Legal Needs Assessment of Emergency Department Patients at Zuckerberg San Francisco General Hospital

Civil legal needs are non-criminal issues that affect one’s ability to meet basic needs and impact nearly 75% of low-income households. While significant data exists connecting social determinants of health to Emergency Department (ED) utilization and health outcomes, little data exists specifically investigating civil legal needs. The objective of this study was to characterize legal needs of patients in the ED at Zuckerberg San Francisco General (ZSFG), an urban safety-net hospital, and identify disparities in needs and ED utilization across demographic factors.

We administered surveys adapted from the National Center for Medical Legal Partnerships to patients in the ZSFG ED to assess patients' legal needs and conducted a chart review to gather ED utilization data. Patients were excluded if they were medically unstable, were in custody or had altered mental status. Analysis stratified number of legal needs and ED visit frequency by demographic factors and assessed association between these outcomes and demographic factors.

We gathered survey data from 101 patients, 62 of whom agreed to chart review. Overall, 72% of respondents had at least one legal need, with over 24% having three or more. Those who were 65+, had an income

Patients who were older, of lower socioeconomic status, unhoused or of marginalized racial/ethnic backgrounds presented with increased legal needs and ED utilization. The development of a medical-legal partnership (MLP) in urban safety-net EDs presents a unique opportunity to connect vulnerable populations with legal resources, a promising avenue to address health inequities that are exacerbated from unmet legal needs.