PUBLISHED:October 30, 2020

Rice co-chairs health subcommittee for American Academy of Arts and Sciences report on closing the civil justice gap


Health Justice Clinic Director Allison Rice explains how medical-legal partnerships can help spot patients’ need for help and connect them with services.

Allison Rice Allison Rice

Clinical Professor and Health Justice Clinic Director Allison Rice co-chaired a subcommittee of experts who contributed recommendations for closing the justice gap as it relates to health to “Civil Justice for All,” a recently released report from the American Academy of Arts and Sciences (AAAS).

Rice, who also engages in HIV and AIDS research and advocacy and had a lengthy career as a legal aid attorney before joining the Duke Law faculty, co-chaired the health subcommittee with Legal Services Corporation Chairman John G. Levi. Levi, a partner at Sidley Austin, also served as one of three co-chairs for the report, which advances seven national recommendations for addressing low-income Americans’ ever-increasing challenges in accessing legal assistance.

The report, part of the AAAS’s “Making Justice Accessible” project, approached the crisis in access to legal services by focusing on four common, often interrelated categories of civil legal problems: family, health care, housing, and veterans affairs. Access to justice challenges for low-income individuals highlighted by the report include an overburdened legal aid system, the inability to afford private lawyers by people disqualified from receiving public legal assistance, and the failure of some to recognize that their problems would benefit from legal interventions.

“The civil justice gap reinforces the inequalities that already undermine our society,” the Executive Summary states. “At-risk populations — by income, race, gender, and education level — cannot receive justice if they cannot access even basic legal advice. The outcomes — evictions, family separations, job loss, and other hardships — are often catastrophic.”

By one measure, according to the report, 40% of all poor and low-income households experience some sort of health-related problem each year, yet only about 10% seek legal help. Health issues, such as those arising from disability, age, or military service, can create or exacerbate housing, employment, and family problems that have civil legal dimensions, and legal problems such as eviction and domestic violence can lead to health problems, the report points out. “The relatively high incidence of socially determined health issues suggests that legal help could make a notable difference in addressing more health-related problems,” the report states.

The health subcommittee’s three key recommendations involve the increased use of medical-legal partnerships to promote a broad definition of health that incorporates its social determinants, facilitate effective and efficient collaboration in solving civil justice problems, and expand sources of revenue for helping to solve health-related legal problems. These track with the report’s broader recommendations to bring new advocates — “service providers who are not lawyers” — into the effort to solve civil justice problems and foster greater collaboration between legal services providers and other trusted professionals.

“A lot of the medical-legal partnership model is getting the health system to screen for health-harming legal needs, and then facilitate collaborations among lawyers, medical providers, social workers and others within the health system to find remedies to those legal problems,” said Rice.

In some cases, medical providers can spot clear legal needs, such as a patient’s need for assistance in accessing disability benefits, or more subtle ones, she said. “If a child is coming in repeatedly due to asthma, it might be because they live in an apartment with mold. The parents might not ever see that as a legal problem or they might, but they don’t feel they have a way to solve it. So the health providers, who have an ongoing relationship with the family and who are trusted helpers, can identify and spot issues and help the patient access legal help. The medical providers can assist in the legal matter by documenting issues and assisting in advocacy by writing letters or medical opinions”

As they become knowledgeable about legal issues affecting their patients, professionals in the health system can often identify issues before they turn into legal problems, and help patients solve the problem without legal intervention, she said.

In other cases, health providers and lawyers working together may spot the need for broader policy solutions to common problems, she added. “The more impactful work that can be accomplished in medical-legal partnerships is engaging medical and legal professionals in policy advocacy toward reforms that solve a problem for the entire community, not just a single client.”

David F. Levi, the Levi Family Professor of Law and Judicial Studies, director of the Bolch Judicial Institute, and former dean of Duke Law, also contributed to the report as a member of the housing subcommittee.