AHLA's Speaking of Health Law

COVID-19 GC Roundtable - Part 3

April 22, 2020 AHLA Podcasts
AHLA's Speaking of Health Law
COVID-19 GC Roundtable - Part 3
Show Notes Transcript

In the third podcast in this series with hospital general counsel on the front lines of the coronavirus pandemic, Sarah Swank, Counsel, Nixon Peabody LLP, speaks with Elizabeth Trende, Senior Associate General Counsel, Ohio State University Medical Center, Aletheia Lawry, Associate General Counsel, HonorHealth, and Brian White, General Counsel and Vice Chancellor for Legal Affairs, University of Kansas, about the challenges their health systems are facing—including staffing, budget, and operational issues—and how they are dealing with those challenges. From AHLA's In-House Counsel Practice Group.

To learn more about AHLA and the educational resources available to the health law community, visit americanhealthlaw.org.

Speaker 1:

Welcome everybody to, uh, ALA's Covid 19 GC Round table part three. Uh, today I have three of my colleagues from the in-house practice group joining me. I'm gonna have them each introduce themselves. Emmy, why don't you go first?

Speaker 2:

Okay. My name's Emmy Trendy, and I am the Senior Associate General Counsel and managing attorney for the Business and Transactions Group at osu Wexner Medical Center at Ohio State.

Speaker 1:

Great. Thank you Alaia?

Speaker 2:

I'm Alaia Laurie. I'm Associate General Counsel with Honor Health. We're a six hospital system in the Phoenix, Scottsdale area.

Speaker 1:

Great. And Brian?

Speaker 3:

Hi, I'm Brian White. I'm General counsel at the University of Kansas, and, uh, oversee our medical center campus in Kansas City and our primary campus in Lawrence, Kansas.

Speaker 1:

Excellent. And I'm Sarah Swank from the law firm of Nixon Peabody. Uh, today is April 21st, 2020. And we're just gonna jump right in. Um, so let's, let's start with you, Brian. How much of your time are you spending on covid 19 matters, and has your typical day changed at all?

Speaker 3:

Well, I<laugh> define typical day. I don't think there is a typical day in, in our world. Uh, and Covid 19, uh, certainly just adds to the craziness. Um, yeah, certainly, uh, my responsibilities expand beyond just our medical center campus into the main campus too. So probably about 90% of my day, if not more, uh, is covid 19 even, um, when I'm dealing with athletic issues, a lot of times those issues now are covid 19 related also. So, um, it's pretty much all consuming for, um, both myself and for my, my teams on both campuses

Speaker 1:

And Emmy. How about you?

Speaker 2:

I, I would say easily 80% of the day on, uh, on a typical day as it as it touches all of our, all of our hospital and health system campuses. And, and as Brian said, you know, we've got staffing and, and HR that plays into that, which certain certainly touches, uh, touches every corner of the university, so it's very quite consuming right now.

Speaker 1:

And Alicia, how about you?

Speaker 2:

Uh, so my days sort of vary between, uh, 100% of my day spent on covid, um, to maybe 10 or 20% the next day. So has been sort of driving the variability. Net variability from my day has been, um, do we have a new executive order from the governor? Uh, when all the waivers were coming out, it was definitely a hundred percent of my time, uh, spent on that. I know our employment attorney is spending almost a hundred percent of his time, uh, on covid issues right now as we work through workforce issues with P P E and decreased revenue and potential furloughs.

Speaker 1:

So how, um, alacia how are you staffing these mat the matters in your legal department? Are you using internal resources, external resources, consultants? And then also how are, are you, like, what do you think six months from now will look like on, on those, on things that are piling on your desk?

Speaker 2:

Yeah, so, um, we are using solely internal versus still. Um, we are one of many health systems, I'm sure that, uh, have, have looked to try and reduce some staffing actually. Uh, and in April, um, rather than do a salary reduction, we did inquiry PTO days. So, um, all of our attorneys have had to take five PTO days in April. Um, uh, this isn't the labor group, so maybe I can say that probably all of us worked on our PTO days. Um, but, uh, you know, it definitely has been a challenge. It's actually a time when I think legal tasks are needed more than they were even before, and yet we're trying to deal with reduced resources to pay for our employees. So, um, again, I think we've been internal. We've sent a couple of things out where we need just a quick look at something and to get something out the door and didn't have the time to do the research because, um, quite frankly, we, that's what we generally send things out for is when we don't have time to sit down and do the research on it. And that certainly has not changed with, um, covid, although we're trying to do some of it in half, mostly because questions arising and things keep changing, and we need to be relatively knowledgeable about, um, what the waivers look like, what all of the funding opportunities look like, so that we can quickly answer questions.

Speaker 1:

Great. That's, um, Emmy, are you seeing the same thing as the lathia? Are you seeing, are you using more internal resources at this point? Are you using external resources and do you think that will change in six months from now?

