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C I T Y
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38 ISSUE SSUE 48
UESDAY,, N SEPTEMBER 14, 2020 2021 TTUESDAY OVEMBER 24,
NewClinic COVID-19begins restrictions will prohibitlegal indoorhelp dining,for personal gatherings advising patients Salud offering help evictions, deportations, other legal woes BY JAKOB RODGERS KAISER HEALTH NEWS
COMMERCE CITY— In her 19 years of living with cerebral palsy, scoliosis and other ailments, Cynthia Enriquez De Santiago has endured about 60 surgeries and her heart has flatlined at least four times. But the most unusual doctor’s referral of her life came last year: Go see an attorney. Enriquez De Santiago sought help at a Colorado health clinic that takes a novel approach to improving the health of its patients: It incorporates legal assistance into its medical practice for patients facing eviction or deportation proceedings, among other legal woes. And the state’s Medicaid program helps fund the initiative. Although Medicaid traditionMarc Scanlon and Bea Garrity offer legal advice at Salud Family Health Centers’ Comally doesn’t fund clinics to supply merce City, Colorado, clinic, one of more than 450 medical-legal partnerships nationlegal assistance, Colorado is one COURTESY PHOTO wide. of several states that have been helped persuade a primary care asgiven permission to use some of ships across the nation that typitheir Medicaid money to help pay cally serve impoverished people and sociation, the state’s legal aid organization and six community health for such programs. Every day in migrants. The vast majority don’t centers operating in cities across Commerce City, four lawyers join rely on Medicaid dollars, which are Montana to pool $20,000 to help the physicians, psychiatrists and used only in fewer than 10 states, social workers at Salud Family according to the National Center for hire an attorney, who can split time among the clinics to help patients Health Centers’ clinic in this suburb Medical-Legal Partnership. affected by the pandemic. north of Denver, as part of Salud’s The role of these sorts of medicalSince the start of 2020, that investphilosophy that mending legal ills is legal partnerships has grown over ment has helped more than 130 as important for health as diet and the past year as millions of people By Ellis Arnold patients seek unemployment claims exercise. in the U.S. havetesting faced lost A long line of cars outside the city of Brighton’s rapid site income at Colorado Community Media — and potentially stave off financial and the threat of losing their homes The goal: Reduce toxic stress and Riverdale Regional Park. The site has had to close early many days in recent ruin. during the covid-19 pandemic. Some keep families intact, on the premise weeks dueserve to high demand. County’s 14-day have test positivity rate As Denver metro continue One woman hadcounties been waiting forto partnerships helped patients that it will their health Adams for inch closer to localassistance stay-at-home orders since unemployment checks, while unemployment years to come, said Scanlon, was 15.9 percent, asMarc of Nov. 17, accordingsecure to Tri-County Health Department. applying in March 2020, and only othersrates have were fought some of thethan evicthe attorney directs the prounder Colorado’s system of coronavirusBrighton andwho Commerce City’s test positivity both higher recently received her fi rst check, tions that weren’t already barred by gram. related restrictions, the state announced 13Mostly, percent.that Forty-five people in Brighton andor29federal in Commerce City have said Dale-Ramos. Without legal help state moratoriums. has meant helping a new level of rules that prohibits indoor died from related benefi healtht issues.“All To limit the spread of COVID-19, along the way, the woman “would the issues that people are people withCOVID-19 unemployment dining and personal gatherings — a have just been like, `I can’t do this strugglingthat with in the pandemic are claims Social Security at leastand 15 counties moved Disabilto tighter restrictions prohibits indoor and change that applies to the majority of the anymore,’” Dale-Ramos said. all the same issues that medicality Insurance denials. But it also personal gatherings. This sort of legal-medical partnerlegal partnerships have been trying regularly entails helping patients Denver metro area and many counties in ship centered on the notion that to work with forever,” said Vicki — many of whom speak only Spanotheris regions. Girard, a law professor and co-direc- doctors can do only so much to keep ish after having arrived here from The state’s COVID-19 their patients healthy.dial, which has tor of the Georgetown University Mexico or Central America — with Photo by Belen Ward been in effect since September, is the set Health Justice Alliance in Washingimmigration hearings. of different levels of restrictions Proponents See Lasting Impactthat each ton, D.C. The program is among at least Advocates for such programs cite In Montana, Kallie Dale-Ramos 450 existing medical-legal partner-
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the example of a child suffering from asthma caused by mold in a dilapidated apartment. While a doctor couldn’t force a landlord to clean up the property or break the lease, a letter from a lawyer might be persuasive, said Dr. Tillman Farley, Salud’s chief medical officer. “Some of these impacts carry out for decades,” Farley said. “And once you get into effects like that, then you’re really talking generational changes in health outcomes.” Beyond common sense, evidence from emerging research suggests the approach can work. Patients at Veterans Affairs clinics in Connecticut and New York, for example, saw their mental health improve significantly within three months of consulting a clinic attorney, according to a 2017 study in Health Affairs. And at Colorado’s partnership, a survey of patients from 2015 to 2020 found statistically significant drops in stress and poor physical health, as well as fewer missed medical appointments among its 69 respondents, said Dr. Angela Sauaia, a professor at the Colorado School of Public Health who led the research. The possible reasons for missing fewer doctor appointments after getting the legal help, Sauaia said, included patients having more income, being less depressed and having an improved immigration status that made them less fearful to venture into public. Medical-legal partnerships should be considered part of health care, Sauaia believes. “You should be referring to them the same way a provider be referring a patient countywould is required to follow based on theto aseverity specialty, such aslocal endocrinology of a county’s virus spread.or surgery.” The dialbiggest grew out of the state’s The challenge forsafer-atthese home orderis —securing the policystable that came after programs fundthe statewide stay-at-home order this ing. Many are funded with a small amount ofallowed seed money, or by grants spring and numerous types of that run only a year or two. businesses to reopen. Medicaid, established in 1965, is a The state recently to colorfor nationwide health switched care program identifiers — levels blue, yellow and people who have low incomes or are orange rather than numbered levels — to disabled. It’s jointly funded by the federal government and each state, avoid confusion. Until Nov. 17, level red and traditionally has covered medimeant a stay-at-home order. Now, level cal costs such as physician visits red — “severe risk” — is the secondand hospital stays. In recent years, though, some
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