Medical-Legal Partnerships Bring Comfort, Relieve Stress

On a sunny Sunday morning, a 14-year-old boy accompanied his mother into a local hospital emergency department in Northwest Connecticut. The single mother, in her early 40s, had terminal cancer and was nearing the end of her life. Her only family member, her brother who lived out of state, was willing to care for her son, but without documentation in place, the hospital’s social worker was mandated to call the state to take custody of the boy. Fortunately, the mother mentioned that she had been working closely with a social worker at Smilow Cancer Hospital. Because of that, Attorney Rebecca Iannantuoni, legal supervisor at the Palliative Care Medical-Legal Partnership (MLP) at the Solomon Center for Health and Law Policy at Yale Law School, received a call at home that Sunday morning.

“I was able to talk to the social workers in both hospitals, the brother and the mom’s doctor at Smilow and pretty quickly worked out a standby guardian document,” said Ms. Iannantuoni, whose areas of expertise include elder law and planning for people with special needs. "The patient was transferred to Yale New Haven Hospital, where her regular providers were, with the plan to send her to stabilize her before sending her to hospice. I raced into the hospital that Sunday morning and the mom signed the standby guardian document. She was quite grateful. She was then transferred to hospice.”

The mother passed away with the peace of knowing her son was with her family. It’s just one example of how the Solomon Center Medical-Legal Partnerships allow medical providers and lawyers to work together to address patients’ legal needs, with the assistance of Yale Law School students.

“The Medical-Legal Partnership is a collaboration with Yale Law School and Yale New Haven Hospital, where lawyers and law students work together to help a number of patient populations,” said Emily Rock, Medical-Legal Partnership Fellow at the Solomon Center. “MLPs have grown over the last 10 to 20 years to over 400 across the country. Studies have shown these partnerships improve access to housing and utilities, reduce stress, improve access for personal and family needs, and improve access to education and employment. We really see evidence of how these programs work as we support patients at Smilow Cancer Hospital.”

Ms. Iannantuoni oversees a small team of Yale Law School students who work to address the legal needs of patients—often at the end-of-life. She works with Gena Lennon-Gomez, MSW, LCSW, a member of the Palliative Care Program at Smilow Cancer Hospital, who does a comprehensive social assessment of each new patient in need of assistance before making a referral to the Medical-Legal Partnership.

“Within that assessment, we’re understanding the family composition, their needs, their financial picture, and what’s worrying them—what’s causing that existential distress,” Ms. Lennon- Gomez said. The Palliative Care Team often sees a need for estate planning and custody arrangements for children.

“When you’re diagnosed with a serious and life-threatening illness, you may need help executing those documents, and if it’s not in your budget—oftentimes, these are people who are already suffering some kind of financial loss—we try to help patients and families.”

She and other social workers determine patient needs, and share the information with Ms. Iannantuoni, who works with the Yale Law School students to provide the legal assistance. “I let the students do as much as they’re initially comfortable with and I review and supervise documents and their execution, so they’re never on their own,” Ms. Iannantuoni said. “It’s exciting to watch these future lawyers who are anxious about having those initial conversations with a patient start to learn how to have them. I’ve had more than one say, ‘this is the best experience of their law school career.’”

Housing and employment are two big areas where the Medical-Legal Partnership assists, Ms. Rock commented. She recalled an incident where they helped a woman receiving cancer care get housing assistance after she fell behind on her rent. She cited another case where the team helped a woman who took family and medical leave for cancer treatment only to be fired.

“In this instance, we were able to write a strongly worded letter to the employer and cite case law explaining why you cannot fire someone due to their medical treatment—and she was able to get her job back.”

The Medical-Legal Partnership team is often able to intervene earlier than most lawyers get involved, long before an issue becomes a lawsuit or legal action that could be lengthy and full of conflict. Ms. Iannantuoni and Ms. Lennon-Gomez agree the best part of their work is the ability to relieve patients of their existential distress. “You’re taking a person in an extreme point of crisis and distress and giving them some peace, it is quite a remarkable experience,” Ms. Iannantuoni said.

“You get a real sense of gratitude and honor to be part of someone’s life,” Ms. Lennon-Gomez added. “We always celebrate birth, but death is a critical part of life and if there’s any way we can help you through the process and relieve stress, that’s meaningful. We think that provides personal comfort.”