By: Elaine McCardle
The patient had sickle cell disease and other chronic health conditions that necessitated emergency surgery, which caused him to miss work. As he was recovering from surgery, he fell behind on rent and was about to be evicted. When housing advocates at Mass General Brigham learned of his predicament, they immediately contacted LSC’s Housing Law Clinic.
Deena Zakim, Clinical Instructor at the Housing Clinic and Director of its Medical Legal Partnership, raced to court, met her client for the first time, and explained to the judge why he was behind on rent and how it was related to his health conditions.
“We were able to prevent his eviction and get extra time from the court to raise money to catch up with rent and get him back on track,” says Zakim. By keeping a roof over his head, “his health has stabilized, he’s no longer in a crisis related to the sickle cell that required surgery, and he’s able to work again.”
This kind of holistic approach to meeting people’s legal and medical needs is the purpose of medical-legal partnerships (MLPs), through which lawyers and healthcare providers team up to address social problems that affect patients’ health. One of the first MLPs, if not the first, emerged at Boston Medical Center, in 1993, and since then the model has grown across the country.
At LSC, three clinics are involved in medical-legal partnerships. The Housing Law Clinic and the Family Justice Clinic (FJC) have partnerships with Mass General Brigham (MGB), while the Estate Planning Project works with the VA Boston Healthcare System to identify military veterans in need of estate planning, often on an emergency basis. These three medical-legal partnerships are only possible because of the support they receive from grant funding and individual gifts.
“A medical-legal partnership is a recognition of social determinants of health,” says Marianna Yang, clinical instructor at the FJC. “There are legally focused stressors and trauma in people’s lives that impact their physical wellbeing. The partnership represents a holistic view of the person.”
This fall, the FJC/MGB medical-legal partnership will celebrate its 20th anniversary. It was created in 2005 by Sarah Boonin ’04 as her Skadden Fellowship project at LSC, and through it, students in the hospital’s social work program identify patients experiencing intimate partner violence, refer them to FJC for legal help when appropriate, and support them through the process. All FJC students are trained within the MLP, and under the supervision of clinical instructors, they represent patients in legal proceedings in order to obtain divorces, restraining orders, orders for child support, and more.
“Our clients really need this, on both sides,” says Rebecca Greening, clinical instructor at the FJC. Given the financial, emotional, and other barriers many face in getting family court legal representation, “It is a lifeline for a lot of our clients.”
Greening says law students are drawn to FJC for many reasons, including their recognition that the MLP “is an excellent model for budding attorneys to understand multidisciplinary cooperation and to learn to work across disciplines.” She adds, “I want to emphasize is that this is really a relationship rooted in mutual understanding and respect for each of our disciplines, so that clients can get as much as they can on both sides given the limitations on capacities that we separately might provide.”
At the Housing Law Clinic’s MLP, most cases involve eviction defense; many involve reasonable accommodation issues where the tenant is facing eviction as a result of a disability. Students represent the tenants in court, fighting the evictions using reasonable accommodation defenses under the Fair Housing Act, the Americans with Disabilities Act, and Massachusetts Anti-Discrimination law, G.L. c. 151B. The students work with the hospital team to seek supportive documentation demonstrating the disability or health-related need for the accommodation, connect the tenants to necessary resources, including mental health services, secure emergency rental assistance, and more. The legal and hospital teams meet every other week at LSC for case consultations and are in constant communication as cases develop.
“When these clients come to us, their issues are way more complicated than just legal issues, so to have an advocate who understands the health side is really important,” says Salomon Campos-Rice ’27, who completed the Housing Clinic last spring and is returning as an advanced clinical student this year. “I work with the housing advocates to make sure we’re up to date on rental assistance applications, and the housing advocates help them with that because it would be very difficult for a client to do it on their own. They’re even available to go with them to return the applications that they helped them fill out. Then I can focus on the legal issues.”
“I think it’s a transformative way for student to learn the efficiencies of collaborating with nonlawyers,” Campos-Rice adds.
The benefits of the collaboration go in both directions, says Bridget Faison, supervisor of the housing advocates program at MGB. Her team includes three other advocates who identify patients with physical and behavioral health issues who need help achieving stable housing. “I love the partnership, I love working with the LSC students,” she says. “Because our work is so intertwined, it’s important we build relationships with one another. Deena is so fabulous, my team thinks she’s the greatest, because she is so practical, she uses language we can understand, and she is so in the trenches with us and available to us when we need her.”
Students “get thrown right into litigation because we are in court all the time,” notes Zakim. “They learn how to do motion hearings and explain to judges why, based on the Fair Housing Act and other anti-discrimination laws, their clients should be able to keep their homes.” The clients’ housing problems “are usually very related to the health crisis they are experiencing,” she adds. “Students also learn how to work with tenants experiencing mental and physical health crises who really benefit from the relationships they build with students as their advocates.”
And, she says, “It’s all very high stakes.” When patients with medical conditions are evicted, it often disrupts their healthcare; they may end up in a shelter or other housing situation far from MGB, for instance. “So students see the impact of their work really quickly,” she says. “You see the tenant avoid eviction and keep their home. The tenant’s kids don’t have to move schools and go to shelters and lose their medical team.”
Through its MLP, the Estate Planning Project of the Veterans Legal Clinic works with the VA Boston Health Care social work team to identify veterans who may be preparing for end-of-life, planning for upcoming surgeries or procedures, or managing complex financial questions.
During her semester with EPP last year, Lexi Zyskowski ’27 went to two VA hospitals and worked closely with two veterans in palliative care. “They were pivotal in how much I learned and grew that semester,” says Zyskowski, who plans to return as an advanced clinical student next spring. She not only learned how to build trust with clients, but she drafted legal instruments and got them executed, “which I’ve never done in other classes in law school.”
“We can talk as much as we want about estate planning, but when you are working with someone who is at end-of-life care, you really feel how much it matters,” she says.
Destini M. Agüero, director of the EPP and LSC deputy director, got the collaboration underway in 2018 with the Brockton VA Medical Center in Brockton, Mass. Since then, she has worked with other area VA hospitals and gotten many referrals from community VA social workers. With VA Brockton clients, the referrals usually come from the hospice and palliative care unit. “These cases can be urgent so having that established line of communication with their social worker has been life changing,” Agüero says.
“For one veteran, I met with him on a Saturday morning and he was incredibly motivated to get his plan done and put it behind him,” she says. If he passed away without a will, “he would not have gotten his wishes, so executing his plan was vital. We completed it that same Saturday afternoon, with the help of two people visiting other veterans to act as my witnesses,” and the veteran passed away that evening.
Health issues prevent many veterans from traveling to LSC, “so it’s been so crucial to be able to provide in-home and bedside legal services for those who are home bound, bed bound, or whose mobility is limited,” she says, as “I always prefer to meet with someone in person.”
“Any time service providers work together to lift up a client/patient who may be overwhelmed by the systems in their life, there is no downside,” she says. “Ultimately, we practice client-centered lawyering at the Legal Services Center. And I have found that our MLP partners do the same with their patients . . . By working together, we help to unburden our shared clients/patients and also learn from each other about our respective systems.”