AHLA's Speaking of Health Law

GC Roundtable: Two Years Later

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Sarah Swank, Counsel, Nixon Peabody LLP, reunites two years later with two of the hospital general counsel she spoke with on the first episode of the GC Roundtable series and again one year later—Richard Korman, Chief Legal Officer and General Counsel, Avera Health, and David Rowan, Chief Legal Officer, Cleveland Clinic. Together, they reflect on their experiences over the past two years and how the pandemic has affected their lives professionally and personally. They also discuss the “Great Resignation” and the future of the health care workforce, the mental health crisis, and the future of health care delivery. From AHLA’s In-House Counsel Practice Group.

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Speaker 1:

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. It is the GC round table two years later. Uh, my name is Sarah Swank. I'm with the law firm at Nixon tea buddy, out of the Washington DC office. And today I have with me rich Corman and Dave Rowan. Uh, rich, why don't you introduce yourself to the audience?

Speaker 3:

Good. Thank you, Sarah. And, uh, Dave, uh, good day everyone. Uh, my name is rich Corman and I'm chief legal officer and general counsel for Avera health. Avera health is a healthcare system based in Sioux falls, South Dakota. We comprise about, uh, 40 hospitals and hundreds of care locations throughout Eastern South Dakota, Southwest Minnesota, Northwest Iowa, and Northeast Nebraska. Happy to be here today and looking forward to talking about, uh, two years of COVID remarkable, how two years has gone by

Speaker 2:

It's it's slow and fast, right? Um, Dave, why don't you introduce yourself to the audience?

Speaker 4:

Thank you, Sarah and rich. Good to be connected again. And I think as we talked a little bit before, no one thought we'd be, uh, uh, doing these many, uh, sequenced, uh, events, but Dave brown, I'm the chief legal officer at the Cleveland clinic. I've been, uh, the general council where chief legal officer for about 26 years. Cleveland clinic has not surprisingly it's it's major facility in Cleveland, Ohio with a number of hospitals, um, in Northeast Ohio. Uh, we have about 18 hospitals in total and then we've got, uh, five hospitals in Florida in facilities and other locations. We also have a facility in Abu Dhabi, Cleveland clinic, Abu Dhabi that we maintain in connection with the, of healthcare. And we just opened up a hospital in London and we have some other international operations. So happy to be here, Sarah, back to you.

Speaker 2:

Great. Thank you. So just to frame this for the audience, um, uh, in March of, I think the end of March of 2020, um, ALA said, you know, you did a couple podcasts where you talked in-house council, it'd be really great to get the general council perspective on what was happening. And so I called up rich Dave and mark, who couldn't join us today, mark, um, Goldstone, um, and said, Hey, would you like to be on this podcast? We're trying to get information out to the country and you agreed<laugh> thank you. Um, and so we then a year later said, oh, we should, we should take a look at where we've been in this year. And then we should get back on a podcast and talk about it. And so now, you know, rich and Dave here we are two years later. And I think we partly joked partly we're a little sad that the idea that we might need to have a year or two reunion. Um, so here we are, I, I went back and pulled my questions to try to see was I, were we talking about the right things? What were we talking about? And I, and I looked, and the very first question I asked you was, what do you believe your role? What do you believe your role as a general counsel is in response to, in the response to COVID and, and is it different than it was before COVID and so I, I'd almost like to ask you that question again. What has been your role and do you think it's changed? I'll start with you Dave.

Speaker 4:

Well, I think that, uh, thanks, Sarah. And, uh, I think that part of the role is changing all the time, regardless of whether there's COVID or not. Uh, but in particular with respect to COVID, I think that all of us had to pivot very rapidly, uh, into, uh, whether people were going to be in the office or not in the office. Uh, and that's something I think I'll, I'm gonna park to the side for now. I think that the hybrid model and how we interact. Uh, but I think that as far as, uh, being in the office, I've been in the office, uh, that's the regular mode, because I think that during COVID, there's been much, uh, let's say counseling, uh, working with a governance team to be as flexible as possible. And I think that's in our model, the CEOs down the hallway and, and you, you, I mean, there are many things coming up every day. I think that we have a practice area approach where we have lawyers who specialize in, in areas that we have repetitive need for, and also tied into the clinical areas, those clinical areas, of course, we're, uh, operating at full speed. And I think that, uh, I'm very happy that the legal department and I also cover government relations quickly, went into a mode of the hybrid model or stay at home or whatever, and got the work done. And I think that's, uh, that's a tribute to them. And I think that, uh, everybody on this call probably has been amazed at how well people can adjust, answer questions that were different than before COVID. And I think one thing that it was along with all the bad things that happened, there were a lot of decisions that had to be made where you looked at the regulations, you said, this is what we're gonna do. And if we're going to modify a ventilator, for example, to handle two patients versus one, how do we go about that? I think there's a lot of decision making that, uh, was a good training ground for all of our lawyers to make decisions, evaluate risk and alike. Uh, so I think that, uh, I think everybody has been pleasantly surprised at how quickly the model changed. Um, I think more recently we're all dealing with, uh, the increased inflationary pressures and the like, but Sarah, I'm gonna leave it at that and let rich take up the next question.

