Sarah Swank, Counsel, Nixon Peabody LLP, speaks to three GCs of children’s hospitals about their experiences, and those of their institutions, during the pandemic. They discuss challenges related to staffing, remote working, and treating patients with mental health issues. Sarah’s guests are William Chaltraw, Chief Legal Officer, Valley Children’s Healthcare, Moses Vargas, General Counsel, Connecticut Children’s Medical Center, and Fatema Zanzi, Chief Legal Officer, Ann & Robert H. Lurie Children’s Hospital of Chicago. 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.
Sarah Swank, Counsel, Nixon Peabody LLP, speaks to three GCs of children’s hospitals about their experiences, and those of their institutions, during the pandemic. They discuss challenges related to staffing, remote working, and treating patients with mental health issues. Sarah’s guests are William Chaltraw, Chief Legal Officer, Valley Children’s Healthcare, Moses Vargas, General Counsel, Connecticut Children’s Medical Center, and Fatema Zanzi, Chief Legal Officer, Ann & Robert H. Lurie Children’s Hospital of Chicago. 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.
This episode of HL, a speaking of health law is brought to you by HLA members and donors like you. For more information, visit American health law.org.
Speaker 2:Hello everybody. And welcome to today's podcast. We have with us today, three chief legal officers from children's hospitals. I'm Sarah Sweet from the law firm of mix and Peabody in the Washington DC office. And we're gonna start with our guests. Um, William, why don't you go first and introduce yourself.
Speaker 3:Thank you, Sarah. I'm, uh, William show. I'm the chief legal officer at valley children's healthcare, which is located out in central California in the Fresno Madera area. I've been the chief legal officer here at valley children's for about six years. Um, and prior to coming in house, I was in private practice here in central California, representing hospitals, physicians, and medical groups throughout the state of CA California. So happy to, to be with you, Sarah, and to talk to Moses and, and Fatima.
Speaker 2:Great. Thank you, Moses. Why don't you go next?
Speaker 4:Uh, yes. Uh, hello everyone. Moses Vargas, um, calling you from Connecticut children's I have, um, been here for a little over 10 years and, uh, similar to William came from private practice where I also was trained as a healthcare regulatory, transactional lawyer for a number of years. And, uh, before I came in house, um, you know, the children's hospital world is it's infectious. You get in and you never wanna leave and it's, it's a great place to be. So I'm excited to speak with everyone.
Speaker 2:Great. Thank you. And Fatima, why don't you tell us about yourself?
Speaker 5:Sure. Um, I'm FAAN, I am the chief legal officer here at Laurie children's. Our full name is Anne and Robert H Laurie children's hospital of Chicago. Um, and I've been here for about two years. Um, February 10th was my second year anniversary and I also came from private practice. I was a healthcare transactional and regulatory lawyer, and, um, really enjoying being in the children's hospital world as well. It's been quite a ride, uh, given that my experience here started at the right at the beginning of the pandemic.
Speaker 2:Great. Well, that leads me into my first question. And I'll start with you, uh, you know, we, we keep hearing in the news like about COVID and, you know, it's not really impacting children, you hear, or, you know, people will use that either as a policy discussion or, um, a data point. Um, but it seems to me that children's hospitals played such a huge role in, in the pandemic. And you got like a front eye view right. In, right out of the gate, right. Starting in house. What, what do you think the role, what are some of the roles that children's hospitals have played during the pandemic, uh, that you, that you've seen and, and did anything surprise you?
Speaker 5:Uh, that's a great question. Um, I think we did play a role. I mean, thankfully the, the virus wasn't as, uh, deadly with children and, um, but certainly children were affected in many ways. Um, in the beginning, uh, a lot of it was just testing and making sure that they were safe. And, uh, obviously, you know, so schools, um, were, were really focused on that as well. And, and then of course we got the vaccine and, and then it became available to children and then it was all about getting kids vaccinated. Um, and you know, we've also played a really big role in, and being sites for research, um, uh, for vaccine re search for these kids. Um, and then I would say that the there's sort of, as we've all discussed in this country, a twin pandemic going on with behavioral health. And I think what we've seen, um, is really an exacerbation of, of behavioral health needs of children. And, um, we've felt that adequately here and the needs of children, especially those who, you know, were in remote learning for a long time. Didn't get a lot of their social and psychiatric needs taken, um, care of, um, or they were exacerbated during the pandemic and were definitely seeing a lot of that happen here. So we've played a Q and, and being, um, I think, uh, there for the children who, who needed a lot of that psychiatric and behavioral health need as well.
Speaker 2:And Moses, how about you? What, what, what's something that surprised you?
