Tag Archive for: discrimination

When Legal Assistance Can Improve Health

By Lonnie Powers

In April, The National Center for Medical-Legal Partnership (NCMLP), an organization dedicated to “leading health, public health, and legal sectors in an integrated, upstream approach to combating health-harming social conditions,” played host to more than 400 legal and health care professionals at its 11th annual Medical-Legal Partnership Summit in Indianapolis. The annual confab seeks to help organizations leverage the various ways in which civil legal aid—free legal assistance and representation for low-income people facing non-criminal legal issues—can protect individual and public health.

The idea that legal assistance could impact public health was proved in 1975, when California Rural Legal Assistance won a groundbreaking victory in Carmona v. Division of Industrial Safety, which banned the use of short-handled hoes by farm workers because they forced workers to stay bent over for long periods of time, causing them crippling back injuries. Field managers had required the use of short-handled hoes because if they saw workers standing up, they knew they were not doing their work. After the hoes were banned, back injuries among the farm workers dropped more than 30 percent.

More recently in Massachusetts, Greater Boston Legal Services (GBLS) won two victories that enhance the health, safety, and independence of disabled people. First, GBLS settled a federal class action lawsuit against the Massachusetts Department of Transitional Assistance (DTA) for disability discrimination, based on claims that DTA didn’t have adequate systems to provide disabled clients with reasonable accommodations and that it routinely screened out disabled people from food stamp and cash assistance programs in violation of federal law. In a second class action lawsuit, GBLS took on the MBTA, Boston’s regional public transportation system, reaching a settlement requiring the MBTA to improve accessibility to bus and subway services. As a result, the MBTA has made nearly all of its stations fully accessible and has trained staff to respond to the needs of differently abled people using public transportation.

The formal medical-legal partnership model was created at Boston Medical Center (BMC) in the 1990s, when Dr. Barry Zuckerman, then the chief of pediatrics, became frustrated by the lack of clinical progress of his young patients as a result of substandard housing, poor nutrition, and other life circumstances―what are known as “social determinants of health.” Zuckerman hired a part-time attorney from Greater Boston Legal Services for the Pediatrics Department to assist his patients in addressing these unmet needs. The success of the program ultimately led to the creation of NCMLP.

Today, there are nearly 300 medical-legal partnerships in health care facilities in 36 states, including a partnership launched last September between Community Legal Aid and UMass Memorial Health Care in Worcester. Medical-legal partnershipsinvolve embedding lawyers and paralegals in the medical setting to ensure that patients can meet basic needs for food, housing and utilities, education, employment, health care, and personal and family stability and safety―all of which are essential ingredients to maintaining good health. The concept is best encapsulated by the description of a September 2015 segment of PBS NewsHourthat examined a medical-legal partnership in Nebraska: “What happens when a little boy gets a lifesaving bone marrow transplant for his leukemia, but can’t return home because the house he lives in has cockroaches that threaten his recovery? His doctor calls a lawyer.”

The partnerships go far beyond direct advocacy to encompass training for health care workers to identify health-harming social conditions, reforming clinical practice and institutional policies to better respond to patients experiencing health-harming conditions, and preventing such conditions by detecting the broader societal patterns that create them and advocating for policy and regulatory remedies.

Medical-legal partnerships are taking off as health care providers increasingly acknowledge their positive effects on patient health, the ability of health care workers to better understand and screen patients for social determinants of health, and in reining in health care costs. A study of a medical-legal partnership in California, for example, found that two-thirds of the families who participated in the program reported improved child health and well-being. Another study, which focused on a collaboration in Georgia, found increased physician satisfaction, a bump in Medicaid reimbursements to the partnering hospitals for their services, and a savings of $10,000 in annual continuing education costs.

From migrant farmworkers in California in the 1970s to disabled people in Massachusetts three decades later, civil legal aid organizations have long demonstrated expertise in identifying and rectifying the environmental factors that adversely impact the health and safety of vulnerable and underserved communities. Institutionalizing that expertise on the health care continuum through medical-legal partnerships is a logical step that enables our health care system to treat our most complex and vulnerable patients more effectively, efficiently, and cheaply. And that benefits all of us.

