On a sunny day in the rose garden at Oregon Health & Science University’s Doernbecher Children’s Hospital, there was an atypical sight — a wedding.
With nurses as proud witnesses, mom had a bouquet, dad had a boutonniere, and their newborn son, who had been in the hospital for just over a month, was dressed up for the occasion.
Jessica and Marc Biritz, of Grants Pass, Oregon, had been at Doernbecher since their son, Malakai, was born with gastroschisis, a birth anomaly of the abdominal wall that can cause some organs to be found outside of the baby’s body. As they stayed with their son through surgeries, recovery and treatment, life outside of the hospital continued to throw them challenges: their landlord, long absences from work and mounting hospital expenses.
OHSU’s Medical-Legal Partnership program was there to help — and not just with the legal solutions. They organized a wedding for the family, helping them achieve a milestone that seemed out of reach.
“It was a really hard time financially for us, and we would not be in the position we are now without OHSU’s help,” Jessica said. “We’re now coming up on one year of marriage and expecting our second child!”
OHSU serves its patients knowing that health is more than just showing up to the appointments, taking a medication or running tests. Life outside of the hospital — whether it’s a living situation, employment status, family stability or other personal circumstance — has a significant impact on an individual’s health throughout their lifespan; research shows that up to 60% of health outcomes are determined by nonmedical factors.
To address these personal circumstances, also known as the social determinants of health, OHSU offers a Medical-Legal Partnership program, or MLP, to low-income patients and their families, including OHSU’s youngest patients being cared for in Doernbecher’s Neonatal Intensive Care Unit, like Malakai.
MLPs are evidence-based, interdisciplinary collaborations between health systems and legal service organizations designed to address the social, economic and environmental factors that contribute to health disparities. Supported by the Medical Legal Partnership of Oregon and Oregon Health Justice Center, OHSU’s multidisciplinary team includes clinicians, legal professionals and social workers. Collaboration among these specialties is necessary to ensure patients have the care and support they need to be healthy, inside and outside the hospital.
“We know that life outside the hospital plays a substantially larger role than medical intervention in affecting health outcomes. We want to find every way we can to help mitigate those personal risk factors so we can improve the health and well-being of our patients and their families,” said Ladawna Gievers, M.D., associate professor of pediatrics (neonatology) in the OHSU School of Medicine. “This program is such a unique and beautiful thing to be able to offer, and it’s really an honor to help the families who come through our doors.”
Providing guidance, advocacy
A patient’s health can be harmed by many factors — food insecurity, poor housing conditions, insurance denials, unfair employment practices, family instability — that may require legal action to overcome.
Those personal circumstances become particularly stressful when they affect a child who is struggling with a health issue. For example, a child with chronic asthma living in an apartment whose landlord refuses to address a mold infestation that is exacerbating the child’s condition, or a parent whose workplace is threatening termination of employment due to frequent time off to care for their child’s medical condition.
“It’s overwhelming and all-consuming to have a health issue that requires hospitalization, while also keeping all of the other issues in your life under control,” said Lauren Mutrie, M.D., adjunct associate professor of pediatrics in the OHSU School of Medicine. “If you’re in the hospital with your child, your sole focus becomes their health and survival. All of those other issues are still present, and not only are they still present, but they’re snowballing. It’s impossible to juggle everything at the same time — you need help, guidance and advocacy, and that’s what the MLP can provide.”
MLPs have a significant impact on patients’ health and well-being, including overall better health outcomes, improved compliance with medical treatment, reduced stress, fewer visits to the emergency department and increased use of preventive health care services. These outcomes can be even more significant when interventions are offered early in a child’s life.
Serving NICU patients
Doernbecher’s perinatal MLP serves OHSU’s youngest patients and helps dozens of families each year. Like the Biritzs, the families are facing the nightmare of a sick child, all while other personal circumstances continue to create challenges outside the hospital.
The Biritzs’ son, Malakai, received surgery soon after birth to treat his gastroschisis. Even after surgical repair, infants with gastroschisis can have problems with nursing, eating, digesting food and absorbing nutrients, and are at higher risk of infection.
The MLP team was there to provide support during his almost two-month-long stay in the NICU.
“Being in the NICU with your child is really hard, and truly no one can prepare you,” Jessica said. “It was such an emotional roller coaster, but they helped take away so much of the stress and the pain we were feeling. They were really such a blessing to us.”
During that time, the Biritzs were going through challenges with their landlord, who was threatening eviction, but the MLP team was able to step in as a legal advocate and provide rental assistance so they could focus their time and energy on Malakai’s recovery.
Additionally, the Biritzs were under severe financial stress, since their extended hospital stay required a significant amount of time off work. Although Jessica and Marc had plans to marry, with everything going on related to their son’s health, a wedding simply wasn’t a financial priority.
Knowing the Biritzs’ desire to solidify their family, BreAnna Dupuis, LCSW, a medical social worker, considered how the MLP team could help. With support from the NICU staff, the team was able to orchestrate a wedding ceremony for the Biritzs, including covering the cost of their marriage license and supplying an officiant.
“The folks in the NICU got us a beautiful cake, a bouquet of flowers and a boutonniere for my husband, brought us clothes and even a cute little outfit for our son,” Jessica said. “We had a ceremony outside in the rose garden with all the nurses there. It was just so special.”
While MLPs are growing — adopted by nearly 450 health care organizations across the U.S. — OHSU staff hope these programs continue to be integrated into a wider variety of health care settings and clinical specialties. They especially hope more NICUs will consider the impact that MLPs can have on children’s health throughout their lives.
“These interventions are so important to improving the long-term health outcomes of children, and if we want to have any chance at reducing health disparities, this type of interdisciplinary work is necessary,” Mutrie said. “This is the medicine we need.”