AHLA's Speaking of Health Law

EMTALA and COVID-19

March 23, 2020 AHLA Podcasts
AHLA's Speaking of Health Law
EMTALA and COVID-19
Show Notes Transcript

Sarah Swank, Counsel, Nixon Peabody LLP and Charles R. Whipple, Senior Vice President and Deputy General Counsel, Wellforce, discuss how hospitals are gearing up to respond to the coronavirus pandemic. The podcast covers alternative testing/screening sites, as well as legal issues related to staffing, diversion, and capacity. Stay tuned until the end to get a glimpse into the life of a hospital general counsel during the pandemic! From the Public Health System Affinity Group of AHLA's Hospitals and Health Systems Practice Group.

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

Speaker 1:

Collaborate on. This is Sarah Swank from Nixon Peabody and Charles Whipple. Uh, today we're gonna be talking about Inala and Covid 19. Um, I, my name again is Sarah Swank, and I am in the law firm in Nixon Peabody out of the Washington DC office. And it's my pleasure to have with me today. Uh, Charles Whipple, he's the Senior Vice President and Deputy General Counsel of Wellforce. Wellforce is an integrated delivery system in eastern Massachusetts with four community hospital campuses, an academic medical center, a children's hospital, a home care division, and a physician network of more than 2000 physicians that spanned from Cape Cod to New Hampshire of the New Hampshire board. Um, Charles has been just like me, a uh, member of a H L A for more than 20 years, and he used to be the chair of the in-house practice group. Charles, welcome. Um, I'm looking forward to talking to you about mentality today.

Speaker 2:

Thank you very much, Sarah. I appreciate the opportunity to have that discussion about this, uh, evolving situation that is, uh, challenging our healthcare system today.

Speaker 1:

Yeah, it's, um, it's, we're like, we're definitely living in unprecedented times here. And, um, and so what we're gonna talk a little bit about is Anala Emergency Rooms, um, maybe some of the all offsite, um, screening facilities that are getting set up and how those interplay with the Tala roles. Um, so Charles, you have been in the, kind of the Eastern Massachusetts area and I know years ago you and I are reached, I were reaching out to you when the Boston Bombers, um, situation happened and you personally have worked through, um, a crisis situation. Were there any lessons that you had learned, um, from that sit from that situation that you think, um, would be helpful for our audience today?

Speaker 2:

Well, yes, unfortunately, you know, the Boston area, uh, teaching and community hospitals did, uh, have learned, get some experience related to, uh, disaster prep preparation and response with the Boston Marathon bombing a few years ago. I think there are some lessons we can learn. I think there are some very large differences though, in the pandemic with coronavirus that we're facing today. In a typical emergency response, there's an event that occurs and then you call, put in together your incident command and respond. And it's very intense at the time with the outbreak of the coronavirus and Covid. 19 hospitals in the Boston area have been able to call upon that experience of responding to an event. But we're actually doing this in advance. I mean, yes, there are cases in eastern Massachusetts of Covid 19 and, uh, patients that are suspected to have Covid 19, but there hasn't been one traumatic, impactful event that occurred that triggered it. And so we have the ability to be preparing in advance of what we believe is going to be a tremendous surge on our institutions. Um, and so we are getting all gearing up, but we're having this waiting. So yes, our training with, uh, incident commands, uh, services and NMS under the FEMA model have, we've prepared underneath those and we've tested them with the Boston Marathon bombing responses and we've put'em in place, but we're just gearing up now waiting for the event to happen as we see the spread of this virus, uh, go from pockets throughout the country, um, in, in, uh, so it's a kind of a waiting game. It's an odd, odd place for providers and systems to be in, uh, continuing to run their day-to-day operations, uh, while there are prep, prepping for a surge of coronavirus patients. So it, it's, it's an interesting, uh, balancing act that's going on right now.

