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Increasing LGBTQ+ Access to Legal Services via Medical-Legal Partnerships
Published online by Cambridge University Press: 11 July 2022
Abstract
This Note details and proposes a solution to the deficit in access to justice and to care faced by the LGBTQ+ community due to historical and ongoing homophobia and transphobia in both the legal and medical fields. The proposed solution is the integration of medical-legal partnerships (“MLPs”) into LGBTQ+ resource organizations. These organizations already serve and have the trust of the queer community, which lowers one barrier to access medical and legal services for the LGBTQ+ community: mistrust and negative past experiences. MLPs are the ideal solution to this problem because they would not only allow LGBTQ+ individuals to access medical and legal services, but to receive holistic services that account for their personal circumstances as well as their physical health. Underlying this premise is the concept of social determinants of health, which are environmental and social factors that create systemic roadblocks to wellness. By creating an integrated MLP, professionals can address these social determinants head on and remedy the underlying causes of poor health. This is especially important for LGBTQ+ people whose minoritized identities often lead them to have multiple negative social determinants of health. The integration of MLPs into LGBTQ+ resource organizations would allow queer individuals to get the care they need—not just physically, but socially and environmentally.
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- Student notes
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- © 2022 The Author(s)
Footnotes
†
Amelia Melas, 2022 JD Candidate. Her focus is on health law, particularly access to care and systemic inequities. After graduation, she intends to sit for the MA Bar and begin practice at Faber, Daeufer & Itrato in their Boston office. The author can be contacted at amelas@bu.edu
References
1 Throughout this paper, I will mostly refer to the LGBTQ+ (Lesbian, Gay, Bisexual, Transgender, Queer/Questioning, plus all other identities on the sexual, gender, and romantic spectra) community and individuals who identify as members of that community as LGBTQ+, but I also interchangeably use the word “queer.” The term “queer” has a long and complicated history amongst LGBTQ+ individuals, but has been reclaimed in recent decades and no longer has a pejorative connotation for many younger members of the community. See Merrill Perlman, How the Word ‘Queer’ was Adopted by the LGBTQ Community, Colum. Journalism Rev. (Jan. 22, 2019), https://www.cjr.org/language_corner/queer.php [https://perma.cc/KR7N-QYPG]; Cory Collins, Is Queer OK to Say? Here’s Why We Use It, Learning For Just. (Feb. 11, 2019), https://www.learningforjustice.org/magazine/is-queer-ok-to-say-heres-why-we-use-it [https://perma.cc/47SR-XYZ3].
2 See, e.g., Obergefell v. Hodges, 576 U.S. 644, 675 (2015) (holding that same-sex marriage is a fundamental right protected under the Due Process and Equal Protection Clauses of the Fourteenth Amendment); Bostock v. Clayton Cty., 140 S. Ct. 1731, 1737 (2020) (holding that employers who fire employees for being homosexual or transgender are discriminating based on sex and, therefore, violating the Civil Rights Act of 1964).
3 See, e.g., Andrea L. Wirtz et al., Gender-Based Violence Against Transgender People in the United States: A Call for Research and Programming, 21 Trauma, Violence, & Abuse 227, 233 (2020); Tim Fitzsimons, Nearly 1 in 5 Hate Crimes Motivated by Anti-LGBTQ Bias, FBI Finds, NBC News (Nov. 12, 2019, 6:36 PM), https://www.nbcnews.com/feature/nbc-out/nearly-1-5-hate-crimes-motivated-anti-lgbtq-bias-fbi-n1080891 [https://perma.cc/N79D-BVSA]; Drew Tripp, ‘We Don’t Like *** Around Here’ | 911 Call Yields New Info on Alleged LGBTQ ‘Hate Crime’, ABC News 4 (Nov. 2, 2020), https://abcnews4.com/news/local/charleston-south-carolina-911-call-alleged-lgbtq-hate-crime-homophobic-slur [https://perma.cc/QC22-EYND]; Kristine de Leon, Man Charged with Attempted Murder, Hate Crime After Allegedly Attacking 2 Transgender Women in MacArthur Park, KTLA5 (Oct. 16, 2020, 4:05 PM), https://ktla.com/news/local-news/man-charged-with-attempted-murder-hate-crime-after-allegedly-attacking-two-transgender-women-in-macarthur-park/ [https://perma.cc/6UDG-EMRS]; City News Servs., LA County Report Shows Increase in Reported Hate Crimes, Highest in Years, NBC L.A. (Oct. 24, 2020, 1:47 PM), https://www.nbclosangeles.com/news/local/la-county-report-hate-crimes-increase/2448765/ [https://perma.cc/4SHT-Y96G].
4 The Partnerships, Nat’l Ctr. for Med.-Legal P’ship, https://medical-legalpartnership.org/partnerships/ [https://perma.cc/4EFR-6JPM] (last visited Apr. 9, 2022).
