1. 1 Incorporating a Legal Services Program into A Hospital Setting By LegalHealth©

2. 2 Objectives for Today Overview of LegalHealth Model Nuts and Bolts of Starting a Hospital Collaboration Program Conflict Issues Funding

3. 3 LegalHealth Direct legal services through legal clinics at hospitals and community organizations. Serving adults and children seeking preventive health care and the chronically ill. Training of physicians and social workers on range of legal needs of their patients and families.

4. 4 LegalHealth Hospitals Maimonides Pediatrics Oncology Mt. Sinai Pediatrics Internal Medicine Palliative Care Beth Israel Pediatrics Oncology ALS Clinic Palliative Care Bellevue Hospital Adult Ambulatory Kings County Hospital Adult Ambulatory

5. 5 LegalHealth Hospitals St. Luke’s Roosevelt Pediatrics Pulmonology Our Lady Of Mercy Social Work Department – mainly mental health clinic Elmhurst Hospital Social Work Department Lincoln Hospital Adult Ambulatory Queens Hospital Cancer Center of Queens Hospital

6. 6 LegalHealth Health Clinics Ralph Lauren Center for Cancer Care and Treatment

7. 7 LegalHealth Community Partners American Cancer Society Cancer Care Gilda’s Club Share MS Society Hemophilia Foundation Friends of Karen Lupus Foundation

8. 8 Other Models for Medical- Legal Collaborations in Hospitals Boston Model – lawyers are employee’s of hospital Connecticut – lawyer part of a children’s advocacy group but stationed full time at hospital and community clinic VOLS - volunteer law firm staffing of a pediatric unit

9. 9 Models, cont. Rhode Island - medical and law students staff a help desk and make referrals to Legal Services Offices Cleveland – lawyer affiliated with Legal Services office, but physically works out of the Children’s Hospital

10. 10 Nuts and Bolts of Hospital Collaboration –LegalHealth Model Getting in the Door Outlining Benefits to Hospital Defining Goals of Program Roles Logistics Working with Key Health Care Personnel Training Setting up Legal Clinic Funding

11. 11 Getting in the Door Note-There is no one way to get in the door. Access the climate of the hospital (nexis search, talk to people in the medical field) Personal contacts most effective. Try to work with leadership.

12. 12 Getting in the Door, cont. If not possible to work with leadership then establish relationship with chair of a particular department; or work with proactive physician who can help access leadership or chair of department if not on board already. Once you are in one hospital easier to get another interested.

13. 13 Outlining Benefits to Hospital A cost saving factor Holistic approach to care for patients Another quality of care incentive A means for residents to fulfill their Residency Review Committee requirements A comprehensive educational experience for health care professionals

14. 14 Defining Scope/Goals of Program Target population e.g. Pediatrics, Community Medicine, Internal Medicine, disease specific units (Oncology) Service Model –Independent relationship –Employee –One hospital vs. multiple hospitals

15. 15 Goals, cont. Identify “ask” from hospital –Money contribution –In-kind support space computer/internet access phone place for copying

16. 16 Roles Be clear about roles, reassure hospital that you are not taking on general counsel role. Offer to meet with General Counsel. Be clear that legal program will not be in adversarial role. Have discussions up front about medical malpractice issues and referrals.

17. 17 Working with Key Hospital Personnel and Their Roles Doctors To learn about the legal issues affecting their patients To make informed referrals To help us advocate for their patients To advocate directly for their patients

18. 18 Key Hospital Personnel, cont. Social Workers To be a source of referrals To provide the psychosocial support To assist with legal issues To serve as intermediaries to reach doctors Important to distinguish lawyer’s role from social worker’s within context of collaboration.

19. 19 Logistics Have staff dedicated to collaboration. There needs to be at least one person in the hospital able to help with logistics and administrative issues. Establish a system for referrals -- do you want walk-ins? Point person for medical records

20. 20 Logistics, cont. Establish consistent hours and consistent on-site legal staff, so that hospital staff can connect a face with the program Legal staff should spend time at the hospital, outside clinic hours, so that they become known by the medical staff Develop a PR plan so that doctors, social workers and patients know about program

21. 21 Training Insist that training be part of the collaboration Train on issues affecting patients Train on issues of interest to doctors Curriculum should be a medical-centered model (work with personnel within hospital responsible for training to accomplish this)

22. 22 Training, cont. Target who training should be for, residents attendings or faculty Work with faculty to determine logistics of training cycle, e.g. what is the resident rotation?

23. 23 Setting up the Clinic Clinic should be started only after sufficient training Clinic should be housed in unit where training occurred, if possible Clinic should be consistently staffed Learn about the hospital’s no show rate, this will guide scheduling of legal appointments

24. 24 Setting up Clinic, cont. Try to brand your name so word spreads about clinic

25. 25 Potential Conflicts/Issues HIPPA Discharge planning Mandatory reporting issues Minor’s rights issues

26. 26 Funding Get financial commitment from hospital Do joint grant applications with hospital partner Foundations that fund law or health (or both) Disease/condition specific funders