Speaker 1:

Yeah, it's interesting cuz my preparedness, I guess, trip like experiences for, while I was in house in Washington DC and we were doing bioterrorism preparation and then, uh, H one n one swine flu preparation in 2000, um, nine. And in some ways, like the bioterrorism event would be, you wouldn't see it coming and swine blue, we, we saw it, but it's, this still feels different to me and it has since the beginning. Um, I think, you know, I'm trying to think through what are some of the reasons why that might be. I mean, one, I think it's the spread of it and, um, a also just the seasonal nature of each one, N one, um, gave us some relief over the summer and time, bought us some time to create a vaccine, um, and, and distribute it, um, during the next season of it. So it's, it's been quite interesting. I was talking, um, yesterday with somebody, an attorney who was in, uh, the New Orleans area during Katrina and, and talking about maybe some of the differences in similarities that we may, may see, uh, with, uh, shortages and, uh, supply shortages and personnel shortages.

Speaker 2:

Well, that is the supply shortages and the ability to gather appropriate and necessary resources is the items that are obviously charge, uh, causing the greatest amount of concern, uh, both locally in the Boston area, but nationally and the ability to have appropriate levels of, uh, personal protective equipment to, uh, as we do not have a vaccine against this, there's research going on against it. We have to be able to take, take precautions to protect our frontline staff, our nurses, our techs, our physicians so that we can continue to provide care when needed most and, and not being able to acquire sufficient amounts to give us comfort. We have enough right now, but if, if there's a huge surge, you know, that next layer of inventory is, is the challenge that we're, we're facing. And the fact that there has been a delay in having a sufficient number of tests, uh, kits in order to determine if someone has coronavirus, has, you know, caused a challenge with understanding and the, the scope and spread of the virus. And that really plays into the waivers that have been coming out of the federal government. And in this podcast that we're talking about, the Tala waiver that has been put out because there is this mixed message that's being portrayed in our 24 hour news cycle that we have now that we didn't have with prior, uh, disease incidents such as, you know, swine flu or H one M one or sars. It was a much slower news period, and now it's a constant churn and you have messages going out of everyone should get tested. Tests are widely available when they're not widely available. Now, there have been a lot of improvements to test being available, but it does induce a lot of patients to seek, uh, conversations with their providers, with their doctors in order to show up at emergency rooms looking for tests. And, and initially the CDC guidance was fairly prescriptive as to who would be tested, uh, if they showed up with symptoms.

Speaker 1:

So that's interesting. So emtala, when we think about emtala, one of the things that they look at is the, uh, medical screening exam. And part of the screening is, is the, the visit, whether it's in an emergency room, urgent care center or a physician visit, whether that's in person or telehealth. Um, but this idea of like the, the visit that and the screening and evaluation. And, and so, um, I know there are certain, I've seen that certain hospitals have set up testing centers outside of their ED or like drive up centers, and I think we're now starting to see alternative locations being, um, set up for screening and testing. What are some of the things that you, you've seen and we know, um, will, um, allow or permit for these alternative sites and it distinguishes between hospital controlled and not hospital controlled. So maybe we should talk about hospital controlled sites. Have you, have you seen any of that? Are there, are there suggestions or other things you've seen around, um, setting up alternative sites that are not, um, part of the emergency department?

Speaker 2:

So a number of, um, hospitals in the Boston marketplace have set up screening locations that are actually outside of their emergency rooms and pop up tents to have the, the patients who are seeking tests to be not actually in the emergency department itself, where we are all still receiving our normal patient load, uh, slightly reduced patient load, but uh, still receiving emergency patients have that screening take place outside. Uh, fortunately we're getting to springtime in the Boston area, so the weather is more conducive to having those pop up tents. Either other locations have created offsite, uh, testing spots in parking lots, um, uh, adjacent to the hospital or near the hospital, or even some have looked at setting up offsite testing locations at urgent care centers that they operate. Uh, and that goes along with the, uh, directives that, you know, we are allowed, uh, CMS advising that you can encourage the public to go to off-campus sites instead of going to the hospital itself. Uh, instead of going to that emergency department, being able to direct people to go some to another location before they show up at the emergency room. Another aspect that's been going on in the Boston marketplace, uh, with community hospitals is discussions with their private practitioners who are on their medical staff to set up a centralized screening location in an effort to not have to replicate testing capabilities in a number of physician offices. And so if every private physician on a community hospital medical staff was going to be doing coronavirus testing, they would need appropriate p p e, the swabs, uh, of which there was a shortage of that as well as the, the face masks and the, and the, uh, gowning. But having them come to one central location so that we don't have to spread out and have minimal resources of PPE and swabs, we can have the centralized and that helps out because there is a limited number of tests. I mean, you can collect samples, but if you not the test to actually provide it, you know, it's not really doing a great job for advancing our identification of those who have the disease or carrying the disease, getting that centralized location to Marshall Resources.