Speaker 4:Um, you know, I think I would echo everything that Fatima said, um, you know, uh, a different angle for, and when I'm, I'm, I'm fairly certain, I would think that, uh, Lori's in, um, valley experienced the same thing, but what was interesting in the children's hospital world that was separate from other adult hospitals, is that because children initially weren't getting ill, but yet we were having to, we were to not, um, to close down our operating rooms and, you know, all procedures. So we immediately had a lack of revenue that was coming in the door coupled with the fact that we still had high expenses, the, the distinguishing factor there was that the adult hospitals and, and not to sound, you know, really kind of crashed, but they had adults, right, who were getting COVID and they were getting, they were treating those PE those individuals. And so they had revenue coming in at, at a different angle for us. It was, there was complete shutdown of revenue for us. And so there was extreme, extreme, um, financial burden and loss on our part, which then resulted in and, you know, immediate furloughs, um, elimination of positions. And so from a legal perspective, we were intimately involved in, in strategically figuring out how do we roll this out? And we, and it went through phases. We did one phase where we first said, all right, we think this is gonna be enough. And then that was like in March, or maybe April of 2020, and then in June or July, we, we found out like, no, this is continuing. We had to do another cut. And it was extremely significant. It wasn't just position elimination, which I think we faced up to almost a hundred, but the, the concept of furlough, which we defined as, you know, any reduction of hours, whether it's from 40 to 30 or 40 to 20 or whatever, like we had hundreds of individuals who affected just by who were furloughed. And once again, just that not only are you dealing with legal risk around, you know, are these people gonna Sue you for wrongful termination or whatever the, but then you're just dealing with morale issues, right? You're dealing with retention, people not feeling safe in their jobs. And, and so it was, it was very, very stressful as a member of the executive team for us to figure out what is the right way, how do we handle this? How do we learn from others? What are others doing? You know, I remember as the, as the GCs of children's hospitals, we came together almost like on a weekly basis, say, what are you guys doing with this, or how you're handling that, or blah, blah, blah, you know, that kind of stuff. And so that was a very, you know, I, I wouldn't say it was unexpected necessarily, but it was unique, right? It was unique. We can usually learn from our, you know, the adult hospitals, but this was really a clear distinction of how it, the pandemic affected. I think children's hospitals a little bit different than the a are adult partners.
Speaker 2:It's gotta be hard to watch, you know, knowing that there's people that need care and yet you're furloughing people at the same time and you're straining your own institution at the same time. Um, it's gotta be very difficult to, to watch. Um, and knowing that there's be a ripple effect of that, um, that more like moving forward. And I think we're probably seeing that now. Um, William, what, what was something that surprised you, um, during the pandemic and the impact on, on children's hospitals?
Speaker 3:Well, I mean, I would, again, I would echo what Moses said too. I think it's a great point. And I think there's probably that ripple effect you were talking about, which is so we, we were fortunate that we did not, um, have to furlough or lay off workers, but we still lost workers, um, you know, throughout the pandemic, um, that would go to work at other organizations. And now I think, you know, I'm, I'm assuming that Connecticut is having a similar issue too, which is getting that workforce back. So now we're getting to a point now where the, those volumes are coming back and, and, and, and to the extent that you delayed care, um, you know, having the, the staffing to actually fulfill those needs to accept those transfers for the, from the adult hospitals or other hospitals, um, is I think become a challenge to us too. And I think it's gonna be a challenge for, for the future. Um, I think we're hearing that a significant number of those people who left, whether they were furloughed or just retired, or just said, I'm not gonna do this anymore. For whatever reason. Um, they may not be coming back and we need to probably focus on how we're gonna build a resilient workforce in the healthcare community. And so I think that's something that surprised me is that, that was some of the result of the pandemic.
Speaker 2:Yeah. I think that's a really interesting point because I was looking at some of the number staffing levels by state. I don't know if you all saw it and there's some states that are well above 50%, you know, missing staff in hospitals. And I don't know what, where that children's hospital lives over that state analysis. Um, but it, um, you know, that's, I think resulting in a lot of, um, travelers and traveling nurses or temporary staff that's increasing, I know costs and, and can sometimes impact the quality of care or at least the consistency, um, certain cases, but you know, what, you know, what is that impact? What are you seeing now? I mean, I think, I, I think it could almost sound, I don't think any of us mean this. It almost could sound crass like, oh, what do you mean? You're surprised that people are burned out or there's a, a staffing issue. I think when people are not watching it in healthcare, they might not realize how actually bad it is and how impact it is. Um, so I don't know, William, if you wanna start, what, what are some of your experiences around that or thoughts around the, what could be like the staffing crisis we're in now, what that might look like into the future?
Speaker 3:Yeah, so I think what mean, what we are looking at is, is what our opportunities are to partner with other community organiz like universities to develop, um, the workforce of the future, whether it's, you know, working with local universities, develop their nursing programs, um, obviously focusing on, um, you know, wellness issues for our staff that that remains, um, you know, but in taking a look at other opportunities to, to support the team as, as we rebuild that staff. Um, so it'll be an interesting project, but I think it's gonna be a project. I, I had heard that in the state of California, that we are currently down about 45,000 nurses, uh, across the industry, and that's only gonna continue to grow over the next few years. So, um, and that's something that's, you know, project that post pandemic.
