Partnership offers legal, medical aid

Wal-Mart effort in state used as model in Texas

— Wal-Mart Stores Inc. and its charitable arm are participating in a medical-legal partnership to assist patients from low-income households at Texas Children’s Hospital in Houston.

The initiative, announced Nov. 1, is patterned after a similar partnership the company established last year with Arkansas Children’s Hospital in Little Rock.

Funding comes from the nonprofit Wal-Mart Foundation and includes participation of volunteer attorneys from the retailer’s staff as well as other lawyers willing to donate their services, known as pro bono, or for the good of the public.

As with the Arkansas program, the aim of the Texas initiative is to deal with legal problems related to matters such as substandard housing, Medicaid qualification or the need for specialized equipment, or establishing legal guardianships by parents for special-needs children who reach age 18.

The Houston project includes the participation of the Houston Bar Association’s volunteer attorneys group. Similar medical-legal partnerships also have been established in other cities.

The National Center for Medical Legal Partnership counts 97 such agreements across the nation in all but 16 states.

“There was a real need for this,” Jeff Gearhart, executive vice president, general counsel and corporate secretary at Wal-Mart, said in an interview. “We were so lucky that Arkansas Children’s Hospital staff embraced this and allowed us to set up the MLP there.” He said 90 of the company’s attorneys signed up to handle cases for the partnership.

The company also partnered with Legal Aid of Arkansas, as well as outside firms. Since July 2011, Gearhart said, the Arkansas partnership has handled 275 cases.

“We’re happy for other companies to join.

We’re happy to have others participate,” he said. Wal-Mart has had several health-care initiatives over the past several years, including $4 generic prescription drugs. The company also has a long-term goal of reducing health-care costs by as much as 25 percent through leading a coalition of business, government and industry leaders in applying standards and technologies for efficiency.

Carrie Brown, a physician at Arkansas Children’s Hospital, said the Arkansas partnership has handled cases ranging from housing issues to custody cases to denial of services by government agencies.

“We see an impact,” she said, as families become more stable and parents are better able to take care of their children. Brown said the initiative has helped parents retain employment, obtained wheelchairs for children and gotten aides assigned to help children with learning.

Legal issues, she said, have included situations in which landlords have shut off electricity, equipment denials by Medicaid and non-parent guardianship assignment.

“It’s a fairly long list, and a variety of groups are involved,” Brown said.

Jean Carter, executive director of the Center for Arkansas Legal Services in Little Rock, a nonprofit legal-aid organization, said that with funding from the Wal-Mart Foundation, the center has been able to line up lawyers to assist with landlord-tenant disputes and guardianship issues in cases of underaged mothers whose parents provided little care to their daughters.

“It’s been very positive, and certainly families and children are dealing with serious problems,” she said. “We can put these legal resources to work to help them.If you take care of the legal problems, it will improve the health problems.”

Michelle Brzozowski of Cherokee Village and her adopted son, Zechariah, are among those who have benefited from the program. A victim of shaken-baby syndrome, Zech, now 14, suffers from encephalopathy and seizures, in addition to kyphosis and scoliosis, which involve curvature of the spine. Initially, she said, she was unsuccessful in obtaining Medicaid approval for a piece of equipment called a “sit-to-stand” that enabled Zech to stand and bear weight to help prevent brittle bone disease.

“It was horrible. We went through 2 1/2 years trying to get Medicaid to approve,” she said.

Wal-Mart attorneys Lori Chumbler and Karen Davila and paralegal Cassandra Stewart took on the case and, within a year, the equipment was provided and covered by Medicaid.

“We couldn’t have done it without their help. They [Medicaid] were not going to budge,” Brzozowski said. “I certainly didn’t have the funds to get the equipment. It makes you pull your hair out.”

“What Wal-Mart and Children’s Hospital have done, I think, is wonderful,” she said.

Amy Pritchard, staff attorney at Arkansas Children’s Hospital, said the hospital has made more than 200 referrals for assistance since July 2011 having to do with legal problems that adversely affect patients’ health. The hospital, she said, has trained doctors and social workers to identify legal issues that potentially pose a health risk.

Common issues, she said, include special-education students who are not at the hospital and need special accommodations to attend school, as well as prescription and Medicaid denials.

Housing conditions, typically in the rental market, also are a factor.

“Arkansas law is lacking on protection of tenants, in regard to health and safety issues,” Pritchard said.

One role Wal-Mart has played, she said, is funding for training for providers at the Centers for Children in Lowell, a collaboration of the University of Arkansas for Medical Sciences and Arkansas Children’s Hospital. The two entities also operate the Centers for Children in Jonesboro.

Chumbler, associate general counsel for Wal-Mart, said the company works with doctors, social workers and nurses to flag legal issues.

“They’re kind of the front lines,” she said.

Typically, she said, a legal aid attorney will do a quick assessment and, if potential legal issues are identified, the case will be assigned to an attorney who has agreed to handle such cases for free.

New York-based law firm Akin Gump Strauss, Hauer & Field LLP assisted in establishing the Texas medical-legal partnership, she said.

In addition, about 90 inhouse attorneys at Wal-Mart have volunteered to assist in the medical-legal partnership, Chumbler said.

Medicaid cases, she said, typically are not adversarial. One early case handled under the medical-legal partnership involved a child who needed a new wheelchair but who also suffered seizures. The doctor recommended a wheelchair that tilted back to stabilize the child’s head.

Medicaid initially denied the request, she said, but later approved it after attorneys provided the “legal magic words.”

Ellen Lawton, lead research scientist at the National Center for Medical-Legal Partnerships, said the model for such partnerships has been around for about 20 years. She said the model stems from an increased awareness that many problems that confront low-income households and those with disabilities are in the legal arena. They include households with disabled children, veterans centers and other populations, she said.

“Having Wal-Mart embrace this model in Arkansas I think has really shifted awareness of what’s available to get their needs met,” she said.

And in the legal community, she said, there is an ethic that lawyers should give back to their communities through pro-bono work.

“Wal-Mart is living up to that commitment to the legal community. As the model grows across the country, Wal-Mart has highlighted this as an important part of health care,” Lawton said. “It’s a terrific model of teamwork that we’re using around the country.”

Business, Pages 61 on 01/27/2013

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