When lawyers are welcomed in the doctors' offices

A innovative program has been providing legal help for struggling families to deal with health-related disparities. It seems to have worked fine, but now funding has come to an end.

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The drug Reserpine in tablet form being counted out to fill a prescription in a pharmacy.

A innovative program has been providing legal help for struggling families to deal with health-related disparities. It seems to have worked fine, but now funding has come to an end.

You could get confused about why lawyer Scott Crain is sometimes at the Odessa Brown Children’s Clinic. He is helping children with asthma, among other patients, but he’s not a doctor.

Odessa’s director, Ben Danielson, M.D., likes to boast that Crain sometimes gets bigger health results than Danielson does. The doc has spent more than 20 years fighting the health disparities that, to give one example, make an African-American child with asthma more likely to get hospitalized than a child of another race.

Crain is part of a program called the Medical-Legal Partnership for Children that had a three-year grant from the Robert Wood Johnson Foundation to provide legal help to families at Odessa Brown, Harborview’s pediatric clinic and Seattle Children's Hospital. The grant ($380,000) will run out this week, although Danielson is hopeful there will be some new benefactor for what he sees as a triumph of effectiveness.

If a family can’t get a landlord to fix the mold in the carpet and the mold is making their daughter with asthma cough and wheeze, then prescriptions won’t vanquish the underlying trigger for those asthma symptoms — except for a prescription for legal help to force a landlord to get rid of the moisture.

Crain works for Northwest Justice Project, but he is also part of the Medical-Legal Partnership for Children. Annette Quayle is director of the Washington MLP. She says the program has helped about 800 people in 235 families over the past three years. Crain has fielded more than 300 phone consultations, and trained folks like social worker Seema Mhatre of Odessa to do some of the letter-writing work without needing him.

Each organization in the partnership donated supplies and staff time so that the grant was supplemented. Quayle estimates it would require about $150,000 per year to keep the program going.

Crain sometimes has to write a demand letter to landlords asking them to pull up moldy carpet or fix a leak in a pipe that’s soaking a home. He is a wizard of forms who can help a family dropped from food stamps or public assistance to re-apply or overcome an obstacle cutting them off from help.

"There is a broad range of involvement we can get into," Crain said. "Sometimes we are just helping remove a roadblock that keeps them [families] from some services." In general, Crain hopes that his involvement empowers families and health-care folks to do the same road-clearing on their own.

Poverty and frustration — and the daily drip of worry into these families — can be its own toxin. It can eat away at people, contributing to their burden of diabetes or high-blood pressure, Danielson said.

What MLP does goes beyond the direct help to families of children but also educates doctors, social workers, and staff in all three institutions to think outside the clinic room and become more effective advocates for children within schools and other bureaucracies.

“We had a little 8-year-old girl with sickle cell disease” who was kept out of her elementary school classroom for months, Danielson says, by crippling pain in her hands triggered by the cold from walking four blocks to catch her school bus. It took Crain’s expertise — finding the right school authorities and the right forms to fill out — to move her bus stop closer to her own home and get her back in school. Because of the way sickle cell disease damages circulation of the blood, exposure to the cold can trigger a painful spasm, he explained.

For Danielson, that 8-year-old being kept from her education shows the crux of institutional racism. Her mother didn’t know how to wrestle the bureaucracy to win the small victory that unlocked a whole school day for her daughter. Education and safe housing go a long way toward keeping kids healthy, he explained. The girls’ mom had called the school, and asked for help. But it took the strategic and legally focused work of Crain to apply pressure in precisely the right place and with the right words.

“I will continue to sell the value of this program,” Danielson said, during an interview on a sunny day at the brightly painted clinic at Yesler and 21st in Seattle’s Central District. Odessa sees about 20,000 visits per year by families. Danielson’s dreams for the MLP extend beyond just training health personnel at the three clinics and providing direct help to families. He believes that graduate schools for both doctors and lawyers at the University of Washington ought to be incorporating this linkage into their training.

In these budget-cutting times, there is a return-on-investment for adding the legal therapy to doctor’s prescription pads. “If we solve some of these legal problems for families, we can keep some of the sickest patients — the medically complex kids — out of the hospital or shorten their stays.”

The medically complex children with severe chronic diseases cost the whole system a lot of money, and sometimes they may stay in a hospital longer because there is no nursing ready for them upon release, Danielson argues. The work that Crain does, and the training about legal issues of health staff, may make such transitions and access to community easier for these families. It may save both pain and money.

Although efforts are still being made to secure more funding, the Northwest Justice Project plans to incorporate the medical-legal partnership effort into its work, with Crain continuing to address the needs at the Odessa Brown Children's Clinic and Harborview's Pediatric Clinic. And a Northwest Justice Project general counsel said the group has been fortunate, in the meantime, to find an Equal Justice Works AmeriCorps Fellowship program attorney, Amy Alexander, to work with it and SeaMar Community Health Clinics in the same field.

Chronic disease added to social marginalization is a recipe for poor health and what may seem like intractable problems, Danielson said. The remedy is thinking outside the exam room.


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