Speaker 2:

I, I have to echo what a LATHIA has said by far, we're using a lot more internal resources. You know, again, I, it's funny, I always tell people when they come and interview for an in-house position with us, and they're coming from a law firm setting, the deal is whether you have a health law background or not, be prepared to learn on the job no matter what. Because health law is in a constant state of flux. It has been for the past few decades, and we are just seeing a, a ramp up of that. Of course, it's more rapid now over, over the past few weeks. But this is the style of learning that a lot of our staff is, is used to and, and, and looks forward to, certainly with the, with the academic medical center that I, that I represent over the past, uh, over the past few weeks with all of the fast development work that's being done, not only on the hospital clinical care side, but we are involved in development of, of viral transport, medium testing, development, all kinds of public-private partnerships that are rolling off almost faster than we can get them typed and and formalized. So we have been able to, to utilize outside council resources in some of those areas that are not our typical day-to-day. Uh, it, in especially outside partnerships and, and on the FDA work and internally, have done a lot of, a lot of fast learning and a lot of, a lot of fast, uh, ramping up as, as well. I, I can say that as a manager from an HR perspective, it's been a very fulfilling time. Of course, it's very, very high pressure having to process and having to, to learn all those things, but people are, uh, a, certainly not board. And, uh, b I think finding a lot of fulfillment in seeing not only the project development, but the end result that that unfolds right in front of them, the way that the contract connects and the p p e gets into the facility, or we're able to disinfect faster, or we're able to staff up and turn a convention center into a hospital overnight if we need it. I think all of that, despite the stress and, uh, despite the, the strain on the resources is very fulfilling on the other end of it.

Speaker 1:

I mean, it sounds like you're, the, the idea of being focused on the mission is now even more important than seeing the results of that. Um, you also stated that things are in fluff. I mean, I've never, I don't, well, none of us have ever seen this many laws change in this short of time. It is, um, it's, it feels like there's a slowdown right now, and we still have legal changes, which is quite interesting. Um, because the weeks previously were so fast and furious, um, having been in house during the re when the recession hit, there was some of the similar things happening where we had less, less elective procedures. And I remember having to, um, wanting to try to take as much as we could and do it in-house, which a lot of times meant me personally, seeing up late nights and working on them. Um, but knowing that that was giving back to the institution and ensuring, you know, financial stability to put forward our, our non-profit community driven mission was really important to me. It sounds like it's important, was important to you. Um, Brian, how about you? Are you, how are you looking at internal and external resources and do you think there'll be a change in six months?

Speaker 3:

Oh, I hope so. Um,<laugh>, uh, I, I, I guess that the nuances that I'm seeing, I don't know if, if you guys are seeing this also, but you know, one, we, we were short staffed to begin with. We had two open positions that have been subject to a freeze, uh, that we haven't been able to fill. Um, and, uh, more so now with everything that's going on, uh, the need for our office to respond and respond timely as things are changing, uh, has created evermore pressure at the same time, you know, my staff is working from home, uh, oftentimes balancing, uh, uh, home life and trying to work from home, uh, kids being held, uh, all the stresses that come with that, and I know everybody's dealing with that right now. Um, so it's not, it's not anything novel, but it is, it is new and different and, you know, when you're working with a team that is, you know, facing the reality of, of budget cuts, uh, we're state institution, uh, our, our governor announced yesterday that the, uh, revenue projections for the state are gonna be, uh, 1.3 billion, uh, off, uh, this year with 800 million of it, uh, between now and July 1st. Uh, and, and, and understanding that those types of, uh, financial pressures that are, are also, uh, uh, uh, taxing on just the, the mental psyche of the staff. That's one, already overworked. Two, trying to, to deal with a, a different type of reality of what that work life looks like. And, and I gotta say, you know, uh, you don't have an unlimited budget to work with outside council, but I will tell you with the American Health Law Association message boards where we can, and, and sounds like a, a gratuitous plug here for the in-house practice group, but being able to be on our, uh, message board and sharing some of those issues and insights and really, uh, working off of each other, uh, collectively through this, has been great. But also, uh, a lot of law firms, uh, have really stepped up. Many of the firms that I've worked with and individuals I've, I've met and, and built relationships with through hla, uh, are on top of this. And they're, for the most part providing a lot of that advice, whether through, uh, uh, webinars or other learnings, uh, uh, for free. And so the benefits we get, uh, from HLA and, and from those, uh, other, uh, uh, members of h l a, whether they be in the firms or or another, uh, uh, hospitals or health systems, has been, uh, a, a, a really good godsend, uh, through this time. And, uh, uh, you know, collectively, if we all, uh, are working together, it makes it a lot easier, uh, uh, for us to get through each day. So that's kind of the work balance on my end. And

Speaker 1:

Yeah, I was say, we can definitely plug our practice group, the in-house council practice group, definitely sign up. Brian's in charge of tracking membership, and we have had an increase in membership. Yeah, we'll have more and more resources and benefits, and we'll talk about that, uh, later in the podcast too. Um, why don't you, you know, Brian hit on a little bit about what's happening in, in his state and some of the financial pressures. I know, for example, in New York, uh, with New York City, really hard hit, there's announcements from the governor around, you know, potential cuts. Um, what are you seeing in, in your, in, what are you, what are at least Alicia, what are you seeing, uh, in your, uh, geographical area?

