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Unique medical-legal partnership expands

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Practitioners involved with the state’s first medical-legal partnership are excited about the cases they’ve taken on, as they help patients who have unmet legal needs that can make medical conditions persist, if not worsen.

Medical-legal partnerships also have been getting national attention recently. The American Bar Association issued a statement June 15 in support of the American Medical Association’s resolution passed that day by its House of Delegates to support these kinds of partnerships.

medical legal Anna Obergfell, right, attorney and director of the medical-legal partnership at Wishard in Indianapolis, works with doctors at Wishard’s Pecar Health Center, including family doctor Dr. Daniela Lobo, left, when patients have legal issues. (IBJ Photo/ Perry Reichanadter)

The Indianapolis partnership started in early 2008 with the support of the Indiana Health Advocacy Coalition to provide legal aid to pediatric patients and their families who receive treatment from Pecar Health Center, part of Wishard Health Services, on the city’s northwest side. Attorneys at Baker & Daniels, Neighborhood Christian Legal Clinic, and Indianapolis Legal Aid Society supported the partnership early on and continue to do so.

The early goal of the partnership, which continues more than two years later, was to help address medical issues that would be easier to solve if a legal problem was also resolved. It brought various partners to the table – doctors, lawyers, caseworkers, and social workers – to determine the best practices to address the patient’s issues.

Patients are helped by the partnership by first meeting with a doctor about a health issue, and then the doctor will ask a series of questions that could have an effect on the health issue such as housing, financial needs, eligibility for benefits, child-support coverage, guardianship, or if the patient was in a domestic-violence situation.

Lawyers who work with doctors in the partnership said they tend to hear more concerns about housing than any other issue. At Pecar, housing issues make up about one third of all legal issues referred to lawyers in the partnership. This is also the case at most of the other locations, including a growing awareness of patients who might need legal help when applying for benefits and filing for protective orders.

The biggest change the partnership has undergone since early 2008 is how much it has expanded and continues to expand.

In the past year and a half, the partnership has grown to include two more Wishard sites: Tavonna Harris Askew now spends time helping patients of the North Arlington Health Center, and she will also call on ILAS from time to time for help with housing and guardianship cases. Indiana Legal Services attorney Jay Chaudhary has been spending part of his time at Midtown Community Mental Health Center.

Other Wishard sites have also asked to have lawyers readily available to doctors and patients. Wishard’s medical-legal partnership director who started in fall 2009, Anna Obergfell, currently oversees the partnership’s work at Pecar. But as she takes on more responsibilities, NCLC attorneys will likely help fill in as they did before she joined the partnership as staff.

Obergfell added that another Wishard program, EMBRACE, which helps women with cancer regarding issues that go beyond medical needs, has begun working with a group of women attorneys at Baker & Daniels. Those attorneys help provide legal services, such as will preparation and guardianship issues.

While some of the patients are terminal, just knowing they have their affairs in order can help them focus on their treatment and more of their energy enjoying time with their families, Obergfell said.

Chaudhary said one of his recent cases involved a patient who has a mental illness. He was able to have the doctor testify at the Medicaid hearing as to why the patient could not work, which is almost unheard of for a Medicaid hearing, he and others in the partnership said. He is also working closely with the doctors who complete medical reports to make them aware of what review boards look for and how to connect the illness to why the person can’t work instead of just saying the person has an illness and listing the symptoms. He said most doctors do the best they can, but by explaining the legal side, it should help everyone.

chad priest Priest

Another ILS attorney, Adam Mueller, helps address legal needs of patients at St. Francis Neighborhood Health Center at Garfield Park, which has intake sessions on a regular basis for patients.

Attorneys from the different nonprofits have also collaborated on various legal issues, especially if one organization has more experience with a certain issue than another. For instance, NCLC tends to take immigration cases for patients because it does more immigration work than ILS and ILAS.