5 John Kezer & Jessica Pekala, Medical-Legal Partnerships, 48 Colo. Law. 30, 32 (2019).
6 Id.
7 Id.
8 Id.
9 Ellen Lawton, A History of the Medical Legal Partnership Movement, Cmty. Health F., Fall/Winter 2014, at 12, 12, https://medical-legalpartnership.org/wp-content/uploads/2015/01/NACHC-Magazine-A-History-of-the-Medical-Legal-Partnership-Movement.pdf [https://perma.cc/DC54-U8NH] (last visited Apr. 9, 2022).
10 Id.
11 FAQ, Nat’l Ctr. for Med.-Legal P’ship, https://medical-legalpartnership.org/about-us/faq/ [https://perma.cc/3MLS-JMT6] (last visited Apr. 9, 2022).
12 See Kate Marple, Nat’l Ctr. for Med.-Legal P’ship, Framing Legal Care as Health Care: A Guide to Help Civil Legal Aid Practitioners Message Their Work to Health Care Audiences 3 (2015), https://medical-legalpartnership.org/wp-content/uploads/2015/01/Framing-Legal-Care-as-Health-Care-Messaging-Guide.pdf [https://perma.cc/3LLD-NVF9].
13 See id. at 1.
14 See Medical-Legal Partnerships Pro Bono Project, Am. Bar Ass’n, http://web.archive.org/web/20210506012124/https://www.americanbar.org/groups/probono_public_service/projects_awards/medical_legal_partnerships_pro_bono_project/ (last visited Apr. 9, 2022).
15 The Partnerships, supra note 4.
16 The Partnerships, supra note 4.
17 See Marsha Regenstein et al., Nat’l Ctr. for Med.-Legal P’ship, The State of the Medical-Legal Partnership Field 1, 9-10 (2017), https://medical-legalpartnership.org/wp-content/uploads/2017/07/2016-MLP-Survey-Report.pdf [https://perma.cc/ZPT9-RLRM].
18 See Kezer & Pekala, supra note 5, at 32.
19 See Robert Pettignano et al., Can Access to a Medical-Legal Partnership Benefit Patients with Asthma who Live in an Urban Community?, 24 J. Health Care for Poor & Underserved 706, 708 (2013).
20 Social Determinants of Health, Off. Disease Prevention & Health Promotion, https://health.gov/healthypeople/objectives-and-data/social-determinants-health [https://perma.cc/SL79-2XHS] (last visited Apr. 9, 2022).
21 Paula Braveman & Laura Gottlieb, The Social Determinants of Health: It’s Time to Consider the Causes of the Causes, 129 Pub. Health Reps. 19, 20 (2014).
22 Id. at 24, 25.
23 Marple, supra note 12, at 3.
24 Id.
25 Id.
26 Id.
27 See, e.g., Margaret Middleton et al., Lessons Learned by an Interdisciplinary Research Team Evaluating Medical-Legal Partnership with the Department of Veterans Affairs, 68 S.C. L. Rev. 311, 326 (2016); Stacey-Rae Simcox, Lightening the VA’s Rucksack: A Proposal for Higher Education Medical-Legal Partnerships to Assist the VA in Efficiently and Accurately Granting Veterans Disability Compensation, 25 Cornell J. L. & Pub. Pol’y 141, 179-81, 186-88 (2015).
28 Marple, supra note 12, at 3.
30 See Marple, supra note 12, at 3.
31 LGBTQ+ Communities and Mental Health, Mental Health Am., https://www.mhanational.org/issues/lgbtq-communities-and-mental-health [https://perma.cc/AH4R-4LZ8].
32 FAQ, supra note 11; HRSA Recognizes Civil Legal Aid as “Enabling Services,” Allows Health Centers to use Funding for MLP, Nat’l Ctr. for Med.-Legal P’ship (Oct. 27, 2014), https://medical-legalpartnership.org/enabling-services/ [https://perma.cc/8NUC-UGQ4]; Jennifer Trott et al., Nat’l Ctr. for Med.-Legal P’ship, Financing Medical-Legal Partnerships: View from the Field 4 (2019), https://medical-legalpartnership.org/wp-content/uploads/2019/04/Financing-MLPs-View-from-the-Field.pdf [https://perma.cc/24F3-4Y7Z].
33 Trott et al., supra note 32, at 2.
34 Id.
35 Id. at 5.
36 Id. at 2.
37 Id. at 5.
38 See id. at 7 (noting that “insufficient and sometimes unstable funding sources” restrict MLP budgets to “core services” rather than growth and optimization).
39 Id. at 3.
40 See Luz E. Herrera, Rethinking Private Attorney Involvement Through a “Low Bono” Lens, 43 Loy. L.A. L. Rev. 1, 5-6 (2009).
41 Webinar: Health Center Toolkit Webinar Series Part 2: Funding, MoUs & Sustainability, Nat’l Ctr. for Med.-Legal P’ship (Dec. 21, 2020), https://medical-legalpartnership.org/mlp-resources/laying-the-foundation-part-ii/ [https://perma.cc/G5RB-E9HB].
