By: Elaine McArdle
What do you need to be mindful of when working with a client who has PTSD? How do you set appropriate boundaries with clients regarding communications? When trying to prove a client’s eligibility for disability-related benefits, how do you translate medical records into the most effective legal arguments?
LSC students and clinicians are trained in the law but often encounter complex medically related questions in connection to their cases. Meanwhile, doctors often see that their patients face legal barriers but may be unsure what role they can play to help patients avoid legal harms.
To bridge this gap, the Pro Bono Medical Advisory Board (MAB) was launched in 2021 by Julie McCormack, senior clinical instructor and director of LSC’s Safety Net Project, Dr. Grace Chang, head of Harvard Psychiatry at the VA Boston Healthcare System, and Heeyoung Linda Park ’21, a student in the Safety Net Project of LSC’s Veterans Law Clinic.
The MAB is composed of three psychiatric residents at the VA Boston-Harvard South Shore (HSS/VAB) Psychiatry Residency Training Program, along with an attending psychiatrist. It meets monthly at lunchtime for wide-ranging discussions on whatever topic arises. It focuses primarily on psychiatric issues and professional issues, such as how to develop trusting relationships with clients or patients, McCormack says. Over the past five years, topics have included treatment approaches for diseases such as PTSD and substance use disorder, using trauma-informed skills, best practices for sharing disappointing news, and helping law students interpret medical charts while helping doctors understand how their medical charting affects patients’ legal issues.
Meetings are open to all LSC students and staff, and the room is usually packed, says Jack Regan, LSC senior fellow.
“It’s really an amazing resource,” says Regan, who represents clients in the Veterans Law Clinic. “A lot of people we see have underlying mental health issues of varying degrees. This is about how we as lawyers do the best job, and this input is very valuable in terms of navigating situations that can just arise.”
Thirteen psychiatric residents have served on the MAB since it launched, says Dr. Justine Lazatin, assistant program director for the HSS/VAB Psychiatry Residency Training Program. Lazatin, who last year became MAB’s attending psychiatrist, was an inaugural member when she herself was a resident. “As a trainee, I was drawn to the partnership between the LSC and the MAB as it seemed like a unique way to serve our patient population through a different lens,” Lazatin says.
The board includes a mix of junior and more senior medical residents to maximize continuity, and serving on it is considered an honor, says Chang, its attending psychiatrist until she retired last year. “We are looking for professionalism, maturity, commitment,” adds Chang, who is now emerita professor of psychiatry at Havard Medical School and continues to participate in the MAB in an advisory role.
The MAB is the first initiative of its kind in the country, its founders believe. It is distinct from a medical-legal partnership because of the way the MAB functions as a dedicated space for cross-disciplinary case rounds and wide-ranging discussion about topics at the intersection of law and health. (According to Daniel Nagin, LSC’s Faculty Director, “the MAB is the latest initiative in LSC’s long history of engagement with medical providers to advance the wellbeing of clients.” LSC’s co-founders Gary Bellow ’60 and Jeanne Charn ’70 partnered with medical providers in the earliest days of LSC to do “legal check-ups” for patients at a large hospital-based primary care clinic. Today, LSC has thriving medical-legal partnerships with Mass General Brigham through both the Housing Law Clinic and the Family Justice Clinic and with Brockton VA Medical Center through the Estate Planning Project. The MAB represents an entirely new and innovative model for bringing medical expertise to bear on behalf of client communities.
As a student in the Veterans Legal Clinic, Jett Watson ’26 represented a veteran who suffered from severe PTSD incurred during his military service. The client received a less-than-honorable discharge from service, which negatively affected his military benefits, and Watson was representing him in a discharge upgrade petition.
“I knew I’d be trying to discuss how the client’s PTSD had impacted some bad choices he made in the Army, and I was trying to learn more about ways to do that,” says Watson. He found MAB meetings invaluable.
“A lot of what we talked about was how mental health conditions or physical health conditions with resulting mental health [effects] exacerbate or maybe encourage misbehavior,” says Watson, “and how to explain to a military body, where rules are everything, what someone with severe PTSD is really facing and how that impacts not only their behavior but their way of thinking.”
The MAB’s guidance, he says, is “especially important for veterans’ advocates and public benefits advocates, where some baseline understanding of common medical conditions is really important.”
The idea for the MAB was born in 2020. As part of the Safety Net Project docket, McCormack supervises students who represent clients, including veterans, seeking to prove eligibility for disability related benefits. During the Covid-19 pandemic, McCormack and her student, Park, were discussing potential resources to assist with interpreting complex notations made by doctors on medical records, and how that information could be reconciled with the legal requirements for disability benefits. They agreed that getting doctors and lawyers together could be helpful to professionals in both fields.
They met with Chang, who “was so enthusiastic about this project,” recalls Park, now a litigation attorney at the Legal Aid Foundation of Los Angeles. “We were really thrilled because her specialty was psychiatry, and a lot of the knowledge we needed was about the trauma our clients faced and how to fit that into legal language.”
A member of the Harvard Medical School faculty since 1991, Chang hadn’t worked directly with LSC before “but was aware of the good work it had done,” she says. “I know Julie from other settings and have always respected and admired her, and I was quite humbled by her commitment to social justice.”
Chang believed psychiatric residents could benefit from learning about the broader impact of their work on their patients’ lives, such as how medical charting can affect eligibility for disability benefits. “It seemed to me a wonderful opportunity to put together a board with some carefully selected psychiatry residents,” Chang says. “This helps demystify the law and demystify psychiatry.”
Park graduated HLS before the MAB fully launched but is thrilled for its evolution and success, and eager for its growing possibilities. “I would love to see more interdisciplinary cooperation between the medical and legal fields so we can join forces helping the most marginalized people,” she says. “It’s great to have a one-stop shop where two fields can cooperate and people can get the services they need.”