Speaker 2:

Yeah, so we're seeing the exact same thing. Um, the Phoenix Scottsdale area is a, a heavily tourist focused area. Spring train, half of spring training got canceled. Um, and, and so we're about to sort of move out of the season that we tend to see our biggest tourism dollars, and we're expecting huge cuts, um, in the state budget. But then also for us as well, we rely pretty heavily on, um, the sort of six months of the year that we have tourists, and then snowbirds who, who like to spend, um, winters down here because it's about 65 degrees out instead of minus six like they're used to, um, back up east, uh, feel for you guys in Kansas and Ohio and Vermont. So, um, we're our revenue, uh, I know like in, in March, our shut down elective surgeries, um, about two weeks in, so we had about two weeks with selective surgeries, about two weeks, not, we saw 34 million swing, um, in, in projected revenue from what we were expecting. And we had 34 million, um, then what we were expecting. So, um, I said we're, we're, we're on the six hospital system. We have one opening later this year. Um, I think<laugh> right now, we're still on track to open that hospital in, in, uh, q4. But, um, it, it's just really gonna be a struggle and it's gonna be a, a bigger struggle, I think, for us as well, because even when elective surgeries do come back, um, it'll come back at the time of the year when we have our lowest number of people here, uh, ready for that. And so, um, uh, as I said, I think, you know, we've spent a lot of time trying to see how we can handle, uh, upcoming budget crunches for us internally and what we're gonna do, I guess we're, I'm, I'm a little different. I'm the only one who, who isn't attached to a university that's on the call right now. Um, but you know, we're facing those exact same things that they are. We just have, um, a little bit more flexibility ourselves in terms of what we're gonna do to meet those. Whereas if you're associated with the state, you're sort of at the mercy because you're not the decision makers. Um, so I imagine that, that, uh, we probably are in a more, um, in a better place in terms of how we can help affect that. I know we've done a lot of work with, um, reviewing all contracts that are coming up for renewal to see if there's any that we can, um, postpone or at least defer payments on. So the budget, the budget piece is definitely hitting us, uh, very hard here as well.

Speaker 1:

So, um, Emmy, why don't you, you know, one of the things Brian talked about was like, uh, this idea of, uh, work life balance or if there is such a thing, uh, or if there ever was such a thing, and now is there such a thing? How are, are you work? Do you go into the office or are you working from home? And, and how about the rest of the legal department?

Speaker 2:

No, our entire department, we, we received the directive in internally from our, from our chancellor about, uh, mid-march that, and telework should telework and the university's always had, uh, always had remote working policies, but it, it was official at that time. And right about the same time, I know a lot of other folks experienced the, uh, the closure of schools. So, uh, not only did, did most of our workforce go home, uh, but then their children, their home, uh, their home caregiving and, and kind of with, with those, uh, with those support challenges. And we just found out from our governor yesterday, school's not going to be in session again until the fall. Uh, there seems to be a little bit of a ripple effect from that. I'm hearing it come down from, uh, from other states that if they hadn't already made that call, that that call is, is being made or, or in the process of, uh, of being made. So, you know, that having the entire team at home, you know, my, my team, that the group that I supervise is, is mostly transactional in nature. So that's an advantage. I've never been more grateful electronic signature capability in my entire life, uh, that than I have right now. I'm also getting a high number of vendor emails after, Hey, have you thought about an electronic document management system? Have you thought about an electronic process manager? Uh, I definitely had before. And if I had not, this was a, this was a, a very apropo time to, to reach out. Uh, I believe that, you know, we, we've talked, and Sarah, you and I have just discussed over email kind of the, the challenges, not only that I face, but I, I've got three children. My oldest child has pretty significant special needs, and we were relying on the school system, the behavioral and therapeutic supports before this happened. And when the school closed, a lot of those resources just kind of went. Uh, we're, they're doing the best that they can. I'm, I think that our, uh, our, our teachers are really stepping up and the, the pupil services planners are, are doing that. But we do have a lot of, a lot of employees. I'm certainly not alone in having, uh, full-time caregiver responsibilities at home that are a little bit beyond the norm, as well as, uh, as well as having the, the full workload. So, uh, you know, I, it's hard when, when people throw word balance. I'm one of those that kind of counters and says, you know, it, it's less a matter of, of balance cuz it's not going to balance. Right now it's, uh, we're doing everything all in the same place, but trying as we go on to find places where we can set up those professional boundaries and may that we we're protecting, uh, protecting ourselves, uh, you know, as human limits, who, excuse me, as human beings who don't, who aren't limitless, who, uh, I, I've told my whole staff, you know, tell, be sure and remind everybody. Just cuz you're not physically sitting in a chair in the office doesn't mean you became an electronic bot who can automatically respond to, to every email 24 hours a day. You know, we're, we're here to support all the frontline providers, but keep in mind that there's an end of their shift at the end of their day. There should be an end to your shift as well. So, um, I I, I know the tendency is to always stay on call, but I, I think that I'm learning, uh, and again, it's on the job learning, just like the legal part is on the job learning where to, uh, where to set up those boundaries so that, uh, so that I can be in it for the long run and so that my team can, can be in it for the long run as well. We're trying to stay connected, uh, trying to stay strategies, uh, to share strategies that have worked and definitely to, to give grace to each other as we all try to navigate this.

