Renee* was desperate to find a way
out of her abusive marriage. But, knowing her husband was
monitoring her every move, she could not visit the
community's Legal Aid office to seek help for herself and
her children. So she went to the dentist.
Renee confided in the Northern Dental
Access Center's on-site attorney, who helped her plan
a safe escape. She later told the center, “When
I saw that there was an attorney available while I was at
the dental office, I could finally ask for help and feel
The nonprofit Northern Dental Access Center teamed up
with Legal Services of Northwest Minnesota in 2015 to
provide free legal advice to low-income people with
health-harming legal needs. This
medical-legal partnership (MLP) in Bemidji,
Minnesota, is the first MLP within a dental clinic
In addition to one-on-one consultations, the Northern
Dental Access Center also offers “Know Your
Rights” chat sessions that anyone in the
community can attend. Each session focuses on legal
issues such as consumer rights or public benefits. At the
end of a session, attendees receive a wallet-sized guide
so they can take the information home and share it with
Health-Harming Legal Needs
According to the National Center
for Medical-Legal Partnership, a health-harming legal
need is “a social problem that adversely
affects a person's health or access to healthcare, and
that is better remedied through joint legal care and
healthcare than through healthcare services alone. It is
a type of social determinant of health.”
Much of a person's health is determined by environmental
and social factors such as housing or access to
healthcare. The average low-income individual deals with
two or three health-harming legal needs at a time.
In traditional healthcare settings, a doctor may refer a
patient to legal services. But the technical language in
law and medicine can be difficult for the patient to
understand, and he may spend precious time and money
commuting between the doctor and lawyer. And the doctor
may never know if the patient receives the help he needs.
partnership allows healthcare providers and lawyers
to work together much more closely, as paralegals and
public interest lawyers are brought into the healthcare
setting. In an MLP, the patient can receive medical and
legal advice in the same place.
Health and Law: Then and Now
Law has been shaping public health for centuries, most
commonly as quarantines and food safety policies.
According to Jill Krueger, director of the
Network for Public Health Law – Northern Region,
public health law had a focus on sanitation and
infectious disease control from roughly 1850 to 2000.
The next emphasis came after September 11, 2001, as
public health law focused on emergency preparedness for
terrorist attacks and, later, natural disasters after
Hurricane Katrina in 2005.
Some would say that law is the most powerful social
determinant of all because it touches all of us.
While these emphases have not disappeared, the current
era of public health law has a new focus on social
determinants of health.
“Some would say that law is the most powerful
social determinant of all because it touches all of
us,” explains Ellen Lawton, Co-Principal
Investigator and Lead Research Scientist at the National
Center for Medical-Legal Partnership.
Bringing lawyers onto a healthcare team began in the
1960s, as Jack Geiger (link no longer available) helped
found the community health center movement. At the first
community health center in Mississippi, Geiger hired a
lawyer to help low-income patients solve legal problems
that affected their health.
In the 1980s, the nation was hit hard by the HIV/AIDS
epidemic. To fight legal discrimination and treat their
patients, HIV/AIDS clinics needed help from lawyers in
how to best care for all aspects of their patients'
health and well-being.
The first medical-legal partnership began at Boston
Medical Center in the mid-1990s. Lawton was a lawyer
hired to be part of the healthcare team made up of
physicians, nurses, and social workers.
In the wake of the Affordable Care Act, social
determinants of health are at the forefront of
discussions, as healthcare providers are working to
address the many factors that affect their patients'
health. The two most pressing concerns, according to
Lawton, are housing and public benefits.
Strengths and Concerns in Rural Areas
Housing and public benefits are concerns that affect
rural and urban locations alike, but the problems and
solutions may be quite dissimilar. Krueger explains, for
example, that access to food might look different in
rural communities. Rural communities tend to have fewer
businesses – and fewer places that accept WIC or SNAP
benefits – than urban areas. Some rural communities may
have to apply for government loan programs to keep their
only grocery store in business.