Speaker 2:So what are you seeing in Illinois? I mean, is it similar to California?
Speaker 5:Yeah, I mean, I think we're seeing workforce is sort of the number one enterprise risk. Um, I think we're all feeling, um, and, um, it, you know, Moses brought up a great point. The primary issue we were dealing with when the pandemic happened was our workforce. Just like a lot of other corporations were, was, how are we gonna manage our workforce? How are we going to manage the volume issue? Like you mentioned the financial issue. And then, um, you know, when things started to open up again, it was, you know, the great resignation, right. Everybody resigning, everybody deciding, or, or, or, you know, retiring or whatever. Um, so it's been this like rollercoaster ride with the workforce. And how do you retain, how do you recruit, how do you make people feel, um, engaged, um, in this pandemic world? Uh, we did a lot of work on our flexible workforce policies. Um, you know, we had a very small number of, uh, workforce that was remote work before the pandemic, but that completely changed in our viewpoints to, and I think for retention purposes, we had to change, uh, with respect to our workforce. Um, you know, over the last few months with the OCN surge, we had severe staff. I mean, everybody did staffing issues all across, um, the board and we made a, a decision as an institution actually temporarily reduce our bed capacity. So we could properly staff those beds in a safe way. Um, and, um, of course that had financial implications for us, but we thought that was the right thing to do because we didn't want our staff to be in a position where they didn't, you know, have the resource, they need to be able to provide the, the highest level of care that we expect out of our institution. So there was, there was definitely a lot of difficult decisions that had to be made in a fairly rapid way. And, um, and the other thing about it, it, it was the, the decisions had to be made, um, and, and all of the various stakeholders, stakeholders, and thoughts about how this was gonna implicate all those stakeholders had to be thought of as well. So, um, you know, I think in the early days of the pandemic, the executive team was meeting daily to talk about all of these issues. We've now moved to more of a twice a week kind of, um, um, uh, frequency, but definitely staffing and workforce has been the number one area of focus. And I think you've hear, heard it across the board, not just at children's hospitals, but all other hospitals as well.
Speaker 2:Yeah. And so Connecticut, are you, what now are going across the country here? I mean, Moses, do you, are you C you're seeing, are you seeing this as well? And you know, one of, one of the things I was, I was talking to a doctor actually, um, recently, and, uh, she had had a tough, it was a, it was adult patient, but she was having a tough, tough time convincing this person to take a particular treatment for COVID and the person was resilient to taking it, um, partly due to some misinformation. And I just could, you could almost hear it in her voice. Like she was just tired. And she started talking to me about, um, her worry of comp compassion, fatigue, and, and that it was something different than burnout. Um, and that it was not having the resources you need, whether you're a, a doctor or you need a nurse, or it's a drug, or it's a mask, or it's a, it's just a ventilator, it's a, it's a surgical supply. Um, uh, it's a bed to place somebody it's a place to go, you know, a home health nurse to go visit a patient. They it's just, um, a daily thing. And I think the other thing that struck me was hearing when people were trying to do placements or this, or trying to call for resources, sometimes it was taking not, maybe it would take like, like, we'll say it's like takes like maybe five, six calls. Usually it's taking like 40, you know, just trying to find the staff or the person or the thing that they need. I don't know. Moses, are you, is, is that something that you're working through in your Csuite in your organization? Um, and is that, is that something that you, you yourself are thinking about into the future? How, how do you problem solve for that?