Speaker 1:

I mean, that's, yeah, you and I, yeah, we're talking about trying to care for, well, there, I mean, Alicia, we were just talking about like your dogs in the background or your kids in the background or, I, I feel like it was, maybe, I don't even know. There's covid time, so it's hard to remember what day it was, but I thought it was like, had been like at least over a month or 5, 5, 4 or five weeks, I'm sorry, month. Like, yeah, four or five weeks in. And the first child, I, five year old twins, the first child actually walked into my office during a client call and I thought, that's a really good ratio. I'm, I'm, I'm gonna put that under the, under a, a covid win right there. Um, I don't know, do

Speaker 2:

It sounds like I won't, Sarah, I won't, I won't tell him myself too bad. But, um, that sounds like when I got a speeding ticket going to law school, I went to law school, the 70 miles commute each way. Um, and I got a, a ticket my last year of law school and I just wanted to look at the cop and go, well, you know, that comes out to about 12 cents a mile. I'm really okay with that. Not that I break the law<laugh>, um, you know, something Emmy said, and, and Brian had sort of said it too. Um, but I was really reminded when Emmy was talking about, you know, electronic document management, um, which is on our list to look at, but I actually had just implemented a, a new contract management system, um, mid-February. And so my team had done a whole lot of work getting ready for that. And even the couple weeks after when, when you have a new system go live, and then this all started, um, and so, you know, they, they all had, felt like they were working towards that goal. They were gonna get it up, they were gonna get it live. They were gonna get a little more work life balance back. Um, and then Covid hit. So, um, I think they've had a lot of work, extra work balance<laugh> not so much life balance, um, just because of the timing on it. So, um, but I think what Emmy said is really important and, and something I'm gonna make sure I say to my staff, which is, those frontline people have an end of the shift. We need to have an end of the shift too. I think that's, that's a very, uh, poignant reminder to of, of what we need to do to take care of ourselves as well.

Speaker 1:

So, Brian, do you have any war stories from this new, what, what we'll call the new normal, which is the sort of working at home? Any interesting meetings or, or things that have happened? Uh, or just balancing acts you've had, you've had to do lately?

Speaker 3:

Yeah, it really, men that I can really share to this audience, uh,<laugh>, you know, I've heard a

Speaker 1:

Few, I've had a few people, I've had a few tell me something I share with, well, you can you can email me later or something

Speaker 3:

<laugh>. Yeah, I mean, you know, it's, it's, I I think the, the pivotal words that were just mentioned, were making sure that we show grace not only through our own teams, but also to the, to the folks we're interacting with, um, whether it's through Zoom or otherwise. Um, it's, it's such a unique situation for everybody and we don't know what, what that situation looks like. I mean, I've got team members who have, uh, close relatives that have, uh, passed away from Covid. I've got, uh, you know, family member or, uh, team members who are single parents dealing with that, that, uh, children at home situation, which creates some awkward, uh, comments on Zoom. Uh, one I can share, we did have one of, uh, one of my deputy general counsel on one of the, uh, campuses, uh, was was on a Zoom call with, uh, a large amount of people was our E O C, um, uh, meeting as we're talking about Covid. And one of the kid yells in the background, mom, the, those lawns on fire,<laugh>,<laugh> got out, they're outside lawn on fire. So, you know, it's, it's one of those things where there's, uh, uh, you, you just have to appreciate that everybody's dealing with different types of things. And I think really the challenge for us as, as, as, as leaders, not only for our staff, but uh, for, for our clients and who we work with, is recognizing that, you know, at some point, hopefully in the near future, we'll be talking and we are already starting to talk about what that reopening looks like. Um, but that once stuff starts to become more normal, which is gonna take some time, but once that starts understand that the, the mental and the psychological impacts of what folks are dealing with right now will have a lasting impact, probably much longer than what we will, uh, uh, see from the, the physical impacts of, uh, of Covid-19. And, and just to know that that's, uh, that's something that, uh, uh, I've tried to do with my staff all the time, which is we all think our clients as they come to us with questions that, you know, maybe, maybe half of those questions are really good questions. The other ones are really where, you know, they should be making a decision and they, and they, and they just keep deferring and trying to figure out ways not to make decisions or to get legal to make decisions for them. Um, but to, to understand and to approach those, uh, situations also with grace, cuz you just have no idea what they're dealing with also at this time. So it's a, it's a trying time and, and patience and grace, I think are the two things to, to stress over and over again.

