Add a lawyer to the pediatric health care team!

"Savvy pediatricians are adding lawyers to the health care team serving low income and disadvantaged children. The lawyers are not there to protect the practice," said Barry Zuckerman, MD, chief of Pediatrics at the Boston Medical Center, speaking at the PAS Annual Meeting, "but to improve medical care for children.

"All of us who care for low-income and minority patients get tired of seeing kids treated and hospitalized for preventable causes such as poor housing conditions, inadequate nutrition, and unstable living situations. In many cases, these are legal problems that present in the pediatrician's office."

Dr. Zuckerman has headed BMS's Family Advocacy Program since 1993. The program integrates legal help and medical help for patients and their families. Medical professionals recognize the multiple social factors that can adversely affect pediatric health, but lack the specialized training to effect change. Legal professionals have the tools to make change happen on the local, state, and national levels.

Boston's original FAP has grown into a network of 32 medical-legal collaboration sites in 24 states. On Friday, Dr. Zuckerman launched the Medical Legal Partnership for Children (MLPC) at a national summit held in conjunction with the PAS Annual Meeting. Funded in large part by the W.K. Kellogg Foundation, MLPC is designed to foster the formation of more partnerships between pediatricians, hospitals, and legal organizations.

MLPC addresses critical access to care issues, Dr. Zuckerman said. Just as low-income patients often lack access to medical care, they also lack access to legal care. Most jurisdictions have intricate rules that govern housing, education, nutrition, health-care delivery and other factors that can impact health. Bureaucratic enforcement of housing codes, food stamp or Medicaid eligibility, and other social programs is typically spotty to nonexistent.

"We have seen that lawyers and healthcare professionals working together can often prevent illness and give sick kids a better shot at recovery because they can address the full continuum of needs, including housing, food, education, health care, and a safe, stable environment, Dr. Zuckerman said. "Parents with an asthmatic child don't recognize substandard housing as a medical or a legal problem. Health care professionals recognize the social antecedents of medical problems, but we don't have the training to effectuate change. We need to practice preventative law the same way we practice preventative medicine."

Dr. Zuckerman encouraged pediatricians to form more MLPC groups in more jurisdictions. Details vary by locale, he said, but pediatricians typically work with a hospital-based pediatric unit, Legal Aid, and pro bono assistance from local law firms.

"Pediatricians talking about the social antecedents of poor health care are very credible," he said. "There is enough political cover today for even the most timid hospital administrator or general counsel to join the effort."

MLPC can help local groups create their own partnership with information, technical training, website resources, and conferences. Local partnerships can also apply for grants to help leverage funds raised locally. Information is available at www.MLPforChildren.org.