The MLP – Major League Public [Interest Law]

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By: Steven Burke ’24

This summer, I’ve been incredibly fortunate to intern in Buffalo with Neighborhood Legal Services (“NLS”), a local nonprofit and provider of civil legal services. I worked under Mike Reiser, the director of NLS’ Medical Legal Partnership (“MLP”) with Roswell Park Comprehensive Cancer Center (“Roswell”). I am indebted to Mike and the entire Public Benefits Unit at NLS for letting me tag along as the first intern to work on Roswell matters.

I also wish to extend my deepest thanks to Kristin Graham Koehler (’94) and David Koehler (’94) for their continued support of the University at Buffalo’s Summer Funding and Fellowships Program supporting summer public interest fellows. It is heartening to know that there are many UB Law alums like the Koehlers who remain committed to encouraging the next generation of attorneys as they begin their legal journey.

When I first got an email notifying me that I would be assigned to the “Roswell MLP,” I wasn’t exactly sure what I would be up to, or what the acronym stood for. I thought I interviewed for an internship focusing on access to public benefits. I was of course happy to help NLS in any way, but was I signing up to help a Master Limited Partnership? The plumbing business MLP at Union and Broadway? I had never heard of a Medical Legal Partnership before. Would I be working with PBMs, insurers, and CMS all the time?

As it turns out, my work with the Roswell MLP has touched almost every area of law and provided an incredible introduction to the myriad practice areas that comprise what we might call “public interest law.” I’ve been to family court to secure emergency orders, appealed denials of Social Security benefits and Medicaid providers’ decisions to not cover certain drugs, drafted wills, written briefs to stave off evictions, and completed gender-affirming name change petitions. This list is far from comprehensive – new challenges come across my desk each and every day. Since I am still unsure of the shape my legal career might take, I am very thankful for the broad scope of my role this summer.

The reason attorneys working in MLPs are “generalists” is due to the fact that health scares don’t magically end one’s legal problems – they magnify them. Not only do our clients come to us with debilitating or terminal cancer diagnoses, but they also must contend with a variety of lingering legal issues. I am often in awe of the strength of our clients, working with us as best they can, at what is undoubtedly the most difficult time of their lives.

I want to shed some light on two areas where MLPs can help to alleviate some of the burdens our clients carry. First, as the COVID-19 pandemic showed us, genetics are far from the only determinant of individual and communal health outcomes. A wide swath of social factors and inequities, referred to as Social Determinants of Health (“SDOHs”) have a great impact on one’s personal health and how one interacts with the health care system more broadly. SDOHs might include access to healthy food, reliable transportation, or secure housing; employment status; and past or present exposure to domestic violence (to name a few). While doctors and nurses are incredibly skilled at diagnosing and treating medical conditions, integrating legal assistance into the health care delivery process for those who need it can drastically improve health outcomes. Having attorneys integrated into the care team to prevent crises like evictions, utility shutoffs, and insurance benefit denials helps patients reduce outside stressors and focus on recovery. With a committed team of lawyers and social workers, patients do not have to constantly worry about things like having to return to work or disputes with their landlord. Peer-reviewed studies have shown that patients that work with MLP attorneys report less stress and improved mental health, and are also more likely to take the steps necessary to protect their health, such as taking their medications as prescribed.

Secondly, it is jarring to see how wide swaths of the population either go without or are simply unaware of legal remedies that may be available to them. I’ve seen disconcerting statistics showing that 4 in 10 American adults would either have to borrow money, sell something, or not be able pay if faced with a $400 emergency expense. My experience within the Roswell MLP brought this home for me. We often see clients that might have had a below-average, yet steady source of income, perhaps with a car or a home. These clients likely would not have qualified for NLS’ services if they weren’t Roswell patients. However, a cancer diagnosis completely upends their lives and places them in incredibly dire financial straits. On top of it all, these clients may bring with them legal issues that have followed them for some time. Due to the expense of hiring a private attorney, however, they haven’t confronted these issues, meaning that they have compounded by the time the client, now qualified for pro bono assistance, speaks to us.

Experiences like this over the summer piqued my curiosity as to how the legal community is serving those of moderate means who do not qualify for pro bono assistance. This area of focus is referred to as “low-bono” assistance (think clients with annual income 200-400% of the Federal Poverty Level). As a one-time economics student, it’s interesting to see how attorneys and legal services providers across the country are attempting to bridge this financial gap.

As the summer comes to an end, it’s hard to express how grateful I am to NLS, Roswell, and Mike Reiser for the opportunity this summer. Not only was I fortunate to serve a variety of incredible clients, but I also learned quite a bit. Those seeking a broad introduction to public interest law or the legal field in general should certainly consider working within MLP programs.

Name: Steven Burke ’24

Name of Fellowship: Kristin Graham Koehler ‘94 and David Koehler ‘94 Public Interest Fellowship

Placement: Neighborhood Legal Services, Inc.

Location: Buffalo, NY

One important lesson I have learned from this fellowship: “Experiences like this over the summer piqued my curiosity as to how the legal community is serving those of moderate means who do not qualify for pro bono assistance.”