42 Id.
43 Id.
44 Id.
45 Obergefell v. Hodges, 576 U.S. 644 (2015).
46 Bostock v. Clayton Cty., 140 S. Ct. 1731, 1743 (2020).
47 Lawrence v. Texas, 539 U.S. 558, 578-79 (2003) (holding that statutes outlawing same-sex, consensual sexual acts are unconstitutional as a violation of an individual’s right to privacy).
48 Romer v. Evans, 517 U.S. 620, 635-36 (1996) (holding that using “homosexuals” as a class served no legitimate state interest where the state passed an amendment that forbade protections for “homosexuals”).
49 See supra note 3 and accompanying text.
50 Leonore F. Carpenter, The Next Phase: Positioning the Post-Obergefell LGBT Rights Movement to Bridge the Gap Between Formal and Lived Equality, 13 Stan. J. C.R. & C.L. 255, 267 (2017).
51 Id.
52 Though homophobia is often confined to hatred and discrimination against people who are homosexual or homoromantic, the term is also often used to encompass the broad scope of hatred and discrimination towards anyone who identifies as LGBTQ+. For the most part, I will use the term homophobia in this latter, broader sense unless specifically discussing transphobia (hatred, “fear,” discrimination towards people who are transgender or gender nonconforming). See What is Homophobia?, Planned Parenthood, https://www.plannedparenthood.org/learn/sexual-orientation/sexual-orientation/what-homophobia [https://perma.cc/GX6R-9VB8] (last visited Jan. 15, 2022).
53 See generally L.A. Cnty. Bar Ass’n Ad Hoc Comm. on Sexual Orientation Bias, The Los Angeles County Bar Association Report on Sexual Orientation Bias, 4 S. Cal. Rev. L. & Women’s Stud. 305, 305-06 (1995); Jennifer Durkin, An Examination of the First Eleven Studies of Sexual Orientation Bias by the Legal Profession, 8 UCLA Women’s L.J. 343, 344-46 (1998).
54 Edgar Bodenheimer, The Inherent Conservativism of the Legal Profession, 23 Ind. L. J. 221, 221, 233-35 (Spring 1948); Arthur Larson, Lawyer as Conservative, 40 Cornell L. Rev. 183, 183 (Winter 1955); Characteristics of the Profession, Britannica, https://www.britannica.com/topic/legal-profession/Characteristics-of-the-profession [https://perma.cc/SJ8X-UABA]; Matt Samberg, A Plea for Liberalism in the Legal Profession, medium.com (Oct. 6, 2015), https://medium.com/@mattsamberg/a-plea-for-liberalism-in-the-legal-profession-97886ddaeae1 [https://perma.cc/2WN8-ZTRR].
55 See, e.g., Durkin, supra note 53, at 350-51.
56 Veronica Root Martinez, Combating Silence in the Profession, 105 Va. L. Rev. 805, 807 (2019).
57 See id. at 807-08.
58 Denny Chan & Vanessa Barrington, Just. in Aging, How Can Legal Servs. Better Meet Needs Low-Income LGBT Seniors? 1 (2016), https://www.justiceinaging.org/wp-content/uploads/2016/06/How-Can-Legal-Services-Better-Meet-the-Needs-of-Low-Income-LGBT-Seniors.pdf [https://perma.cc/YZ7N-B7VP].
59 Amy Killelea, Collaborative Lawyering Meets Collaborative Doctoring: How a Multidisciplinary Partnership for HIV/AIDS Services Can Improve Outcomes for the Marginalized Sick, 16 Geo. J. Poverty L. & Pol’y 413, 413-14 (2009).
60 See Joanne Csete & Jonathan Cohen, Health Benefits of Legal Services for Criminalized Populations: The Case of People Who Use Drugs, Sex Workers and Sexual and Gender Minorities, 38 J.L. Med. & Ethics 816, 825 (2010).
61 Shabab Ahmed Mirza & Caitlin Rooney, Discrimination Prevents LGBTQ People From Accessing Health Care, Ctr. Am. Progress (Jan. 18, 2018), https://www.americanprogress.org/article/discrimination-prevents-lgbtq-people-accessing-health-care/ [https://perma.cc/NY7C-4UA6]; Health Care Refusals Harm Patients: The Threat to LGBT People and Individuals Living with HIV, Nat’l Women’s L. Ctr. (Jan. 2013), https://nwlc.org/wp-content/uploads/2015/08/refusals_harm_patients_lgbt_hiv_1-24-2013.pdf [https://perma.cc/QZ34-33EY].
62 Mirza & Rooney, supra note 61.
63 Gatekeeping is generally defined as “control[ing] who gets particular resources, power, or opportunities, and who does not.” Gatekeeping, Cambridge Dictionary, https://dictionary.cambridge.org/us/dictionary/english/gatekeeping [https://perma.cc/T2QD-ZQ26].