Speaker 4:Yeah, no, absolutely. And I don't know if I'm gonna be able to offer anything in addition to what Fatima and, and William said where it's, it's exact same issues. Um, you know, I think also people are tired, right. And particularly in specific areas in the nursing world and especially in our emergency department, um, because they are kind of what fat, most saying earlier, there's a twin pandemic now with the mental health crisis going on in children, which, you know, could be a result of, you know, um, the pandemic. Um, but we're, we're seeing just exhaustion right by our staff members. And we're trying to figure out really kind of tailored approaches to these individuals to figure out what can we do to help them. Um, because when there's exhaustion, there comes so many different things, right. Errors occur and, you know, um, their, their employee injuries happen, you know, all this stuff. And so we're really trying to look at it from an enterprise perspective to figure out, um, for us, workforces are number our, our biggest enterprise risk as well. And how do we stay on top of this, um, to really a, you know, figure out what is the right thing to do, but then execute and do that and have the staff feel confident that we are gonna do something. Um, because a lot of times, you know, it's easy for the C-suite to come out and say, right, we recognize this is a problem. This is what we're gonna do, but do we always follow through, right? And so this is something where we really, really have to make sure we're, we're following through a couple things I wanted to mention that was just kind of tangential around. This is that one thing we found as a result of all of this, that applies to our workforce is that naturally with the pandemic, we, you know, there was a shutdown and this, the concept of remote working became much more available, right? And many of our, the people who aren't at the bedside who had the opportunity to be able to work from home did so a vast majority of our staff members were now working from home. What resulted in that, that was kind of an interesting legal issue. And I don't know if Fatima or, or William faced this, but we started noticing that a number of our employees just at their Liberty decided to move out of state. And we quickly determined that we had literally over, you know, probably close to a couple of dozen of individuals who were no longer in, in Connecticut. And when you have full-time people working outside of your state, you you're essentially doing business from those states. And so there's many implications for having your employees in other states. And we made a decision, you know, we had to do this full analysis as to what, what, what did it really mean for our employees to be in other states? And do we have to comply with our employment law and blah, blah, but, you know, have insurances and all this stuff, and quickly decided like we had to nip that in the bud and kind of come back from that and took a pretty strong stance as an organization that we were only gonna do business in a kind of a tri-state region. And everyone had to reside for the most part in, in those, those three states, that was kind of an interesting ripple effect of the pandemic that we saw, that we kind of, that we had to push, um, on for as well, trying to think what that there was a second one I wanted to mention, but now it's escaping me, but, um,
Speaker 2:We'll find it again. Don't you worry? Um, uh, so I, you know, here, here's one thing that, uh, was just curious about, so we'll turn a little bit to you as people. Um, and that's one of the things that I'm trying to do in this podcast is, um, us attorneys sometimes were, we don't always present ourselves as, as people, right, right. In this. So like, how does the pandemic impact us? And I was trying to think of, uh, uh, like what recently has been the thing that, where it's like, I do it all day and I talk about it and we do it and we can intellectualize it, but then it like hits you as like a person. And you're like, I'm always surprised by it. I don't have good cognitive dissidence between work and home, I guess. But for me, it's been the one to one ratio, which a hundred percent ratio between me trying to plan a work. And my kids having to quarantine, it has literally been every single business trip has been canceled including last week, ALA, sorry, we, we were negative, but we were exposed. Um, but like, I can't get on a plane. I can't get on a car. I can't like, uh, if you guys want me to come visit, you I'd be like, if I plan it, we will be quarantining that week. I mean it, or I think of the top of my kid of my parents telling me about, um, in the beginning of the pandemic about waiting in line for polio shots and just thinking, gosh, that's so strange. And then being like that surreal moment where I'm standing with my kids at the hospital, waiting for their shot, you know, and thinking that was so impactful to my parents and I never heard them talk about it. And then it wasn't until like, you know, 20, 21 that they ever told me about that experience and how they remember it so clearly. And just it. So I don't know if any of you have those moments where you're just like, well, I guess that's how today went or, or you just stop and say, this is a little surreal. Um, even though I do this all day, I don't know. Do you, one of you wanna have anything you'd wanna share with us? I will call on you. Well, William, how about you? I heard you laugh. We'll have start with you.
Speaker 3:Well, I mean, I think the, the entire thing has been surreal from the very beginning. So I think it's all been a challenge. And I think like, you, it, it seems like every other day, for example, talking about our, our, our kids, which I have too in school every other day, you're getting a letter regarding an exposure and how to, and how to just manage that. And then, you know, having a, a, having one who's in one school in high school and how they treat it completely differently than the child that's in grade school and, you know, the ever evolving, um, decisions of the administrations and how they, they, they do that. It keeps you always on your toes. So you can't even not manage even just a business trip, but your day-to-day life and how you're gonna to manage the, the, the board meetings that you need to attend to, or the, the appointments you need to get to. So it's, I think the entire thing has been surreal from the very beginning, but I think to that point, it's, it's caused us to create, you know, and, and, and to be more flexible and more understanding, um, it is not uncommon to have your entire day disrupted because you've got a, a, a, a member of your team who calls you, or sends you a text message and lets you know, that their child is, is sick, um, or has been exposed and needs to quarantine and, and they're gonna have to, you know, address those issues. And so I think it's, it's created, um, that level of flexibility and understanding, um, at least with, with my team and, and we did move of like, um, Connecticut LS. I mean, we, we did not allow that remote work prior to the pandemic and moved very quickly to that and experienced those same challenges, um, when it came to that remote work. Um, and we do have people living outside the state, Moses, if you can imagine, because most people seem to be fleeing the state of California. Um, it's
Speaker 4:Interesting. We actually told people they could not work from California. Yeah.
Speaker 5:California is not allowed on our state.
Speaker 3:Yeah,
Speaker 5:Exactly,
Speaker 3:Exactly. So, so we had that, that similar issue, which is we had a number of employees who decided they wanted to leave the state if they could work remotely. And so setting, setting up a similar process, but I think it's just managing the data that that's been, you know, somewhat surreal and, and given us that flexibility and, and resiliency. So it, it's interesting. Um, and I think in the end, it'll, it'll make us a little bit stronger at least as leaders, um, within the organization. But, um, but we could have a time out from that if we wanted to for a little while. That'd be good.