Speaker 2:

Yeah. Rich, how has your role either stayed the same or changed? Um, because of the pandemic?

Speaker 3:

Oh, thanks Sarah. And actually, I would just, uh, echo a lot of what, uh, Dave said as well. Uh, you know, some of attorneys and other staff within the office of general council here are now permanently working from home and those of us working in the office as, uh, well, maybe, uh, lower a number, but nonetheless our availability, um, regardless of where you are, needs to be, um, top of mind, uh, regarding my role before COVID, um, first of all, it's, it's hard to almost remember, um, when COVID wasn't with us, because it seems like the last two plus years has gone by so quickly, but it also feels like it's, um, 10 years in the making. Um, but prior to COVID, um, you know, the bread and butter issues that we were facing in the legal department, uh, really did not revolve around, you know, um, uh, you know, virtual work, virtual care, but as I can imagine as well with Dave, a lot of those issues and questions have come up and still come up, um, because, you know, uh, various care locations now not only include physical locations, but also virtual locations and the regulatory and, uh, uh, legal, uh, status of those going across state lines. Um, now we don't have the international component that Dave has at the Cleveland clinic. Um, but that would be, uh, uh, another, um, issue I'm sure, uh, he'll be discussing as we go on in this podcast. Um, I've also received quite a few more governance questions, uh, since the, uh, pandemic hit with regard to, you know, attendance, uh, uh, board meetings and board committee, um, and, uh, the work that needs to be done at each one of those levels, um, either via phone or via WebEx or zoom or, or whatever platform that you on, but all in all. Um, I think we've adapted very well, um, over the time period. Um, but then also, um, um, as Dave indicated, you know, solutions need to come much quicker. Uh, it seems like, um, nowadays, because you know, what is, um, appropriate today may not be so tomorrow based on, you know, uh, best practices, government regulation, um, or the like, so it's, uh, still somewhat a work in progress. Uh, but it seems like, um, from prior to COVID within COVID and hopefully coming out of COVID, um, we still, uh, certainly add value, um, to this decisions that are being made all throughout Avera for the benefit of our patients.

Speaker 2:

Yeah. So it's one thing I, I, haven't hearing a lot thinking a lot about, um, this impacts our work. We look at it across the country, is this, this idea of the great resignation or the idea of people taking a time to think about, uh, their work setting. And, and we know that that has impacted healthcare, uh, quite Aquid a lot. And, and in fact, it's, it's, it's nursing it's, um, it's CEO retirements, we're seeing legal retirements, uh, uh, um, it's people saying I'd rather work, um, virtually or as a traveler, or what are some of the things you are seeing around, around staffing and resignations and how the future of like our, our workforce, especially in healthcare, what are some of the things you've been seeing or thinking about, um, and how have you been kind of keeping Aris of those and advising your board about those as well? Um, Dave, I'll start with you.

Speaker 4:

Sure. Thanks, Sarah. Um, and I'll just say rich, I think, uh, um, I, I can say ditto, I think that you did a great summary of what you're doing, and I think it's, it's just evidence that no matter where you are, what size organization you got, some of the same issues and problems. So, Sarah, I think that, uh, from the standpoint of, uh, staffing and healthcare and staffing in a lot of other industries that, uh, that there just are not enough people obviously inflation compensation, but it's not just the money. And I think that, uh, in, in the COVID, we've had various waves where, uh, you know, we had a lot of COVID related workforce problems. And how do you staff up then you've got, uh, a overwhelming demand for healthcare services and not enough staff. Um, and again, it's not just money and, and you have to respect people who have been working extremely hard, some burnout, uh, some deciding that they're gonna take a break of some type, and it's a challenge. Uh, and I think that, uh, it's it's, I would, as far as I can tell pretty uniform across the us, and not just only in the us. Um, you mentioned how do you keep your board informed? I think that, uh, we had implemented before, COVID the idea of an executive committee of the board, and I'd say we've had great participation by board members, um, in keeping them informed on what we're doing and getting suggestions from them. Uh, so that's worked out very well. I think, uh, we had a CEO who's communicated on a very regular basis and other executives, uh, to deal with workforce issues. One thing we did was we did not reduce during COVID, uh, reduce wages or do any layoffs. Um, and that was certainly beneficial to our workforce, but we like everybody else, you know, struggling with what works. Clearly, you have to be flexible with bear to work at a home or remotely, but with caregivers, frontline people that's not possible. And, um, I think that we try to be as transparent, provide as much, uh, hope that there's, there's additional staff coming, but it's, it's difficult. Um, and, uh, I think we're all struggling with some of the same things.

