How MLP Works: A Utilities Case Study

What Happened When the Heat Went Off? An MLP Patients-to-Policy Story

thermometer behind the frozen windowNo heat or electricity meant asthma attacks, sickle cell pain and the inability to refrigerate medicine for thousands of low-income people in Boston. Click through the slides below to see how medical-legal partnership works – how training and patient legal care led to clinic and population health innovations, and how the impact increased and became more preventive as the interventions progressed. Each step of the way, attorneys and health care professionals communicated and worked together as part of the same team, better addressing the complex needs of their patients.


  • Train & Identify Need

    Mom and Baby at DoctorMassachusetts has laws in place to protect children, the elderly and chronically ill individuals from utility shutoff, but this protection required medical documentation that could only be provided by a physician.  MLP attorneys trained nurses, doctors and other health care team members how to screen patients at risk for utility shut off and trained doctors to write protection letters that included the correct information to demonstrate medical need.

    During the first year of the partnership, physicians wrote letters protecting 193 people from utility shutoff.

  • Treat Patients

    Heat & ElectricityHealth care team members increasingly identified individuals and families whose lights and heat had already been shut off, and consulted with their legal partners about how to help these patients.  The legal team opened a new legal clinic at the hospital to assist people who needed their utilities restored, set up payment plans with utility companies and ensure future shutoff protection.

    The legal team helped people get their heat and electricity turned back on.

  • Transform Clinic Practice

    Shut off LetterWhile the training was effective in increasing screening, the legal clinic quickly had more referrals than it could handle, and doctors and nurses were spending too much time during patient visits drafting utility letters and consulting the legal team.  Increased screening led health care team members to recommend a form letter be added to the patient Electronic Health Record (EHR).  As the health care team got better at detecting need, they caught more cases upstream before utilities were shutoff and had an efficient solution embedded in the EHR, saving clinic time.

    The next year, physicians wrote 350% more letters helping 676 people.

  • Improve Population Health

    Health care team members from Boston Medical Center with attorneys from MLP |Boston.

    Health care team members from Boston Medical Center with attorneys from MLP |Boston.

    There were still larger problems with the utility regulations which stated that only doctors were authorized to write and submit protection letters, not nurses or nurse practitioners.  And letters had to be re-certified every six months, even for medical conditions that were chronic and unchanging like sickle cell disease.  Health care team members knew that these regulations created undue burden on the clinic and on patients, but it was the MLP attorneys who understood the process and timing of regulatory change and advocacy. When the Massachusetts Department of Public Utilities announced a hearing to revise its utility shut off regulations, the MLP team was ready. Together, the attorney and health care team members submitted testimony that resulted in regulation changes that reduced the need for chronic disease re-certification from 12 times per year to twice a year, and allowed nurses and nurse practitioners to write and submit letters.

    As a result of the regulation changes, more than 10,000 people with asthma and 400 people with sickle cell disease seen annually at Boston Medical Center are at a significantly reduced risk of the health complications that arise from having their lights, heat and air conditioning shut off during the year, while reducing burden on the health care clinic.