In her first week on the job, Mary Frances Dennis ’18 was sitting with a physician and an administrative assistant, helping them complete an affidavit that would allow a patient’s case to proceed to court.
Dennis is the first intern assigned to the new South Carolina Medical Legal Partnership (MLP), which formally connects Furman University, the Greenville Health System and South Carolina Legal Services in work to improve health outcomes for people throughout the Upstate, especially those living in poverty.
The partnership—the first of its kind in South Carolina—coordinates and streamlines access to non-medical assistance when a medical problem has roots in or is made worse by a social or legal problem.
“For someone who wants to go to law school or medical school, you couldn’t ask for a better experience,” Dennis said. “I’m learning something new every day.”
The MLP acknowledges the reality that time spent in a doctor’s office is only a small fraction of what goes into a person’s overall health.
“It’s recognizing that the fullness of healthcare policy has to be concerned with a lot more than healthcare,” said David Gandolfo, a philosophy professor and chair of the poverty studies program at Furman. “We believe that it really is a way of getting better health outcomes for the poor.”
The roots of the partnership go back years for everyone involved.
“That’s frequently the case with a good idea,” Gandolfo said. “You’re not the only one who has it.”
This year marks both the 50th anniversary of Legal Services in Greenville and the 25th year that Furman students have interned with the agency. MLP interns will do what Furman interns have done at legal aid for years—essentially the work of a paralegal. They’ll draft complaints, investigate claims and observe in court.
Kirby Mitchell ’90 is a senior litigation attorney with legal aid. Last fall he was designated fulltime to the MLP. He said the MLP interns’ experiences will complement their academic work.
“I’m not criticizing classroom learning,” he said. “But we’re not that.”
On the medical side, Dr. Nancy Powers ’77, a GHS developmental pediatrician, supervised a graduate student, Annie Maertens, on a 2012 leadership project assessing whether the community would benefit from an MLP. The lawyers, pediatricians and families surveyed universally agreed it would.
Powers, who is now pediatrics medical director for the South Carolina MLP, identified a case that has come to be known as the MLP’s first. One of her patients, who was almost 18, was charged with a crime, but there were civil issues involved as well. Mitchell took the case and early threads of the partnership were woven.
In 2014, two fellows training with South Carolina Leadership Education in Neurodevelopmental and Related Disabilities (LEND) worked with Powers to submit a grant request to the South Carolina Developmental Disabilities Council. That grant provided seed money for the MLP and Powers has since written and received others which funded its creation.
At the same, Furman was moving toward an MLP in an academic setting.
In 2011, Mitchell joined Gandolfo in teaching a May X poverty studies course. Mitchell brought the law into the picture and took students to court, introducing them to judges and helping them understand what it’s like to represent low-income clients.
In 2015, the course shifted to focus on the intersection of poverty and health problems rooted in or exacerbated by legal problems. Mitchell and Gandolfo changes the name to Poverty, Medicine and the Law: Greenville’s Medical-Legal Partnership.
They want their students to see how social determinants affect people’s health and then ask themselves what can be done about those issues.
“We treat the class as a pipeline to get them to answer that question,” Mitchell said. “We want them to feel pressure to answer that question.”
The official MLP was created on paper in spring 2016 and the work began the following fall.
Currently, the South Carolina MLP is the only one in the country—and there are nearly 300 of them, in 41 states—in which the educational institution involved is a liberal arts, undergraduate institution.
Gandolfo is confident Furman students bring the maturity and skills needed to the MLP. Their liberal arts training has prepared them to connect unconnected dots with innovation and new thinking.
“It’s obvious that you need physicians and lawyers,” he said. “It’s not so obvious that you need an undergraduate institution. But we know that they can be as useful in this kind of setting as medical students and law students are. And it’s really beneficial for their own education and development.”
The work interns observe and participate in will not only be useful to the MLP but also in shaping students’ understanding of their own potential.
“It gives the students the chance to engage a real problem where real people are being hurt and get a feel for how can their talents and energy and their knowledge be used . . . to make people’s lives better,” Gandolfo said. “It’s really motivating to see that your studies make you useful.”
Doctors and lawyers and social workers will be learning, too, about each other’s work and the potential for improvements and better connections.
“As we work together, we’re learning systems and how we can interact more smoothly,” Powers said.
GHS staff have always been able to refer patients to Legal Services. But the MLP is something more.
“The ‘something more’ is our working relationship—earlier identification of concerns,” Powers said. “We’re working together as a team.”
Dr. Kerry Sease is medical director of the Bradshaw Institute for Community Child Health & Advocacy at GHS and senior medical director of pediatric academics. She said the doctor’s office is often a trusted source of information. The MLP allows for a better connection between offices—a “warm transfer,” Sease called it, instead of simply handing over a phone number.
The MLP includes a care coordinator who can follow up with families and be sure the right connections are made. And after a legal solution is found, the same coordinator will stay in touch to be sure the resolution sticks.
“It should be a win-win,” Sease said. “A win for the families, a win for the system.”
In the big picture, Powers envisions medical staff being better educated about all the ways the community can support patients.
“Not every child needs a lawyer,” she said. “But where are the community resources?”
On her side, Dennis is paving the way for future interns, building the job description as she goes.
“It’s my job to say, ‘This is what I want to do. Can I do this?’” she said.
It’s a dream come true for Dennis, who’s the daughter of a nurse but the first person in her family with an interest in law.
“I’ve always been interested in how health plays a role in people’s overall success,” she said. “It’s potentially what I want to do with my career—so I feel pretty lucky.”
She and the interns to follow will be preparing for a world in which the lines are more blurred as organizations work together to improve a community’s overall health.
“Who goes to the doctor expecting a lawyer?” Mitchell said. “But it’s different now.”
“It’s definitely a true collaborative model within a community,” Powers said.