Speaker 2:

Yeah. It's looking at some of the numbers around, um, staffing. There were some states that were over 50% understaffed in some of the hospitals, which is, you know, some of that could be, you know, actually having COVID, some of that could be leaving the hospital or going to a different care setting. Some of it could have been retirements. I mean, it's a, it's a lot, it's a lot of different issues. It seems rich. How about you? What are some of the items you've been thinking about around, um, staffing or resignations or, you know, changes in, in the C-suite, um, and, and how are you keeping your, your board informed of these market issues and care issues?

Speaker 3:

Great. Thanks, Sarah. And, and once again, just echo what, um, Dave said about, um, uh, his challenges with the Cleveland clinic, um, at Avera as well. It's, it's a challenging employment environment, um, because who, uh, we are competing with for employees has essentially expanded, um, due to COVID, uh, someone can, uh, essentially make the same, or even more, um, at a fast food establishment than working at one of our nursing homes. And we've been working hard to try to rectify that by raising, um, salaries all throughout Avera. Um, however, those have challenges as well, because, um, more often than not, we are the largest, um, employer in each one of our, um, locations. And so if we raise our salaries, then of course the market in all of those areas, they have to raise all of their salaries as well. And it just, uh, inflationary pressures may feed off of each other. So we're always concerned about that. Um, another aspect of staffing is really right sizing, um, staffing and having, uh, those 19 to 20,000 folks who work for us working at the top of their license as what they, as we tell folks, um, we want everyone to be, um, as productive as possible, but also doing what they can to take care of patients wherever they are. Uh, one area that we're seeing significant, um, challenges is in, uh, long term care, um, in our nursing homes, um, all throughout our footprint, um, it's becoming harder and harder to find folks to work in our nursing homes so that we can, you know, keep them, uh, open, um, and accessible, um, to the top of the license of each one of those, uh, nursing home locations. Um, and then finally, how we've been able to keep, um, our board and other governance structures informed. Um, uh, as Dave said, uh, they began, uh, an executive committee, uh, component, um, but here at, uh, Avera, uh, we've actually increased, um, email communication, uh, from, uh, the central, um, executive office here at Avera to all of our, um, board chairs and, and, um, governance individuals, just making sure that they are kept up the speed on how we are meeting the needs of, uh, uh, each one, um, of their communities as well. Because as, um, you can imagine we have board members and others, um, from, uh, within our footprint and outside of our footprint and making sure that they have, um, up to date information about, you know, staffing and, uh, just numbers in general has been a benefit for all of us in working through COVID

Speaker 2:

No, it's interesting. One of the things you said, Dave, and, and I keep hearing you say you're echoing each other, right. Which is, which is we, you know, I did a hosted of podcasts where we had, I purposely had chief legal officers from children's hospitals from different parts of the country. So I had, there was somebody from Connecticut, there was somebody from Chicago and someone from California. And what I thought was there may be some differences, like some similarities, some differences. What was interesting was there were some different approaches and we definitely, I think people learned from each other, but it was really much more similar than I think any of us thought. And in fact, somebody said, wow, I guess you're right. You did put, we were, we were from, you know, from three different parts of the country. And we really are having a shared experience in, in, in, in that I, one of the, um, items that we did touch on in that podcast. And it's something that I'm just, uh, I'm seeing a lot, both, you know, on the innovation side and also, you know, in the, in the operational side of, of hospitals and health systems and others, which is the, um, working through what they're calling the, the mental health pandemic, the idea that we, I think one article I read and NPR said it it's a tsunami. Um, like, and some people say the wave, the waves have come, uh, of a mental health, uh, pandemic that, that in fact, that, that this might have increased, um, pressures on people that were already suffering or who had a health condition, but also that we all collectively have experienced a level of ongoing trauma in various forms because of it, including our own mental health professionals who are out treating and, um, helping people. And so, uh, this is something that I think, and for example, on that podcast, we heard one, uh, chief legal officer say, well, we're building a, a, a mental health facility for children because it, it really is that critical to the needs of our state and our community. Um, what are some of what you are seeing in, in response to what has been called this mental health crisis? Um, rich, why don't I go with you first on this one?

