Medical-legal partnerships are part of a long tradition . The original MLP was established in 1993 at Boston Medical Center , the largest safety net hospital in New England . Frustrated by their ability to treat kids ’ illnesses but not the conditions that were causing them , pediatricians brought lawyers into their clinic to help them more effectively fight the legal and administrative battles that would improve their patients ’ health .
In 2001 a Brown medical student and several faculty created the third MLP in the nation , the Rhode Island Family Advocacy Program , based at Hasbro Children ’ s Hospital . Funding eventually ran out , but the pediatrics-based program was rekindled in 2011 as the Rhode Island Medical-Legal Partnership , with then-newly minted attorney Jeannine Casselman , JD , as its legal support . Casselman says , “ One person cannot meet the needs of thousands of families who are followed at a single practice .”
To achieve maximum impact , she and the partnership ’ s board chair , Elizabeth Tobin-Tyler , JD , worked with the Boston MLP for training and technical assistance . In its past work with the Transitions Clinic , the Boston group was embedded in its interdisciplinary care team meetings .
To ensure their medical-legal partnership ’ s success over time , they knew they had to train the next generation to work “ interprofessionally ,” says Tobin-Tyler , an associate professor of family medicine . She worked with other medical school faculty to design a joint course for Roger Williams University law students and Brown medical students called Poverty , Health , and Law , which they taught for 10 years . Meanwhile , as the MLP model gained traction nationally , Tobin-Tyler was receiving more and more requests for syllabi . In response to that demand , in 2011 she co-edited the seminal textbook Poverty , Health and Law : Readings and Cases for Medical-Legal Partnership . She began to consult on the development of MLPs nationally and internationally , and in 2019 she published Essentials of Health Justice , which focuses on the structural and legal determinants of health injustice .
Writing extensively on the positive health impacts of MLPs , which now number nearly 450 in the US , Tobin-Tyler has noted reduced stress , improved health care compliance , higher immunization rates , lower ER visits , and better outcomes for children with asthma and sickle cell disease ( all of which can also translate to lower health care costs ). She also points to a study that shows MLPs are good for docs , too : while most physicians who serve a low-income population say addressing their patients ’ social and legal needs is as important as their medical treatment , most also say they lack the confidence to do so . Having a legal partner gives them that confidence .
Early on , though , doctors resisted the idea of adding a lawyer to their team , Tobin-Tyler says : “ We had to change the cultural understanding of what lawyers do . If our shared goals are social justice , public health , and good health for patients , what can each professional do to support them ?” After all , like Vanjani and Trimbur , public defenders are committed to helping the most vulnerable individuals . And just as the Transitions Clinic team takes a social determinants approach to health , Rhode Island public defenders practice “ holistic representation ,” where lawyers look outside the courtroom to address underlying issues .
At the Medical School , Tobin-Tyler teaches medical and graduate students about the social and structural determinants of health , health policies affecting patient and population health , and physician advocacy . She also teaches medical students how to write legislative testimony and policy briefs on health-related legislation to persuade policymakers of the need for change , and encourages them to testify at the Rhode Island State House .
“ When I first came to Brown , in 2013 , there was some hesitation among students ,” Tobin-Tyler says . “ They ’ d say , ‘ If I ’ m going into surgery or cardiology , why do I need to know this ?’ Our response to that is , ‘ Just because you ’ re only seeing patients when they need surgery doesn ’ t mean they don ’ t have contextual issues that are affecting their health , and you should know about those issues and facilitate support .’”
“ This is the basic premise of the Social Medicine elective , a month-long clinical experience that our group offers to medical students ,” Vanjani adds . “ At the end of a month accompanying patients on their journeys outside of the clinic ’ s walls , students usually feel a bit traumatized by the structural violence they ’ ve witnessed their patients face , but also invigorated by their newfound knowledge of social systems and their bureaucracies and empowered to address systems failures moving forward .”
‘ I GOT YOU ’
After talking with Teddy Wright , Thigpen heads out to meet Mr . M , who was released from a Florida prison on medical parole two years earlier because of cirrhosis of the liver and kidney disease . Along the way he fields a call from a court-appointed attorney who ’ s trying to find a bed for another of his patients — he ’ s about to get out of prison , and homelessness will likely jeopardize his drug treatment .
When Thigpen parks in front of the vinyl-sided triple-decker , a tall , frail-looking man with long skinny arms is just unfolding himself from the back seat of a taxi . ( The clinic pays for his transportation to and from the dialysis center , a town away .) Together they climb the three flights of stairs , pausing often so Mr . M can catch his breath . Once in the apartment , Thigpen sets about connecting an outdated computer to a printer and helps Mr . M call Trimbur , his physician , so she can check on his medication supply .
As Thigpen leaves to go assist the next patient , Mr . M calls down the stairs after him : “ I love you , bro .” “ Peace , brother ,” Thigpen calls back . “ I got you .” HD
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