Speaker 2:Yeah. I can take a, I can take a break from that. I think my favorite is my and my kids come in and they're like, are you doing that boring talk again? I was like, oh my job being a lawyer. Like, and they're like, and then they always are so curious, um, like who all the squares are. So I'm like, well that's so and so, and that's my friend, so and so, I mean, it's just like, yeah, it's pretty funny. Um, but what do you think, how is this, how is the had to do, have you had any surreal moments during all this?
Speaker 5:Yeah, I mean, I think it totally, uh, changed my viewpoint of what meant it meant to go in house. Uh, probably cause I probably had a vision of what that was gonna be when I took this job in like late, uh, 2019 and then started in February of 2020 and had, you know, plans, right. That totally got thrilled, what that in-house vision was gonna be. But frankly it was a, I've seen it as a, you know, um, a silver lining. I know that we taught a lot of talk about that, but I, I got to know my team really well. I got to know the executive team really well because we were in the fast hole together. We were like, you know, it was, we were talking every day, multiple times a day, trying to figure out really hard problems that none of us had faced before. So I wasn't like the newbie trying to face it alone. It was like we were all trying to face all these really hard problems together. So that was, um, to me, um, exciting. Um, and I, I think frankly for me, it's also just the endurance, um, you know, keeping it up for, for this. I mean it's a high level of activity all the time and making sure that I'm taking breaks for myself, um, to just step away and, um, reflect and, and, and just recharge. Um, you know, for the first couple months, I think for the first six months, I don't think anybody like left the they're they're constantly working, right. It was weekends nights. Like we were just just stuff going on all the time, but I think we quickly, I think we all realized in both my legal team and the executive team that, you know, we really needed to step away and recharge. And I, I actually just got back like, uh, from Palm Springs myself because, you know, I was like, I just needed days to get away and, um, and reflect and, and, and not necessarily be in the grind and really making sure that I unplugged, which I frankly did not do very well when I was in practice practice. So, um, you know, that was that's one luxury, I think, as having it being an in-house lawyer that I now have is that I have a, a great team I can rely on and I can actually step away for several days and not have to be on top of things or be on calls, um, which has been good. And I think it's important for leaders to step at example, so that people on their team, when they go away and, and, and spend time away from the office that they actually do step away and unplug. So I, I will say that, you know, the endurance and, and the needing to sort of step away and really be unplugged was something that I learned through this, um, through the last couple of years,
Speaker 2:I think that's a great one. I think I just post about unplugging, cuz I must be thinking about it too a lot. Just like the word unplug. Uh, I, I, one thing I've been doing and it's not because I don't love my clients. I am in private practice. I love them all. But at 10 o'clock at night, I keep my phone down in my home office. I have the ringer on, you could call me. I will probably check my email again, cuz I do have an email addiction problem, but I'm not carrying it around my house with me everywhere. Like I used, it was like with me, like at every moment and I was checking it all the time and that, and you know, I like if someone really needs to me and some people do at night, I, I will answer my phone. I will check it again. But it, it just was like, it was the physical presence of bringing my phone everywhere. I went way after hours. I just needed to like say goodbye to my phone for a little bit. I don't know. Moses, how about you? What, what has been surreal during this? So what are some of your war stories or tips for audience?
