Medical-Legal Partnership Medical-Legal Partnership for Children in Durhamfor Children in Durham

Duke PediatricsDuke Pediatrics

Lincoln Community Lincoln Community Health CenterHealth Center

Duke Children’s Law Duke Children’s Law ClinicClinic

Legal Aid of North Legal Aid of North CarolinaCarolina

Medical-Legal PartnershipMedical-Legal Partnership

An alliance between An alliance between pediatricians and lawyers to pediatricians and lawyers to benefit low-income and at-benefit low-income and at-risk childrenrisk children

Provides an opportunity for Provides an opportunity for pediatric providers to refer pediatric providers to refer patients for legal patients for legal assessment in situations assessment in situations where a non-medical where a non-medical obstacle is impairing the obstacle is impairing the overall health of a child. overall health of a child.

Duke Children’s Law ClinicDuke Children’s Law Clinic A clinical education program A clinical education program

at Duke Law Schoolat Duke Law School

Allows law students to Allows law students to interview, advise, and interview, advise, and represent low-income clients represent low-income clients under the supervision of law under the supervision of law school facultyschool faculty

Focuses on cases that Focuses on cases that benefit the well-being of benefit the well-being of children; particular expertise children; particular expertise in special education and in special education and school discipline mattersschool discipline matters

Legal Aid of North CarolinaLegal Aid of North Carolina Statewide non-profit Statewide non-profit

program, with local program, with local offices around the offices around the state, that provides state, that provides free legal assistance free legal assistance in civil cases to low-in civil cases to low-income personsincome persons

Particularly focuses on Particularly focuses on housing, consumer, housing, consumer, government benefits, government benefits, and family law issuesand family law issues

Medical-Legal PartnershipsMedical-Legal Partnerships

Acknowledge the influence of Acknowledge the influence of social factors on healthsocial factors on health

Recognize that some social Recognize that some social factors are remediable by factors are remediable by enforcement of existing laws enforcement of existing laws and regulationsand regulations

Consider attorneys as Consider attorneys as “subspecialists” that can “subspecialists” that can remedy some of the non-remedy some of the non-medical obstacles that affect medical obstacles that affect child healthchild health

Utility Shutoffs

Violence In the Home

InadequateChild Care

InsufficientSpecial

Education

Illegal Immigration

StatusLimited Access to

Health Care

Insufficient Household

Income

Lack of Transportation

Poor Housing

Conditions

Inadequate Nutrition

ChildHealth

Burden of PovertyBurden of Poverty

Nearly 20 percent of Nearly 20 percent of Durham’s children are in Durham’s children are in povertypoverty

Nearly 25 percent of Nearly 25 percent of children from birth to children from birth to five are in povertyfive are in poverty

Poor children have 15-30 Poor children have 15-30 % higher risk of suffering % higher risk of suffering from chronic illnesses from chronic illnesses than do children from than do children from non-poor familiesnon-poor families

Medical-Legal Partnership in DurhamMedical-Legal Partnership in Durham

• Lawyers provide Lawyers provide education education on advocacy topics and on advocacy topics and strategies to medical cliniciansstrategies to medical clinicians

Medical clinicians Medical clinicians screenscreen for potential legal issues and for potential legal issues and referrefer families to the legal team families to the legal team

Lawyers provide Lawyers provide direct legal assistancedirect legal assistance to families to families

Medical clinicians Medical clinicians supportsupport legal services when legal services when appropriate by communicating about patient’s needsappropriate by communicating about patient’s needs

Lawyers and medical clinicians together engage in Lawyers and medical clinicians together engage in systemic advocacysystemic advocacy by addressing legal/bureaucratic by addressing legal/bureaucratic obstacles adversely affecting family healthobstacles adversely affecting family health

Medical-Legal Partnership in DurhamMedical-Legal Partnership in Durham

Benefits cases Benefits cases SSISSI, , MedicaidMedicaid, , Food Stamps, TANF, LIEAPFood Stamps, TANF, LIEAP Denials can be appealedDenials can be appealed Issues can involve Issues can involve

Income and resources Income and resources Disability requirementsDisability requirements Miscellaneous eligibility rulesMiscellaneous eligibility rules

Deadlines are very important; help family file Deadlines are very important; help family file appeal and then refer to legal team for analysis appeal and then refer to legal team for analysis and potential representationand potential representation

Benefits case exampleBenefits case example Twins were born prematurely to a low-income family in Twins were born prematurely to a low-income family in

Durham; Twins suffered from failure to thrive; have lung, Durham; Twins suffered from failure to thrive; have lung, intestinal, and heart problemsintestinal, and heart problems

Pediatric social worker recommends that family applies to Pediatric social worker recommends that family applies to Social Security Administration for SSI benefitsSocial Security Administration for SSI benefits

Benefits are denied; pediatric social worker refers to Duke Benefits are denied; pediatric social worker refers to Duke Children’s Law Clinic through Medical-Legal PartnershipChildren’s Law Clinic through Medical-Legal Partnership

Law clinic accepts case; law student talks with family & Law clinic accepts case; law student talks with family & doctors at hospital and pediatric practice; collects and doctors at hospital and pediatric practice; collects and analyzes medical records; researches legal standards; analyzes medical records; researches legal standards; drafts statement for doctor to review to be submitted to drafts statement for doctor to review to be submitted to SSA on twins’ behalf to support claim; submits all forms to SSA on twins’ behalf to support claim; submits all forms to SSA on behalf of familySSA on behalf of family