64 See Carey Goldberg, On Being Gay in Medicine: A Leading Harvard Pediatrician’s Story, WBUR (Mar. 31, 2021), https://www.wbur.org/commonhealth/2012/03/30/being-gay-in-medicine [https://perma.cc/YK8V-38JH].
65 See Timothy Wang et al., The Current Wave of Anti-LGBT Legislation 1, 3-4 (2016), https://fenwayhealth.org/wp-content/uploads/The-Fenway-Institute-Religious-Exemption-Brief-June-2016.pdf [https://perma.cc/CU2F-9FJ9] (talks both about historical waves of anti-LGBTQ+ sentiments and legislative efforts to disenfranchise LGBTQ+ people and about current legislative efforts to use “religious exemptions” to allow doctors to refuse to treat LGBTQ+ couples, particularly as it relates to family planning or reproductive services (adoption, fertility treatments) as well as counseling and treatment related to transitioning and reproductive services).
66 See Shawna S. Baker, Where Conscience Meets Desire: Refusal of Health Care Providers to Honor Health Care Proxies for Sexual Minorities, 31 Women’s Rts. L. Rep. 1, 2 (2009).
67 Id. at 2-4.
68 See Cindy Loose, Flurry of Bills Aim to Set Limits on Transgender Kids — And Their Doctors, Kaiser Health News, (Feb. 11, 2021), https://khn.org/news/article/flurry-of-bills-aim-to-set-limits-on-transgender-kids-and-their-doctors/ [https://perma.cc/5RL4-JHFZ] (detailing recent legislative action to prevent transgender minors from getting gender confirmation surgery, especially in the wake of President Biden reversing the previous administration’s restriction on transgender service members). It is concerning that this kind of legislative action is analogous to legal crackdown on abortion providers—by making it increasingly more difficult to provide abortion services, lawmakers can effectively push medical professionals away from those kinds of reproductive practices, which then makes it more difficult to even find a doctor to provide an abortion in the first place. This makes abortions harder to obtain without directly putting strain on the individuals seeking the abortion (following Planned Parenthood of Southeastern Pennsylvania v. Casey in letter but not in spirit). 505 U.S. 833 (1992). Similarly, by highly legislating and regulating medical providers who specialize in hormone replacement therapy, gender confirmation surgery, etc., legislators can strongly discourage doctors from practicing because it is just too difficult.
69 See Elvia R. Arriola, The Penalties for Puppy Love: Institutionalized Violence Against Lesbian, Gay, Bisexual and Transgendered Youth, 1 J. Gender, Race & Just. 429, 456-57 (1998).
70 Id.
71 See Lindsay Mahowald et al., The State of the LGBTQ Community in 2020 at 17-19 (2020), https://americanprogress.org/wp-content/uploads/2020/10/LGBTQpoll-report.pdf?ga=2.214761111.1090511619.1649817673-409270205.1649817673 [https://perma.cc/F7MV-QUJK] (look in particular to Figure 11, which conveys the proportion of LGBTQ Americans who postponed or avoided medical care for fear of discrimination, and to Figure 12, which reports that “more than in 1 in 10 LGBTQ Americans faced mistreatment by a doctor or health care provider”); Joanna G. Patterson et al., Cultural Competency and Microaggressions in the Provision of Care to LGBT Patients in Rural and Appalachian Tennessee, 102 Patient Educ. & Counseling 2081, 2081-82 (2019) (finding that discomfort and distrust are commonly reported by LGBTQ+ patients in settings where cultural competency and compassion are lacking and where healthcare providers have long been able to discriminate against LGBTQ+ patients in the decision whether to provide their services and in actual treatment).
72 See Alison B. Alpert et al., What Lesbian, Gay, Bisexual, Transgender, Queer, and Intersex Patients Say Doctors Should Know and Do: A Qualitative Study, 64 J. Homosexuality, 1368, 1375-81 (2017) (a qualitative study that distills information that LGBTQ+ people would like to see from medical professionals in order to make them more comfortable and to improve the quality of care that queer people are receiving).
73 See id. at 1378-79.
74 Id. at 1379-80.
75 The American Medical Association (AMA) has put out guidelines/recommendations for practices to create friendly environments for queer people, which is a great step that will need to be instituted much more universally. See Creating an LGBTQ-Friendly Practice, Am. Med. Ass’n, https://www.ama-assn.org/delivering-care/population-care/creating-lgbtq-friendly-practice [https://perma.cc/9BBJ-KKPV] (last visited Jan. 20, 2022). Though it is an important and laudable effort to promote LGBTQ-friendly practices, the recommendations are not mandatory and may not (and likely will not) counteract the microaggressions and microinsults committed by homophobic employees of practices that are attempting to be more inclusive. See Patterson et al., supra note 71, at 2081-82 (look particularly to the explanation of the subconscious nature of microaggressions and microinsults—meaning they will not be so easy to eliminate as the AMA recommendations would seem to indicate).