Speaker 1:

Yeah. And so we know that Tala says if it's a community site, then the, the tala obligations will not apply. And it's interesting that you're saying that it's happening across your, um, medical staffs. Um, it also, uh, I mean it was interesting just the fact that that guidance came out in, um, it feels like it was a long time ago, but it was March 9th, um, was kind of telling us where we think cms, um, was where we might be heading, which was towards these community, um, screening locations as well. One of the things, you know, another thing I read Charles was, um, uh, Tufts University's president, um, offering up the campus, um, for care. We know, um, if there is gonna be major surges in the hospitals, um, we'll have to look at, um, uh, where patients are cared for and if they, um, come to the emergency room, um, do they get transferred somewhere else if, if there's no more space or do they stay? Um, just curious if you, um, and any thoughts about, or or anything you've learned in the Boston area, which I know is, is, um, un unfortunately ahead of some of the other areas in in across our country. Do you have, have you seen these, um, like alternative places like the universities are otherwise being set up, but I I've heard, um, of people in certain cities setting, like, um, they're like decommissioned hospital buildings that they're now trying to get up to speed and in the Tufts University space and other spaces, um, have you, what are your thoughts about that?

Speaker 2:

So in the Eastern Massachusetts market, and we are very fortunate to have a, a number of world class academic medical centers and excellent community hospitals, all in a very small geographic area. Um, over the course of the last 40 years, there have been a number of community hospital closings. So there are actually are vacant hospitals in and around within, you know, a 15 mile radius of Boston. And there have been discussions, uh, in the, uh, among providers about whether or not some of those facilities can be stood up, uh, to take a patient overflow from a surge. Uh, there's one south of the city that's Steward Healthcare has been reported is going to, uh, attempt to, uh, reopen this facility and, and designated as a, uh, COVID 19 treatment center. Um, so there are, there's some benefits of being in the, in a small geographic area with such a density of providers and universities. You reference, you know, different, uh, universities or medical schools, um, being able to step up, um, as is across the country. Um, Boston and the colleges and universities have sent their students home and are doing most of their educational, uh, efforts in an online manner leaving large dormitories and college facilities open. Uh, I'm not aware of any specific agreements that are in place right now to utilize that, but it is potential for space. And if some of the medical schools have had more detailed discussions with providers about the ability to, um, Marshall resources of ppe, um, but also the ability to, to potentially house patients. I think it's also an interesting aspect of yes, when a patient does show up at your emergency room, you do have to give them their, uh, screening to, to, uh, ensure that, but you don't actually have to admit them if you're able to divert them to a alternative care site. Um, if they don't have symptoms, if they're not emergent, uh, you may be able to have, um, the ability for them to go home or the ability for them to utilize a skilled nursing facility if that is available. Or there are some other unique startup opportunities, um, companies in the Boston area who are talking about home hospital services, uh, that discussions are ongoing with them that patients who may require a higher level of care than say a skilled nursing facility or home health services, but may be able to have a hospital level care at home without taking up a bed inside of one of the hospitals that may be needed in a search. So, I mean, there's some interest.

Speaker 1:

Go ahead. There's a lot. I mean, it's really interesting. There's a lot going on with that and, um, I know there's CBC guidance about when to, you know, um, to, to have somebody basically go home and the thing looking at, at, at the time, at least for now, the criteria really relates to the ability to care for themselves and who else is in the house that might be vulnerable or who could care for them. But it sounds like we're, one of the things to prepare for is also to, um, where that may end up being the best place for people to go. And it'd be interesting to see if that criteria changes over time, the CDC criteria.

