Hospitals don’t want repeat customers — especially when it comes to preventable medical issues.
What is it that brings patients back time after time? Often, it’s nothing doctors can address — at least not by themselves.
As part of a new partnership at Philadelphia’s St. Christopher’s Hospital for Children, lawyers are riding to the rescue.
The Center for Child and Adolescent Health at St. Christopher’s Hospital is a busy place where doctors help 24,000 patients a year. The hospital is located in one of the country’s poorest congressional districts, and most of the patients come from low-income families. Staff members treat a lot of health issues that Lee Pachter, chief of pediatrics, says have roots in poverty.
“If we see a child in the emergency room for asthma, and give them the best quality medical care and prescription treatment, and they go back to a house that has dust mites and molds, we’re really just putting a Band-Aid on the problem,” said Pachter. “That child will be back again.”
Adding lawyers to the team
Problems with housing, landlords, insurance coverage, utility companies, custody issues, domestic violence — so many non-medical issues are deeply entwined with patients’ health that Pachter decided to include lawyers in the treatment team.
“Just like if I’m a primary care doctor and I see a child with a heart murmur, I would consult a cardiologist,” explained Pachter. “Now if I see a child that has a legal condition that contributes to poor health, I can consult a lawyer that is on-site and can help the family address the issues.”
Pachter says most patients at the hospital have two to three unmet legal needs that affect their health.
“Medical-legal partnerships” have been around for more than a decade, and St. Christopher houses the first such partnership in a pediatric setting in the region.
Pediatrician Dr. Dan Taylor is the partnership’s medical director. He explains that all patients are asked about potential legal issues. As they are signing in, the registration staff gives out the medical-legal questionnaire, which was developed to ask patients about key issues that could be affecting their health.
“As they are waiting for the provider to come in, they fill this out and then they give it to the provider, and then we discuss the screening process and everything in here,” said Taylor.
Creating a “one-stop-shopping” approach is very important, say Taylor and Pachter. The clinic is a natural point of connection since parents already come there regularly for their children’s well visits. It’s a place where they feel comfortable.
Pachter adds that when patients are referred to other services in different locations, they tend not to go because it involves taking more time off from work.
St. Christopher’s partnered with the legal clinic for the disabled to bring two attorneys on board.
Cases in point
One of them, Eileen Carroll, says sometimes her job means helping a family with paperwork in a custody case.
Just trying to break down that legalese — helping families get to … what information is being requested, how do I answer this question?” Carroll said. “Sometimes, a little bit of one-on-one help can go a long way.”
Her colleague Elizabeth Oquendo says resolving problems quickly is gratifying. She remembers when a mother coming in for a well visit found out that her child’s insurance had been terminated.
“Right there on the spot, we were able to sit down with mom, get in touch with the county assistance office, figure out what had happened to the child’s benefit and work toward getting the insurance back on, so the child could come back for their immunization visit,” recalled Oquendo.
Philadelphian Helen Howlett recently got legal help at St. Christopher’s. After she was awarded partial custody of her niece and nephew, she needed to get them on Medicaid but was turned down.
“They assisted in our appeal of denial of health-care coverage for the children,” Howlett said. “They were extremely helpful guiding me through the murky governmental channels. And they were instrumental in cutting through the red tape.”
The medical-legal partnership has been in place for little over six months. Out of 1,700 families who filled out that questionnaire, 60 percent needed help with a legal issue.
Howlett says that having that legal expertise available made it possible for her to focus on the children’s health, rather than struggle with paperwork.