Speaker 1:

Yeah. That's, are, those are great points. And even, uh, even though I'm not in-house counsel anymore, I just re I, I realized that I was answering things at like 11 o'clock at night and, um, and feeling like, oh, if everyone's in house working so hard, I need to be responsive. And then realizing like, it's okay to say to someone, I'll get to you in the morning or, or Can I get to you in the morning? Would that be okay? And most times the answer is, oh no, that's great. That's actually, that's, that's a very reasonable time and how appreciative everyone is. Uh, it just feels like people are working, um, for a common goal and it just feels, it feels to me like, uh, even I can feel the angst on the other side of the email because a lot of times the emails, I'm getting someone saying, I'm walking into a meeting and, and an hour and 15 minutes and I need an answer. Um, and sometimes if they couldn't find the answer, just like looking around, it was because it was a complicated answer. And it may be that they, maybe, you know, maybe they can get an answer before that time and many times might. I just think you might have to walk into that meeting and not necessarily know the answer, but we'll, you know, the answer will be<laugh> will be right back at you as soon, soon enough, because you've bet really ask, you know, be really smart in-house people and they have really good questions. Um, one of the things I was worried, wondering about is, uh, and I'll start with you. Alacia. Alacia is like, what is, what are, what is your biggest concern right now? We've heard everything from, um, ppe, you know, will elective procedures go off, you know, um, compliance with like, some of the CARES ACT funding? What, uh, just general compliance, um, financial sol solvency, what, what are, what, what to you, what right now are you thinking are some of the biggest concerns you're grappling with? Yeah, so

Speaker 2:

Obviously PPE is a big thing for, um, all of healthcare systems. Uh, ours is sitting, um, on the dashboard is green right now. So I'm feeling very, uh, blessed<laugh>, I guess, um, that we don't seem to be struggling for that here right now. Um, I think what my biggest concern from a legal perspective is right now is how this is going to change the way we deliver healthcare and how the hospitals and health systems generally, but my health system specifically is going to be able to adapt to that and whether we're going to be able to adapt well to that, um, and how we in legal can help support that. Uh, we are a relatively young system. We only started about five years ago. We were the merger of two small systems, one with three hospitals, one with two. Um, and, and so the challenges that you sometimes face with a small system trying to grow into a bigger system are already there. And now we're looking at, um, I think sort of a whole new way of delivering healthcare. And, um, part of that I think is gonna have to be a focus for those of us in metropolitan areas on how we help liver healthcare out in the rural communities, because I think there are a lot of rural health providers that are not gonna make it through this.

Speaker 1:

How about, uh, you Emmy, what are, what are some of the concerns that we heard, um, Lathia talk about rural healthcare, uh, some of the other issues, PPE still seems to be an issue. What, what is, what is some of your biggest concerns right now?

Speaker 2:

Uh, think first and foremost, I mean, I, I'm just so concerned about all of our staff, our frontline staff, our physicians, our, uh, our doctors and nurses and PCAs. You know, that that part of going in-house, those are all my coworkers. Uh, you know, I, I miss seeing them, but, and now a lot of the communication is, if it's not through email, it's through, uh, a lot of people are tweeting out experiences talking about, uh, what it's like. And practitioner burnout was, was something that concerned us for this even happened. It's, uh, you know, of course being a, a public, uh, a public entity, we are in the business of giving, not only to our own patient base, but also serving the community also, uh, serving the, the students and teaching. And, and there are just so many factors at play there and at, at any time, those, those providers are my most precious resource. And to see the, uh, the, the raw emotion and the the ways that, that this plays out, I mean, it, it, it really, it really hit ya. I know a lot of us, myself included<inaudible> because we wanted to be closer to the action, you know, know, we, we didn't wanna be a few steps removed. You wanted to, to be there and more hands on and, and setting things up and seeing how legal operations played out. But, uh, this is a very hard part of, uh, of that work. I, I, we've seen the problem develop over the past few years as, as physicians are, are asked to kind of do more managerial tasks, more administrative tasks, uh, sometimes the state of the law is helpful in that area. And sometimes I think it's, uh, it, it's a hindrance to, uh, to, to the whole burnout, uh, to the whole burnout issue and how things are done and, and, and the steps people have to leap through. We're asking people to innovate all the time, and now it's extremely concentrated. It's on the clinical front, it's on the developmental front. It's trying to do so many things at once. And seeing that play out on a human level, I think has been, has been the most difficult part for me. I just hope that we can keep, uh, keep all these talented and, and very giving people, uh, sustained through all of it.

