To help chronically ill patients at Boston Medical Center keep their utilities on during cold Boston winters, the hospital’s medical-legal partnership started writing protection letters. Unable to keep up with the demand, they turned their attention to strengthening the protection laws to help families upstream.
Boston winters are notoriously cold, and living in an apartment without heat or electricity can mean asthma attacks, sickle cell pain and the inability to refrigerate medicine. Health care providers at Boston Medical Center see thousands of low-income patients each month living in exactly these conditions.
In 2010, nurses and doctors were frustrated sending patients home with medicines that would not help and to housing that would exacerbate systems. Massachusetts had 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.
Through the hospital’s medical-legal partnership, attorneys worked with 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.
As health care team members increasingly identified individuals and families whose lights and heat had already been shut off, 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 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 healthcare 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. The next year, physicians wrote 350% more letters helping 676 people, and used less clinic time to do it.
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’ testimony submitted testimony that resulted in regulation changes that reduced 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.