Medical-Legal Partnership in DurhamMedical-Legal Partnership in Durham

Housing casesHousing cases Poor housing conditions affecting the Poor housing conditions affecting the

health of a childhealth of a child NC says rental housing must be “fit and NC says rental housing must be “fit and

habitable”habitable” Tenant may be entitled to repairs, rent Tenant may be entitled to repairs, rent

abatement, damagesabatement, damages

Housing case exampleHousing case example Pediatrician is treating children with asthma, but Pediatrician is treating children with asthma, but

despite appropriate medication cannot keep asthma despite appropriate medication cannot keep asthma under controlunder control

Upon questioning, pediatrician learns that rental Upon questioning, pediatrician learns that rental apartment had flooded and mold still infests apartment had flooded and mold still infests apartmentapartment

Pediatrician refers family to Legal Aid of North Pediatrician refers family to Legal Aid of North Carolina through Medical-Legal PartnershipCarolina through Medical-Legal Partnership

Lawyer contacts landlord and demands that mold be Lawyer contacts landlord and demands that mold be cleaned up. Landlord, wanting to avoid suit, complies.cleaned up. Landlord, wanting to avoid suit, complies.

Medical-Legal Partnership in DurhamMedical-Legal Partnership in Durham

Family law casesFamily law cases Children’s health & well-being can be affected by Children’s health & well-being can be affected by

instability in family relationships/violence in instability in family relationships/violence in householdhousehold

Victims of domestic violence can get restraining Victims of domestic violence can get restraining orderorder

Family relationships can be stabilized, especially Family relationships can be stabilized, especially to allow for appropriate consents for medical to allow for appropriate consents for medical treatment for childrentreatment for children

Limited family law services offered through the Limited family law services offered through the Partnership – referrals to other attorneys can Partnership – referrals to other attorneys can sometimes be madesometimes be made

Family law case exampleFamily law case example Grandmother brings child with cerebral palsy to Grandmother brings child with cerebral palsy to

pediatrician for care, revealing that the child’s pediatrician for care, revealing that the child’s mother is abusing drugs and is not taking care of mother is abusing drugs and is not taking care of child. Grandmother is unable to enroll child in child. Grandmother is unable to enroll child in school.school.

Pediatrician refers family to lawyer through Pediatrician refers family to lawyer through Medical Legal PartnershipMedical Legal Partnership

Lawyer prepares necessary paperwork that allows Lawyer prepares necessary paperwork that allows child to be enrolled in school despite not living child to be enrolled in school despite not living with his parent & then seeks custody for the with his parent & then seeks custody for the grandmother to stabilize the child’s care.grandmother to stabilize the child’s care.

Medical-Legal Partnership in DurhamMedical-Legal Partnership in Durham

Special Education casesSpecial Education cases Children with disabilities that affect learning are Children with disabilities that affect learning are

entitled to special education services and related entitled to special education services and related services such as speech therapy, occupational services such as speech therapy, occupational therapy, physical therapy, special transportationtherapy, physical therapy, special transportation

Children (ages 3 – 21) are entitled to a free Children (ages 3 – 21) are entitled to a free evaluation to determine their need for servicesevaluation to determine their need for services

Parents are entitled to participate in the Parents are entitled to participate in the development of an Individualized Education development of an Individualized Education Program (IEP) for their childrenProgram (IEP) for their children

Special Education Case ExampleSpecial Education Case Example

Pediatric psychologist working with a child with Pediatric psychologist working with a child with emotional issues learns that the child is struggling in emotional issues learns that the child is struggling in school and is at risk of failing. Parent says she has school and is at risk of failing. Parent says she has been unable to get the school personnel to help.been unable to get the school personnel to help.

Psychologist refers family to the legal team through Psychologist refers family to the legal team through the Medical – Legal Partnership.the Medical – Legal Partnership.

Lawyer reviews school records then accompanies Lawyer reviews school records then accompanies parent to meeting at which a new IEP is developed parent to meeting at which a new IEP is developed to address the child’s needs. Lawyer relies on to address the child’s needs. Lawyer relies on information from psychologist to build the case for information from psychologist to build the case for services for the child.services for the child.

Medical-Legal Partnership in Medical-Legal Partnership in Durham: LogisticsDurham: Logistics

As clinician identifies a family with a potential As clinician identifies a family with a potential legal problem, clinician offers family opportunity legal problem, clinician offers family opportunity for free legal consultationfor free legal consultation

If family is interested, clinicians refer to legal If family is interested, clinicians refer to legal teamteam

Clinician fills out a referral form and faxes it to Clinician fills out a referral form and faxes it to the Duke Law Clinic or Legal Aid of North Carolinathe Duke Law Clinic or Legal Aid of North Carolina

Law office contacts family and sets up interviewLaw office contacts family and sets up interview Lawyer and referring clinician work Lawyer and referring clinician work

collaboratively when needed to achieve goalscollaboratively when needed to achieve goals

MLPC Website: : http://www.law.duke.edu/partnershipforchildren/http://www.law.duke.edu/partnershipforchildren/

Contact informationContact information Duke Children’s Law ClinicDuke Children’s Law Clinic

Duke Law School, DurhamDuke Law School, Durham Phone: 919-613-7169 Fax: 919-613-7262Phone: 919-613-7169 Fax: 919-613-7262 Staff: Jane Wettach, director; Staff: Jane Wettach, director; Brenda Berlin, supervising attorney; Brenda Berlin, supervising attorney;

Sandra Pettiford, clinic administrator; Sandra Pettiford, clinic administrator; Duke law studentsDuke law students

Legal Aid of North Carolina – Legal Aid of North Carolina – 201 W. Main Street, Durham201 W. Main Street, Durham Phone: 919-226-5912 Fax:919-682-8157Phone: 919-226-5912 Fax:919-682-8157 Staff: Madlyn Morreale, Staff AttorneyStaff: Madlyn Morreale, Staff Attorney