Speaker 1:

Yeah. I, and it's really, uh, it's interesting to see throughout the country. We've got places that are furloughing healthcare workers because they,

Speaker 2:

Uh,

Speaker 1:

Don't have the revenue coming in, and then other places where they're testing positive and have to be put on the sidelines either because they themselves are sick or vulnerable, or maybe they are able to use telehealth during that timeframe. Um, but it is, and then the other places, it's just, they're so, like, you look at New York City how just desperately needed they are. And even with telehealth, it's just, there's people being, um, people going there and volunteering their time to go work. Um, Brian, what, what are some of your biggest concerns right now? What are the things that you're thinking about?

Speaker 3:

Yeah, I I, I think it's right along those lines. I mean, we, what the, what the future of the, how this will change the healthcare delivery model, I think is, is an important question to ask. And we have a a thousand bed hospital, um, that has essentially closed down, and it obviously is taken care of sick patients, and we have 26 of our census this morning for covid 19 patients. Um, but you know that it's been like that and, and most hospitals are like that. So what, you know, where are those patients that would be filling those hospitals? How are they getting their care now? And does, does it look similar to what it is now going forward? Or will the, will that infusion of patients, uh, back into the hospitals, uh, uh, happen, uh, in the future? And we know elective cases have been postponed, and those will start looking back up. But, you know, really trying to figure out what that, that model looks like. I think, uh, additionally, the, the rural model, um, has always been under a question, particularly in, in, uh, states like Kansas and Iowa and, and Nebraska where, you know, you have, uh, uh, a a really dispersed population across, uh, a a large geographic region in trying to figure out where the healthcare delivery model, uh, exists. I think that's even more so under the micro, uh, microscope. Um, but, but probably the one area that, uh, I haven't heard talk about that. That's one area that I've been given a lot of thought to as a academic, uh, institution. You know, we've, we have all but shut down most of the, uh, research trials, clinical and other and otherwise that have been going on. I mean, that, uh, trying to figure out exactly what that model's gonna look like going forward. I mean, uh, you know, it's, it's, um, sometimes difficult enough to recruit patients and to research trials, uh, uh, that, uh, are are more elective in nature and that don't flow right from a clinic visit. But when you're not, when those are shut down and now you're trying to reamp'em up, how, uh, how likely are some of these patients, uh, going to wanna be to become subjects and research trials knowing that, um, this disease is, is not going away. I mean, even when we reopen, the disease is gonna be here until we get a, a, a vaccine. And so, uh, really, uh, concerned and, and thinking about what that's gonna do to, uh, that, that leg of the three-legged stool, uh, on the research side is, is another concern that's out there for us.

Speaker 1:

Yeah, it's really interesting because I, I read an article about, um, the fact that people are not getting their, or especially children, but others are not getting their vaccines right now because they're not going into the office. And that ironically, we are maybe hurting, uh, immunity to certain things during this time that we're waiting for a vaccine to be developed, produced, and distributed for Covid 19 on the same front, like you said, the FDA put guidance out around, uh, COVID 19 and clinical research, which caused some people to close trials or to modify trials or to maybe even have to reduce the number of participants. Some had to go virtual bits, they could make it happen. And yet at the same time, clinical research and scientists have never been more important. And so we're gonna see there, there may be outcomes to this that we haven't even thought about yet, or we're just starting to think about during this time period.

Speaker 3:

And, and I'll add to that, Sarah, I mean, remember that many of those clinical trials first started in a phase where you're working with animals or other types of lab work, where those labs that don't have human subjects in them even yet have come to a standstill. Um, and so, you know, I think the ramifications there are gonna be, uh, long spanning and we're gonna feel it for, for for many years.

Speaker 1:

Yeah. So, um, so one thing I wanted to ask, um, is what, um, what, you know, we're all in the prac, the HLA in-house council practice group. Um, you know, I've been in-house council a lot longer than I have been outside council, but, um, I think it's less than 50% of my career is the outside council. But, uh, one, one of the things that I think a H L A has done for me was, you know, create this incredible network of people to talk to. And so even in the beginning, people were reaching out to me and just chatting offline or just to say hi or to see how people were doing. Um, one of the reasons I think we even came up with this podcast series was I was speaking with Char Charles Whipple, who used to be the chair of our practice group years ago. And, uh, he was joking that he had heard from me more in the last, like, couple weeks right before Boston was starting to consider the surge than he had in the last two years,<laugh>. And I kept checking on him and seeing how he was doing. Um, but, you know, how, what is age LA meant to you during this time and what do you see, you know, where we can try to, you know, we're trying to get programming and other materials out for our in-house, uh, folks. Um,[inaudible] why don't we start with you as the vice president of, um, vice chair of, um, publications, but also just sort of what ALA personally has meant to you during this time.