76 See Special Comm. on Race & Ethnicity, Report of the Special Committee on Race and Ethnicity to the D.C. Circuit Task Force on Gender, Race, and Ethnic Bias, 64 Geo. Wash. L. Rev. 189, 266 (1996).
77 See, e.g., Killelea, supra note 59, at 424-25; Tishra Beeson et al., Making the Case for Medical-Legal Partnerships: A Review of the Evidence 6 (2013), https://medical-legalpartnership.org/wp-content/uploads/2014/03/Medical-Legal-Partnership-Literature-Review-February-2013.pdf [https://perma.cc/DRH9-QTAB]; Regenstein et al., supra note 17, at 26 (noting improved patient outcomes after receiving MLP services).
78 This is one of the general premises underlying the idea of Kickstarter. See About Us, Kickstarter, https://www.kickstarter.com/about?ref=global-footer [https://perma.cc/X6NL-577W] (last visited Jan. 20, 2022). Although the establishment of MLPs would invariably differ in that there is no crowd-funding aspect, the idea of having an established community which continually expands the network of clients/customers—and which ensures early success of the venture—is the same idea behind putting MLPs in these LGBTQ+ organizations that already engage with the community and would have a client base ready to utilize the MLP’s services.
79 See Doug Meyer, An Intersectional Analysis of Lesbian, Gay, Bisexual, and Transgender (LGBT) People’s Evaluations of Anti-Queer Violence, 26 Gender & Soc’y 849, 856-57, 862-65 (2012); see generally Intersectionality, Equality Network, https://www.equality-network.org/our-work/intersectional/ [https://perma.cc/9RMG-A7S4] (last visited Jan. 20, 2022) (explaining what intersectionality is, particularly in the context of needing more education and resources in LGBTQ+ organizations and activism to address intersectional issues).
80 See Christina M. Kaul et al., Recognition of the Health-Harming Legal Needs and the Value of the Medical-Legal Partnership, 35 J. Gen. Internal Med. (Supplement) S550 (July 2020) (this highlights the need to acknowledge health-harming legal needs and social determinants of health when treating people, and the authors also emphasize the importance of the two pieces of the MLP working together in quickly solving the patient-client’s problem in a direct, precise manner; instead of the doctors having to treat the patient separately and the lawyers not having a real idea of what the core issue is, their collaboration allowed for a more effective treatment of the patient-client).
81 See Danielle R. Cover, Pro Bono Grievances, 12 Cardozo Pub. L. Pol’y & Ethics 375, 378 (2014); Scott L. Cummings & Deborah L. Rhode, Managing Pro Bono: Doing Well by Doing Better, 78 Fordham L. Rev. 2357, 2379 (2010).
82 See Trott et al., supra note 32, at 4, 6.
83 PFLAG, PFLAG, Inc. Financial Statements 5 (2020), https://pflag.org/sites/default/files/files/documents/PFLAG%202020%20Financial%20Statement.pdf [https://perma.cc/Z3JR-EFB9].
84 Jane Hyatt Thorpe et al., Nat’l Ctr. for Med.-Legal P’ship, Information Sharing in Medical-Legal Partnerships 5 (2017), https://medical-legalpartnership.org/wp-content/uploads/2017/07/Information-Sharing-in-MLPs.pdf [https://perma.cc/LJ9P-2MVZ].
85 Pettignano et al., supra note 19, at 708.
86 Thorpe et al., supra note 84, at 7-8.
87 See, e.g., JRI Health, JRI, https://jri.org/services/health-and-housing/health [https://perma.cc/LY4G-E8AA] (last visited Jan. 20, 2022); The Clinic @ BAGLY, BAGLY, https://www.bagly.org/clinic [https://perma.cc/E2E3-D6BK] (last visited Jan. 16, 2022); The Fenway Institute, Fenway Health, https://fenwayhealth.org/the-fenway-institute/education/the-national-lgbt-health-education-center/ [https://perma.cc/9JNL-23RS] (last visited Apr. 16, 2022) (Describing the National LGBTQIA+ Health Education Center as its research, training, and health policy division). These few organizations are solely in the Boston area as well, to say nothing the availability of LGBTQ+ health services and education throughout the rest of the country.
88 Trott et al., supra note 32, at 4.
89 See id. at 4-5; Regenstein et al., supra note 17, at 10, 19.
90 Trott et al., supra note 32, at 3-4.
91 Paula Galowitz et al., Ethical Issues in Medical-Legal Partnerships, in Poverty, Health and Law: Readings and Cases for Medical-Legal Partnership 157, 164 (Elizabeth Tobin Tyler et al. eds., 2011).
