leverage the law to improve health · – without legal help, tenants often lose by default –...

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Leverage the Law to Improve Health

How Civil Legal Aid Partnerships can Advance Individual & Population Health

April 12, 2019


The Northern Nevada Alliance for Health & Justice

Rita Greggio, Esq.MLP Attorney

Washoe Legal Services

Allison Cladianos, MPHMLP Program CoordinatorNorthern Nevada HOPES


Objectives

• The Medical-Legal Partnership Model• The Northern Nevada Alliance for Health and

Justice• Common problems in Landlord/Tenant law


WHERE IT ALL BEGANMedical-Legal Partnership origin story


The Medical-Legal Partnership Model

Medical

Legal

Medical-Legal

Partnership


The Medical-Legal Partnership ModelNorthern Nevada HOPES

Washoe Legal

Services

The Northern Nevada

Alliance for Health and

Justice


Northern Nevada Alliance for Health and Justice (NNAHJ) Program Model

Northern Nevada HOPES

NNAHJ


Social Determinants of Health


Legal services referral

Legal education

clinics

Legal consultation


Types of Legal Services


Legal Services and improving health• Consumer protection• Family law• Immigration• Income maintenance• Landlord/tenant• Record sealing• Wills, living wills, guardianship,

power of attorney

• Improved ability to prioritize health and health care

• Improved continuity of care• Obtained insurance coverage of

care/treatment/prescription• Increased access to healthy built

environment• Mitigated risk of homelessness• Improved habitability of living

conditions• Improved ability to prioritize health

and healthcare


Big wins in 2018Count

Number of internal referrals 306

Number of closed cases 148


Level of legal service

Counsel & advice55%

Referrals/Non-Response

16%

Legal representation before court/agency

16%

Limited services8%

Negotiated settlement (without

litigation)4%

Extensive services1%

N = 148


Legal education clinics 2018Count

Legal education clinics to date 10

Substance Abuse Continuing Legal Education (CLE)- pending* 1

Total participants 197


Program Interns to date• 4 Public Health interns

– School of Community Health Sciences, UNR• 1 Law student intern

– William S. Boyd School of Law at UNLV • 1 Paralegal

– Paralegal/Law Program at TMCC


Housing and HealthHow Does Housing Affect Health?• Poor living conditions can affect health

– Example of first MLP in Boston• Evictions

– Without legal help, tenants often lose by default– Having an eviction record can make it difficult to secure future housing– Housing instability can have snowball effect: job loss, homelessness,

cycle of poverty, all of which affect health


Housing and HealthThe Role of Medical Practitioners• Doctor-Patient relationship

– Trust an openness: often patients will revealinformation about housing issues in course of medical consult

– Legal referral as part of treatment? – Practitioners must have education and access to resources– Medical practitioners can help to reduce barriers to accessing legal aid

• Deal with consequences of poor living conditions– Exs: treating bedbug bites, asthma triggered by mold, illnesses caused by vermin

infestation, stress and anxiety caused by eviction, etc.


Housing and Legal AidHow Legal Aid Addresses Housing Issues • Indigent/low-income individuals often cannot afford private attorneys

– Most legal aid orgs provide legal assistance to low-income renters facing eviction

• Disparity in power relationship between landlords/tenants– A study published in the American Journal of Sociology in January 2019 found that

exploitation of tenants is the highest in poor neighborhoods, when exploitation is defined as being overcharged relative to the market value of a property.

• Prevention and education – Catching issues early and empowering clients though education can avoid snowball effect discussed earlier.


Housing and Legal Aid2017 Nevada Justice Gap Report• State Bar and NV Supreme Court Access to Justice Commission• Significant Findings:

– Unmet legal needs• Need: 147,000 legal problems/yr. among NV households at < 125% federal poverty level• Capacity: 35,000 problems/yr. addressed with help from legal aid• Gap: 112,000 problems/yr. for which people do NOT get help • 76% of the total legal needs of this population go unmet

– Unmet housing needs• Stakeholders identified housing/affordability as the #1 unmet need in NV


Issue Spotting for Medical Professionals• Uniform Residential Landlord and Tenant Act (State Law)

– Habitability (Poor living conditions)– Essential Services– Eviction – Generally, no SELF-HELP!– Landlord Retaliation

• Fair Housing Act (Federal Law)– Discrimination in housing: unlawful to refuse to sell, rent to, or negotiate with

any person because of color, disability, familial status, national origin, race, religion, and sex.

– Reasonable accommodation issues, including service animal and emotional support animal issues


Example from our MLP• Eviction case involving an HIV-positive single parent of two children, one of whom is severely disabled. • Referred to our program by medical provider – told provider that she felt she was being harassed by her landlord.• Landlord claimed, without evidence, that one of the client’s children, a teenager, had vandalized the apartment complex. • The client was served with an eviction notice that contained no details as to when the alleged conduct occurred, who

witnessed the conduct, etc. • The eviction came at a time when the client was in the middle of taking her disabled child out of state for a number of

weeks for major surgery. • In court, the judge agreed that the landlord’s complaint was too vague and not appropriate for summary disposition. • Judge found that the landlord would have to refile the eviction and do it as a formal eviction (meaning higher costs for the

landlord, higher burden of proof, etc.)• The client wanted to move out due to the landlord’s poor treatment of the client, so we helped the client avoid further court

proceedings by negotiating a move-out date that gave the client enough time for the child’s surgery and to get new housing. • This case was particularly significant because the client was a longtime patient of the clinic who had no access to

transportation and would not have been able to receive legal help outside of the clinic. Additionally, because the client was low-income, eviction would mean homelessness and would have had a negative impact on the health of the entire family.


The Northern Nevada Alliance for Health & Justice

Rita Greggio, Esq.MLP Attorney

Washoe Legal [email protected]

Allison Cladianos, MPHProgram Coordinator

Northern Nevada [email protected]

leverage the law to improve health · – without legal help, tenants often lose by default –...

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