Speaker 3:

Oh, very good. Thank you, Sarah. Uh, actually, uh, one of the, uh, uh, components that we are able to provide to many of our communities is our behavioral health services. Um, and we were fortunate here at Avera that, uh, we had a, a, a, an individual who came forward and, um, donated a, a, a large amount of money to us for us to expand our behavioral health services in the, uh, Sioux falls and surrounding areas here in South Dakota. Uh, we actually started construction of that new facility after COVID began, and it just opened about a month ago, um, with, uh, a greater expansion of inpatient beds for mental health services. We actually opened, um, an urgent care, um, for, um, behavioral health needs, and then also expanded, um, significantly our services, uh, to, uh, young folks to teenagers, um, because through the pandemic, um, we have been seeing just like I presume everyone else around our area and the country, a large increase in, uh, uh, behavioral health concerns involving our, our young folks, um, our teenagers, and even down into, um, elementary school age, uh, individuals, um, and we will continue to see that need increase, um, because actually in response to this, uh, call, I did check with, um, our administrator of that area. And within 24 hours of opening, uh, we were full. Um, wow. And that's just the need for the area. Um, right now, um, in behavioral health services. And one other item that we did, uh, work with, uh, another healthcare provider here in our community, along with the city of Sioux falls and, uh, mini haha county and Lincoln county, which are the two counties where the city of Sioux falls is located. We opened, um, um, uh, an entity, uh, as well called the link, which is focused on more, um, dependency issues, uh, wherein if one of our community members is having a concern with, uh, dependency, they can go there and receive the help that they need in hopes of keeping them out of the hospital emergency rooms or our homeless shelters, um, or other care locations, which just, aren't not right for them at that moment. So, uh, the communities coming together and hopefully expanding those services, and that will be something, uh, we will expand probably into the future because, um, uh, those needs will only be growing.

Speaker 2:

Yeah, I think I appreciate you sharing that because for the, for people that are in the audience or either one managing a, a legal department or working on those issues and in both in medicine and legal and, and social work and the community, and otherwise, they probably know how, what is happening, but others might not. And so I think hearing those numbers, like you open a facility and it's full automatically, it's something I think is really powerful to help push health policy and help push health services. And, and, and, and try to think like an optimistic outcome to this, maybe that it does kind of create this idea that mental health services are health services. And we talk about health parity, but we know that that didn't get us probably where we need to, where we fully needed to be. Steve, how about you? What is, what have been some of the programmatic implications of, of mental health after the pandemic or during the pandemic, and what are some of the solutions that you're seeing at the, at the Cleveland clinic?

Speaker 4:

Well, Sarah, I'm, I'm glad you raised the topic enriched, uh, kudos to you in a era. I mean, it, those are a lot of efforts. I know that, uh, this is something that's getting, we've always had, uh, a number of services in, uh, beds on behavioral health, um, and with respect to juvenile, um, and let's say youth, uh, mental health issues, you both have said what we've seen. I mean, it's just, uh, an overwhelming problem. Uh, and that it's one that there are clearly not enough beds counselors and alike right now, and that, uh, we are looking at how we can expand our services and we do a lot already, but, but we, and others need to do more. Um, I'll, I'll say one thing is that, I mean, it's an area that's been traditionally underfunded, pre COVID, and it's only, uh, more severely underfunded with all the additional problems. Uh, as I mentioned, government relations, uh, uh, reports to me, we've got a great director and team. And so, uh, they, along with others, uh, clearly trying to get additional funding. Um, but regardless of that funding, um, you know, we are, uh, looking at how we can expand and particularly with regard to young adults, uh, where the, the need is. And, and as you said, rich all the way down the, the age groups, um, I think the other thing that I'm just gonna throw out is that during this period of time, too, we have seen that there's additional, um, violence, uh, against caregivers. Uh, and it's not just behavioral health patients, but, but that is another factor that I think has been pretty uniform across the us, that with all the stresses and strains that our caregivers are also under, um, uh, you know, additional pressure with regard to, um, uh, problems that arise with patients. And I think that caregivers in the behavioral health area are really renowned for being, um, great to deal with those types of issues, but, but with additional monument, like it really does wear on the workforce. Um, but I just ended by saying we all have to do more, uh, because it's, these are the kind of problems. If you don't deal with them early on, certainly with youth children, uh, it doesn't get any better. And, uh, so that this along with a lot of other areas, I think that, that there's been additional focus on social determinants of health. Um, certainly beyond just the mental health. I know that led and other issues have a lot of attention by our group infant mortality. So I know I'm morphing into a little bit broader discussion, Sarah, but I think that, that there has been additional focus on again, disparities and, uh, that's, I think they've been, uh, clearly echoed across the us as far as we all have to do more.

