A system-level approach to addressing health-harming legal and social needs: A case study of the NYC Health + Hospitals and LegalHealth medical-legal partnership

Social, environmental, and economic factors play an outsized role in the health of individuals and whole communities. Housing inadequacies, immigration concerns, food insecurity, public bene t needs, and family law matters often negatively a ect health, and call for the involvement of lawyers who can work collaboratively with health care clinicians and population health experts to create solutions at both the individual and population levels.

The medical-legal partnership (MLP) approach seeks to embed patient-facing lawyers as part of the standard of health care to ensure that these factors are e ciently addressed. The largest med- ical-legal partnership in the country — between NYC Health + Hospitals (NYC Health + Hospitals) and the LegalHealth division of the New York Legal Assistance Group (LegalHealth) — embodies the importance of linking patients to crucial legal services in order to improve health and well-being by recognizing that good legal “care” is consistent with their mission. The medical-legal partner- ship serves as an example to other public or non-pro t hospital systems that may be interested in incorporating legal services into a holistic strategy to address the health-harming social and other non-medical factors that a ect their patients.

This case study is an outgrowth of a January 2018 webinar1 and a September 2018 site visit, both of which delved into the inner-workings of the NYC Health + Hospitals-LegalHealth partnership for the purpose of understanding (1) how the use of patient-facing legal services ts into NYC Health + Hospitals leadership’s overall mission and (2) how LegalHealth structures a variety of legal clin- ics across the NYC Health + Hospitals system to meet the legal needs of many di erent types of marginalized patients.

In September 2018, the authors conducted a series of interviews with NYC Health + Hospitals and LegalHealth leadership and sta at each organization’s headquarters in New York City (for a list of all interviewees, see the inside cover). Additionally, they visited LegalHealth clinics at two acute care hospitals: NYC Health + Hospitals/Metropolitan, located in the East Harlem neighborhood of Manhattan, and NYC Health + Hospitals/Bellevue, located on the East Side of Manhattan. During these visits, to better understand the work ow and operations of the LegalHealth clinics, the authors met with sta attorneys during clinic hours, interviewed NYC Health + Hospitals/Metropolitan’s Director of Social Work and NYC Health + Hospitals/Bellevue’s Chief Executive O cer, and spoke with clinicians and social workers who refer patients to LegalHealth attorneys.