Community Hospitals also has been involved with the partnership. A law student intern of ILAS, who was also getting a master’s degree in public health, worked with patients at Community on their legal needs. ILAS will continue to help with legal issues there on a case-by-case basis, said John Floreancig, executive director of ILAS.

Obergfell said at least one other hospital system in Indianapolis is in the planning stages to join the partnership, and there has been talk among ILS, which is statewide, and other legal partners regarding more possible medical-legal partnerships around the state. It is still too early to say when or where that will happen.

Other attorneys also support the program, including Priscilla B. Keith, general counsel of Health & Hospital Corp., Wishard’s parent organization; co-founder Chad Priest, who was previously with Baker & Daniels and is chief executive officer of Managed Emergency Surge for Healthcare Inc.; and NCLC Executive Director Josh Abel and managing attorney Chris Purnell.

Attorneys said the Indianapolis program is unique because it involves so many partners. In most cases, there is one hospital or medical program and one legal organization, but Indianapolis is now seen as a national model for other large partnerships, Priest said.

Askew said it’s been interesting to see the different legal aid organizations and law firm supporters come together, as well as three different hospital systems that usually would be competing for market share.

She and others involved say it’s also interesting to see lawyers and doctors collaborate so closely.

One recent case involved a landlord who requested a signed doctor’s note to show that the air conditioning needed to be fixed. Obergfell said the landlord received a note signed by a doctor – and a lawyer in the partnership. The landlord resolved the matter soon after getting the letter.

Doctors and lawyers and others in the partnership also get together on a quarterly basis for CLE and CME courses that address legal and medical issues to help those involved in the partnership.

In another example of many partners working together, Askew mentioned a case of a girl who came to a Wishard site as an asthma patient. When she was younger, she’d been taken from her mother. She had been living with her dad until he was sent to prison. The father’s health plan had covered the girl’s asthma care, but because he lost his coverage when he went to jail, she no longer had health-care coverage. After the girl’s doctor shared this information with lawyers in the partnership, attorneys helped reunite her with her mom through a guardianship case. The girl’s mom had changed enough since the child was taken from her so it was OK for the mom to be back in the girl’s life. And, because of the reunion the girl was again eligible for benefits to cover her asthma care.

“The reason for MLPs is to improve health care,” said Dr. Enid Zwirn, chair of the Indiana Health Advocacy Coalition. “The idea of MLPs is a good idea and will last the test of time. I think in the next 10 to 15 years, there will be more of an expectation from health-care providers that if they can identify a legal issue, they can contact a lawyer to help their patient.”

Zwirn added she’s heard from Dr. Lisa Harris, chief executive officer and medical director of Wishard Health Services, that even novice doctors have come to her to express how much the partnership has helped them do their jobs and treat patients.•

