By Edgar Martinez. Special thanks to Professor Brittany Kelly, JD, MSW, LSW, Indiana University Robert H. McKinney School of Law.

The twenty-first century ushered significant advances in medical treatment for preserving health and combating diseases.[1] Through these medical advances, healthcare providers have successfully reduced morbidity and mortality, while improving public health and safety.[2] However, advances in patient health and safety present new areas of moral trepidation among health care providers concerning their ability to ethically render patient care.[3] The ethical standards of healthcare providers to “do no harm” can conflict with government regulation when legal regulations are promulgated which could mandate healthcare providers to withhold patient care and worsen healthcare disparities.[4]  Furthermore, healthcare delivery and patient safety could be compromised resulting in two potential outcomes: 1) healthcare providers might refuse to deliver adequate care out of fear of criminal liability and revocation of their license, or 2) healthcare providers might be sanctioned or prosecuted for rendering care that is prohibited by the rule of law. Thus, the delivery of healthcare could be compromised due to reduced access to healthcare and healthcare providers thereby compounding health disparities for patients already suffering from limited access to healthcare.

                 To prevent this compromise in healthcare delivery and improve better access to healthcare, it is of paramount importance that healthcare organizations, healthcare providers, and social workers interface and collaborate with lawmakers. Together, they could create policies that would improve the delivery of healthcare rather than impede it.[5] Establishing medical-legal partnerships (“MLP”) is an example of how the medical and legal communities could collaborate to formulate legal regulations which would uphold the standards of healthcare delivery, improve access to healthcare, and mitigate the concern among healthcare providers for rendering patient care without fear of criminal liability. Medical-legal partnerships would unite healthcare and legal professional resources to ameliorate and improve the social determinants of health.[6] Furthermore, medical-legal partnerships can improve patient outcomes by incorporating legal expertise into the health care team to address health-harming needs on a state and federal level.[7] The MLP approach can reform upstream influences that can improve patient and population health.[8]

                 The National Center for Medical-Legal Partnerships (“NCMLP”) exemplified the importance of medical-legal collaborations as innovations to curtail healthcare disparities by utilizing the rule of law and policy work towards improving access to healthcare on an individual and community-wide level.[9] For instance, in Washington state, hospitalized children who met hospital discharge criteria and required lifesaving out-of-hospital care faced predicaments on placement after their hospital stay. At-home care expenses were not affordable nor reimbursable by health insurance.[10]  Given the lack of financial access, hundreds of children were forced to stay at extended care facilities away from their homes and families.[11] The NCMLP filed a complaint against Washington state healthcare authorities and the Medicaid director through the Americans with Disabilities Act.[12] A federal judge ruled in favor of the families acknowledging that “[T]he state must fulfill its obligation to these children.”[13] Subsequently, the Washington legislature passed a bill to increase the funding for at-home care. This exemplifies how an MLP can utilize medical-legal resources to overcome healthcare barriers and optimize the delivery of healthcare for families community-wide.

                 Additionally, the implementation of an MLP can help ensure that healthcare providers are practicing within the standards of care in accordance with safe medical practice and ensure that laws are not promulgated, which could diminish healthcare delivery. In contrast, when there is no MLP collaboration, and laws are created that affect the behavior of healthcare providers (“HCPs”), patient outcomes can worsen. Proponents of government regulation allege that regulation of HCP’s behavior can function to improve quality and access to health care by promoting or deterring HCP behavior, with the goal to improve the physician-patient relationship.[14] However, as a practical matter, these regulations could alter the provider-patient relationship by compelling healthcare providers to practice defensive medicine. HCPs might avoid or limit the administration of medical treatment out of concern for violation of a regulation.[15] For instance, pursuant to opioid prescribing regulations, HCPs might provide reduced pain medication which could fail to ameliorate pain and result in patient suffering.[16] A medical-legal partnership could reduce the possibility of negative patient outcomes and compromised healthcare delivery by facilitating dialogue among healthcare providers, policymakers, and legislators to create alternative prescribing guidelines that would preserve the autonomy of healthcare providers to safely treat patients and remain in compliance with legal regulations.

                 Medical-legal partnerships are a solution for bridging gaps between healthcare delivery and legal regulation by creating a forum between healthcare providers and legislative bodies to optimize upstream influences and alleviate healthcare disparities. The collaboration invites perspectives from medical and legal communities which can create laws to overcome healthcare barriers and improve healthcare delivery while preserving a healthcare provider’s ability to ethically render patient care rather than practice defensive medicine. Medical-legal partnerships would strengthen collaboration between the medical and legal communities thereby improving patient outcomes, healthcare delivery, and access to patient care.