Speaker 4:Uh, um, I'm trying to think of something unique. Um,
Speaker 2:Can I give you my favorite? So maybe this will, my favorite still is Brian. I'm gonna shout out to Brian White who told us about this podcast and only the way Brian can about his employee who was on a zoom call and then said, I have to leave. My son just told me the lawns on fire, which has been my actual standard for if I'm doing OK that day with my kid. If the lawn's not on fire, it's a win. I have succeeded in life somehow. It's my, it is like, actually keep that in my head every once in a while, if I'm like, geez, I'm going great. The lawn's not on fire. That's good. Um, so, so Moses, so I would say,
Speaker 4:You know, I would say like, you know, I, I don't know if this is, I think where, where I've struggled the most where I, you know, I really need to, and I've been trying to talk to our executive team more about this is the, I desperately need us to go back in person. And part of that is because it is too easy to double multitask when you're on zoom. Right. And so you're, you can be on the camera and you can hear things that are going on, but inevitably I'm answering emails or doing something else to get ready for the next meeting. Or, and I'm not the only one. Right. And so it's almost like there's this meeting going on of people that are on camera and there's relative discussion, but everyone, you can tell everybody's doing something else at the same time and it's just, and maybe that's multi asking and maybe that's great. I don't know. Maybe we're being more efficient. I, I don't know, but it feels like it's in the, I, I find because of that either we're doing more or we're trying to juggle more, um, and it does get exhausting and it does get, and, and, and I found like there was once where someone said, oh, you said you were gonna do this. And I was like, oh my God. Like, and I'm usually really pretty good about staying top of it, you know? And I'm just like, we've gotta simplify at some level, we have to get back, you know? And that doesn't mean that you couldn't be physically in a room and like checking your phones or anything. It just made it, the, the zoom meetings make it a little bit easier to, to do other stuff. And so that's kind of one thing for me that, um, and I, and I'm paying more attention, like when I'm on bigger zooms, like right now we have the joint commission actually, um, on site, we're having all these leadership meetings above. Like, you can just, you can see people like just doing multiple things. And, um, out of know, I, I think that's one thing that I would love to figure out, cause I don't think Zoom's gonna go away to be honest. Um, there are too many efficiencies, probably the good outweighs the bad with it. Um, but there's, we've got, maybe it's just me. Maybe I need to be more disciplined and not be, you know, I get focused on other stuff, but that, that's one thing that I really need to figure out how to, how to manage or
Speaker 2:Yeah. I should be like, well, you did promise to do that Moses, the beginning of this podcast. So you're gonna have to film that later. That's funny. Um, so, um, one thing I, I do wanna talk about, cause I heard is touch it on it and it's a thing I think some was shocking to me, um, which is this mental health like crisis the way about mental health crisis? That's supposed to, uh, you know, I, I remember reading about it and I was even talking to a doctor, um, I think at Johns Hopkins about like what they thought the next big issue would be. And it was this mental health crisis. And at the same time I was actually working with a client and I was just, we were just talking about it. Like I was just saying, you know, on the side about how it's something I'd been thinking about, it wasn't anything that was particularly touching my life, but it just seemed like a worry that like these, the kids and teenagers and, and that I even wanted to do an HLA podcast about it, but I couldn't figure out how to do it quite right. In the right sensitivity to it. Right. Like to give it the right, the right feel. And I, um, and she ended up telling me about like, um, somebody who, um, that a neighbor of her close friend and her daughter like having to be institutionalized, becoming suicidal because she wasn't able to do like an activity that she loved and just was caught really isolated. And I, I, and I, it just really took me a, a back and, and I looked at the, was it the press release at a Colorado? Children's that I was it, were they the first to go? I can correct me, but, and just, just being like in shock, like knowing it was bad hearing about it, reading about it, talking to the doctors and still not maybe grasping how bad it really is. Are you, I mean, I, I assume you're seeing it, but I, I would love for you each to, to talk about it if, if you want to, because I think it's something that I would think our audience might not have. You know, like I said, you, you read an article, you maybe you have some stories in your life or people that you talk to, but to really connect to what's happening with like data and, and the impact on care, who would like to go first with that one?
Speaker 4:I mean, I I'd, I'd be happy to, to jump the con to start the conversation. So here in Connecticut, we, um, similarly, you know, there's been a surge of mental health patients that are coming to our, our emergency room. And we do have within our emergency room, we have kind of dedicated space. It is not a psychiatric unit, but it's designated space to help kids. It's, it's a more safe environment, I should say for these kids who have mental health issues. And there were, I think there like eight or 12 beds, I can't remember the exact number dedicated in this little, this space. And we were surging up to, without exaggeration, this, this doesn't include the medical patients. Like just the mental health patients are surging like 30 to 40 per day. So you imagine you have 11 or 10, 12 kids let's say in the safe zone and you have up to 30 eat kids elsewhere. Plus the medical issues, right. What's interesting about Connecticut is that our diversion laws are really unique and that in order for our emergency room to go on diversion, we have to get another hospital to accept the patients for the period of time that you're on diversion. And since we're the only children's hospital in the Northern half have of Connecticut, there were just other, the, the, the adult hospitals don't wanna deal with these kids, right? They don't, they have adults, you can't easily commingle kids with adults. Um, and so we were actually going to the state and saying, we need help. We need to go on diversion. We can't be, we can't ACC all of the children, even in, in the state or even just the Northern half of the state who have mental health issues. They all can't come to one place cause we don't have capacity. And so we were, we went on a desperate plea with the governor's office and others, and with our Connecticut hospital hospital association