But leaving prison can come at a cost , too : an individual is 12 times more likely to die — from homicide , suicide , overdose , or disease — within the first two weeks of release . What ’ s more , once you ’ re involved with the criminal legal system , it ’ s hard to regain your footing . The burden of court costs , the surveillance of parole or probation , the fear of being sent back , the interruption of drug or alcohol treatment , the damaged personal relationships , the discrimination that comes from having a criminal record : such stressors often lead to repeated incarcerations , making it more challenging to secure safe housing and stable employment , let alone get healthy .
The Transitions Clinic team seeks to address all these issues by intervening at this moment of extreme precarity . Before leaving prison , an individual who has been identified by a medical discharge planner at the Department of Corrections is assigned to a community health worker . Within two weeks of release , they are seen by one of two physicians , Assistant Professor of Medicine Catherine Trimbur , MD , MPH , or Vanjani ( who are married ).
At weekly panel management meetings , staff gather around a conference table to talk through each patient ’ s needs . They discuss how best to treat someone ’ s diabetes , high blood pressure , or kidney disease and how to help them gain access to disability benefits , food stamps , and housing . They identify who needs a cell phone , who needs a shower chair , and who just needs some company . They strategize about next steps , everyone adding their own distinct perspective .
Sarah Kler , MD , who spent her third year of medical school working at the clinic , says it opened her eyes to the extent that the legal system is an inherent part of how many people experience health and well-being . She describes the panel management meetings as “ a really creative space where they ’ re constantly trying new things and working with community partners to maximize ” the care they provide .
MUTUAL AID
It was at a panel management meeting almost three years ago that the team learned that one of their first patients was facing reincarceration . According to Vanjani , the group decided to draft a “ strengths-based letter ” detailing what the patient had accomplished since getting out of prison — and the ways his physical and mental health would suffer from going back .
“ The community health worker took that letter to court and the public defender presented it to the judge ,” Vanjani says . “ We later learned that the judge largely based his decision to not reincarcerate our patient on the medical context we had provided in the letter .”
More successful letters followed , as did positive feedback from the judiciary . Eventually Vanjani , Martino , and others sat down with an
“ If our shared goals are social justice , public health , and good health for patients , what can each professional do to support them ?”
attorney from the Office of the Rhode Island Public Defender and James Lawless , the office ’ s social services casework supervisor , to brainstorm ways to formalize their collaboration .
The first step was to include the public defender office on the clinic ’ s information-release form . That way , if a patient is facing charges ( or has a legal issue in the future ), the two entities are authorized to give each other information about their shared client . The team went on to create two customizable form letters explaining the harmful effects reincarceration and court fees could have on their patients . ( They also created a website , docsforhealth . org , in partnership with the Roger Williams University School of Law ’ s Pro Bono Collaborative , which makes available at no charge a library of fillable forms and templates — tools any provider can use to advocate for patients on a wide range of matters , such as missed court appearances , preventing utilities shut-off , deportation , access to shelter , and non-emergency medical transportation .)
According to Lawless , a judge has only what ’ s readily available — like a police report or criminal record — on which to base a decision . A letter from a physician explaining how incarceration could be harmful to the defendant ’ s health may carry more weight than the same information would coming from the public defender . After all , Lawless explains , “ it ’ s our job to zealously advocate for our client .” Such a letter enables an attorney to provide “ credible information that for the court paints a much clearer picture of the person in front of them . It ’ s powerful ,” he says .
The Transitions Clinic-Rhode Island Public Defender partnership is proof positive that two professions with a traditionally contentious relationship — think malpractice suits — can be mutually helpful : lawyers learn to focus on health outcomes for their clients , and physicians learn how to play a role in legal outcomes for their patients . It also demonstrates the need for diverse skills on a team : just as Thigpen gives the doctors valuable intel about a patient ’ s life at home or on the street , Lawless can find out the date and location of a patient ’ s court appearance , which the patient doesn ’ t always know . As interest in this new paradigm has grown , Vanjani and Lawless have begun presenting it to groups across the country .
18 HEALTH DISCOVERIES l WINTER 2022