When Eric Campbell's diabetes spiraled out of control last summer, he knew his nearly empty pantry was to blame.
An unexpected $130 cut to his Hennepin County food support left him with only $2 a day to spend on food. His caregivers at Hennepin County Medical Center's Whittier Clinic were alarmed as Campbell's health deteriorated, but they couldn't do much to help. It was a legal problem killing him.
Nurse practitioner Annie Goldbaum, though, was able to call in a lawyer — a colleague in her clinic who she thought could help. Attorney Carrie Graf met with Campbell, got permission to see his records and found the county had mistakenly calculated Campbell's food assistance payments.
That kind of legal intervention is increasingly common in Minnesota. Some health care clinics are adding on-site attorneys to their teams of doctors and nurses to provide convenient, free legal advice to low-income patients.
The state's first medical-legal partnership began more than 20 years ago at Community University Health Care Center in Minneapolis. Whittier, also in Minneapolis, began in 2013. A third partnership opened this spring at a St. Cloud clinic. Hamline University's law school is setting up a similar relationship with a clinic in St. Paul.
At Whittier, some 500 clients have been referred to Graf and other attorneys with legal issues tied to their health. The arrangements are gaining traction, Graf said, because health reform has forced hospitals and clinics to look more at the whole patient.
"They are realizing that in order to provide really great care that's affordable they need to be looking at all of the circumstances that are contributing to a patient's health," she said.
For Campbell, it may have been the difference between life and death.
At the time, he'd just moved into a small apartment in Robbinsdale after being homeless. His newly established disability benefits helped him pay for the apartment, but not much else.
"I was eating mostly rice and potatoes and stuff," he said. "Being starchy foods then, they're not good for my diabetes."
He was surprised when Hennepin County suddenly decreased his food support by more than two-thirds. Campbell, though, figured it would be simple to plead his case once the county saw how little money he had for food.
"I went to the office several times and explained to the lady there's no possible way your calculations is right," he said. "It was like talking to a wall."
As the dispute dragged on, Campbell's health deteriorated quickly. Goldbaum said her patient's blood glucose rose to an alarming level. Campbell's kidneys started to fail and the 44-year-old was added to a transplant list.
Goldbaum said Campbell was in mortal danger but outside of giving him some food from the clinic pantry, she couldn't do much to save him.
Graf, who runs the medical legal partnership between the clinic and Mid-Minnesota Legal Aid, agreed to meet with Campbell during his next clinic visit and got permission from Hennepin County to review his case file where she found "a pretty substantial error that had been made" in calculating his benefits.
Though he was living independently in his own apartment as part of a new program, the county still treated him as though he were living in group housing, where he wouldn't need as much aid. After talking with Graf, county officials acknowledged the mistake and agreed to restore her client's food support.
"In further conversations with the county it turned out this was an error they were making for about 200 food stamp recipients," Graf added. "These are all people who are living right on the edge of not being able to feed themselves."
Graf and others say while there's a clear need to expand legal-health work for low-income people, funding remains a big challenge.
There is no dedicated, consistent source of money to pay for these projects. Most collaborations receive contributions from multiple partners, including legal groups, hospitals, universities and foundations. That cost-sharing makes these arrangements possible for now, but also vulnerable to any downturn in the partners' finances.
Care providers, though, see the benefits.
Goldbaum said her colleagues knew that free legal help could make a big difference in the health of many Whittier patients, though some providers did wonder if the arrangement might also hurt their practice.
"I think there was some concern from some people, like 'Whoa, we're bringing lawyers into the clinic. Does that mean that our patients are going to get legal help if they have some kind of medical malpractice concern?'" she said. "But that hasn't come up at all."