Hospital Hosts On-Site Legal Aid Services

Saint Luke's Hospital of Kansas City has launched a partnership with Legal Aid of Western Missouri that puts an attorney and a paralegal inside the hospital to help indigent patients address legal issues adversely impacting their health.

Legal Aid began its first medical-legal partnership in Kansas City in 2007, but the Saint Luke's partnership is the first to use legal staff working full-time at a medical site. Amber Cutler, an attorney with Legal Aid, said that has been critical to the success of the four-month-old project.

"On site is best, not only because we are more accessible to the patients, but because we are more visible," Cutler says. "The referrers on staff forget we are here if we aren't on site. If they are seeing you, your presence reminds them 'Oh yeah, we have that resource that we can refer these people to.' It's a critical component."

Bonnie Johnson, RN, an attorney and director of risk management at Saint Luke's, said having an attorney or a paralegal inside the hospital walls also improves patient relations and expedites the discharge process. 

"If they're here on staff, any time there is a consult for the medical-legal partnership, they can go directly to the patient's room, start building that trusting relationship during the intake interview and talk about what their obstacles and issues are," Johnson says. "That has been a great distinction from some of the other medical-legal partnerships that have popped up across the country."

Nationally, medical-legal partnerships for indigent patients have been around since 1993. MLPs integrate lawyers into the healthcare team to help patients deal with legal problems that directly or indirectly harm their health. The programs have been endorsed by the American Hospital Association, American Bar Association, American Medical Association and American Academy of Pediatrics. The Saint Luke's MLP is funded by a $150,000 annual grant awarded by the hospital's foundation.

Johnson says the Legal Aid staff handles a variety of concerns. That includes helping indigents sign up for Medicaid, establish legal guardians, find housing, and address safety issues such as domestic violence or mold in the home that could trigger adverse health events necessitating care in the emergency department.

"Our indigent patients often are uninsured or very under-insured, and are dealing with a lot of societal issues that affect their health," Johnson says. "The partnership makes great sense. If we can take some of the legal stresses off our patients they are going to be better patients who are more able to deal with their health issues if they aren't worrying about all of the other social barriers they face."

The Saint Luke's medical-legal partnership is based on the I-HELP model. I stands for income and insurance issues; H is for housing issues; E is for ensuring patient safety in domestic situations; L is for legal status; and P is for power of attorney and guardianship.

Cutler says she's done about 20-25 referrals a month since she started working as a contract vendor at Saint Luke's in January, and about half of the referrals have been housing-related.

She said the partnership takes a holistic view toward patients. "For example, we may agree to represent a disabled individual with an appeal for Social Security benefits," she said. "During the course of representation, we may also assist with an appeal for Medicaid health insurance. If we are successful, the patient gains an income source to secure stable housing and health insurance to obtain ongoing treatment improving his or her overall health. If we see a patient who's been referred to us by the social worker for one legal issue, we do a screening to see if there are other legal needs."

Johnson said having Legal Aid on site also has helped expedite guardianship and durable power of attorney procedures. "The financial impact is once you have a decision maker for the patient, we can act effectively and efficiently and provide timely care for the patient," she said.

"If they don't have a decision maker we don't know who to turn to so we make 500 phone calls. Maybe it's a family member that hasn't seen them in 20 years, and it takes longer to make decisions."

Once a decision-maker is appointed, Johnson said, a discharge plan can be built. "Nursing homes and long-term care facilities won't take a patient without a decision maker so they're here longer than they need to be while we are waiting for guardianship," she said.