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Evo Terra: From custody battles and guardianship issues to pending evictions and rodent infestations, patients throughout the Richmond community face legal challenges that can have serious impacts on their health and wellbeing. To help, VCU Health has established a medical legal partnership with a dedicated team that offers free legal advice and representation for eligible patients and families in the Richmond area. As associate general counsel for the MLP, Allison Held leads the program and is here to talk and share a little more about what it entails. This is “Healthy with VCU Health.” I'm Evo Terra. Let me start my questions, Allison, with a rather obvious one. What is a medical legal partnership and why does VCU Health have one?

Allison Held: Thank you for having me today and highlighting our medical legal partnership, or MLP, as we call it at VCU. The MLP model was developed by a pediatrician in Boston in the 1990s. He was the chief of pediatrics at Boston Medical Center, which like VCU is a large safety net hospital. And he was tired of treating children with asthma and sending them home to moldy apartments. He was tired of seeing anemic toddlers and telling their parents to go out and buy more and better food when he knew they couldn't afford to. He was frustrated by treating babies with lung ailments and sending them home to unairconditioned apartments. And he grew so frustrated by this, that he did something that was considered pretty radical at the time. He hired his own team of lawyers. So he hired three lawyers and stationed them in the pediatric clinic, and he had what he called “Walk-in Mondays” so that lawyers could fight the legal and administrative battles to improve children's health in ways that pills and surgery couldn't.

And this sparked a movement across the country, which we call medical legal partnership or MLP. And there are now more than 400 MLPs across the country in 48 states. Most of these programs are at children's hospitals and at large academic medical centers and hospitals that serve large, low income populations like VCU and community health centers. So MLPs are essentially programs that add lawyers to the health care team to address social issues that are rooted in legal problems for low income and underserved patients and families. Our lawyers become part of the health care teams and the clinics that we serve. Our physicians, our nurses, our social workers refer patients to a lawyer in the same way that they would refer a patient to any subspecialty like psychology or cardiology. Our lawyers intervene to address social determinants of health, such as unlawful evictions for housing conditions, public benefit denials, employment discrimination, family law issues, including domestic violence, issues with immigration status.

And we help children and families to advocate for themselves in school and at work at VCU. We know that we're improving people's lives every day, but we also recognize that circumstances outside our clinic walls, such as food or housing or a child not getting the support she needs at school, can have a profound effect on patient health. So, adding lawyers to our health care teams make sense, and we see the difference that we can make in our patient's lives and in our community, by providing this free, compassionate service to our patients and families. We provide this service through community partners, and our partners are Central Virginia Legal Aid Society, CancerLink, McGuire Woods and Dominion Energy. We also rely on many other pro bono attorneys in the community.

Host: It's not often that we hear about legal advice that is actually free. So that's quite encouraging. You had mentioned a few areas where legal matters obviously affect someone's health. Could you maybe share a few more examples of how the MLP can help?

Allison Held: Most common example and the legal issue we see the most at the Children's Hospital relates to patients and families living in substandard housing conditions that are contributing to poor health. For example, a child with asthma or a pulmonary condition that lives in an apartment with mold or a leaky roof, or is infested with cockroaches or bedbugs. These conditions can make asthma or other breathing problems worse. So, in these kinds of cases, our lawyers are able to intervene to require the landlord to comply with the law and to make these repairs. We often see in these cases that these health issues improve once we've been able to address the legal problem.

Another example is in the employment area, particularly with cancer patients, when we're working with a patient who has cancer and is going through treatment. He or she may need to take some time off from a job, work reduced hours, or sometimes we see patients lose their jobs as a result of their diagnosis or their treatment. So we help advise patients on their rights, represent them in the case of a wrongful termination, and hopefully help patients keep their jobs and their income and their benefits so that they can adhere to treatment plans and focus on getting well.

