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, 18 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.