Speaker 2:

So yeah, I, the preparations for, for this expected surge of patients, uh, whether it's through testing or coming to the ED or being able to open up capacity for them is, is going to really change how, I think how healthcare is delivered in the future. I mean, obviously the, there is a, a huge undertaking of converting to telemedicine for physicians who, who don't want their patients to come into offices and potentially in effect, uh, other individuals. But I think it's gonna be, uh, interesting after we get through this, I think the way the healthcare is delivered is going to have been fundamentally altered.

Speaker 1:

Yeah, so it's interesting. So we have, so we talked about like coming to the ed, which is an tala term of our, the defined term, which means, you know, people with their walking in or, or ambulances showing up, um, you know, and EMTALA being an anti-dumping law, you can still see in the guidance that c m s is really concerned that hospitals not turn away patients. And so even with the community, if somebody shows up and wants to get tested or screened, not necessarily, um, still turning them away and looking at enforcement around, you know, transfers or, or deterring people from seeking care in the emergency room. Um, so, but I would, what I'm interested also in hearing about is, um, so as people set up these alternative sites and, um, one of the other things that mtel the, you know, we're looking at under tal that, that, that is a concern is signage and people under understanding where to go. And, and especially with these potential surges, I mean, we're seeing in certain states the National Guard is, is on alert, um, you know, how best can a hospital, what do you think are some things, you know, to, to prep around signage or, or kind of movement of people, again, you, we, like you talked about, there's this idea of putting the tent out maybe to do some triaging with a, a nurse, an appropriate nurse, trained nurse, and you can tell when there's an emergency and getting them as fast to the, the actual emergency department, but, um, alternative entrances. But what are some, I guess what are some other things around signage or training on campus or that you're, that you're seeing or, or things that, um, that are some ideas for response?

Speaker 2:

One, one of the most important things is actually community education about where to, to, uh, seek, um, a test or treatment with that if you think that you may have symptoms of or wanna be tested for, for coronavirus, and it's getting that information out in advance to say, we are doing screening at this location and it, and so that they're, you want'em to go to the right place to begin with. I mean, yes, if they come to the, the emergency department, um, follow rules are still applying, you have to do your screening and, and be able to, uh, determine that there's not an emergency condition that is existing and then be able and then move them to the appropriate site. But if you're able to provide education to them on the front end, whether that's through your website or through your marketing department for communicating of where we're doing this on your webpage and so forth, getting'em to go to the right place to start with, uh, and then not have a surge all show up at the emergency department for, for tests. It's, it's that communication aspect that is gonna help, help do this. And encouraging patients and providers and educating providers, physicians offices that before, you know, if a patient calls up wanting a, a co uh, coronavirus test, um, engaging'em in a conversation about what symptoms they have before just sending them to the ed. And if you've informed your physicians on the medical staff, if it's a community hospital, like, look, this is where our central testing location is, and they can direct them to that as opposed to just telling their patients to go to the emergency room.

Speaker 1:

Yeah, I think that's a spot of the time I've been spending lately is helping with, um, some communication strategies and keeping up with the latest on what that might look like, um, because the situation's so fluid and, and rapidly, rapidly changing. Um, you know, one of the things I think you, you hit on was this, this idea of telehealth and um, and the fact that we now have some waivers around that. Um, but are you seeing, um, do you think like telehealth could be a good, obviously can be a good solution to me for a tele ICU and some, and, and for this idea of physician offices, do you think telehealth has a place in the emergency department? Is there, is there a place where that could be helpful or, or, or is it really focused on hospi like, um, other parts of the hospital and physician offices?

Speaker 2:

Yeah, I think the telehealth is, is probably focused in other areas than in the ed. Um, having telehealth capabilities and the waivers and flexibility that been, that been given out, uh, related to how telehealth can be delivered by providers in their offices will allow them to have that conversation and video with their patients to determine if they need to go to the emergency department or not. But, and or for other practitioners to have, uh, consultations with their providers or their patients actually using telehealth in the ed. I don't know how many, how many organizations are actually set up to possibly have that, and I'm not exactly sure how how this waiver is going would assist with a, a teleevaluation, um, to meet an TLAR requirement as opposed to a, a physical, uh, eval to determine if there's an emergency medical condition.