Speaker 2:

No, it's interesting because all the issues that we're talking about existed before COVID existed, um, violence and healthcare, or I wrote an article for HLA on active shooters, um, because I was thinking a lot about violence and what was happening, and I think there's probably, it, it, I, I don't think it went away. It's likely we'll get worse with mental health, um, opiate addiction and that crisis, um, our, the staffing in burnout was there before. So I think you're right, Dave, these, these are issues we knew about before. Um, also social determinants of health, the idea that, um, you know, in health equity, which I think is a, a newish word about something that we probably all have thought about, but we need to put like a framework around it so we can focus on it, um, in, in the ways that we're focusing on these other issues. Uh, I, I think you completely agree. Um, what's interesting is at the same time we're working on those issues, we have new tools in some ways, because which you were talking about this idea of like a lot of virtual care, um, not being its own thing, but being something that is integrated into care delivery. Um, we have new codes from CMS around, uh, even, uh, remote therapeutic services. So you, you know, doctors could get data as they're going out through their month and could, um, you know, we have virtual visits that were, you can reach out, there's some payment for talking to your doc doctor and in between, um, if you meet certain criteria, we obviously have telehealth that we're looking at. Um, Dave, when I think about the Cleveland clinic, I, I think about drones and AI and research and, and rich, when I think of a, I think about this really intricate telehealth, you know, and, and, um, so, you know, in some ways you're both at places that are really focused on some of this cutting edge healthcare delivery, what do you think is the future of care delivery? Like what does it look like? Um, rich, what do you think,

Speaker 3:

Thank you for that, Sarah. And I guess I would say all of the above with regard to the delivery of healthcare, uh, we have a program, um, here that's being championed by our senior vice president and the communications called precision patient relationships. And what that really boils down to is we have to provide healthcare to our, uh, patients wherever they are. Um, either are they at home? Are they at work? Are they, um, at, uh, another location? Are they on vacation for two months? Are they, um, uh, in their vehicle for that matter? Uh, what the pandemic has taught us is we have to be flexible in how to deliver the healthcare that is needed in our communities. And so we are trying to develop programs, um, to have virtual visits, uh, which we have done and succeeded, and we are, um, delivering, uh, care virtuals, virtual visits. We are even instituting in some locations where our ACOs are active home visits. Um, we are utilizing, um, another business unit of ours called Aberra at home, where caregivers go to individual's home and deliver healthcare. And that's part of, uh, you know, that initiative to bring healthcare to where those patients are. Um, and through, uh, uh, the reimbursement, the regulatory issues, um, we've developed, you know, plans where, uh, due to, um, some flexibility brought on by COVID, you know, we can, um, be financially successful in bringing those healthcare models to the communities, um, where we deliver services. Uh, and that's something that we believe will continue even when, um, COVID is in our rear view mirror. Um, hopefully that will be sooner rather than later. So it's just another way of thinking about bringing healthcare to, um, the communities where we offer services, where is that patient located and what is the best mechanism to get'em their healthcare that is needed at that time?

Speaker 2:

Great. It's interesting. Cause there's some of the models that were happening previously, um, up Dave, I'm gonna ask you the same question, but it's interesting. Cause one of the things I've been thinking about is thinking about working with clients on watching some of these kind of initial Teleme. They were called telemedicine programs at the time and not telehealth, but, but the idea of like things would kind of get launched and they would sometimes there would be a strategy around it. Sometimes it would be a champion within the organization would push like a particular service line forward. Um, and then there would have to be a reevaluation of what technology went with that, or if there was supplemental services from another department that had to go with it and there was a lot of tweaking and it makes me think now, like a lot, we grew a lot real fast in this area, even, even places that were really entrenched in telehealth. I'm wondering if there will be like a reevaluation or a supplementing or some kind of reation of a strategic plan around technology, innovation care and care delivery.

