MLP in Action: 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.


  • Screening Patients

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

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

  • Delivering Legal Services

    Heat & ElectricityHealth care team members were better able to identify individuals and families whose lights and heat had already been shut off, and consulted with attorneys 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, working to 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.

  • Advocacy through the EHR

    Shut off LetterWidespread screening led to more referrals than attorneys could handle. And doctors and nurses were spending too much time during patient visits drafting utility letters and consulting with the legal team. Health care team members recommended that a utility 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 before utilities were shutoff, and had an efficient solution embedded in the EHR to advocate for patients.

    The next year, physicians wrote 350% more letters, protecting 676 people from having their utilities shut off.


  • Improving the Law

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

    Health care team members from Boston Medical Center with attorneys from MLPB.

    There were still larger problems with the utility regulations. Only doctors, not nurses or nurse practitioners, were authorized to write and submit protection letters that additionally 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 an undue burden on families and the clinics, and attorneys 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, attorneys and health care team members submitted joint testimony that resulted in regulation changes reducing 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 also reducing burden on the health care clinic.