to please bring the, the adult of partners together. So we could figure out like a diversion triage plan, which we did do. Um, but it ultimately, we were trying to, the only way we could get there was by kind of distinguishing and saying, cuz even children, uh, a five year old versus a 17 year old is vastly different. And so we had to even kind of break them down into right kids. I think we said either 15 or 16 and older, please. How about we just divert those kids elsewhere to the adult units, cuz they're closer to adult age than obviously these younger kids. Um, and so those are just a number of challenges that we had, you know, I think we were maneuvered through them they're and it's kind of a, a cyclical kind of process we're noticing, um, where with these kids, um, you know, it's just, there's not a lot of predicted predictability about it. We are getting ready to, um, file a certificate of need to open up a medical psychiatric unit, which will be the only one in the state. So that's moving forward. We're trying to figure out ways to, um, you know, really help our flow issues with within the organization so that these kids don't get stuck. Cause they're just armed enough psychiatric beds in the state to accommodate all the need. Um, so we're trying to figure out how to do our part, um, and, and um, you know, try and really figure out how do we, I, I think I like the idea, I, I think it was Fatman that you said, or someone said that they're putting psychiatrists out into schools, you know, I think that's a brilliant idea as well. Um, anyway, those are things, some of the things that we're trying to do here in Connecticut
Speaker 5:We're facing similar challenges. I mean the ed, um, I think our QD levels have gotten really hard, you know, high, um, you know, lot more kids with suicidal ideation, lot more kids with aggressive behavior, um, autistic kids who have that aggressive behavior who have, whose parents simply cannot manage them at home and it's becoming dangerous for their home environment. So they're coming to the E D. Um, which of course, if, you know, if you see this it's increasing prevalence in the, in the community, then it's really impacting our workforce as well. So we've had a lot of discussions about workplace VI, you know, violence against from patients against our, our providers and how do we, um, you know, manage that type of, um, increase in, you know, um, violence, uh, with our workforce because it can happen right when you have a higher acuity population, a more aggressive population. So, um, you know, making sure we're staffing properly, we actually had a, um, we went into incident command for behavioral health specifically. So, you know, we had a COVID incident command that went on for many, many day, many months. And then we actually last year went into a behavioral health incident command to really focus on what things that we needed to do to manage the surgeon population of patients, as well as the, really the stress on our workforce for, uh, man eing, this and we, we went through, um, a significant amount of increased training of our workforce to manage these types of patients. Um, we also, you know, we have a little like almost like a, um, a cart that goes around and, you know, you can call the behavioral health task force or the little cart that will come and will, you know, um, help you manage a patient. That's having an episode. Um, we do in fact have a psychiatric unit with 12, um, 12 beds, but it's just, it's always full it's. It's just always full. And, um, and we have patients who have both psychiatric and medical needs that are on medical floors and, you know, making sure that those, um, providers on those medical floors were equipped to be able to handle the, these behavioral health patients, um, was another challenge that we faced. I mean, all to say that this is really a system issue, um, a community issue, and we've also been working with our government officials, um, on figuring out how do we change, um, this across the board, you know, need more residential beds, um, need more, you know, um, people who are in primary care practices who really understand how to manage patients with psychiatric conditions. Um, we, we, we, because we just, the workforce of people who are be behavioral health trained is very small and how do we increase that workforce? So, um, you know, really just thinking about that, we actually have a whole team that's really focused on our behavioral health strategy right now, because it's gonna be a multipronged strategy. It, there's not this like one big bang that's gonna fix it all. We we're really gonna have to make, you know, a lot of different inroads in a different, in a lot of different ways, looking at in our partners strategy, looking at our internal, what we can do differently, looking at the, you know, reimbursement, um, barriers to getting, um, you know, uh, parody with reimbursement. Sure. There's parody with coverage, but really is there parody with reimbursement? So all of these issues sort of coming to roost and, and forcing us to come up with some solution.
Speaker 2:Yeah. It's, it's really good. I'm glad that you can share that because I think it will be helpful to people to have context, but also to like other, uh, hospitals out there, not even just children's hospitals that are, are facing these same issues, what are some solutions or things that we're think you're thinking about, um, as we start wrapping this up, I mean, one of my unfair questions that I will not really ask you, but, you know, it's kind of like, what, what does it look like when the pandemic's over? Right. I mean, one of the things we're thinking around is, and is like, well, probably I'm not gonna speak for all of us, but it feels a little bit like, um, you know, maybe what the pandemic is for lawyers. It's a definition that's used by the world health organization, and then we've got the public health emergency and that's a different definition. And then we've got definitions at the state side and we have definitions of like when waivers come and go. But like, it seems to me looking at where we are with healthcare, that, that this, that even when the pandemic is over and whatever things are declared or not declared that there's just, this is gonna, we're going to have a lot of recovery and healing to do from this. And so it doesn't change things just to like change the definition except some of the waivers might you, but, but, but it's not gonna necessarily change that this will still be something that will be work through. I mean, maybe you won't have the, I mean, just to hear that you have an incident command on mental health versus the, the COVID, you know, that speaks, I think volumes. So as we, as we wrap this up, um, if each of you could tell us something that you'd like to leave the audience with something that you think would be helpful for them. Um, let's see, uh, let's start with Moses Ha ha ha.
Speaker 4:The short end of the stick there.
Speaker 2:Think fast.