Speaker 2:

Yeah, so I, I think you said it well, which is there's a lot of various connections that I have made through A H L A and there really is sort of a spirit of camaraderie. Um, but there's also a, um, you know, core competency in lots of people that I just really have, um, found to be very helpful during this time. Um, and me and Brian both do a lot of research. I haven't reached out to them, uh,<laugh> yet, but, um, but we may soon, um, because we actually do some, some research and ours is sort of on hold except for the COVID 19 research that we're doing. Uh, and, but because that's not a main focus, not something that I have spent a lot of time looking at, um, there are some other department, other things in my department that do some research, and so, um, that may be something they're doing, but, but trying to help people make connections to say, Hey, how are you doing this? But, um, but also otherwise other ways as well. Um, the number of people shared what their state's doing and, uh, what their governor's orders is looking like and what they would have wanted to see difference if they had it had more input has been really, really helpful. Um, I know that we're just sort of all consumed with this covid and, um, the 19 pandemic. Um, but, but it's been nice to see that we're sort of all in it together. Uh, and the community boards have been good for having posts, um, both to just get some questions answered, but also see what other people are thinking about and what kinds of things we might need to be aware about that we haven't thought about yet.

Speaker 1:

How about you, Emmy? What would you like to add?

Speaker 2:

Yeah, I'll say we had, uh, we have two attorneys on our team who right as this hit were just then onboarding literally in the process of onboarding. And, uh, and another new attorney on the risk management side of our office who actually came on after this had already started. So, uh, you know, with the caveat that as a state employee, we don't endor endorse any product or service. And so this view is my own, but I was certainly grateful to have the sort of onboarding resources in a box that you can get through a H L A for somebody who's new to, to learning health law, uh, to learning hospital setting, which both of these, both of these attorneys were, were newer to that piece of it. To, to, to in-house hospital work, and be being at home, everybody being remote, it was either probably going to be me on the phone trying to train with PowerPoints through a Zoom, or I could refer them to some of the, uh, some of the well-prepared, excellent educational resources that we had and just say, uh, set aside a few hours in your day and start doing the fundamentals course online. Start looking at, uh, at these particular presentations. And th this will be an excellent resource in getting you trained up and, uh, and on board. So I would say that the educational offerings especially have been indispensable to our team during this time.

Speaker 1:

Yeah. And so I, I agree it's been, um, an organization that I have made some of my closest friends and has been a great resource, um, for me and for others that I've referred to, um, as well. Um, so I, you know, we're, I think we should talk a little bit about the future. We, we have a little bit, uh, but, uh, talk about what we think might be, might, what might be happening in the future. We've got elective cases, elective procedures that may be coming online and, and maybe some cultural changes, like Brian said, there could be mental health or other cultural changes that have impacted all of us that we won't really feel the full impact until maybe some of the stay at home, uh, orders are lifted. Or maybe not even until after we have a vaccine and it's distributed widely. Um, I know that there's testing issues that are, are being discussed as well and monetary financial issues, but, uh, you know, given and even a potential, another search, uh, which we're seeing from our public health officials could be a very distinct possibility or even additional pandemics in the future. Um, with all that, uh, w I'm gonna start with you, you, Brian. Um, what would you like to leave our audience with regarding the future? What are some, some, some things that you'd like to talk about?

Speaker 3:

Yeah, I think the only thing that I, I, and again, it's not probably the best topic cuz we don't see it much on the message boards and, and rightfully so because I think folks are, are hesitant to put these types of things. But I think, uh, particularly the audience that's listening in now and those that are either associated with our practice group or are listening in and, and are wowed by our conversation and wanna join our practice group and welcome them, uh, but I think that they're, uh, I think the issue that, uh, we're gonna be, uh, having to really wrestle with and probably won't feel as comfortable unless you have those deep relationships discussing is when governor's orders start to, to peel off and it becomes more regional, uh, issues about how and what a reopening looks like because, uh, there will be cases where, particularly in the hospitals where, um, a covid 19, um, illness is attributable as hospital acquired. And as we start dealing with reopening our hospitals and our, uh, campuses and our research labs, trying to figure out what is acceptable from a risk perspective, uh, and from a legal perspective as to what those processes look like, what, uh, a a hospital or a university is willing to accept as a risk and knowing that in all likelihood there will be, um, uh, uh, acquired illnesses, uh, that may or may not be, but arguably, uh, um, could be held responsible, uh, for the decisions that we're gonna be making in the next few months of, of what that plan looks like for reopening. And I, I don't, I don't know, other than making sure that you stay plugged in, uh, to our resources that you are, uh, feeling free to use the anonymous, uh, questions as posed to kind of, uh, create that dialogue. And then I'll, I'll just stress this again and again. It's, I feel bad being the, uh, head of, of membership for our practice group, but, uh, plug in this, but the mentorship program is, is so invaluable right now, and if you're not in it, it's a great time to get into it, which is to, to find someone and be matched up with someone who, uh, may be more seasoned, maybe, uh, has a different point of view where you can just pick up the phone and talk to them and know that you're not being charged by the hour. Um, and, and can kind of, uh, uh, um, share, uh, stories. And, and, and if you don't, if you're part of a system that doesn't have a lot of attorneys into it gives you an opportunity to talk to another, uh, legal person about, you know, what's being discussed and, and other possible avenues for advising our clients on these tough issues, particularly around the risk of, uh, risks that are involved with reopening. So

