Medical legal partnerships (MLPs) offer a powerful solution for addressing health-related social needs. Integrating legal services into health care settings enables clinicians to tackle situations that can contribute to health disparities. Today, five clinics within UT Physicians are providing medical legal partnerships to help patients eliminate social barriers that get in the way of receiving medical care.
“Patients affected by income insecurity, wrongful termination, spousal abuse, domestic abuse, housing insecurity, and the inability to gain transportation — these are issues that we as physicians are totally unprepared to deal with,” said Thomas J. Murphy, MD, family medicine specialist at UT Physicians Family Practice – Bayshore.
Tracing the history
Murphy co-founded the first academic medical legal partnership in Texas in 2016 at UTHealth Houston. MLPs are spreading rapidly across the state and expanding nationally, he said. More than 75,000 patients in the United States received help from MLPs last year, resolving legal issues that hindered health.
MLPs support the World Health Organization’s definition of health, which includes physical, social, and mental well-being — not merely the absence of disease.
“The adoption of a concept of a paralegal or lawyers associated with our clinics will become an essential concept over time,” said Murphy, assistant professor and Stanley Family Distinguished Chair of Population Health and Community Medicine with McGovern Medical School at UTHealth Houston. “We can prescribe medications for illness, but dealing with the social, mental, and physical aspects of where patients live to help make their lives better is important for the overall health of the communities we serve.”
Making a difference
A child with asthma living in a mold-infested apartment is an example of a health-harming legal need. Physicians can develop the most sophisticated and accurate asthma treatment plan available, but it won’t be much help if the child returns to a poor-quality living environment.
While a social worker can visit and identify a new housing solution, Murphy said the legal entity can take action, such as break a lease when health is involved.
Murphy said medical legal partnerships have a direct and immediate impact on the lives of UT Physicians patients and ultimately will improve health outcomes. The opportunity to develop a new path to health care is what excites Murphy about creating MLPs within UT Physicians clinics.
MLPs are in place at these locations within UT Physicians:
- UT Physicians Multispecialty – Jensen
- UT Physicians Multispecialty – International District
- UT Physicians Pediatric Primary Care – Texas Medical Center (plus CHOSeN program for children with special needs)
- UT Physicians Comprehensive Adult Sickle Cell Center
- UT Physicians Multispecialty – Victory
Medical legal partnerships in action at UT Physicians
The MLP team comprises three paralegals and four attorneys and is part of Lone Star Legal Aid. Participating clinics survey new patients and conduct ongoing screenings every six to 12 months. Once the clinical team identifies health-harming legal needs, they bring a paralegal to work with patients.
Matthew Simonds is a full-time paralegal embedded within the UT Physicians Pediatric Primary Care – Texas Medical Center. Being on-site provides efficiency since the family is already at the clinic. Patients go directly from their appointment to working with social workers to complete referral forms. Then they proceed to Simonds to complete a thorough intake interview.
“Attorneys review their information sooner and reach out to them quicker,” Simonds said. “This prevents losing contact after they leave the clinic, which delays our ability to provide services.”
Simonds said the medical legal partnership team helps patients with a variety of legal issues. These range from preventing evictions, obtaining guardianships, and securing affordable housing to filing for bankruptcy and divorce.
“I enjoy being the liaison between the medical and legal staff,” Simonds said. “I work with both sides to obtain any information or documents needed to help resolve the patient’s issue.”
Rosalie Miranda, paralegal, handles patient referrals from UT Physicians Multispecialty – Jensen and the UT Physicians Comprehensive Adult Sickle Cell Center. Working in this role for the past five years has been fulfilling in a number of ways.
“There’s a sense of accomplishment because you’re helping people who otherwise wouldn’t be able to afford an attorney,” she said. “It’s just a weight off their shoulders. They’re able to focus on other things and not worry about feeding their children or being behind on rent.”
Quantifying results
People experience positive outcomes, studies show, when legal services and expertise address social needs. Outcomes include reduced hospital admissions, improved medication adherence, and lower levels of stress. Professional organizations support them, including the American Bar Association, American Medical Association, and American Academy of Pediatrics.
Murphy agrees that the success stories and personal stories within UT Physicians have been dramatic over time. He described two studies based on UT Physicians MLPs that have been published in medical journals. In 2019, the organization divided 320 patients at the Jensen clinic into two groups as part of a study that was published in the Texas Academy of Family Physicians. After 18 months, results showed the group referred to the lawyers had a higher rate of visits to the emergency department but fewer hospitalizations.
“We were able to make people more aware of their health earlier so the emergency room visits didn’t convert to a hospital visit or stay,” Murphy said. “This was very gratifying for us.”
The second study, published in March 2024 in the American Board of Family Medicine, showed that patients referred to the MLP significantly reduced their anxiety and depression scores.
Murphy is proud these studies have been published and validated.
“We know the need is there, and we’re fulfilling a need,” he said.