Lonnie Powers is executive director of the Massachusetts Legal Assistance Corporation.

Language Access Projects Crucial to Making Legal Services Accessible

By Lonnie Powers

People who do not speak English, or who have limited proficiency with English, can face many challenges when trying to access government services or pursue justice through the courts. Federal law and regulations have established standards to shield limited English proficient (LEP) persons from illegal discrimination. But the reality is that such people are often left to advocate for themselves in individual courts and local governmental offices, and due to limited English proficiency, they are often unable to do so effectively.

It’s not at all uncommon for our civil legal aid advocates to work with recent immigrants and refugees who have next to no proficiency in English and who are dealing with complex issues, such as eviction from housing or denial of health care benefits. More often than not, our clients have been instructed by court clerks and government officials to bring a family member or friend who can translate for them. In some instances, they will even try to have an LEP person’s child translate sensitive information.

All of which, of course, is in clear violation of Title VI of the Civil Rights Act of 1964, which specifies that no person in the United States may be excluded on the basis of national origin “from participating in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance.”

The American Bar Association’s 2012 “Standards for Language Access in Courts” specifies that courts should provide notice of the availability of interpretation services, translated signage and qualified interpreters for LEP litigants, who are often recent immigrants or refugees. Courts are also expected to have written forms available in translation, and to have court judges and staff trained on language accessibility. Compliance with these standards is not uniform, and many LEP litigants still do not have equal access to justice in courts throughout the country. Federally funded programs frequently fail to meet these standards, and LEP persons often receive agency notices in English or a language other than their preferred language. LEP persons are often not informed of their right to interpreter services or are outright denied access to an interpreter. The failure to comply with federal language access standards has resulted in lawsuits and investigations by the Department of Justice in several states, including Rhode Island and New Jersey.

Here in Massachusetts, the state’s Office for Refugee and Immigrants (ORI) published a report in 2009 identifying the most commonly cited service gaps for LEP persons at the Department of Transitional Assistance (DTA), which included a lack of interpretation during intakes and a dearth of translated written material. As part of compliance with the ORI recommendations, DTA drafted and published a Language Access Plan.

In response to these legal access issues, civil legal aid advocates in many states have established coalitions with other social justice organizations to advocate for LEP persons. In Washington state, the Coalition for Language Access recently launched their “Tools with Health” community education program, through which they disseminated consumer “Know Your Rights” pamphlets and “I Speak” cards.

The Washington D.C. Language Access Coalition and Legal Service N.Y.C. have each published data reports on language access barriers that persist in their local communities. New York houses several language access initiatives, including the Long Island Language Advocates Coalition and the Language Access Project of Legal Services N.Y.C. California is home to the Long Beach Language Access Coalition. These coalitions hold meetings, organize conferences, and spearhead community education initiatives to help empower LEP persons with knowledge of their rights.

In Massachusetts, the state’s Language Access Coalition organized “Building Bridges through Language Access Advocacy and Collaboration,” a 2014 summit that brought together advocates from legal services, community-based organizations, and civil rights organizations who explored ways to improve compliance with language access legal obligations in their communities. Meanwhile, the Massachusetts Legal Assistance Corporation (MLAC) created a Language Access Fellowship in 2013 through which an advocate placed at an MLAC-funded organization could strategize full-time on ways to mobilize language advocacy initiatives across the state.

When considering the vast array of need in accessing justice, the ability to receive and respond to critical information in a timely manner cannot be overstated. Language access projects play a vital role in making this happen.

Lonnie A. Powers is the Executive Director of the Massachusetts Legal Assistance Corporation. He has more than 40 years of policy and legal experience at the state and national levels, having devoted the majority of his career to establishing, building, sustaining and revitalizing legal aid organizations. Lonnie began his legal career in his native Arkansas, first with the Attorney General’s Office and later with Legal Services of Arkansas, where he served as Executive Director.