Speaker 1:

That's kind of what I think we're gonna be too. Yeah, sorry. Sorry, go ahead. I was gonna say no, I was gonna say, I think that's exact, I would, it's interesting cuz I have the two big areas of like ethics or diff really difficult issues that I see have seen are one, when we don't have the ventilators that are needed and what will the decision tree look like for valuable resources. And this is the next wave of questions I'm seeing, which is how do we deal with li liability and litigation strategy knowing that there's immunity in certain states. And so, uh, and then looking at what the governors have put out, see if they'll still, how long they'll be in effect and whether and what the scope is. And these are really difficult discussions to have and they're very, uh, but these are the discussions that we need need to have, uh, right now. Uh, Alicia, what would you like to add or what would you like to leave the audience with regarding what the future might look like?

Speaker 2:

Yeah, I, I, I think I just second what Brian said, which is, um, things you are still changing. And so as our providers, our, um, operations folks are deciding, um, you know, how we move forward into the next phase of what this is going to look like, um, they've got a lot to consider. And as in-house counsel, we have a lot to offer them in terms of what are your potential risks. And I think it's a very important time for in-house counsel to be at the table for them as well, providing support for the decisions that they're making. You may have immunity today and the governor's order could end tomorrow and you don't have immunity anymore for something that might be, um, you know, a hospital acquired uh, uh, issue. Um, you know, we, we've gotta make these plans moving forward, keep balance that. There may be a second. Um, I know I sit on our ethics committee and we've been doing a lot of that planning in terms of how we allocate scarce resources and we don't know what that next scarce resource may be as well. Um, we all about ventilators, but you know, we were looking even at, um, uh, drugs that are used in the IU that we started getting concerned about the, the availability of those. And so how to get all of that back, um, I think is gonna be very difficult. And, um, I think our operations people have a really hard road ahead of them in trying to make those decisions as well. Um, they're, they're making decisions like, do we grab everything that we can so that we have it and are prepared, but doing that takes away from somebody else who might need it more. Um, I think that's actually been a really wearing weight, um, on them as well as they've been trying to decide how they get a hold of resources and I don't think that's gonna get better because I think we have phases of this that will be going through. Uh, and so encourage everyone to, to be a part of those discussions. The legal per can really help them, um, in a lot of ways. One of the ways sometimes is just telling them you can't do that or you can do that. And sometimes that just makes it easier for them knowing that they made the decision that had to be made, but they have, you know, a legal reason that they had to do it the way they did.

Speaker 1:

Okay. And Emmy, what would you like to leave the audience with in regards to what you think the future holds?

Speaker 2:

You know, I'm, I'm reminded of of a quote that that came when we have our, our daily update with, with the governor here and our department of health director, Dr. Amy Acton, who had said, you know, people talking about, you know, look, look toward a bright future. But she said, I really am seeing a bright right now in terms of the level of collaboration, in terms of the level of, of innovation. I can say that even within our department, you know, a lot of in-house attorneys become managers of, of their own staff and of, of certain business areas, even in our area, the, the way we were able to leap into telework, not not just us, but other, at, at our, at our partner hospitals all around, everybody on this phone call now, hospitals and health systems being such a heavily regulated industry. And who would've thought five minutes later we are doing it from our kitchen tables and not really missing much of a beat. I mean, there, there have been some challenges, but we did it and we learned, uh, the, these lessons that, that my health system is taking home in terms of where telework is possible, where in make sure we might be able to leverage this experience to conserve some resources. Uh, we're, we're a state instrumentality, so spaces at a premium, uh, don't even get me started on parking and, and, and coming on site, but it's really fostered some, uh, some creative solutions and collaborations. I mean, with, uh, sometimes when, when the governor tells you, you gotta cooperate, you guys share, uh, it takes that, but we were, we were doing it already. It's been wonderful to see all the quote unquote competitors, uh, in the area, different hospitals and health systems talking to one another. What do you need? What can we get to you? How can we come to the table together to work for, uh, the health of the whole population? And it, it, it took this really humbling event, uh, sudden event to, to get us to that point. But I'm trying to stay focused on the good coming out of it in, in the moment because there does seem to be a lot of it.

Speaker 1:

I, I mean, I think that's a wonderful way to end this, um, podcast. And I wanna thank you, you and Alicia. Brian, thank you so much for joining us today. Um, I, we, we hope that this was important to the audience. If you need any additional information, please take, check out the American Health Law Association, coronavirus, um, tab, click into their website. There's tons of resources there. Come to our in-house PG uh, um, practice group. We have lots of resources as well. And, uh, and thank you all so much for, for joining us today.