Facing the medical and legal consequences of poverty

A new medical and legal partnership at Le Bonheur Children's Hospital looks to unroot the environmental causes of illness among Memphis' disadvantaged. 
Poverty is more than a social issue. Its effects on disadvantages like malnutrition and substandard housing can lead to lifelong health problems for children who grow up in impoverished environments.

Considering that Memphis’ poverty rate is double the national average, local health providers are teaming up with legal groups to alleviate the ample environmental challenges that contribute to poor health.
Memphis CHiLD, which stands for children’s health law directive, is the first medical-legal partnership of its kind in the Mid-South. It works to help eliminate the disparaging health inequalities that many patients face such as disability or special needs.

This program allows doctors and lawyers to team up and act as preventative and healing forces for patients who may be living in poverty and illness.

Dr. Janet GoodeProfessor Janet Goode, Memphis CHiLD medical-legal partnership director and Cecil C. Humphreys School of Law visiting assistant professor, explains that this medical-legal partnership is the only way to break the cycle of poverty and health disparities.

“I think what we have learned is that health and law are not as different as we thought,” Goode said.
“There are a whole host of conditions we call the social determinants of health that impact people’s health that occur outside the four walls of the hospital or the walls of your doctor’s office. The whole idea behind the medical-legal partnership is that when you address underlying social determinants of health you get better health outcomes.”
The University of Memphis law school, Memphis Area Legal Services, University of Tennessee Health and Science Center and Le Bonheur Children’s Hospital came together up in 2015 to create Memphis CHiLD and promote access to the full circle of health resources for Memphis children and their families.
Initially, the founders of Memphis CHiLD considered working mainly with kids with chronic asthma attacks due to the sizable correlation between the condition and substandard housing.
As the team made rounds through the entire hospital they saw children who suffer from an array of medical problems stemming from poverty, said Jeannie Kosciolek, Memphis Area Legal Services managing attorney.  

“We try to treat families and all their needs, and that goes along with their legal conditions as well as their medical conditions,” Kosciolek said. “With Memphis CHiLD, we have Dr. Mutrie to help with health concerns, and we (at MALS) are also able send social workers to help with these conditions and the family’s ability to treat these conditions.”
The opening of the Memphis CHiLD legal clinic in 2015. Memphis CHiLD includes an on-site legal clinic located inside of Le Bonheur where University of Memphis law students work under the supervision of the MALS staff. They are able to work on cases and referrals, meet with patients and clients and conduct training sessions. Le Bonheur residents and other medical professionals have access to the clinic where they can seek training and resources.
Goode added that working with families who may have children with special needs is a way that Memphis CHiLD is critical to the community. Living with a disability requires both medical assistance and governmental assistance, such as individualized education programs and supplemental security income.
She cited a recent case where a grandmother took custody of her granddaughter who was diagnosed with autism. The grandmother needed help navigating how to receive physical custody of the child and whether or not she was entitled to child support from the biological father of the child.

On the medical side of this case, the grandmother also needed help understanding what autism is and how it affects her granddaughter and what resources the child may need to succeed in school and in her community. Helping families with children that have disabilities receive custody, benefits and resources requires help from both legal and medical sides.
Dr. Lauren Mutrie, Memphis CHiLD medical director and a general pediatrician at Le Bonheur Pediatrics, said that having an medical-legal partnership can help patients and doctors reduce the rate of hospitalization and sickness, something that can drastically improve a child’s chances to have a happy and fruitful life.
“Working in an environment as a doctor without a (medical-legal partnership) presence and continually seeing and treating children who suffer from issues caused by something like substandard housing is extremely frustrating,” she added.
So far Memphis CHiLD has made great strides over the course of the year. Goode states that not only has the program has given presentations and speeches to over a thousand people throughout the country but it has also accumulated about 350 referrals from the hospital, which is quite a large number for the small time the team has offered help. Moreover, Memphis CHiLD is busily training students, both legal and medical, as well as medical residents. This year the team presented at the National Center for Medical-Legal Partnership’s annual summit.
Going into 2017, Mutrie and Goode agree they are excited about having the baseline data they need to demonstrate the health impact the medical-legal partnership has had on children at Le Bonheur and in the community. Next, the team will create a program where willing attorneys can provide their services pro bono to Le Bonheur patients. 
Mutrie says that she eventually hopes to translate their work from “helping a single child and family then on to community and hospital to city and state and then, eventually, to making actual legislative and policy changes that will protect the health of our kids and prevent illness in children.”

Read more articles by Rachel Warren.

Rachel Warren is a freelance writer whose writing has appeared in RSVP Magazine and Focus Magazine in Memphis. She is a sales associate at the Peddler Bike Shop. Rachel likes riding bikes, playing roller derby, watching scary movies and writing about Memphis. 
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