Iatrogenic Legal Assistance?

Harvard Professors Jim Greiner and Cassandra Pattanayak have posted a remarkable randomized experiment (“What Difference Representation?“) with evidence showing that offers for free legal representation from the?Harvard Legal Aid Bureau (HLAB) ended up hurting unemployment claimants.

HLAB is a “student-run, faculty-overseen” legal service clinic at Harvard Law School.? It is “the oldest student legal services organization in the country.”? In the experiment, unemployment benefit claimants (who were pursuing “first-level” appeals) were randomized into one of two groups: a treatment group which was offered free HLAB representation, and a control group which was not offered representation.? Prior to randomization all claimants agreed to participate in a randomized study.? (“If the randomization was not to offer, the student-attorney so informed the claimant by telephone and provided her with names and telephone numbers of other legal services provides in the area who might take her case.”)

The claimants who were offered representation were no more (or less) likely to win their administrative appeal – but “the offer caused a delay in the proceeding.”? The claimants offered representation had to wait on average 42 percent longer (53.1 vs. 37.3 days) before they received a decision of an Administrative Law Judge.

The results are particularly striking because not everyone who was offered representation was represented, and because those who were not offered HLAB representation were sometimes represented by alternative organizations.

The study highlights, again, the simple power of randomized control studies.? There is a persuasive transparency to randomized control trials.? The randomization doesn’t tell us why the offers caused a delay, but we should be fairly confident that those who were lucky enough not to be offered free legal assistance by HLAB had a better shot of cashing unemployment checks sooner.? This initial study’s main limitation is that its sample size is only 207.? Still, that is sufficient to raise the serious concern that HLAB’s offers of representation are hurting its potential clients. In medicine, iatrogenic effects are adverse side effects caused by medical treatment – this study points to a legal analogue in which well-intentioned legal assistance ends up resulting in adverse “side effects” for the clients.

This study raises deep ethical questions both for HLAB and other legal service providers.? Does HLAB have a duty to stop offering representation or to change its modus operandi?? Does it at least have an ethical duty to disclose the results of the study to prospective clients?? Can other student legal service organizations ethically ignore the results of the study?

Will other organizations submit themselves to the institutional risk that their services will be found lacking?? When in doubt, bet on narrow “head in the sand” self-interest.? The authors report that another Boston-based provider of similar services “did not limit its opposition to a refusal to participate on its own part. Instead, when it discovered that HLAB was conducting a randomized evaluation, it halted its previous?practice of suggesting that clients it could not itself represent call HLAB.?And as of the time of this writing, this provider is currently using its power over the intake system of a third organization to prevent this third group from conducting its own randomized evaluation.”

A Last Minute Charitable Gift Suggestion

The HLAB story also motivated me to redirect some of my year-end charitable giving.? In the past, I’ve given to causes (such as?A Better Chance) which made me feel good but which turned out to have an?abysmal record or at least no reputable evidence of success.? But this year, I’ve given money to two charities, MIT’s?Poverty Action Lab (PAL) and?Innovations for Poverty Research (IPA), which are dedicated to using randomized control studies to find out which public policy interventions work to alleviate poverty.? (Disclosure:? I have number-crunching friends at both charities.)? Would microcredit organizations do better using statistical credit scores instead of traditional subjective committee decision-making?? Does providing free chlorine dispensers at water sources reduce child diarrhea?? Scholars associated with these charities ran randomized experiments (described?here and?here) to find out.? What I love about these charities is that they add to our knowledge – even when they establish that a particular intervention doesn’t work.?? As a reader of this blog, if you’re inclined to support data-driven decisionmaking, you could do a lot worse than contributing to these non-profits.

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  1. Drill-Baby-Drill Drill Team says:

    If a benefits claim process involves more LAWYERS than SOCIAL WORKERS then it is doomed.

    If an engineering problem involves more lawyers than engineers then it is doomed.

    IF a medical procedure involves more lawyers than doctors then it is doomed.

    And if a law process involves more lawyers than lay citizens, it is doomed. Has anyone noticed that the majority of our legislatures are lawyers, and deadlock is the norm?

    Yep, America has more lawyers per capita than any other country. Armies of Lawyers. Progress to put up a simple super efficient green windmill is delayed in courts for months then years.

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  2. MikeM says:

    “If the randomization was not to offer, the student-attorney so informed the claimant by telephone and provided her with names and telephone numbers of other legal services provides in the area who might take her case.”

    There it is RIGHT THERE. Perhaps rather than the offer slowing down the process, the opposite happened. The alternative was to offer names and numbers of competent legal service providers, which sped up the process.

    To continue the medical analogy, that’s like giving your control group a known effective drug and then claiming the drug you’re studying retards recovery compared to people who don’t receive it.

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  3. Eric M. Jones says:

    Even though it fits with my prejudice, I allow for the possibility that the study has huge gaping holes.

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  4. AaronS says:

    While I would be interested in how well other providers performed (i.e., is this about ALL involved lawyers…or just the Harvard students?), there might be a couple of things at play here….

    First, it might be that there is a natural defensiveness in the bureaucracy against those who use a lawyer. Maybe it is perceived that such a person has means that make them ineligible for unemployment. Or perhaps some folks just like to give lawyers a hard time because it is just the right thing to do.

    Second, it might be a case of knowing too much. For instance, if you are a river guide on a wild river, you have a pretty good idea of all that can go wrong if you go over that ledge…so maybe you avoid it. The newbie, however, oblivious to the risk, goes over and does well. Likewise, maybe lawyers, knowing all the particulars, just get too many forms and so forth in motion, while the untrained person just takes everything at face value, perhaps making it easier on the bureaucrats.

    Lastly, maybe these students, be they ever so bright, are being so careful not to miss anything–or not to blow a good grade or opportunity to make a good impression–that they are going overboard, making life more difficult than it needs to be.

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  5. Jim Greiner says:

    Hi, Ian, thanks so much for the shout-out re the article.

    One thing your post highlights is the bravery of the Harvard Legal Aid Bureau’s students in undertaking the randomized evaluation. They were under no obligation to do so (they initially turned us down before reconsidering), and as you highlight, not all legal services providers have embraced the idea of gold-standard study.

    My impression is that randomized trials are the exception, rather than the norm, in almost all fields except medicine. Given their power to provide important and useful information, and given resistance from some quarters, how can we encourage their widespread acceptance? I think by doing as you suggest in your post: by supporting (financially and otherwise) entities that agree to undergo rigorous evaluation. With that in mind, the Harvard Legal Aid Bureau and the charities you highlight deserve congratulations and support.

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  6. Surprise says:

    HLA at least means well and were willing to have this printed.

    An organization to avoid giving a nickel to, working for, or (Lord help you!) being a client of is the Jewish Vocational Service. (I worked there as a contractor.) While my experience working there was mostly painless, that of clients is another matter. If you like being a sausage then by all means make yourself a client of JVS. If you dare fancy yourself something more than that, avoid them at all costs!

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  7. Rod Joyce says:

    As one whose career has involved both pleading and judging court cases my suspicion would be that this was an entirely understandable case of too much academic knowledge and too little real life, making the right judgment calls, experience of the realities of litigation including what actually and economically wins cases.

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  8. Browning says:

    Some “legal” issues are really just fact issues, of no great complexity. Lawyers can’t help much. Persons who own little and have no children can represent themselves in obtaining a no-fault divorce and lawyers don’t change the outcome – they all get divorced. Here, the applicants either meet the criteria for benefits, or they don’t.

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