By Carolyn Martin
Among the doctors, nurses and administrators at Boston Medical Center is an unlikely bunch of professionals to be working the hospital corridor. Sprinkled among the staff in white coats and surgical scrubs are lawyers and, even more unusual, these lawyers don’t represent the hospital — they work on behalf of some of the hospital’s youngest patients.
The staff of attorneys in the Family Advocacy Program works through the hospital’s pediatrics department, ready to help children and their families who need legal counsel for a variety of issues: cleaner and better housing, food stamps or even assistance in getting special education services through the public schools.
The Family Advocacy Program was begun in 1993, born out of pediatricians’ frustration with their inability to secure resources for families in need. Treating a malnourished child doesn’t change the cause of the ailment, which might be eased by food stamps.
“Now, we’re able to close that circle. When they refer to us, we represent the family in appealing for the food stamps,” said Ellen Lawton, one of three staff attorneys in the program.
Each year, 500 cases or families are represented by the Family Advocacy Program. Many of its clients are the working poor.
Angela Ellis was one of those patients who became a client. The former welfare recipient had a job but lost it during a difficult pregnancy with her second daughter. She lost time at work, which eventually cost her her job.
When Ellis applied for welfare benefits that included covering her second child, she was turned down. The second child was disqualified for aid, according to the welfare department, because she was born too soon after Ellis had been on welfare.
While at Boston Medical Center, where Ellis delivered her child, she was connected to the advocacy attorneys through a family social worker.
Lawton, who specializes in welfare issues, was preparing to fight the decision and was waiting for a legal hearing when she found a discrepancy in the paperwork. The welfare office had miscalculated the baby’s arrival and Ellis’ time on welfare. Lawton notified the welfare office, the discrepancy was corrected and Ellis got benefits for her second child.
“It’s made a great difference,” Ellis said. “I’m pretty sure if I hadn’t had Ellen’s help, I probably wouldn’t be receiving help anymore and I’d be struggling.”
That was one of the simpler cases, quickly resolved. They aren’t all so easy.
Many clients aren’t dealing with a single, isolated issue. They are caught in a web of problems that are often interrelated. That means the advocate attorneys often see clients for more than one reason.
“It’s the holistic nature of the practice,” Lawton said. “We want to treat the family and all the issues. They may be in a housing crisis but may also need assistance applying for disability, or their food stamps were erroneously cut off.”
Lawton said low-income families often have to deal with up to 10 government bureaucracies, and each one expects specific documentation and records. Understanding how to maneuver the tangle of red tape alone is overwhelming.
“That’s what we see the most of — parents doing the best they can, but there are so many different systems operating independently, they can’t get a leg up,” Lawton said.
Ellis echoed the clients’ frustration. “It’s a great help having her there. Things have happened lickety-split. If I have to deal with a person, it takes days for them to get back to me,” Ellis said.
Ellis’ words of praise notwithstanding, quantifying the advocacy program’s success in helping make the health care system more effective can be difficult.
There are records on the number of cases taken on and won, and there is plenty of anecdotal evidence about health improvements resulting from the lawyers’ advocacy, but, “It’s almost impossible to evaluate it from the medical perspective,” said Joshua Greenberg, director of children’s programs at Health Care for All, another Boston-based advocacy program.
Greenberg was one of the founding attorneys of the Family Advocacy Program and practiced law there until last year, when he moved to Health Care for All. Evaluating the program on the grander scale is difficult, he said. “Doing it on an overall caseload perspective, I don’t think it can be done. I was always looking for that silver bullet, but I don’t think it’s there.”
That hasn’t stopped the Boston program from becoming a model for other hospital-attorney advocacy groups around the country. Similar programs are being considered in Connecticut and New York.
Although housed at Boston Medical Center, the program is funded through a variety of sources, including grants from the Boston and Massachusetts bar associations and federal funding from welfare-to-work monies. The hospital also provides funding through in-kind donations, such as office space and equipment.
The attorneys are paid as employees of the medical center, which funnels the grant money to the program. But the lawyers emphasize they work independently for the patients and don’t represent the hospital. In seven years of advocating, Lawton said, there have been no cases brought on behalf of patients against the hospital.
The bulk of the advocacy cases referred by the doctors involve housing issues. Although they’re prepared to take legal action, the lawyers also try to resolve problems through negotiation.
For example, if a child being treated for asthma lives in a rundown apartment infested with rats or roaches, with old carpeting and moldy walls, medical care dispensed at the hospital won’t keep the condition from worsening at home. The attorneys use the leverage of the hospital when taking on the landlord to improve conditions.
“We have direct access to the medical information, and we can explain clearly to the landlord what the link is between the substandard housing and the child’s health,” Lawton said.
The attorneys also operate walk-in clinics at three locations throughout Boston that are staffed by law students who are guided by the attorneys. Although limited to helping families with children at the hospital, the attorneys will see and refer those without children to the appropriate state or federal agency that can address their problems.
And, to keep health care providers educated and updated about patients’ rights, the attorneys run training sessions for hospital personnel. They also take their advocacy work to the Statehouse floor, working for family-friendly legislation and acting as a liaison between the hospital and the politicians.
For the Family Advocacy Program attorneys, it’s a personal reward, not a monetary one, that makes the 50-hour weeks gratifying. Lawton said she could be making three times her salary at a private law firm, but this legal work is more satisfying.
“I’m one of the happiest lawyers I know. This is an incredibly rewarding place to practice.”