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July 6, 2009
PITTSBURG At first glance, it seems an odd idea: Putting lawyers in safety-net clinics.
The two don’t seem to go together.
“There’s a whole cats-and-dogs thing when it comes to doctors and lawyers,” said Krista Postai, executive director at the Community Health Center of Southeast Kansas in Pittsburg.
But safety-net clinic patients, she said, tend to have a fair number of legal problems, which cause them stress, which leads to all kinds of health problems.
So the pairing, Postai said, makes sense.
“When we first got into this, we were asking ourselves ‘Do we really want to do this?’” she said. “Now it’s, ‘We should have been doing this all along.’ Our patients think it’s too good to be true.”
In June, Community Health Center of Southeast Kansas added a full-time attorney and a legal assistant to its staff.
“When you’re dealing with people whose houses are being foreclosed or who are being kicked out of their apartments, or who aren’t getting child support, or who are in abusive situations, there is an incredible opportunity to make a difference in their lives and to actually get at some of the problems that are causing the symptoms,” Postai said.
The clinic’s legal services are underwritten by a three-year, $300,000 grant from the Sunflower Foundation and with additional support from Kansas Legal Services and the Kansas University School of Law.
So far, Postai said, the clinic’s legal office has helped patients make filings for divorce, protection from abuse, child custody, guardianship, and power of attorney.
“We’ve helped some people do living wills,” she said. “We’ve had some cancer patients with limited time to live. They want to put their affairs in order but there’s no way they can afford an attorney. So this is really going to help.”
The clinic also has referred several 16- and 17-year-old girls to its legal office.
“They’re pregnant, but they’re not living at home,” Postai said. “Well, if you’re a minor and you’re not living with an adult, you can’t apply for Medicaid. So our attorney has been helping get them emancipated, so that they can apply for Medicaid, so that there will be a safety net in place for that baby.”
One of two in Kansas
The Pittsburg clinic is one of two safety-net clinics in the state that offer legal services. The other is Southwest Boulevard Family Health Care in Kansas City.
“Our goal is to assist people with whatever legal problem they’ve having at the moment,” said Patricia Thomas, staff attorney at the Southwest Boulevard clinic.
Thomas oversees an ever-increasing coterie of KU law students helping out at the clinic.
“In our first semester back in January 2008, we had six,” Thomas said. “This past semester, we had eight; this fall, we have 12 signed up for both semesters.
“What we have, essentially, is a small law practice,” she said.
Much of the legal office’s costs are underwritten by a Sunflower Foundation grant. The office also receives support from the Kansas Health Foundation and the Health Care Foundation of Greater Kansas City.
“We do a lot of family law and a lot of disability benefits,” Thomas said. “Those two are very big. After that, we do a lot of wills, powers of attorney and guardianships. We have a lot of grandparents who are raising children, and they sometimes need a little legal support so that when the time comes, they can enroll the child in school or get medical treatment.”
The legal office also takes referrals from the JayDoc Free Clinic, KU Medical Center, and Children’s Mercy Hospital.
“I know this is only anecdotal, but I’ve had people say things like, ‘Since you helped me with my divorce, I’ve lost 10 pounds and my blood sugar is down,’” Thomas said. “We’ve come to realize that when you’re about to lose your housing or your job or if you’re trying to get out of a violent relationship, and you don’t have money or insurance, health care might not be at the top of your list of priorities.”
At both clinics, access to legal services is limited to patients.
“If it was open to everybody, we couldn’t begin to keep up,” Postai said. “We’d be swamped.”
Billie Hall, president and chief executive officer at the Sunflower Foundation, said there are plans to open a legal services office in at least one other safety-net clinic later this year, maybe two. Then more will follow.
“Our board has made a commitment to implement as many of these as we can in as many community health centers that have the capacity,” Hall said.
The challenge, she said, is to figure out how to replicate the Southwest Boulevard and Pittsburg models in communities with comparable needs but fewer resources.
“Each community’s model, I suspect, will be different,” she said.
Hall noted that the KU School of Law has a limited number of students interested in working at — and commuting to and from — a safety-net clinic.
The Pittsburg clinic’s access to students, she said, is limited to the summer months, starting in 2010.
Whether safety-net clinics in western Kansas, for example, will have similar access remains to be seen.
Also, Hall said, legal offices receiving grants are expected to be self-sustaining after the initial three years.
Massachusetts was first
Though the notion of blending medical and legal services is fairly new to Kansas, at least 35 other states have embraced the concept.
The first was Massachusetts, specifically Boston Medical Center, in 1993.
“A doctor there, Dr. Barry Zuckerman, was seeing kids with asthma, and despite their being treated within the standard of care and his trying all the appropriate interventions, they didn’t get better,” said Elizabeth Weeks Leonard, a KU law professor who helps steer students toward the Southwest Boulevard clinic.
“The real problem, he came to find out, was that these kids were living in sub-standard housing,” Leonard said. “They didn’t need additional medical attention, what they needed was legal intervention to get the housing up to code or to get them into housing in which their asthma would not be exacerbated by the environmental conditions.”
Zuckerman launched the first medical-legal partnership at Boston Medical Center. Other urban hospitals were quick to follow.
Dr. Sharon Lee, founder and director of the Southwest Boulevard clinic, introduced the model to Kansas.
Still, the vast majority of the medical-legal partnerships — whether they’re housed in hospitals or safety-net clinics — are in the nation’s urban areas.
Community Health Center of Southeast Kansas is the exception.
“We’re very excited about what’s going on in Pittsburg,” said Ellen Lawton, executive director at the National Center for Medical-Legal Partnership. “It’s a beautiful example of what medical-health partnerships are going to look like in the future.”
Lawton said nationally, more and more primary care is being provided in smaller safety-net clinic settings rather than in large hospitals.
Proponents of medical-legal partnerships, she said, need to come up with models that will work in smaller neighborhood or rural settings.
“That’s exactly what’s going on in Pittsburg,” she said.
-Dave Ranney is a staff writer for KHI News Service, which specializes in coverage of health issues facing Kansans. He can be reached at email@example.com or at 785-233-5443, ext. 128.