Speaker 4:Um, well, you know, I'm gonna take something that actually William said and you know, it's, it's really high level, but it's, it's really important that, you know, for us, I completely agree that, you know, there's, even if the pandemic comes to an end, hopefully, you know, knock on wood, there there's gonna be another issue sometime. Right. And hope it might not be pandemic level, but might be something else. And we, as lawyers were trained to that's what we do right. Is we, we provide advice and we help navigate through issues as they as arise. But the one thing about the pandemic is it really, if you're trying to look for the silver lining or, you know, have an optimistic approach, it, it did promote this concept of flexibility and it promoted us. It, it, it helped us to, you know, I think maybe step back a little bit, you know, and learn a lot about ourselves, you know, cause it affected us either personally or professionally our home lives. Um, you know, it affected every avenue from us, but I think that this idea of flexibility and, um, you know, being able to look at things just a little bit differently, you know, I, that's a big takeaway. Um, and you know, there's this idea of losing that personal touch with people, but there's also advantage of being able to, you know, connect with more people, right. Because of the electronic means. So, you know, I, I'm always at half glass, uh, half glass full type of guy. And so I, I think I would wanna walk away from this saying, let's look at the, what, what are the positives we can take at away from this and, um, use those so that as we move forward and we continue to face other issues that might come up, that we can, you know, learn from this and, you know, just, uh, continue to have a similar, proactive, healthy approach, um, to managing other things that come our way.
Speaker 2:Great. I think that's wonderful. I'm a half last full person too. Um, William, anything you'd like to add and leave the audience
Speaker 3:With? Yeah, I think, I mean, I'm, I'm, I'm an optimistic person too. So I do think that we are going to, to get through this and hopefully it'll happen soon. I, you know, where I probably would, would focus on and, and this is coming from the, the perspective of a CLO at a children's hospital is, you know, I, I think that, you know, it's really important as we talk about these mental health issues and other issues that we do need to focus on our kids now more than ever. And I think we uniquely have a role in advocating on behalf of those childrens. We, we have a saying sometimes, you know, people make decisions and, you know, kids don't vote. And so, um, sometimes decisions are made, um, and it's not always in the best interest of children. So I do think that, you know, it's a great time for us to refocus on our kids now more than ever, cuz they really do need us to lead. Um, they need us to make smart decisions, to really do a good job of balancing the risks and benefits, benefits to being unselfish and to really advocate for them. And I think we, as leaders in children's hospitals, um, are uniquely positioned to do that. You know, we're gonna survive this pandemic. It eventually will become endemic, which is just a different phase. Um, and we need to decide what we will learn from this. And I think Tim Moses's point, it'll be interesting. I think we need to have a lot of, you know, learning from how we handled this and hopefully we'll be able to, um, be stronger, um, in the end, both as organizations as well as, you know, as communities. So that was kind of high level, but, um,
Speaker 2:I think it was perfect. I agree with that. We have to give a voice to those who don't get a voice sometimes. And I think that was really, I think really insightful. Um, okay. I'm giving you the last word, but you know, what do you wanna say?
Speaker 5:Yeah. So I totally agree with what, what both Moses and William have said. I mean, I think we do play a unique role in the fact that we have this mission to advocate for children, um, in a deep to, you know, uh, providing clinical care and research and being part of, uh, educating a new workforce that we have coming through who takes care of kids. Um, and, and really making sure that this country realizes that's a really important workforce to have. Um, but, uh, just to pivot a little bit, one of the things that I had my team do this year was read this book called think again, by Adam Grant, who's an organizational psychologist. And, um, it was really meant for us to, to rethink the way our, we, you know, all of our assumptions, um, us as lawyers off with reflect back on our experiences and utilize that experience to provide advice, um, to our client. And it's really forcing us to now rethink our assumptions and our experiences and not necessarily just rely on what we've done in the past or what we've advised in the past. Um, but really have to force ourselves to think out of the box and be more thoughtful about, um, you know, what could be because things are changing so rapidly and, and, and, and, and really focusing on, well, if we can't, um, we, we can't predict what's gonna be around the corner in the future. So we have to be more flexible. We have to be more adaptable in terms of the advice we give here. Um, and we also need to advocate for changes in laws that don't make sense. And so really changing our framework on lawyering, um, and not just relying how we've always done things and how we've always, um, relied on our past, uh, advice, but should we test those assumptions? Should we test those, those legal principles and, and think about ways on providing advice in a new and creative way?
Speaker 2:I think that, I think that's a great way to end this, um, with these themes. And I, I really, um, wanna thank the three of you for coming. Uh, I think, I think you all, well, I think you all know this. I think William and particularly has probably heard me say this children's hospitals have a very special place in my heart, both personally and professionally. I think you do an incredible work and service for the community. And I think you will, uh, I, I, I feel you can, probably audience can hear from you how much you care and that you will, that this is a time to talk about these issues with children in our communities. And, um, so I really appreciate your can to, and coming on today to talk to us. So with that, we'll thank you all the audience for joining us today for this podcast.
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