Medical Legal Partnerships in South Carolina

Kirby Mitchell

Senior Litigation Attorney, South Carolina Legal Services and

Dr. Charles Hatcher, III, M.D

Greenville Hospital System

May 16, 2015

“There is more to health than healthcare.”

“The goal of healthcare reform is to reform the

system. The goal to improve health requires

different questions and different answers.”

(Poverty, Health and Law: Edited by: Tyler, Lawton, Conroy, Sandel, and

Zuckerman).

SOCIAL DETERMINANTS OF HEALTH(CARE)

Evidence shows ‘vulnerable populations’: • suffer disproportionate share of chronic

illness.• do not receive adequate primary care.• experience multiple social conditions that

complicate the delivery of high quality healthcare.

‘Legal problems’ are often immediately experienced by the patient /client as health problems……:

• Families wrongfully denied food, housing, or income supports.

• Children living in substandard housing in violation of housing laws.

• Young adults with disabilities are denied disability / educational / health benefits.

…..and many of these health problems have legal solutions….:

Social factors influence development & severity of disease.

Inconsistent program implementation results in denials of benefits / services.

Many social factors are remediable by enforcement of existing laws and regulations… but currently aren’t remedied, due to lack of enforcement / resources / etc.

….and thus: Medical - Legal Partnership (MLP)

Build a healthcare team able to identify,

treat and prevent health-harming legal needs for patients, clinics, and populations.

Please enjoy this obligatory symbolic marriage of law’s scales o’ justice + medicine’s caduceus / rod o’ Asclepius..

= MLP, baby!

What is a MLP?• Early doctor + legal aid partnerships can be traced back to

the 1960’s.• First true MLP was formed in 1993

– Boston Medical Center– Greater Boston Legal Services– Formed to address housing sanitation for children with asthma

• “Explosion” of MLPs across U.S. since early 2000’s

Dr. Barry S. Zuckerman, MD (photo below) credited as founder of MLP movement.

What is a MLP?

• Currently established in 262 healthcare institutions in 36 states.– 135 Hospitals– 127 Health Centers– 35 Health Schools – 127 Legal Aid Agencies– 46 Law Schools– 70 Pro Bono Partners

MLP Joint Goals• Provide integrated & collaborative medical &

legal care.• Enhance patient access to legal protections

and benefits.• Diminish legal barriers to health and promote

long-term well-being.

Hmmm, interesting… what is the best resource for more MLP information?• www.medical-legalpartnership.org

• National Center for Medical Legal Partnership at the Milken Institute School of Public Health at George Washington University, Washington, D.C. (formed in 2006; at GW since 2013)

• Mission: “To mainstream an integrated medical-legal approach to health and health care for people and populations.”

What is a MLP?

What about our neighbors? Georgia’s MLP…

• HEALTHCARE PARTNERS

– Children’s Healthcare of Atlanta — Egleston, Hughes Spalding & Scottish Rite

– Children’s Healthcare of Atlanta Community Clinics

– Emory University School of Medicine

– Morehouse School of Medicine

• LEGAL PARTNERS

– Atlanta Legal Aid Society, Inc.– Emory University School of

Law– Georgia State University

College of Law

…North Carolina’s MLP…

• HEALTHCARE PARTNERS

– Carolinas Health Care System– Duke Children’s Hospital & Health Center and

Duke Primary Care for Children– Duke University School of Medicine, Pediatrics

Residency Program– FirstHealth of the Carolinas– Guilford Child Health at Wendover, Triad Adult

and Pediatric Medicine– Lincoln Community Health Center– Mission Hospitals– North Carolina Children’s Hospital– University of North Carolina, Lineberger

Comprehensive Cancer Center, NC Cancer Hospital

– Wake Forest Baptist Health Downtown Health Plaza

– Wake Forest Baptist Health Pediatrics—Winston East

– Wake Forest School of Medicine, Pediatric Residency Program

– Wake Forest University Baptist Medical Center– Wake Forest University School of Medicine– Western North Carolina Community Health

Services

• LEGAL PARTNERS

– Duke University School of Law– Legal Aid of North Carolina — Charlotte– Legal Aid of North Carolina — Durham– Legal Aid of North Carolina — Greensboro– Legal Aid of North Carolina — Winston-Salem– Legal Aid of North Carolina, Inc. — Pittsboro– Legal Aid of North Carolina, Inc. — Statewide– Legal Services of Southern Piedmont, Inc.– Pisgah Legal Services– University of North Carolina School of Law Pro

Bono Program– Wake Forest University School of Law

…What about a South Carolina MLP? well, we are working on it… !

3 possible partners in G’ville…

P

What about a South Carolina MLP?• Initial possible focus of this pilot GHS-FU-legal aid MLP project:

– Families w/adolescents struggling with Autism Spectrum Disorders (ASDs)

– Our idea: Insure the necessary support is in place and remove the legal barriers for the critical transition of care prior to the age of majority (18)

• Guardianship / Conservatorship• Supplemental Security Income (SSI)• Social Security Disability Insurance/Disabled Adult Child Benefits (SSDI)• Health insurance• Transition health care needs• Child support• Academic support / IEP representation

Possible Location for this possible GHS-FU-legal aid pilot MLP project?

• Center for Developmental Services (CDS)

– Unique partnership linking Upstate at-risk individuals and families with multi-disciplinary services

• Clarity• Family Connection• Greenville County Schools• Kidnetics• Wonder Center

Location

Location

Location

Thank you to: GHS’s Dr. Nancy Powers, M.D. and Dr. Charles Hatcher, M.D. for their work

on these presentation materials.

Want to talk to someone at GHS about MLP?

Nancy R. Powers, MD, FAAP

Assistant Clinical Professor

Developmental Behavioral Pediatrics

Children’s Hospital Outpatient Center

Greenville Health System

200 Patewood Drive, Greenville, SC 29615

Office: (864) 454-5115

Npowers@ghs.org

Want to talk to someone at Furman about MLP?

Eli V. Hestermann, Ph.D.

Executive Director of Undergraduate Students and Studies, Greenville

Health System

Executive Director of Health Education and Associate Professor of

Biology, Furman University, Greenville, SC 29601

Eli.Hestermann@furman.edu

Want to talk to someone at South Carolina Legal Services (SCLS) about MLP?

Andrea E. Loney, Esquire

Executive Director

South Carolina Legal Services

2109 Bull Street

Columbia, SC  29201

(803) 744-4179

(803) 744-4184 (Fax)

andrealoney@sclegal.org

Thank you!

Any questions / comments / ideas / suggestions / help about MLPs?

Kirby Mitchell

Senior Litigation Attorney

South Carolina Legal Services

701 South Main Street

Greenville, SC 29601

(864) 679-3247

kirbymitchell@sclegal.org