92 Id. at 165.
93 Id. at 171.
94 Id. at 172.
95 See id. at 173.
96 See Galowitz et al., supra note 91, at 174.
97 Id. at 176.
98 See id. at 177. Cf. Jay M. Zitter, Applicability of Attorney-Client Privilege to Communications Made in Presence of or Solely to or by Other Attorneys, Coparties, and Their Staff, 64 A.L.R. 6th 655 at 3 (2011) (discussing various situations in which paralegals, clerks, law students, etc. have been found to be privileged or not; the extension of privilege is highly fact dependent, but as long as the attorney and other involved party are acting to the end of providing legal services, the disclosure of a client’s confidential information is generally found to still be privileged).
99 See, e.g., State Bar of Ariz., Arizona Legal Ethics Handbook § 1.2:210 (3rd ed. 2015), LexisNexis (database updated 2015) (noting that “the attorney-client relationship is generally understood to be a matter of contract”); Jeffrey Jackson & Donald E. Campbell, Ethics and Professional Responsibility for Mississippi Lawyers and Judges § 2.04 (LexisNexis 2016) (giving the example of formation of the attorney-client relationship as something that can be—and is commonly—demonstrated through a written instrument); Susan j. Becker et al, Anderson’s The Law of Professional Conduct in Ohio § 5.07 (2012), LexisNexis (database updated 2012) (“Under traditional contract principles, an attorney and client may enter into an agreement for representation orally or in writing.”).
100 U.S. Dep’t of Health & Hum. Servs., HIPAA Privacy Rule and Sharing Information Related to Mental Health 1, 10-12, https://www.hhs.gov/sites/default/files/hipaa-privacy-rule-and-sharing-info-related-to-mental-health.pdf [https://perma.cc/Y8HC-QGK2]; U.S. Dep’t of Health & Hum. Servs., Your Health Information Privacy Rights 1, [hereinafter Your Health Information Privacy Rights] https://www.hhs.gov/sites/default/files/ocr/privacy/hipaa/understanding/consumers/consumer_rights.pdf [https://perma.cc/XFN9-3HJL]; see generally Tarasoff v. Regents of Univ. of Cal., 551 P.2d 334, 340 (Cal. 1976) (holding that when a psychotherapist knows that their patient “presents a serious danger of violence to another … [they] incur[] an obligation to use reasonable care to protect the intended victim against such danger”).
101 See Mary I. Wood, Protective Privilege Versus Public Peril: How Illinois Has Failed to Balance Patient Confidentiality with the Mental Health Professional’s Duty to Protect the Public, 29 N. Ill. U. L. Rev. 571, 579-80 (2009) (discussing the negative impacts on trust between patients and clinicians that may occur if there is a breach in doctor-patient confidentiality; while serious and notable, it is a different kind of consequence from the more tangible ramifications of breach of attorney-client confidentiality).
102 See Your Health Information Privacy Rights , supra note 100, at 1.
103 See, e.g., State v. Handy, 2012 VT 21, ¶ 26, 191 Vt. 311, 324, 44 A.3d 776, 785 (holding that a convicted rapist’s STD testing results could be disclosed to the person he raped so long as the person does not disseminate that information to anyone besides their doctor or counselor).
104 Thorpe et al., supra note 84.
105 Id.
106 See id. at 7.
107 Id.
108 Id. at 7-8.
109 See id. at 7.
110 Id.
111 This is in contrast to the usual patient/client relationship formation in most MLPs, where the patient sees and engages with the medical provider first. See id. at 7-8.
112 Id.
113 Cf. The Clinic @ BAGLY, supra note 87. The clinic previously allowed walk-in appointments, but now simply require an online appointment to be made before someone can visit the clinic in person; there is no requirement that a person have prior history with the organization before they can utilize the clinic’s medical services. Id.
114 See generally Find a Chapter, PFLAG, https://pflag.org/find-a-chapter [https://perma.cc/NE4X-JC76] (last visited Jan. 16, 2022).
115 See generally About GLAAD, GLAAD, https://www.glaad.org/about [https://perma.cc/YFK3-HX2B] (last visited Jan. 16, 2022).
116 Sara Savat, The Divide Between Us: Urban-rural Political Differences Rooted in Geography, Wash. Univ. St. Louis: Source NewsRoom (Feb. 18, 2020), https://source.wustl.edu/2020/02/the-divide-between-us-urban-rural-political-differences-rooted-in-geography/ [https://perma.cc/9GN5-AXK2] (citing James A. Gimple et al., The Urban–Rural Gulf in American Political Behavior, 42 Pol. Behav. 1343, 1344 (2020)); Emily Badger, The Real Reason Cities Lean Democratic, Bloomberg: CityLab (Nov. 15, 2012, 10:20 AM), https://www.bloomberg.com/news/articles/2012-11-15/the-real-reason-cities-lean-democratic [https://perma.cc/6LJS-PJB2] (displaying maps showing political affiliations across the U.S.; though a bit outdated, it still shows urban blue hotspots ringed with purple suburbs; this map also takes into account population density in its representation of the electorate).
