November 22, 2016 - While treating a patient recently, Eileen Moore, MD, associate dean for community education and advocacy at Georgetown University School of Medicine, found herself frustrated that the patient’s asthma continued to worsen, despite using an escalating treatment regimen including a beta agonist rescue inhaler, then an inhaled corticosteroid, then finally oral steroids and back to back nebulizer treatments.
“I was close to sending her to the ER when I asked her to tell me more about her apartment,” says Moore. “She told me that in place of glass in her window, there was cardboard – and it was freezing outside. The conditions were horrible.”
While Moore’s experience illustrates the limits of medical professionals who work with disadvantaged patients in DC, it also identified an opportunity for collaboration. After Moore asked an attorney friend to send a letter to the landlord on the patient’s behalf, the window was quickly repaired.
“That spoke clearly of the power of a medical-legal partnership, and underscored the need to address the health harming social determinants of health. It is my hope and my expectation that the Georgetown University Health Justice Alliance will empower providers to delve into these critical elements of each patient's history,” she says.
Despite their best efforts, Georgetown physicians and students are frequently frustrated when their patients face legal hurdles that interfere with their health and well-being. To help overcome such obstacles, faculty from the Georgetown University Medical Center, including the School of Medicine, and Georgetown University Law Center signed a formal agreement November 8 to form the Georgetown University Health Justice Alliance.
The Alliance will bring Georgetown medical students together with their counterparts at the Law Center to serve the most disadvantaged DC area residents, which has long been a pursuit of many Georgetown medical students. It is also of increasing interest to Georgetown law students because of the “bridge” built three years ago between the campuses by two academics who realized that collaboration could offer a more holistic approach to caring for those in need and helping to reduce health disparities.
“Medical students are hungry for this collaboration, which they view as a way to reduce existing high barriers to effective care,” says Moore.
“Law students are equally excited to become part of the treatment team as advocates fighting to help poor patients navigate and access legal rights that impact health entitlements that are already established but are frequently ignored or misunderstood,” says Vicki Girard, professor of legal research and writing and co-director of the Georgetown University Health Justice Alliance at the Law Center.
“Medical-legal partnerships are part of a growing national movement, and the Georgetown University Health Justice Alliance is helping to lead the way. By dedicating not only health clinic space, but significant Law Center and Medical Center faculty, student and research resources, the University is working to establish best practices in this type of health care system transformation,” says Yael Cannon, a visiting associate professor from the University of New Mexico who is helping Moore and Girard establish the Alliance.
Endless examples of thwarted care
Moore, Girard and Cannon agree that good health is the foundation for every other life activity. The health of DC residents is influenced by several non-biological factors related to where they live, work, learn and play. Such factors include problems related to food security, housing, education, safety, employment and availability of health care and other benefits — all of which can negatively impact health and require legal help to overcome.
For example, parents worried about a child with cancer who repeatedly misses school because of chemotherapy treatments may not know that they have a right to educational supports to help their child keep up academically. Another is the employee who is fired because she is pregnant — there are legal solutions that can help these families.
“There are numerous areas of law that can implicate the health and well-being of people living in poverty,” Cannon says. “Identifying and removing legal barriers related to domestic violence, family law, public benefits, disability accommodations, educational rights, and immigration status, for example, can help families achieve better health and stability. Georgetown Medical Center providers, who are already working in health clinics in low-income communities, are uniquely positioned to identify legal issues early--before they become crises. This partnership will allow a combined medical and legal team to intervene earlier and more upstream to help children and families.”
Medical and legal check-up
Moore, the Health Justice Alliance medical director, and Girard and Cannon, the Alliance’s legal co-directors, have outlined steps the Alliance will take over the next three years to establish a well-designed medical-legal partnership that will fulfill multiple academic, research and service missions.
The Alliance will bring together faculty, clinicians, other health professionals and students from the School of Medicine with Law Center students and faculty to collaborate inter-professionally through education, research, advocacy and service.
It will establish classes to train and mobilize the next generation of attorneys, doctors, nurses and other professionals on how to achieve greater social and health justice. Building on the work of the School of Medicine Health Justice Scholars program, a curricular track that teaches medical students about advocacy and justice, the Alliance will mobilize students to collaborate inter-professionally to improve the health and well-being of children and families by identifying and treating the health-harming legal needs of Georgetown University health clinic patients.
The first class to enroll both medical and law students will launch this spring. Next fall, the Alliance will start embedding law students on-site at Georgetown health clinics where they will train students to provide free legal services to low-income patients under faculty supervision.
“I cannot tell you how many times I have recommended that a patient must take time off of work to take care of their medical needs, but many won’t do it for fear of being fired,” Moore says. “And I can’t stress enough how wonderful it will be to be able to provide pro bono legal assistance to these patients.
“I had almost come to accept that there are barriers to medical care that cannot be overcome — but I don’t believe that now,” Moore adds. “No one should have to suffer poor health because of unequal access to justice.”