organizations use a Community Centered Health Home model which engages patients utilizing a holistic approach to care.
Regina Rogoff echoes the importance of EHF’s role. To illustrate, Rogoff shares an extreme case of a mother of four who passed away due to complications during child birth. Not recognizing the father of the newborn, who was undocumented, the hospital tried to place the baby in foster care. The father explained the couple never married out of fear of deportation. A referral to People’s Legal Director, Warren-Clem, resulted in legally establishing paternity with the right paperwork and preventing even further loss for this man and his children.
The funding from EHF resulted in education and legal advocacy to improve healthcare for more than 250 families, to change public policy that affects the lives of many uninsured/underinsured Texans, and according to Anna Steiner, EHF Program Officer, has led People’s Clinic in the direction of Value Based Health Care which provides financial incentives to institutions focused on a proactive approach to healthcare.
For more information on Medical Legal Partnerships, the National Center for Medical Legal Partnerships is a great place to start.
A special note of thanks to members of two great teams for the work they are doing and for taking the time to share their journey: Regina Rogoff, Joy Warren and Keegan Warren-Clem, with People’s Community Clinic in Austin, TX along with Anna Steiner & Brian Sasser with the Episcopal Health Foundation in Houston, TX.