117 See David Leonhardt & Claire Cain Miller, The Metro Areas With the Largest, and Smallest, Gay Populations, N.Y. Times: TheUpshot (Mar. 20, 2015), https://www.nytimes.com/2015/03/21/upshot/the-metro-areas-with-the-largest-and-smallest-gay-population.html [https://perma.cc/D64X-LWGA] (discussing cities with the largest gay-identifying populations); Amin Ghaziani, Measuring Urban Sexual Cultures, 43 Theory & Soc’y 371, 373 (2014) (explaining the history of LGBTQ+ individuals settling in port cities in the wake of military discharges and the resultant pull of other LGBTQ+ people to these communities being built by the individuals that were settling in urban areas); Douglas Bruce & Gary W. Harper, Operating Without a Safety Net: Gay Male Adolescents and Emerging Adults’ Experiences of Marginalization and Migration, and Implications for Theory of Syndemic Productions of Health Disparities, 38 Health Educ. & Behav. 367, 371 (2011) (discussing broadly how queer people tend to migrate to areas where other queer people are—per Ghaziani’s article, cities—to find community and explore one’s sexuality without the impediments and threats that an unaccepting environment—where being anything other than cisgendered and heterosexual is treated as aberrant and taboo—cannot provide).
118 See generally AJ Young, LGBTQ+ Population Quick Facts, Ind. Univ.—Purdue Univ. Indianapolis (Feb. 2019), https://diversity.iupui.edu/offices/lgbtq/images/LGBT-Population-Quick-Facts.pdf [https://perma.cc/STJ5-R9T4] (compiling statistics for people who identify as LGBT—based on statistics alone, who is or is not LGBTQ+ would have nothing to do with geography); Nsikan Akpan, There is no ‘Gay Gene.’ There is no ‘Straight Gene.’ Sexuality is Just Complex, Study Confirms, PBS News Hour (Aug. 29, 2019, 6:53 PM), https://www.pbs.org/newshour/science/there-is-no-gay-gene-there-is-no-straight-gene-sexuality-is-just-complex-study-confirms [https://perma.cc/XZ54-RSBC] (explaining the findings of a genome-wide association study that concludes that what genetic basis there is for sexuality is widely polygenic and that sexuality is influenced by genes, psychology, and life experiences; this would mean that there is no particular reason other than conscious choice that LGBTQ+ people would be located only in certain areas, thus it is just as likely that an LGBTQ+ individual is located in rural Texas as in San Francisco).
119 See Gary J. Gates, How Many People are Lesbian, Gay, Bisexual, and Transgender? 5 (2011), https://williamsinstitute.law.ucla.edu/wp-content/uploads/How-Many-People-LGBT-Apr-2011.pdf [https://perma.cc/SAC5-99DE] (Fig. 4 in particular is indicative that potentially more people are LGBT than are actively identifying as such, based on engagement in typically queer behaviors and experience of same-sex attraction; this is especially interesting and salient because sexuality falls along a spectrum and people’s sexual and romantic orientations do not always fit neatly into the stereotypical gay-straight dichotomy).
120 See Leonhardt & Miller, supra note 117 (cities with highest percentages of queer individuals).
121 Ghaziani, supra note 117, at 373.
122 See id.; Bruce & Harper, supra note 117 at 371.
123 See, e.g., The Clinic @ BAGLY, supra note 87; JRI, supra note 87; About Health, The Ctr.: Lesbian, Gay, Bisexual & Transgender Cmty Ctr., https://gaycenter.org/recovery-health/health/#hiv-and-aids [https://perma.cc/4UXU-ZDDF] (last visited January 20, 2022).
124 Distinguishing between increased services and access to justice is incredibly important here. In most cases, simply adding more services, hiring more attorneys, increasing hours, etc. are not enough to provide access to justice. Certain demographics (affluent and white people) access legal services more than others, thus access to justice has to mean providing legal help to underserved populations not just providing more legal services. Rebecca L. Sandefur, Access to What?, 148 Daedalus 49, 50-51 (2019).
125 See Marple, supra note 12, at 3.
126 See Sharita Gruberg et al., The State of the LGBTQ Community in 2020, Ctr. Am. Progress (Oct. 6, 2020, 9:00 AM), https://www.americanprogress.org/issues/lgbtq-rights/reports/2020/10/06/491052/state-lgbtq-community-2020/ [https://perma.cc/8W9L-PJWF] (taking into account people of color separately from just LGBTQ individuals in the reports of discrimination discouraging visits to health care professionals).