And then I'd like to share one last example and that's in special education, which is a relatively new and growing area for us. Education, not income, surprisingly, is the No. 1 predictor of long-term health and life expectancy. So keeping kids in school and providing children with all the support they need to be successful in school is really important. Our providers at the Children's Hospital refer cases to us when they see kids who are having trouble in school, who are being bullied, who may have an individualized education plan or an IEP, or they need an IEP in order to receive special education and any related support services at school. We help families communicate with teachers and school administration with understanding their rights and requesting and enforcing IEPs, as well as 504 plans. And we also work with parents to help them advocate for themselves and their children in school. So, this has become even more important due to COVID and virtual learning, since it can be more difficult to provide these services in this new learning environment.

Host: That is quite expansive. So Allison tell me who can access this program?

Allison Held: We currently provide free legal services to six different patient populations at VCU Health, Massey Cancer Center, the Children's Hospital, Downtown Pavilions, the Complex Care Clinic, the Ryan White HIV Clinic. And then we also serve the Brook Road Campus, which includes the Virginia Treatment Center for Children and the Children's Hospital Brook Road. And we're really hoping to be able to expand our services more widely throughout the health system over time. For now, patients and families who meet our eligibility requirements and are being seen and treated in these clinics have access to these free services.

Patients must also meet our income guidelines and live in Richmond or any of the surrounding counties. We also have two community-based programs where we provide free legal services, and they are at Dominion Place, which is a high-rise residential facility on the VCU campus for older and disabled adults. We work with the University of Richmond law students and faculty to provide free legal services to residents of this facility as part of VCU, Richmond Health and Wellness Program. We also provide free legal services through the central Virginia Legal Aid Society out of the Health Hub at 25th Street in the East End. And any member of the community can make an appointment to meet with an attorney at that location. And you don't have to be a VCU patient to access the services.

Host: Once again, lots of ways it can be accessed. So specifically, how can people who might be undergoing cancer treatment or adults with certain conditions or even families of children at VCU, how can they access MLP Richmond?

Allison Held: The best way to access our services is to talk to your physician, your nurse, your social worker, any of your providers. So your provider will make a referral to us if you meet our eligibility criteria. And the legal issue is something that we can address. Once we receive that referral, one of our team members will reach out to you to start the intake process, but we can also be reached by email and by phone and our email addresses, This email address is being protected from spambots. You need JavaScript enabled to view it., or you can call us at (804) 517-9110. We also take walk-ins, and anyone can make an appointment to see our lawyer at the Health Hub on Wednesday afternoons between 12 and 4. And this would probably be a good time too.

We talked about a few of the areas in which we provide services. The examples that I gave were in housing, employment and special education. In addition to the areas that we talked about, we also do a lot of other kinds of health in cases, especially eviction. We also do a lot of estate planning, for example, bedside wills, powers of attorney and advanced medical directives for patients.

At Massey, we handle public benefit appeals, like Medicaid and SNAP benefits. We advise patients on consumer issues like predatory lending and bankruptcy family law issues, including domestic violence, child custody and guardianship. And we also take immigration cases where the immigration status affects a patient's ability to access health care.

We do not do medical malpractice, and we only address civil legal matters. So we don't do any criminal work.

Host: Is there anything else, Alison, you'd like to add?

Allison Held: I do just want to add that we are very grateful for the support of the health system for recognizing the importance of social determinants of health and the work that we do. We wouldn't exist without the support of the MCD foundation, which provided the seed funding for our program and continues to support us in many ways. And we've also received funding from some local foundations, including the Herndon Foundation, the Virginia Sargeant Reynolds Foundation and the Virginia Law Foundation. And of course, we benefit tremendously from all of the pro bono support that we receive from many lawyers in the community who donate their services to our patients and families at VCU Health. So I just wanted to thank all of our partners for enabling us to provide these important services to our patients and families

Host: Important indeed. I'm glad we've had a chance to talk more about this valuable service for all patients alike. Allison, thanks for being on the program.

Allison Held: Thank you for having me.

Host: That's Allison Held, associate general counsel for MLP Richmond at VCU Health. For more information on the MLP, you can call (804) 517-9110 or email This email address is being protected from spambots. You need JavaScript enabled to view it.. To listen to other episodes from VCU Health, visit VCU health.org/podcast. This has been “Healthy with VCU Health,” and I am Evo Terra. Thanks for listening.