“In a rural area, MLP attorneys cannot be as
specialized as those in an urban setting,” says
Diane M. Goffinet, Senior Supervisory Attorney at
Land of Lincoln Legal
Assistance Foundation, Inc. Urban MLPs may have one
lawyer or paralegal per department in the hospital or
clinic, while rural MLPs may have a single employee.
However, Lawton reminds us of the strengths of rural
communities. Smaller communities offer the opportunity
for healthcare providers and lawyers to not only know of
each other, but they also have a better understanding of
their patient-clients' needs and situations. Lawton
explains, “You know the community's resources
very well. The gaps are easily identifiable – as are the
resources, because there are so few of them!”
You know the community's resources very well. The gaps
are easily identifiable – as are the resources, because
there are so few of them!
Medical-legal partnerships, according to Lawton, are an
effective way to address health-harming legal needs in
rural communities: “One of the most powerful
facets of medical-legal partnership is its adaptability
to local conditions.” MLPs work with whatever a
community might have to offer. For example, a rural
community might not be able to launch a whole new program
with full-time staff, but the community could bring a
lawyer onto its healthcare team part-time.
Triple Benefits of MLPs
Lawton describes three types of benefits that patients
receive through medical-legal partnerships. First,
patients often find their stress levels reduced,
thanks to an MLP. For example, if
a patient's electricity is shut off due to late
payments, yet she needs to refrigerate her medication, a
legal team can help her set up payment plans with utility
companies. Now the patient would not have to worry about
her health or her bills, and her stress level is reduced
as a result.
patients become more engaged in their care. As
patients begin to feel more control over their lives – as
they receive needed public benefits or learn that they
won't be evicted – they can begin to feel more control
over their health as well.
Ideally, patients benefit because they never become
“Ideally,” Krueger says,
“patients benefit because they never become
Medical-legal partnerships are opportunities for lawyers
as well. Traditionally, public interest lawyers work
reactively: They wait for a client to enter their offices
and raise a legal concern. According to the Legal Services Corporation,
there is one legal aid lawyer per 6,500 low-income
people. In some parts of the country, this number jumps
to one lawyer per 13,000 low-income people.
Medical-legal partnerships allow patient-clients to meet
with lawyers and address their legal concerns more
quickly. Lawyers might be able to “prevent an
eviction rather than react to an eviction,”
explains Lawton. And a more efficient system allows
public interest lawyers to help more people.
Krueger loves learning more about healthcare
professionals' specialties, as she works with
epidemiologists and infectious disease specialists.
Working with specialists in other disciplines allows her
to see the world through more diverse perspectives and
collaborate on developing policies to create healthier
Medical-legal partnerships equip healthcare providers
with the tools they need to address health-harming legal
needs. For example, a lawyer on the healthcare team can
help a patient sign up for needed public benefits while
the provider can focus on the patient's physical health.
Lawton and Krueger see the future of addressing
health-harming legal needs as data-focused. Data about a
community can help those in healthcare and public health
determine what that community's specific needs are and
how best to address them. Plus, data can help show
policymakers how prevalent a problem is and why certain
changes need to be made.
MLPs, Lawton predicts, will move away from “a
grassroots kind of partnering to a more structured
partnership that collects data.” In addition,
this new type of partnership will require and provide
standardized training and establish more investment in
order to better connect patients with services.
Krueger also foresees stronger integration of oral health
and mental health into primary care and education:
“And not only in the sense of treating people
with serious mental illness but also teaching kids better
problem-solving skills or mindfulness practices in order
to address chronic stress and promote greater
Medical-legal partnerships seem to be gaining popularity
in an increasingly value-based healthcare system. As
rural providers move to address social determinants and
improve population health by adopting models like
Accountable Care Organizations and Patient-Centered
Medical Homes, they can benefit financially from
implementing MLPs. “As we make that shift to
doing more prevention work,” Krueger explains,
“we can contribute to better outcomes and fewer
preventable deaths, at a lower cost.”
Allee Mead is a web writer for the Rural Health Information Hub. She has written on important rural issues, including maternal mortality and farmers' mental health, and has presented nationally on RHIhub's opioid resources. Originally from rural North Dakota, she has a master's degree in English. Full Biography