Chattanooga Times Free Press
By Todd South
Emily Lay sits at a table of doctors, nutrition specialists, billing experts and pastors, listening as the group peels through patients' problems.
The half-hour weekly roundtable at Erlanger hospital brings a team of varied specialists to train their skills on assigned patients.
While doctors monitor an array of health complications such as blood pressure, weight and diabetes, Lay's ears perk up at the potential to help someone in need of legal advice.
Since January, Lay has worked as Legal Aid of East Tennessee's full-time lawyer in Erlanger, helping needy patients who may need a myriad of nonmedical aid such as a power of attorney, applying for social service benefits, working out child custody, writing living wills or obtaining protective orders for domestic violence victims.
Lay has learned that listening can be the most important thing with a patient.
"There's usually a specific issue ... but if you let them talk, eventually they come out with important facts and how we can represent them," she said.
She has closed nearly 30 cases and has six more active, and she gets about five new patient contacts each week, she said. But her reach is growing as more doctors and staff learn how she can help.
Though this is the first such health-law partnership at Erlanger, the concept isn't new. As early as 1993, hospitals in cities such as Boston, and later in Washington, D.C., and elsewhere had established such programs. The website for the National Center for Medical-Legal Partnership lists 83 such partnerships nationwide.
But for a number of reasons, many have not persisted, said Charlie McDaniel, pro bono project director for Legal Aid in Chattanooga.
The first hurdle is persuading hospitals to bring in lawyers, McDaniel said, while another is to commit a full-time attorney, not just volunteers, to be in the hospital and available at a moment's notice.
"The hospital has to be open-minded," he said. "There's this natural tension between doctors and lawyers."
McDaniel, who was at a Tennessee Bar Association meeting in Memphis when reached last week, said there's a lot of talk among his Legal Aid counterparts across the state about what's being done in Chattanooga.
A recent $100,000 grant from the nonprofit Benwood Foundation will pay for an assistant to Lay and a year of operations.
McDaniel is optimistic about the program. Further outreach and a vast supply of local attorneys willing to devote at least some unpaid time for such cases means success is really just a matter of sharing the service with the medical community, he said.
"A doctor says, 'I can prescribe aspirin,' and I can prescribe a Legal Aid attorney," McDaniel said.
The first five months of Erlanger's costs, nearly $50,000, were paid for in thirds, partly from Erlanger, partly from Legal Aid and the rest from lawsuit proceeds in an unrelated California case, McDaniel said.
Nearly half of Lay's time has been used to promote what she does and educate many of Erlanger's more than 4,500 employees about the legal services she can provide to some of the 300,000 patients who pass through the hospital in a year.
During a recent meeting with Erlanger's chief legal officer, Dale Hetzler, the pair discussed how both Legal Aid and the hospital could track the program's progress.
Lay can show hours spent with patients, numbers of cases filed, wills completed and a host of other tangible items. But most of the benefits are intangible and hard to measure, each said.
If a patient has high stress because she didn't have a lawyer to help her work out paperwork for custody of her grandchild, when the problem is fixed, does that translate to better health?
If, while sitting in a meeting with doctors, Lay hears that a child has been admitted repeatedly for asthma problems and lives in public housing with mold and she files court documents forcing a move, will it let the child breathe better?
Hetzler said the mission of a hospital is to help people. The more resources that can attack patient problems from different angles and communicate, the quicker that healthy person can leave, opening space for other people in need.
Lay, a petite 26-year-old Knoxville native with wire-framed glasses, worked as a Legal Aid intern during law school at the University of Tennessee in Knoxville. She then spent a year and a half in the Cleveland, Tenn., office until it was closed because of funding cuts.
The work with people classified deeply below the federal poverty level is a way, she said, to use skills she has gained to aid others as they navigate an unfamiliar legal world.
She has received referrals from pediatrics and is setting up appointments in off-site clinics of Erlanger, where many people who qualify financially for her help often visit.
"I've got one or two [pediatric cases]," she said. "But I know there's a lot more."