Speaker 4:

Right. Thanks Sarah. That, um, that there's, we have to be constantly looking at how we can innovate for better care, obviously cost effective. Um, and also there's always going to be personalized healthcare, additional gadgets, additional ways to monitor our health on an ongoing basis clearly, and not a lot of entrepreneurial activity. And, and we, we and others, uh, look at how we can adapt what we do. Um, not only telemedicine from a, from individual, uh, engagement and by the way, mental health, uh, uh, what I understand is that really the growth of counseling using telemedicine was, uh, readily accepted by people with behavioral problems. I think it just the intimacy, the not having to go out. Um, and so I think that there are things we've learned in that process. So I think there's, I mean, it'd be the constant evolution, personalized medicine, personalized, um, genomics, whatever, but we also all have to, uh, treat populations that don't have as many resources or may not be as tech savvy. And so we always try to enrich, I know you do too, is that to say, how can we make medicine, uh, more accessible? And it may be something simple, like remember to take your meds every day. Um, and there are lots of things like that, but, but we have to, we all have to think about varying levels of expertise, uh, and resources, and as a, not for profit, we have to serve them all. And for profits very much the same way.

Speaker 2:

Yeah. It's interesting. The, I, I, the idea of like cultural competency, cultural navigation was something that was really like going physically out into the communities, but now it's, um, it's not just that it's understanding how communities interact with technology and whether that there might not just be one way or they might not, or there might be barriers right. To that technology, both from a literary student point of actually having the technology or even just like a cultural, um, consideration around it, either making it more accessible or less based on, on those issues. So it's like not one size all so well, so, um, I asked you this, both you this question last year, so I'm gonna ask you again, which is if you could get into your time machine, if you could go back in time, what would you tell yourself? Um, I don't know if it's last year, but I would say maybe in 2020, like what would you go back and say to yourself about the pandemic or, or personally even

Speaker 4:

Rich you go first

Speaker 2:

<laugh> all right. Rich you.

Speaker 3:

Thanks, Dave. Appreciate that. Okay. Hey, that's a great question today as it was, uh, last year and, and the year before. Oh gosh. If I could go back in time, um, I suppose, you know, just on a personal level, professional level and, uh, it's all about, um, understanding it's all about, um, patience, you know, taking, uh, what is in front of you, um, be it, um, you know, being in your house for two months and, um, not filling up your gas tank because you haven't gone anywhere, uh, during the height of the lockdowns or coming back into the office and seeing, uh, new projects just coming one after the other and knowing that your staff is, um, at its wits end, um, because of, um, the workload, um, that is thrust upon all of us. Everyone just has to have some patience and understanding, um, with each other so that, um, we could not only get through this, uh, pandemic, um, but then also, uh, make sure that what we do actually during the pandemic is, as I mentioned before, you know, value add, and also, um, answers, um, the needs, um, not only for our business leaders throughout our organizations, but the patients that we serve as well.

Speaker 2:

So, Dave, how about you? What would you tell yourself?

Speaker 4:

Um, I would tell myself to take that trip before the borders close down, but that's a personal element.

Speaker 2:

<laugh>, that's, you know, I think not putting off something cuz you think you can do it later. That's a pretty good lesson. That's a pretty good lesson

Speaker 4:

Who would've thought you couldn't go between Canada and the us for over two years, but that's just a personal issue. So now I think that, um, I think we've all been that there's lots of bad things, but there's also a lot of pleasant surprises with the bar state collaborations. I mean, uh, we have seen collaborations with local hospitals. There's still competitors, but collaboration on testing, uh, resources, sharing resources, and like that's been a very good positive. And I think that, um, uh, taking those opportunities, uh, and trying to make those final ma or make those collaborations with government as well, um, and work on those and try to make them long lasting, I think predictably, I mean, how, it, it would've been difficult to anticipate vaccinations and how that would come out in the divisions within society, within workforces and Hawaii. Um, and I think that I'll just reflect on the fact that I think lawyers, uh, I mean most of us that we practice law, but we are also counselors where people get pulled into public relations issues. We get pulled into difficult societal issues with regard to vaccinations and all of the, the temperature that, that went into that. Um, I think that it's probably best we, that we didn't know then how long it's gonna take. Uh, just from a standpoint of, we were always looking for the light at the end of the tunnel and hope and, and I think that there have been a lot of great things and I, you know, this too will pass, but I think that, um, who would've thought that when we're, we're going back a few years and it's, we're over vetted, and then when you go through the pandemic, that's clearly not the case. We go through globalization and you look at medicines and, and uh, devices and the like, and I know that N 95, wasn't something that was in my lexicon. Uh, but you learn that you have to be part of a team that adjusts. And I think there's rewards in all of that. Uh, but in one sense, I think it's good that we didn't know we'd still do it at this