127 See cases cited supra note 2; Danya E. Keene et al., Reducing the Justice Gap and Improving Health through Medical-Legal Partnerships, 40 J. Legal Med. 229, 237-38 (2020) (discussing the ways that MLPs have facilitated access to legal services, enhanced trust in the legal profession, helped clients preemptively and proactively, and empower clients who would normally not have enough legal knowledge to advocate on their own behalves); see also Jordan Blair Woods, LGBT Identity and Crime, 105 Calif. L. Rev. 667, 718-20 (2017) (discussing the complicated accounting for hate crimes and criminal victimization generally pertaining to LGBTQ+ people because it is hard to separate discriminatory animus from other reasons for victimizing queer people).
129 See Judith D. Kasper et al., Gaining and Losing Health Insurance: Strengthening the Evidence for Effects on Access to Care and Health Outcomes, 57 Med. Care Rsch. & Rev. 298, 312-14 (2000).
130 See Comm. Health Care Utilization & Adults with Disabilities, Nat’l Acads. Scis., Eng’g & Med., Health-Care Utilization as a Proxy for Disability Determination 33 (2018) (specifying that health care availability, timeliness, convenience, and affordability are all components of making health care accessible).
131 Jeffrey T. Kullgren et al., Nonfinancial Barriers and Access to Care for U.S. Adults, 47 Health Servs. Rsch. 462, 463 (2012).
132 See discussion supra Section II.B.ii.
133 See Regenstein et al., supra note 17, at 26.
134 Id.
135 Middleton et al., supra note 27, at 318-20 (contains a table of financial savings/outcomes for veterans who used the Connecticut Veterans Legal Center; benefits exist beyond the numbers reported—particularly since the figures do not take into account ongoing cases or money saved because of the preventative care inherent in solving some of the veterans’ legal problems now, like with resolving/reducing debt—but it provides a good metric that demonstrates the immediate financial benefits veterans can receive through better access to legal services).
136 Regenstein et al., supra note 17, at 28 (median financial benefits to patients were $81,595 over the course of a year, benefits to MLP healthcare partners were $119,013 in the same time, though there were fewer data points for the latter figure and it is harder to calculate overall; healthcare partners do not usually report this information because it is difficult to calculate).
137 Middleton et al., supra note 27, at 319-20 (discussing how legal intervention through the MLP gets debts reduced, which facially saves people who access the MLP money, but can also have long-term savings because of the interest that does not accrue)
138 See Keene et al., supra note 127, at 237-38.
139 See, e.g., Kezer & Pekala, supra note 5.
140 See Dayna Bowen Matthew, Ctr. for Health Pol’y Brookings, The Law as Healer: How Paying for Medical-Legal Partnerships Saves Lives and Money 29-30 (2017), https://www.brookings.edu/wp-content/uploads/2017/01/es_20170130_medicallegal.pdf [https://perma.cc/9MPN-78JG].
141 See generally infra note 109 and accompanying text.
142 See Keene et al., supra note 127, at 237-38, 240-41.
143 See George C. Harris & Derek F. Foran, The Ethics of Middle-Class Access to Legal Services and What We Can Learn From the Medical Profession’s Shift to a Corporate Paradigm, 70 Fordham L. Rev. 775, 795-96 (2001); Raymond H. Brescia, Uber for Lawyers: The Transformative Potential of a Sharing Economy Approach to the Delivery of Legal Services, 64 Buff. L. Rev. 745, 761-62, 765-66, 768-69 (2016).
144 Regenstein et al., supra note 17, at 26.
145 See, e.g., Arriola, supra note 69, at 430, 440; Deborah Lolai, “You’re Going to be Straight or You’re Not Going to Live Here”: Child Support for LGBT Homeless Youth, 24 Tul. J.L. & Sexuality 35, 38, 42 (2015); Allison S. Bohm et al., Challenges Facing LGBT Youth, 17 Geo. J. Gender & L. 125, 163 (2016).
146 See, e.g., Russell K. Robinson, Racing the Closet, 61 Stan. L. Rev. 1463, 1514-15 (2009); Siobhán Elizabeth Stade Murillo, Twenty-First Century Regression: The Disparate Impact of HIV Transmission Laws on Gay Men, 30 Emory Int’l L. Rev. 623, 627-28, 633-34 (2016); Matt J. Barnett, Note, Queering the Welfare State: Paradigmatic Heteronormativity After Obergefell, 93 N.Y.U. L. Rev. 1633, 1656 n.137 (2018).
147 See Jeffrey S. Gonzalez et al., Social Support, Positive States of Mind, and HIV Treatment Adherence in Men and Women Living with HIV/AIDS, 23 Health Psych. 413, 413 (2004); Margaret A. Chesney, The Elusive Gold Standard: Future Perspectives for HIV Adherence Assessment and Intervention, 43 J. Acquired Immune Deficiency Syndrome (Supplement 1) S149, S149 (2006).
148 Even the federal government is concerned with social determinants of health. It is one of their focuses in their recent health promotion campaigns. See Social Determinants, HealthyPeople.gov (Feb. 6, 2022), https://www.healthypeople.gov/2020/leading-health-indicators/2020-lhi-topics/Social-Determinants [https://perma.cc/H49N-Y8CU].