More Kudos For HSC

Goar: Hospital discovers sick children need a legal cure

November 20, 2009

Carol Goar

It came as a surprise, even to the director of social work at Sick Kids hospital, that 56 per cent of the children admitted to Canada's largest pediatric health institution are from low-income families. These youngsters account for 65 per cent of patient deaths.

Ted McNeill knew poverty carried health risks, but he didn't expect the evidence to be so stark. "Everyday we see children who are affected by non-medical issues such as inadequate housing and nutrition and families facing financial challenges and immigration issues," he said. "These social determinants of health are the framework that organizes our thinking."

The hospital provides an array of services to families in need: counselling and support; referrals to social service agencies; help navigating the health-care system, and transit fare to bring their kids to follow-up appointments. But there are problems – education barriers, tax disputes, immigration hurdles, employment issues and battles with payday lenders – that lie beyond the scope of social workers.

That is why Sick Kids is launching Canada's first on-site legal service for patients and their families. Pro Bono Law Ontario, a charity that arranges free legal services for people of limited means, is providing the lawyers.

The official kickoff was Thursday. But the real work began last May, when a pilot version of the program was put in place. It has already handled approximately 200 cases.

"Legal assistance is often the last thing on a family's mind," said Lee Ann Chapman, the hospital's bedside lawyer. She can provide advice, notarize documents and help parents apply for legal aid, if they meet the eligibility criteria. (Many don't. To qualify, a single parent's income must be below $12,900 a year. A two-parent family's income must be less than $13,644 annually.)

But Chapman can't take on complex, time-consuming cases. That is where the pro bono lawyers step in. Here are a few of the problems they have resolved:

• A school board administrator refused to allow a student receiving dialysis to attend regular classes on non-treatment days and use Sick Kids' school during hospitals stays, arguing that would constitute "double dipping." An education lawyer got that policy changed.
• A tax official turned down a Waterloo couple's claim for a medical tax credit to defray the $12,000 they spent to be at their daughter's bedside at Sick Kids as she battled a rare form of congenital heart disease. A tax lawyer got the ruling reversed.
• An immigration officer blocked attempts by a couple from China to bring in a child's grandmother for support, while the gravely ill youngster underwent treatment at Sick Kids. An immigration lawyer got her admitted to the country.

Based on the preliminary phase of the program, Chapman estimates the Family Legal Health Program will get 400 to 500 requests for legal assistance a year.

The initiative was the brainchild of Len Ricchetti, a lawyer at McMillan LLP (now an Ontario Superior Court judge). He attended a conference in the United States, where he heard Barry Zuckerman, founder of his country's Medical-Legal Partnership. The Boston pediatrician made a powerful case that medical intervention has limited effectiveness if a child goes home to a frigid apartment, doesn't have enough to eat, can't look forward to going to school or lives in fear of domestic violence.

Sixteen year ago, Zuckerman brought legal advocates into Boston Medical Centre. Since then, more than 160 American hospitals have followed suit.

Now the program has taken root in Toronto. McNeill and his colleagues spent a couple of years adapting it to a Canadian setting. They are not sure they have all the details right. But they are certain Sick Kids has a powerful new tool to help vulnerable children.