Speaker 2:

Point in time. Could be, I mean, a lot of, um, people have to give themselves space to be it's okay to be tired. Right.<laugh> it's okay. It's okay. To wish it was gone. You know, I, I think you're, I think you're right about that. If, if, if mark was here, not that I wanna speak for mark Goldstone, but, um, but one of the things I think he and I would agree, um, is like what to be prepared right. For if this is however this, this COVID 19 looks or whatever it's labeled as, um, it it's likely gonna be with us for a while in some, some form and some, whatever the label or definition he put on it, it's still something that will be, need to be addressed in our society and healthcare or, or some future issue that that could be similar. Um, you know, I think one of the things mark had talked about in a, a prior podcast was, you know, how do we make sure our system is built so that we don't like lose the memory of this and that we're ready again. So I think a lot of people were surprised there was a Delta and then there was an<inaudible> and then there's like a sub variant. And now, like, could there be another one or not? How would that impact hospitalizations? Um, what are some of, you know, I mean, Dave, I remember you all were putting up ho you know, creating other hospital spaces and doing a lot to prepare for surges. Um, rich, I know you did surge preparedness. Um, is there any like one tidbit or, or something that you you can think of that would be helpful for preparing for the future?

Speaker 4:

Well, again, I think that, um, in offering some, some thought or suggestion, I think that everybody on this call and others have have things they add to that. Uh, I think that, that I've been very pleased that the time that I just stay within the law department, but I think it extends the, the socialization. So people know each other, um, and something we need to guard as we go to hybrid violence, but the teamwork because people knew and trusted each other, uh, that's been rewarding to see. And I know that as we kind of move into the new environment, uh, I know we all think about, yes, people can work from home, or I have, I think that's a strong model hybrid, whatever, but that personal connection so that, you know, the person you're speaking with, not just over a zoom call, but you, you evidence that, that teamwork. And I think that, um, and when you go into the clinical areas and, uh, other areas, the teamwork that you see there, you have to reward people, uh, and hope that that's a muscle, um, that you can always call on because there's always gonna be something new.

Speaker 2:

So one of the things I did last year was I made you play a game. I play with my kids, which is high, low haha. The idea is what is the best thing that happened? What is the low and what was the funny thing? And so I'm gonna make you guys do it again, but I'll do it first because that way it makes you think, but I'm gonna make you think on your feet, um, a skill that you obviously have worked on during the pandemic. Right? So, um, so the high, my high was, um, for me, it's been working on health equity issues. Um, I think that this is the next level of support. I'm glad that we're getting that attention around social determinants of health. I hope we take some of these academic words and start talking about people, not having food and that people die because of race that gendered pronouns sometimes create barriers. And we, and we really like kind of have these kind of tough conversations in healthcare and in as a system in our society and, and move things forward. And I'm really, I think my high has been working on those and working out my firm around creating some support for our clients and others on that. And really that's been my high. Um, I think my low was this fall with my kids and really being impacted, um, having, watching them, having to go home because they had an exposure or going back and forth. And I think that has been tough on a lot of, of, um, parents. And I feel very grateful that I have a job with a level of flexibility. And, um, but I also, it's hard to watch how the impact that has on your family and your kids. So that was my, my low personally, I mean, I've canceled speaking things and hybrided in and all that, but really it's watching that impact on schools and children. Um, I think my funny is that I was telling my, um, my, my kids are twins and they're in, um, elementary school and I was telling one of them, I was gonna throw like a birthday party or some kind of thing over the summer, get people together outside. And my daughter being a dead pan and she go and you two know me, well, looks at me and goes, are you gonna have a theme? And I was like, sure, all the theme, why not? And she said, what's your theme? Is it gonna be a grown up theme or a theme kids would like, and I was like, I think it could be a theme that kids are like, I don't know. And she goes, is your theme gonna be public health? And I was like, what? And she goes, just kidding mommy. And, um, so I think that might've been had a lot of public health talks in our house about masking and vaccines and why we're staying home or whatever. But I just was like, oh my gosh, this kid's killing me. I could think of was like, uh bouque of, uh COVID and I dunno, she, she was pretty funny, but, um, so, uh, so rich, what was your high, your low and your funny moment of this year?

