The Knee-Bone's Connected to the...Shin-Bone?

Ellen Lawton, Esq.
Executive Director, National Center for Medical-Legal Partnership

The question arrives at our door almost daily, usually over e-mail, and usually from the lawyers, but sometimes from the health care partners. "Do the lawyers have to be on-site at the health center to be a medical-legal partnership?"

My first instinct is always to say a resounding YES -- that is the whole point of medical-legal partnership -- bringing legal assistance into the health care setting.

But then I qualify that resounding yes with some classic legal parlance: it depends. Depends on how successful you want to be.

Depends on how much the medical partner can integrate the legal partner into their space, consultation practice, training regimen, staffing, screening and triage priorities, electronic medical record tracking and brainstem.

That's right - brainstem. Because MLP is as much about changing the culture of the health care setting -- the social workers, doctors, nurses and administrative staff -- to be advocacy-ready, and legal needs-savvy -- as it is about logging lawyer time in the clinic.

Don't get me wrong -- logging lawyer and paralegal time in the clinic is the key strategy to maximum integration and clinic buy-in, high impact for patients, and efficiency. Call it return on investment. But lots of sites -- both rural and urban -- make the most of their scarce legal staff time on-site by making sure that the front-line health care staff views legal assistance on a par with swabbing cultures and taking blood pressure.

Not every legal partner can score a prime office in the pediatric clinic, just behind the reception area (like, for example, Connecticut's Medical-Legal Partnership Project). And resources will dictate the strategies that you use to increase your footprint in the health setting. But we can all do a better job really integrating our legal partners in the clinical setting, and we can start by asking ourselves a couple of simple questions:

• Do the legal partners give the medical partners easy access to a point person for consultation -- with ground rules for how to use the service?
• Do the legal partners know the clinic team meeting schedule -- and are they a standing agenda item?
• Do the medical partners understand the legal aid referral process -- and recognize the attorney when she walks through the clinic?
• Do the legal partners know who the nurse manager is -- and what she does?
• Do the medical partners understand the difference between pro bono and legal aid?

We could go on, but you get the point. How well do you really know each other, and each other's systems? Balancing TMI and not enough is tricky -- but if you get it right, it will be smooth(er) sailing. And your patient-clients will get what they need.