Sometimes, good legal help is the best medicine

Maria Perez’s fever had climbed to 103, her body ached and she had trouble breathing. After being told in the emergency room that she had pneumonia, Perez went to a clinic in South Los Angeles for a follow-up appointment.

The doctor asked Perez about her housing situation. Her apartment had cockroaches and mice, Perez said, and rain came through a broken window and filled the walls with mold. The doctor wrote prescriptions to treat the pneumonia and an asthma flare-up and then did something that he hoped would prevent her from getting even sicker: He sent her down the hall to talk to a lawyer.

The attorney, Dennis Hsieh, contacted both the landlord and the Los Angeles Housing Department. The living conditions improved, and so did Perez’s health.

“The medicine wasn’t what cured me,” said Perez, 49. “It was Mr. Dennis and what he did.”

Hsieh, who is employed by Neighborhood Legal Services in Pacoima, spends two days a week at St. John’s Well Child and Family Center, gathering information so he can help families in South Los Angeles and Compton address the legal problems affecting their health. He uses the rest of his time filing restraining orders in domestic violence cases, pressing officials to restore Medi-Cal coverage, targeting unscrupulous landlords and applying for immigration benefits.

Jim Mangia, St. John’s chief executive, said the program has become an integral part of the clinic, whose patients have to worry about much more than their physical health.

“The socioeconomic conditions in which our families live are slapping our doctors in the face,” Mangia said. For example, he said, clinic providers often see children with cockroaches in their ears, lead in their blood and bed bug rashes on their legs. “Someone has to hold slum lords accountable for the slum housing conditions, which are poisoning our children,” he said.

National trend

The partnership between Neighborhood Legal Services and St. John’s is part of a growing trend to bring together doctors and lawyers in low-income neighborhoods across the nation. In California, there are 10 such programs that serve 23 hospitals and health centers. Nationwide, there are 76 partnerships at 180 hospitals and health centers.

The first medical-legal partnership opened in 1993 after Barry Zuckerman, a Boston doctor, lamented to an attorney friend that his pediatric patients kept returning with the same ailments.

“The model makes so much sense,” he said. “We can do all we want medically but because of these problems, if changes aren’t made, nobody is going to get better. . . . The unfortunate reality is that we need lawyers.”

The lawyers rarely go to court, he said, but they do prevent utility shut-offs, stop evictions and get access to food stamps for the patients. Zuckerman said, however, that helping individual patients isn’t enough. Now, he said, doctors and lawyers are pushing for legislation and policy changes to eliminate barriers to healthcare and change the way providers relate to their patients.

Ellen Lawton, a lawyer and executive director of Zuckerman’s National Center for Medical-Legal Partnership, said poor people don’t often seek legal help but do go to health clinics. “People don’t recognize the daily problems that they have living in poverty, that many of the problems they have are actually legal problems,” she said.

Hsieh, 28, a Yale Law School graduate, took a leave from medical school to do a two-year fellowship to work at Neighborhood Legal Services and start the partnership in Los Angeles. When the fellowship ends this summer, he will return to UC San Francisco School of Medicine. Neighborhood Legal Services plans to find another attorney to continue the program.

In South Los Angeles, Hsieh meets with clients in a makeshift office and takes detailed notes in a yellow pad. Clients line up to meet with him, often holding stacks of documents. Since August 2008, Hsieh said, he has opened 513 cases and helped 866 clients.

Months after Perez’s initial meeting with Hsieh, she returned to see him last month. Perez told him there were new problems at the apartment: The front door didn’t close properly, the sink leaked and there were still cockroaches. She also showed him a notice from the landlord warning that she would be evicted if she didn’t pay her $687 rent, even though she already had paid. The notice also accused her of slamming the door and being too loud.

“That’s not the truth,” Perez said.

Hsieh said he would send the landlord’s attorney a letter telling him to fix the problems and stop harassing her. He advised Perez to pay her March rent with a money order and to call immediately if she received an eviction notice. When she did get the notice, she called Hsieh, who immediately started working on a defense.

Perez’s landlord, Orlando Beltran, declined to comment. He referred questions to his attorney, E. Houston Touceda, who declined to comment, saying he did not have his files on hand.

At her doctor’s appointment a few days later, Perez told Dr. Rishi Manchanda that she couldn’t sleep, her head hurt and that her throat burned when she swallowed.

“I feel exhausted and nervous,” she said. “My head aches all over. My face feels like fire.”

“Are you having a lot of stress?” Manchanda asked as he took out his stethoscope.

Perez told him what was going on at the apartment and Manchanda asked a series of rapid-fire questions: Are there any rats? Do you have bedbugs? Are there any holes? Is there chipping paint?

“Your health and your housing are definitely linked,” Manchanda said as he listened to her breathing and looked in her nose and mouth.

He prescribed new asthma medication, referred her to a counselor and promised to follow up.

Benefits restored

Another patient, Patricia Mendoza, 32, who lives in Compton, said the state canceled her Medi-Cal when she was pregnant and she couldn’t get coverage for pregnancy-related diabetes. She also had $30,000 in medical bills because of her daughter’s broken arm.

“I was really nervous. Where was I going to get that amount?” Mendoza said.

She had recently arrived legally from Mexico and said she didn’t know who to turn to or where to go for help. But at the clinic, she learned about Hsieh, who filed paperwork and made calls to get her benefits restored.

“I don’t know how they did it,” she said. “They resolved everything.”

Minerva Osorno, 29, recently took her children to the clinic for a check-up. Her 6-year-old daughter had a rash and had been losing hair. Her 2-year-old son’s eczema was getting worse and she wanted to know if he still had lead in his blood.

After the appointment, Osorno, who is pregnant with her fourth child, met with Hsieh.

Her family had been living in a nearby converted garage with cockroaches, moldy walls, no heat and water leaks.

“Do the kids get sick a lot?” Hsieh asked through a Spanish translator.

“When it’s cold, they are always sick,” she said. “I don’t know if it’s because of the garage or not.”

Osorno told Hsieh that the landlord wanted to evict them and the family didn’t have enough money for a security deposit at another place.

Hsieh urged her to call the Housing Department and the city’s code enforcement office.

Even though it was an illegal conversion, he said, her landlord may still be required to pay her relocation fees.

“Really?” she said. “OK, I’ll talk to my husband.”

As he went to get the next person in line, Hsieh said the need in the community is extensive -- as are the issues facing the patients at St. John’s.

“People never have just one problem,” he said. “They lead complex lives.”