Speaker 3:

Well, um, thus far the, the high, um, you know, getting, uh, more and more out in the community, um, on a personal and professional level, you know, doing more meetings in person again, uh, and, um, actually getting to know, um, our neighborhood neighbors, um, again, and, and having them over, uh, which has always been, uh, something, you know, we've wanted to do throughout our, uh, neighborhood. Um, but haven't had the chance. And what better way to do it is when, you know, a lot of, uh, other areas, uh, are closed down and, and, um, reopening slowly, but get to know people in person who are live closest to you. Um, the low, um, I suppose, has been, uh, what you, uh, indicated what we've talked about before. Um, there's been some individuals in, um, my family and friends' lives that have had some mental health challenges, um, throughout the pandemic, um, and really, uh, trying to get them, uh, the services and care that they need, uh, has been something we've been able to focus on, um, uh, in leading them into, um, I guess, a better outlook at life now, now that we are hopefully coming out of this and, um, uh, pandemic and, and moving forward. Um, and I guess the last thing funny is, um, I haven't had one recently, but I will say the funniest thing I recall about, uh, you know, two years ago now, um, you know, we went home essentially in mid-March and didn't come out of our houses until I don't know, Memorial day or so. And, um, I actually had to go fill up, uh, one of our cars with gas and I drove to the gas station and, and it took me a couple seconds to remember how the devil to fill gas can, again, um, you know, put in the credit card and press the buttons and so forth. And so that struck me as funny when you get out of the habit of doing things, you know, I don't know if that's a short term memory lapse or a long term memory lapse. Um, so I found that pretty funny, uh, in dealing with, you know, trying to get gasoline into the car.

Speaker 2:

That's pretty funny, Dave, how about you? What was your high, your low and your funny moment?

Speaker 4:

Hey, rich, I'm gonna, I'm gonna email you. So I I'm on the putting gas in the car. I I'm one step below, so I'll, I'll get some advice from you.

Speaker 3:

That sounds good, Dave.

Speaker 4:

No, I, I think, uh, listen, I think that, uh, that the people I kind of blend to high and low, I mean, I think that we have been around caregivers who have it much worse than, uh, lawyers trying to figure out where they work. And I think that the high is that the kind of the teamwork that I've been very pleased with that, uh, with regard to the lawyers members of government relations, everybody jumped in. So I think I like to say I hire well and delegate better. And I think seeing all of them perform a great service for the institution, no matter where we're practicing is that's, that's rewarding because they deserve all the credit. I think the law is that, I mean, we all lost somebody or saw people who had it much worse. And I think that, uh, that, uh, also I think our caregivers, uh, when, when I came into work most days, but I didn't have to deal with the stresses they had. So I think that, that you see people who had it tough, uh, behavioral health or otherwise. So that's, that's something that, um, is difficult. I think with regard to the funny, um, I'm not gonna give the specifics, but I think we probably have some zoom call stories, all of us about people who forgot the camera or hit the wrong button.

Speaker 2:

<laugh> Dave. My kids still love your, by the way, but I won't say it on this podcast.<laugh>

Speaker 4:

And, and I'm gonna save the rest for my book. How's that?

Speaker 2:

<laugh> excellent. Excellent. Well, I, uh, I do wanna thank you both for, for coming today. We've had a lot of, uh, struggles this year. We've had a lot of, uh, innovation and opportunities this year. Uh, I don't think any of us thought we'd be doing this podcast this year either. Um, it would be interesting if we're getting together next year. I, I, I, I would like it to be an optimistic one, but we, you know, it would be interesting to see what year three out looks like. Um, but I, I do wanna thank rich and Dave, I wanna thank you both for joining us today. Uh, I, and supporting HLA in getting out information, uh, about what's happening in the pandemic. I know it's, it's well received and, and it's been very helpful, uh, to others out there. So I wanna thank you both.

Speaker 4:

Thank you, Sarah. Thanks rich.

Speaker 3:

Yes. Thank you, Sarah. Thanks Dave.

Speaker 1:

Thank you for listening. If you enjoy this episode, be sure to subscribe to a H L a speaking of health law, wherever you get your podcasts to learn more about ALA and the educational resources available to the health law community, visit American health law.org.