LSND Attorneys Helping
to Make North Dakotans Healthy
By Adele Page, Deputy Director,
Legal Services of North Dakota
Imagine Steve, a veteran from Jamestown,
has been hospitalized three times in the last
eight months at the Fargo VA hospital for
lung and kidney problems. Depressed and
overwhelmed with the medical problems,
he falls behind on some bills only to find his
social security benefits unlawfully garnished.
Or, imagine Karen, from Grand Forks,
who cancels needed cancer surgery fearing
she won’t have a place to recover because
her landlord has locked her out of her
apartment after her boyfriend beat her up
and the police had to come to the unit.
Are Steve and Karen’s problems medical or
legal?
The answer is yes. And a new kind of
partnership, the first of its kind in North
Dakota, recognizes that sometimes a
healthcare provider’s ability to point a few
doors down to where a lawyer colleague
might be able to help is a big deal.
response to environmental stress. Data and
research point squarely to the role these
social determinants of health have on a
patient’s wellbeing. The Center for Disease
Control (CDC) reports “poverty limits access
to healthy foods and safe neighborhoods and
that more education is a predictor of better
health.” (CDC 24/7: Saving Lives, Protecting
People TM )
The Minnesota Department of Health
Advancing Health Equities Report (2014)
states 40 percent of the determinants of
health are social and economic factors,
while a mere 10 percent is clinical care. The
next largest factor is health behaviors at 30
percent, which are also impacted by the social
determinants of health.
The collaboration, called Legal Advocates
for Health (LAH), crosses not only legal
and medical disciplines but also borders.
It began last year as a partnership between
Legal Services of North Dakota (LSND),
Legal Services of Northwest Minnesota,
and Family HealthCare. A LAH attorney
is embedded at Family HealthCare and
is a member of the healthcare team. Now,
with the Veteran’s Administration joining
LAH, along with its access to telemedicine
to reach rural residents, LAH is poised to
expand. LAH attorneys are experts in the I-HELP TM
needs that impact the social determinants of
health. I-HELP TM is an acronym developed
by the National Center for Medical-Legal
Partnership to describe common health-
harming legal needs. I-HELP TM stands for
(1) income, (2) housing and utilities, (3)
education and employment, (4) legal status,
and (5) personal and family stability.
The recognition that attorneys are a
part of the healthcare team stems from
a growing recognition that health starts
in our environment: our homes, families,
workplaces, neighborhoods, and our general While embedded at Family HealthCare,
a LAH attorney was asked by a provider
to assist in obtaining an emergency
guardianship for a patient who had lost the
capacity to consent to medical procedures,
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THE GAVEL
but needed a dental extraction to alleviate
significant pain and the threat of infection.
The emergency guardianship was established,
and the patient’s pain was alleviated. The
guardianship, which later became permanent,
also helped the family to ensure the patient
received proper medical care in the future.
The VA medical team now has an attorney
to refer a patient to when he or she has a
problem such as one with a public benefit, a
domestic violence or child support matter, or
end-of-life estate planning or guardianship
needs. The needs of our veterans are
numerous on I-HELP TM issues.
Our healthcare partners are quickly
seeing the advantage of an accessible legal
consultation to ensure their patient’s needs
are met. Many of our patients have needs
for reasonable accommodation in housing
or employment to maintain these important
social supports. The LAH attorney is a quick
and ready reference for a legally proper
request to the employer or landlord.
LSND is North Dakota’s sole legal aid
provider of civil legal services to low-income
North Dakotans. The mission of LSND
is to provide high quality legal advice,
representation, and education to low-income,
disadvantaged, and elderly North Dakotans.
LAH has become an integral tool in
accomplishing this mission.