Why doctors are prescribing legal aid for patients in need

Though lawyers are often the last people doctors want to see involved in patient care, across the country, many medical systems have begun establishing special legal partnerships. Lawyers become allies for disadvantaged patients who need help navigating problems with landlords and insurers. Special correspondent Jackie Judd reports from Omaha, Nebraska.

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    Struggling through an illness is never easy. But studies have shown it is even harder for people who do not have much money, education or other resources.

    In response, many hospital systems across the country have begun establishing so-called medical-legal partnerships. Lawyers become allies, not adversaries, teaming up with doctors, helping disadvantaged patients work through problems that could interfere with their health.

    Special correspondent Jackie Judd reports from Omaha, Nebraska.


    Diego Salcido is only 5 years old, and he has had more happen in his young life than people 10 times his age. A diagnosis of leukemia led to a bone marrow transplant, which failed. So he had a second. Diego's mother is a constant presence by his side.

  • HILDA OLMEDO-CUEVAS, Mother (through interpreter):

    It's been a very rough year. But God has kept me on my feet. I don't know where he comes up with all this strength, my son.


    White count today is up to 1.7.


    Diego has a team of doctors, social workers and lawyers — yes, lawyers — trying everything they can to get him well.


    What do you think it's going to be like when you go home?

  • HILDA OLMEDO-CUEVAS (through interpreter):

    I will be very happy when we go home. Diego will be, as well. We just have to face these new difficulties.


    One of those difficulties is whether the family apartment is safe enough for Diego to live in once he is discharged. On this day, a team from Legal Aid of Nebraska that works in partnership with Nebraska Medicine is dispatched to investigate.

    Diego's father, Victor, shows them evidence of an infestation of bugs, including cockroaches.

  • VICTOR SALCIDO, Father (through interpreter):

    There are so many and we can't seem to get rid of them. They come and fumigate, but there has been no relief from the problem.


    The bugs present too great a health risk to Diego, whose immune system is a ticking time bomb.

    Lawyer Ann Mangiameli delivers the news to Diego's mother that little boy cannot return home.

  • ANN MANGIAMELI, Attorney:

    So, what we would like to do is maybe try to reach out and find some resources to help you guys find a new apartment, and then help you terminate the lease with the landlord and get your rental assistance or your rental deposit back, if that's OK with you.


    Even though lawyers are often the last people doctors want to see involved in patient care, a new attitude has taken hold here.

  • DR. BRUCE GORDON, Pediatric Oncologist:

    We physicians have relatively little understanding of the legal process. And we will say — we say things like, 'You ought to be out of that house. You ought to be in someplace clean.' And then I sort of wash my hands of it and don't realize the downstream implications. Somebody's got to help them get the resources.


    Cancer surgeon Kerry Rodabaugh is that somebody who gathered the resources. In fact, she only accepted a job with Nebraska Medicine once she was assured a partnership, similar to the one she formed at her last hospital, would be created.

  • DR. KERRY RODABAUGH, Nebraska Medicine:

    I ran a medical-legal partnership, and came to find that I could not practice medicine without that.

    We are learning that we really are impacting health. So, if we can get somebody reinstated with their insurance plan, then they're going to be able to afford to take their anti-hypertension medication and their blood pressure's going to be improved. And who would've thought of that — that an attorney's going to fix somebody's blood pressure?


    Omaha is part of a growing movement modeled on a partnership founded in 1993. Doctors at Boston Medical Center linked cases of childhood asthma to mold in homes and brought in lawyers to take on negligent landlords.

    The idea took years to catch on. But national leaders say there are medical-legal partnerships now in almost 300 hospitals and health centers, and that dozens more are being planned.


    … housing issues are the biggest problem.


    The cases that Mangiameli and her team of six lawyers and two paralegals take on range from landlord-tenant issues, to insurance enrollment and reimbursement, to deathbed wishes involving child custody and wills.


    They don't understand the system, and that's where we help. And it is a great deal of stress it takes off, because we know the system.


    In Omaha, almost 17 percent of the city's residents live in poverty. So, to meet the need, the partnership has grown from one department in one hospital to all five of the city's major hospital systems, including two neighborhood clinics.


    There's just a lot of questions — questions I need to ask.


    There, patients are screened not only for health problems, but problems that lawyers could help with as well.

    Nebraska Medicine's payments to Legal Aid of Nebraska have increased from $25,000 to more than $200,000 a year. And in seven years, it has recouped $2 million from insurers in contested reimbursements.

    Partnerships are an increasingly attractive model for health systems, as more of them get paid by insurers, not for specific services, but set amounts for keeping people healthy.

    Hospital administrator Theresa Franco says, if everything aligns, partnerships become a win-win for patients, doctors and hospitals.

  • THERESA FRANCO, Nebraska Medicine:

    If we can take some of these issues and reduce the number of visits to a physician, reduce the number of times that they're going to end up in the emergency room, reduce the number of times that they're going to have to be admitted to the hospital, that in itself will help from a standpoint of using the dollars that are going to be allocated going forward in a much more conscientious and wiser manner.


    Those twin purposes, healthier patients and reduced costs, brought breast cancer survivor Denise Lauritsen to Legal Aid.

    Dr. Rodabaugh wouldn't put Lauritsen through the trauma of additional surgery, which would add to the cost of care, without knowing whether Lauritsen had cancer in other parts of her body. So, a CAT scan was ordered.


    She just really wouldn't have been certain of her disease status, and we wouldn't have been clear on what the next best step for her care would have been. So the CAT scan was critical.


    But Medicaid refused to approve the CAT scan. After nine months, multiple legal briefs and court decisions, Legal Aid and Lauritsen won.


    It gave me peace of mind. I couldn't sleep at night. I worried all the time. I wasn't at peace with myself. And I think that CAT scan was just the final — just the closure on all of it.


    Lauritsen, who did have surgery in 2014, is now strong and well.

    Because medical-legal partnerships are relatively new, research to prove and to quantify how they improve health outcomes is only just beginning. Diego's mother already is certain that having lawyers work side by side with the medical team has boosted her son's chances of living a long life.

  • HILDA OLMEDO-CUEVAS (through interpreter):

    It's a lot of help I'm receiving. I thank God for all of the angels he has sent me.


    This is Jackie Judd for the PBS NewsHour in Omaha.


    This story was produced in collaboration with the Solutions Journalism Network.

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