LA County Health Center combines legal aid with medical care

Maria Guadalupe Reyes was worried about the urgent notice that had arrived, saying her landlord was seeking to evict her from the house she is renting.

So she went straight to the usual place: the Martin Luther King Jr. Outpatient Center.

There, the 72-year-old woman handed the document to paralegal Alejandra Patlán – a familiar face with pink hair and unruffled manners – and waited outside the small second-floor room for her turn with the lawyer.

The glass-walled center on 120th Street in Willowbrook, where patients typically stop to see doctors and have hearing tests, vaccinations and other routine care, may seem like a strange place to seek legal advice.

But the LA County Department of Health Services, which runs this medical center and others across the county, has offered free help from lawyers as an unconventional way to meet the broader needs of its patients.

It now has nine clinics with an integrated lawyer on site through a program called the Medical Legal Community Partnership. Patients can also get legal help over the phone or through online referrals.

At the MLK Jr. Outpatient Center, a team from the Legal Aid Foundation of Los Angeles meet with patients onsite on Tuesdays and take phone calls during the week, answering a slew of questions on immigration issues, the health insurance, government benefits, poor housing and other problems.

When Reyes entered the small room on the second floor, she clasped her hands in her lap and listened to Patlán relaying details from lawyer Sheyda Joolharzadeh on the urgent deadline to respond. Before Reyes received his eviction notice, the team had already written a letter to his landlord, warning him that it was illegal not to accept his rent.

“We’ve got a plan to help you out, okay?” Patlán told him in Spanish. “We will take it step by step.

Another woman stopped after being assaulted on the bus. Patlán told her about a possible visa for victims of crime, which she said was in high demand. And another patient wanted help with a disability claim. She had spotted the signs announcing free help as she stopped at the outpatient center for an injection.

Then there was the 68-year-old man struggling with prostate cancer, who worried about rising medical bills. Patlán presented her with some options, including a program that offers free treatment to eligible men with the condition. She explained upcoming changes in California law that could help her get better coverage under Medi-Cal.

When Patlán learned he was using Mexican government ID, the legal assistant printed out a list of the documents he would need to get a California card, recommending it as a good step to avoid questions about his status. immigration if detained.

Medical officials from the MLK Jr. Outpatient Center said the initiative is linked to their growing focus on “the social determinants of health” – the broader conditions beyond hospitals and clinics that shape the way people live and if they prosper.

“The hard truth about medicine is that when you go to an underserved area, the things that have the most immediate impact on health are actually your accommodation, access to water and sanitation. ‘sanitation,’ said Dr Ellen Rothman, the centre’s medical director. For example, if a diabetic patient “lives in one room with no access to a refrigerator and only needs to eat once a day at McDonald’s, I can give him lots of insulin and that won’t solve the main problem.” “.

Dr Khanhphong Trinh, director of continuity care at the center, recounted the case of an elderly couple receiving care at MLK who lived in their car and continued to get tickets that they struggled to pay. The legal team stepped in to help with the tickets and eventually helped them with housing, which allowed the elderly patients to start focusing on their health needs.

“When you start to meet some of these bigger needs,” Trinh said, “it complements health care.”

This year’s budget for the program was $ 1.5 million, which includes legal services from several nonprofits – including the Legal Aid Foundation of Los Angeles – which outsource with Neighborhood Legal Services in County of Los Angeles. Los Angeles.

Until now, the LA County program has been funded by a California program called Whole Person Care, which covers services that would not typically be funded by Medi-Cal to meet medical and social needs.

Comprehensive personal care ends at the end of December, with some funding for next year. As the state shifts to a new care management system, the county health department is determining how it will fund the forensic partnership. The same is true of other California programs that are based on the same program.

“At the moment, I don’t think anyone has really cracked the code,” said Daniel Nesbit of California Rural Legal Assistance, who heads the lawyer for a forensic partnership with clinics in Monterey County.

While the upcoming transition has raised questions, the California Department of Health Services said under the new CalAIM system, forensic partnerships will be integrated into other services.

Dennis Hsieh, chief medical officer of the Contra Costa health plan, said one solution could be to include lawyers alongside social workers, nurses and community health workers on the “improved case management” teams. For patients considered in the new system.

“This is to ensure that lawyers are seen as – and therefore paid as – an indispensable part of the management of cases,” he said.

The National Center for Medical-Legal Partnership estimates that there are now more than 500 such programs across the country – a huge increase from the roughly 75 programs that existed when the center was established a decade and a half ago. .

Funding has been a persistent challenge for such programs, said Bethany Hamilton, co-director of the center. Almost two-thirds had received money through foundations or other philanthropic activities, according to an analysis released by the center, but such funding often comes to an end. Using the kind of money LA County has used is relatively unusual.

Historically, the US health care system has not focused on the “upstream health drivers” that forensic partnerships address, said center co-director Joel Teitelbaum, professor of health policy and law at George Washington University.

“It is really a sick care system rather than a health system,” Teitelbaum said. “This change is a huge question. ”

UCLA is still evaluating the ongoing program in LA County, but these efforts have gone a long way in improving health outcomes: asthma patients who got legal help forcing their owners to clean up mold and kill cockroaches were less likely to be hospitalized, a study find. Another study found that veterans of these programs in Connecticut and New York City saw significant improvements in their mental health.

In LA County, health officials say legal aid helped a teacher get thousands of dollars in unemployment benefits that she was initially denied; allowed a patient to get an electric wheelchair that had been wrongly denied by their health plan; got astronomical bills covered by Medi-Cal and Medicare; and ensured that tenants could avoid eviction and stay in their homes.

Having a lawyer working in a clinic increases the likelihood that people will get this help, because “a lot of people don’t realize that the issues they face are legal issues,” Joolharzadeh said. For example, she said, a coughing patient might not associate this with black mold in their apartment or realize that they have a legal right to have that mold removed.

Almost a third of cases in LA County programs are related to public benefit issues, followed by concerns about immigration, housing issues, and health coverage. More than 6,000 people have been referred to the program since its launch three years ago. Some hear about it from doctors. Others learn from community groups. And some spot him at the clinic.

“We are now integrated” on site, said supervising attorney Gerson Sorto, who oversees the community legal medical partnership program with LA County Neighborhood Legal Services. “There is a universe of people who would not be able to seek and access legal aid who, because of this setup, are able to do so. “

Rothman said it also altered the relationship between doctors and patients. Previously, “you just weren’t asking patients certain things… because what you could do was so limited,” Rothman said. “It’s hard to have people talk about a level of need and then say, ‘There’s nothing I can do to help you with that.’ ”

Lawyers have also helped advise physicians to ensure that they are providing eligible patients with the correct documents to obtain the benefits to which they are entitled. Rothman said she was still haunted by an affair earlier in her career in which she attempted to write a letter to help a single mother with lupus qualify for disability benefits. The woman was refused.

Rothman later realized that his letter did not address the specific criteria required by the government agency. Legal issues “are the one thing you’re not really prepared for when you get out of medical school,” she said.

Weeks after going to the MLK outpatient center with her deportation papers, Reyes had a court hearing. Joolharzadeh said lawyers for the Legal Aid Foundation have successfully argued that the deportation case should be dismissed due to pandemic restrictions on deportations.

For now, the lawyer said, the 72-year-old is staying at home.