Speaker 1:

Right. Yeah. And seems like from, if we're thinking about, um, one of the tala requirements around stabilizing the patients and looking at the, the type of, um, treatment that's needed, we're often looking at like ve it looks like ventilators and um, tr trying to treat pretty critical, um, pneumonias, um, seems like maybe telehealth may be helpful in trying to stabilize people. But again, you talked about the shortage of we might have some staffing and supply shortages or ventilator support, uh, shortages that may be, um, difficult to stabilize somebody in a particular hospital if you, um, if if there was not, for example, a ventilator available for somebody. Um,

Speaker 2:

Right. Well the waiver, you know, permitting the transfer of individuals who haven't been stabilized, uh, if it's related to the federal health emergency for COVID 19, I think that is helpful from a standpoint of, you know, if someone has presented at an ED that doesn't have the capacity or all their ventilators are in use and they know that there are some, uh, available in a nearby facility and they can coordinate an appropriate transfer, I, I think there is some, uh, relief granted by the waiver in that. But unfortunately the, the deficit of of ventilators to what the expected need is going to be, I think is, is going to limit the effectiveness of that flexibility.

Speaker 1:

So my understanding is that there are other ways to treat somebody without a ventilator, but it's very, um, personnel. I mean, I, you need a, a person actually like pumping a bag, uh, uh, in very small intervals. And, um, that may, we may need staff to be focusing on, on those type of issues. Um, and one of the things mtel requires is a qualified medical professional does a, does uh, uh, the medical screening exam and, and at least the initial screening, um, looking at that, I know some people have asked the question around, does it, does it have to be a physician and RNs do it? Um, and looking at like state licensure and bylaw, um, issues around that have, have you all like, have you thought through some of the, um, initial staffing or staffing when, if it were to become, um, a critical issue where we'll need potentially nurses bagging people in if there's a lack of ventilators?

Speaker 2:

Well, I think a point that you, the, uh, required of a staffing, uh, an appropriate staff member do the screening. I think you missed one part of our, of the workforce that is available to us, which are advanced practitioners, whether it's a nurse practitioner or a physician assistant. I think if appropriately trained, those individuals would be able to comp, be, uh, qualified to give the emala screening. Uh, but workforce, workforce, uh, sustainability is obviously one of the emergency situations that everyone is action planning around in order to, to meet a possible surge. And certainly if, uh, the workforce is depleted due to illness related to covid 19, but having it's, you know, yes, physicians would be the best, uh, a a the normal option that you would have. But then looking at your NPS and physician assistance as well as your nurses to be able to train them up to give appropriate levels of screening, uh, would be necessary to have that continuity.

Speaker 1:

No, I heard, um, somebody say that they had, um, so when you know that for example, elective procedures are, are being canceled and it's, um, depending on what type of physician you are or practitioner you are, um, you may not right now, um, be doing your day-to-day normal, um, duties and they may be be called on to come help. Um, have you, have you heard or seen or thought through any of the plans around, for example, um, I don't know, anesthesiologists or, um, a I'm trying to think, cardiologists or others that may not necessarily, um, they may be needed cuz there's still people that are gonna be having emergency conditions even during this. But, but they may not, um, they might not be having certain surgeries, they may be having others or they might be put up, they usually scheduled for a couple months and may have more time. Have you heard about them as part of the staffing plan, um, to stabilize patients?