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  1. From back in the day before secularism got a stranglehold on Hoosier jurists comes this great excerpt via Indiana federal court judge Allan Sharp, dedicated to those many Indiana government attorneys (with whom I have dealt) who count the law as a mere tool, an optional tool that is not to be used when political correctness compels a more acceptable result than merely following the path that the law directs: ALLEN SHARP, District Judge. I. In a scene following a visit by Henry VIII to the home of Sir Thomas More, playwriter Robert Bolt puts the following words into the mouths of his characters: Margaret: Father, that man's bad. MORE: There is no law against that. ROPER: There is! God's law! MORE: Then God can arrest him. ROPER: Sophistication upon sophistication! MORE: No, sheer simplicity. The law, Roper, the law. I know what's legal not what's right. And I'll stick to what's legal. ROPER: Then you set man's law above God's! MORE: No, far below; but let me draw your attention to a fact I'm not God. The currents and eddies of right and wrong, which you find such plain sailing, I can't navigate. I'm no voyager. But in the thickets of law, oh, there I'm a forester. I doubt if there's a man alive who could follow me there, thank God... ALICE: (Exasperated, pointing after Rich) While you talk, he's gone! MORE: And go he should, if he was the Devil himself, until he broke the law! ROPER: So now you'd give the Devil benefit of law! MORE: Yes. What would you do? Cut a great road through the law to get after the Devil? ROPER: I'd cut down every law in England to do that! MORE: (Roused and excited) Oh? (Advances on Roper) And when the last law was down, and the Devil turned round on you where would you hide, Roper, the laws being flat? (He leaves *1257 him) This country's planted thick with laws from coast to coast man's laws, not God's and if you cut them down and you're just the man to do it d'you really think you would stand upright in the winds that would blow then? (Quietly) Yes, I'd give the Devil benefit of law, for my own safety's sake. ROPER: I have long suspected this; this is the golden calf; the law's your god. MORE: (Wearily) Oh, Roper, you're a fool, God's my god... (Rather bitterly) But I find him rather too (Very bitterly) subtle... I don't know where he is nor what he wants. ROPER: My God wants service, to the end and unremitting; nothing else! MORE: (Dryly) Are you sure that's God! He sounds like Moloch. But indeed it may be God And whoever hunts for me, Roper, God or Devil, will find me hiding in the thickets of the law! And I'll hide my daughter with me! Not hoist her up the mainmast of your seagoing principles! They put about too nimbly! (Exit More. They all look after him). Pgs. 65-67, A MAN FOR ALL SEASONS A Play in Two Acts, Robert Bolt, Random House, New York, 1960. Linley E. Pearson, Atty. Gen. of Indiana, Indianapolis, for defendants. Childs v. Duckworth, 509 F. Supp. 1254, 1256 (N.D. Ind. 1981) aff'd, 705 F.2d 915 (7th Cir. 1983)

  2. "Meanwhile small- and mid-size firms are getting squeezed and likely will not survive unless they become a boutique firm." I've been a business attorney in small, and now mid-size firm for over 30 years, and for over 30 years legal consultants have been preaching this exact same mantra of impending doom for small and mid-sized firms -- verbatim. This claim apparently helps them gin up merger opportunities from smaller firms who become convinced that they need to become larger overnight. The claim that large corporations are interested in cost-saving and efficiency has likewise been preached for decades, and is likewise bunk. If large corporations had any real interest in saving money they wouldn't use large law firms whose rates are substantially higher than those of high-quality mid-sized firms.

  3. The family is the foundation of all human government. That is the Grand Design. Modern governments throw off this Design and make bureaucratic war against the family, as does Hollywood and cultural elitists such as third wave feminists. Since WWII we have been on a ship of fools that way, with both the elite and government and their social engineering hacks relentlessly attacking the very foundation of social order. And their success? See it in the streets of Fergusson, on the food stamp doles (mostly broken families)and in the above article. Reject the Grand Design for true social function, enter the Glorious State to manage social dysfunction. Our Brave New World will be a prison camp, and we will welcome it as the only way to manage given the anarchy without it.

  4. When I hear 'Juvenile Lawyer' I think of an attorney helping a high school aged kid through the court system for a poor decision; like smashing mailboxes. Thank you for opening up my eyes to the bigger picture of the need for juvenile attorneys. It made me sad, but also fascinated, when it was explained, in the sixth paragraph, that parents making poor decisions (such as drug abuse) can cause situations where children need legal representation and aid from a lawyer.

  5. Some in the Hoosier legal elite consider this prayer recommended by the AG seditious, not to mention the Saint who pledged loyalty to God over King and went to the axe for so doing: "Thomas More, counselor of law and statesman of integrity, merry martyr and most human of saints: Pray that, for the glory of God and in the pursuit of His justice, I may be trustworthy with confidences, keen in study, accurate in analysis, correct in conclusion, able in argument, loyal to clients, honest with all, courteous to adversaries, ever attentive to conscience. Sit with me at my desk and listen with me to my clients' tales. Read with me in my library and stand always beside me so that today I shall not, to win a point, lose my soul. Pray that my family may find in me what yours found in you: friendship and courage, cheerfulness and charity, diligence in duties, counsel in adversity, patience in pain—their good servant, and God's first. Amen."

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