MLP Through the Eyes of an EJW Fellow

Life in a Medical-Legal Partnership

Written By: Cristina Dacchille, Esq.

When I applied for a fellowship with Medical-Legal Partnership | Boston (then the Medical-Legal Partnership for Children), I anticipated challenges: long hours, little pay, a never-ending stream of clients in need, the potential for burnout – all of the typical challenges that come along with a career in public interest law.

Looking back on my fellowship so far, only six months away from completion, I realize that it was the unanticipated challenges – and the unexpected advantages – of life in an interdisciplinary setting that made my experience an unequivocally positive one.

To give you an idea of what I’m talking about, I should first offer you a bigger picture of what I mean when I discuss working at a “medical-legal partnership.”  Medical-legal partnership aims to improve the health and well-being of vulnerable individuals, children and families by integrating legal assistance into the medical setting.   MLPs address social determinants of health and seek to eliminate barriers to healthcare in order to help vulnerable populations meet their basic needs and stay healthy. At the Medical-Legal Partnership | Boston, legal staff work with medical providers to assist low-income families in the areas of housing, public benefits, family law and education law.

Despite the fact that I repeated this definition frequently during the fellowship interview process, I didn’t have a concrete idea of what it meant – or why public interest lawyering would look and feel so different in an interdisciplinary setting – until halfway through my first year, when I was assigned to work with a client, who we’ll refer to simply as Ms. X.

Ms. X was referred to MLP | Boston by her therapist after fleeing an abusive relationship with a partner who had kept her locked in an apartment for three months.  She was pregnant and scared, and needed help figuring out how to obtain identification, shelter, and benefits. Soon after being referred to us for help, Ms. X gave birth to a beautiful little boy and we began meeting with her to develop an advocacy plan for her new family. As her story unfolded, we discovered a multitude of legal, financial and social challenges the client would face going forward, only a few of which our office could offer help with.  We also identified other key players in Ms. X’s life: a social worker, housing advocate, shelter advocate and pediatrician.

Slowly, we came to realize that there had been further trauma in her history: torture and rape in her home country as a result of her family’s political activities there.  As a multi-trauma survivor, Ms. X was understandably slow to trust, and (as is probably true for so many clients in this situation) overwhelmed by the number of organizations and individuals offering her assistance.

It was at this point in the advocacy – with the client not knowing who to go to for what kind of help, with me frustrated at the number of agencies involved but knowing full well that the client needed all of them to get her life back together – that I realized the unique challenges and the incredible advantages that medical-legal partnership offers.

Guided by senior staff with (thankfully!) far more experience than I, and with the client’s express permission, I began working with the client’s therapist on developing styles of communication and advocacy that would empower the client rather than frustrate or worry her.  I pulled together a meeting with the other agencies involved in the client’s case and made sure everyone was clear on who was doing what so that we were maximizing the many resources we had accessible instead of duplicating efforts. The client was given a list, in writing, of who to call when she needed something and every advocate was given a copy of the list so she would receive consistent messaging.  Each week in therapy, her counselor took time to go over the progress on her immigration, housing, health insurance and benefits cases and make sure that the client – who was, as expected, manifesting severe PTSD symptoms – was happy with the work being done.

This case represented a massive effort by my organization, but it was also an undeniable success – rare in our business.  The client was granted asylum through the efforts of pro bono counsel.  She and her son transitioned safely from a shelter into their own apartment. Mom received the maximum amount of benefits to which she was entitled and began job training – all as a result of the holistic support given to the family: legal assistance, medical care and social services. One alone wouldn’t have been sufficient.  All of them together – without a collaborating agency focusing the interdisciplinary efforts – would have disempowered an already scared and overwhelmed client.  For Ms. X and the many other clients like her, medical-legal partnership is the difference between solving short-term crises as they arise and achieving long-term solutions that last beyond the concrete service provided.

Don’t get me wrong – life in a medical-legal partnership is not perfect.  At least once a day I feel like an idiot because I don’t understand the diagnostic term a consulting physician just dropped into the conversation.  At least once a week I struggle about how to strike the right balance between our staff’s mission of collaborative and preventive law and the adversarial tactics I was taught in law school.  And every once in awhile, a client’s unexpected and inexplicable tragedy – like the recent death of Ms. X’s son from SIDS – still has the power to break my heart and make me wish for a quiet corner office in a law firm somewhere.

But at the end of most days, I leave the office feeling proud of the work my colleagues and I do.  Even with the strange and constantly shifting challenges that come with interdisciplinary collaboration (and the never-ending battle for social justice that comes with a career in public interest law), we keep moving forward, client by client.  We’ve found a preventive solution that has the power to stop problems before they start, that demands and achieves investment from the medical profession, social workers and reform agencies. And no matter what kind of day it’s been, it feels good to know that in the battle against poverty and injustice, you’re not fighting alone.

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This article orginally appeared in an EJW online forum in 2009.  Cristina Dacchille is a former Equal Justice Works Fellow, and is now a staff attorney with Medical-Legal Partnership | Boston.