Speaker 2:

Yeah, institutions are discussed having those conversations with, with members of their medical staff. So this is in the more than the community setting where you have, you know, a pocket of probably employed physicians by the, by the community hospital. But then you have a, a large number of private physicians who are on the medical staff whose offices have seen decreased volume, uh, due to individuals engaging in physical, uh, distancing as opposed, uh, i I prefer physical distancing as opposed to social distancing because at this time we need social supports, but maintaining appropriate safe space and staying home, their doctor's offices have been, have seen market decline. And certainly as part of surge planning, if we are going to have significant, um, need of physician resources, tapping those physicians to come in to assist, um, with that is part of the work plan, uh, from a standpoint of when elective surgeries, it's, you know, if those people need to do more, more call surgeons coming in and do more call or assisting an ORs if there are surgeons surgeries necessary. But when you have physicians who normally would've a full office who don't bringing them in to assist with the surge is, is part of the action planning for all the organizations in the it should be in the country actually.

Speaker 1:

Yeah. And so here, one thing I was thinking about, and I know this is probably, um, I hope I'm gonna talk about something that I hope doesn't happen, but we, we know that there's days where emergency departments go on different code levels to divert ambulances or, um, and so one of the things that we're seeing in some of the q and a around disasters is understanding, um, that under tala there may be a time where a hospital's just at capacity, um, it would be interesting to see what that does mean and, and that that it may need to, it may be hard to take any more new emergency patients. Um, they, it does, you know, they, they do hear that you still have to of course, you know, work through your state and um, licensure and notice requirements around, around providing public notification of that. Um, but does it, does it appear, I mean, I guess does it appear that that could be the, the case and is that being planned for or is that, and if it is, is that where these overflow hospitals will come in into play and

Speaker 2:

Each institution, um, in the greater Boston area is looking at how they can increase their capacity. And I will give a lot of credit to the state government and regulators who have been very open to discussions about, you know, if there's a need to temporarily increase the number of ice intensive care beds that are operated at the facility, uh, may understand that. And, and they're being very, um, helpful in trying to find a, a safe way to do that to, to increase capacity inside the facilities with respect to emergency rooms being overrun, uh, over overwhelmed and not be able to take any additional capacity. There is an, we're very fortunate in Massachusetts to have a, a well run emergency medical system in our regions to have good coordination among the, among the institutions. Uh, a number of years ago it was changed. Massachusetts hospitals could not go on divert. Uh, so you have to take patients, uh, because they needed to be, they need to be taken and, and be seen. But there's a good coordination, uh, through the EMS system related to who has capacity for certain types of cases. Uh, where would someone be best treated? There are rules and regulations about certain types of medical emergencies must go to the closest facility, uh, versus, uh, others that are required at the closest facility where they certain, uh, equipment and capabilities. So

Speaker 1:

Yeah, so that's great. I mean it's good to, that we're thinking through the, I guess those issues now. Um, and, and make sure that, it's interesting cuz one of the other things that I, you know, when we think about, um, all this is the idea of enforcement and it, it's hard to think about in some ways because we think we've got, we're gonna have these frontline clinicians, physicians on hospitals really trying to save lives with the best that they can. Um, it's interesting that c m s has stated they'll take a kind of, I would say like a case by case approach to that enforcement, um, looking at, you know, what, you know, what's happening with the hospital at the time, like what capabilities they have, what that person's condition was when they kind of showed up. Um, um, you know, looking at transfers and looking at the conditions of like there's a national, you know, emergency. And again, um, looking at, um, if the transfer, if the transfer made sense because of the recipient hospitals, like for example, um, ventilators or, um, certain rooms they might have or professionals at the time or resources. Um, you know, what, what are some of your thoughts around, um, for hospitals? I was trying to think like how, how do you document in the state of emergency? Are there things that we, that people can think about now, um, in minutes to meetings or otherwise just to, to show the thought process or in, in the medical records or to show, show the thought process of, um, of what, what was happening at the time

Speaker 2:

From a, from a documentation standpoint? Uh, I, I don't wanna say that's an afterthought. I, I think our practitioners are, are gonna be working in a, in a real-time environment that are going to require, uh, typical decisions based upon resources that are available. And the fact that CMS and the regulars have indicated they'll look at this on a case by case basis is, uh, pleasing to hear because I think they understand the severity of everyone is going to be trying to do the best that they can to provide the best healthcare possible to patients. And we are in a crisis situation or will be in a crisis situation with the amount of resources that are available with respect to documentation. It's, you know, the facts that are on the ground at the time, you know, we've been advised, we've looked at the CMS guidance with respect to postponement of elective surgeries, um, and encouraged our providers to look at the, the grid that is included in that that is, was issued on Wednesday the 18th of March about what was elective and what's not elective. And it will eventually boil down to professional judgment of the, of the provider. But having that guidance from CMS as to what should get pushed out a little bit and what can be done so we can preserve PPEs is, is welcome. I do, I'm very appreciative of, of the responsiveness of CMS by issuing their, their waivers and giving guidance to, to understand that this is unprecedented territory that we're working our way into and that we're, none of us are exactly sure what we're gonna see. Uh, but they're giving the benefit of the doubt to providers and and caregivers that they're gonna do the best they can.

Speaker 1:

Charles, I wanna, I couldn't agree more. And I, I wonder, thank you so much for joining me today on Fri on a Friday, uh, March 20th here, um, to talk about Tala and the current conditions. I know Boston is one of the hotspots right now, and and I do appreciate you taking the time today to talk, talk to us. Um, so this is gonna conclude our, our podcast today and I hope that you all will check out the, the coronavirus hub on A H L A will be updated information and um, updated in real time as we can get trying to get out information to you all. So please keep checking that, that resource daily. Um, thank you everybody. Um, we appreciate you joining us. Thank you.

Speaker 3:

The following additional content is being included with the permission of the speakers.

Speaker 1:

Charles, you're awesome for somebody who's like, sorry, I

Speaker 2:

Would free-ranging and not sticking just to tala, but it it is, uh, it's all blend together.

Speaker 1:

Yeah, no, we have to, we to put it in the context of where it is and I feel like if we just sit seriously sat and just talked about Inala, we're not getting the big picture. We have to talk about supply shortages, people shortages cuz that's why people are gonna move around or not be stable or, I I think I i I mean I thought you were a rockstar as usual, so,

Speaker 2:

Oh, well I appreciate that. I, well we were talking about, I was actually having thoughts running through my head because I have a spreadsheet that I'm supposed to turn in by 2:00 PM to my ceo, which is, Hey Charles, all of your staff, what skills do they have and where can we redeploy them?<laugh>? And I've had to go around this morning and talk to all of my risk managers and my attorneys and my assistant and say, okay, do you wanna do visitor screening at the front door? Do you wanna be a unit secretary? Can you do patient registration? Can you do e EVs? All of'em are like, no, I do not wanna do EVs. Cuz they're like, I don't wanna clean up patient rooms after covid patients<laugh>. But I mean, when we say we're talking about everybody, it's like, okay, who can do what I have, I have an RN jd. I'm like, Hey, when's the last time you actually did patient care<laugh>? She was like, are you gonna ask me that? I'm like, yes I am. I'm asking you that<laugh>

Speaker 1:

Charles, that's amazing. Cause I, I do remember the prep for swine flu and we got designated as non-essential personnel and we were gonna get sent off campus and I was like, sit there. And I was always like, gosh, we could probably do something. But, um, that tells you the difference. You know, even,

Speaker 2:

Oh, I, I've been having the, the discussion all day, all week long or last week and a half with the, so my offices are actually not in a hospital right now. I used to be inside of one of our hospitals. We're at an office park and we are the only people in the, in the, not the office park, but only people in our building like, why are we still here? I'm like, because we're essential personnel. I'm like, what do you mean? I'm like, if I was a lawyer in a law firm, I'd be working from home. I'm like, we're here because in case it hits the fan, we gotta go help out. And we're, we're part of the healthcare team here. And if, you know, they need someone to go run supplies from hospital to hospital or office to office, we're gonna get in our car and drive supplies from hospital to office. And that's, that's, I mean, everyone's, every, and this is not just unique to my institution. Everybody in, in the Boston area and I'm sure everybody across the country is like, okay, this is gonna be all hands on deck and we mean all hands on deck. I mean our CEOs and a nurse and she's like, yeah, show me how to do it. I'll run a ventilator. We don't have, we don't run a respiratory therapist if in cases it's, you know, everybody's on, on, on calm. Wow. So.