ND medical-legal partnership: lawyers and physicians to help the needy

When it comes to the intersection of healthcare and civil law, Anne Hoefgen, executive director of Legal Services of Northwest Minnesota (LSNM), has a story she often recounts. It is about a woman who once visited a dental clinic in Bemidji, Minnesota. The facility had teamed up with LSNM to offer patients non-criminal legal aid.

The woman was there to have a tooth pulled. Once the procedure ended, she asked if any of her healthy teeth could be extracted too. Her husband waited on her in their car and as soon as she walked out of the office, she told the hygienist, he would drive her back to their farm, where she would not be able to leave.

“So, the safety of being in a dental chair and getting her tooth pulled was better than her home,” said Hoefgen. “So, we intervened and we got her an order for protection and then a divorce.”

Had the dental clinic and LSNM not collaborated, that woman’s fate could have been different. Instead, she benefited from a local medical-legal partnership (MLP).

Operating in 41 states, MLPs unite medical and legal aid organizations to cater to the disadvantaged, the poor and the elderly. They focus on what are called the social determinants of health, which, according to the National Center for Medical-Legal Partnership, dictate some whopping 60 percent of an individual’s well-being.

“If you have a housing problem, if you have got an issue with having enough cash flow; perhaps, you haven't qualified for Medicaid – there might be a legal solution to these,” said Adele Page, deputy director of Legal Services of North Dakota (LSND). “All of these things help to get you healthier because you are going to have food, you are going to have housing, you are going have money and then you are going to be able to utilize the services of a medical provider more effectively.”

Until recently, no MLP existed in North Dakota. The prospect of developing one has, for years, been on the radar of LSND, the sole legal aid organization in the state.

To Page, who spent a decade working as a nurse before switching to law, MLPs presented a compelling concept to deliver wrap-around care to an underserved segment of society. With an incessantly shrinking budget, however, “we had to pick our battles,” she said, “and unfortunately this means prioritizing where we put our services.”

This, though, is about to change. Having joined with LSNM and Family HealthCare, LSND has secured a $200,000 community innovation grant from the Bush Foundation to establish North Dakota’s first cross-border MLP, Legal Advocates for Health. Slated to run for an initial stretch of two years, the project embeds an attorney with the medical staff at Family HealthCare’s clinic in downtown Fargo.

While the three partners are currently seeking a qualified lawyer to lead Legal Advocates for Health, the foundations of the initiative have already been laid out with a pilot that unfolded in the summer of 2016. Back then, LSND and LSNM positioned two law students at Family HealthCare, where they helped patients obtain legal counsel.

“In an average day, I could come back to the office of LSND and have an average of two matters that we could potentially help someone with,” said Chris Cerney, law student at University of North Dakota. “A few hours a week and coming back, knowing that we have the potential to help at least four to six people that week as part of the pilot program, I think that is pretty good.”

Assisting patients with matters like benefits denial, employment discrimination or housing feuds carries its own challenges – especially at a medical facility. Often people who walk into a doctor’s office do not realize the contingency of their health on their family and work ordeals. Nor they know that some day-to-day troubles might have a resolution under the law. Often, it comes down to the medical personnel and its faculty to flag patients’ problems that call for legal aid.

“Training [the medical point of contact] is really important [with regard to] what questions to ask,” said Hoefgen. “If you ask [patients], ‘Do you have a family law issue,’ they might not know what that is. If you have a consumer issue, they do not know what that is.

[We train] the medical staff to be ready if someone says, ‘My landlord never fixes anything,’ that is a housing law problem, but the patient is not going to say, ‘I have a housing law problem.’ They might say, ‘I hate my apartment.’”

The medical staff at Family HealthCare, though, might already be a step ahead. Tending to over 200 patients a day, many of whom are indigenous or immigrants, the nurses and doctors have received cultural competency coaching and regularly work with interpreters. Many also see repeat patients, fostering lasting relationships.

And yet, “an issue might not be identified during the first appointment,” said Julie Sorby, Family HealthCare’s director of community development. “It might be the third appointment, where some trust is established with the nurse – some of these things might not come right away.”

No matter when a concern surfaces, keeping up with underprivileged patients, whose lives might spiral into disarray, is crucial. Low-income individuals frequently sway from one hardship to another, from one immediate crisis to the next, Page and Hoefgen agreed. Often unresolved, the issues hoard up. This is a lesson the pilot MLP highlighted and the Bemidji project further evidenced.

“We cannot expect the patient to follow up on us,” said Page. “[During the pilot], we would find that we had a record of a contact but no follow-up, but if we called the person and followed up with them, we were more likely to continue to help.”

Continual assistance, though, hinges on a steady flow of funds. Within Legal Advocates for Health’s first six months of operation, the partners will commence the search for additional money to sustain the project beyond its inaugural two-year span and expand it to more healthcare facilities.

“I do not doubt that our patients will see the value of it,” said Sorby, “and hopefully we can financially make it work.”