AHLA's Speaking of Health Law
AHLA's Speaking of Health Law
GC Roundtable: Three Years Later
As the COVID-19 Public Health Emergency (PHE) ends, Sarah Swank, Counsel, Nixon Peabody LLP, reunites three 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 and two years later—Richard Korman, Chief Legal Officer and General Counsel, Avera Health, and David Rowan, Chief Legal Officer and Chief Governance Officer, Cleveland Clinic. Together, they reflect on their experiences over the past three years, the impact of the end of the PHE and associated waivers, and the future of the U.S. health care system. They also discuss issues related to telehealth, behavioral health, and supporting the wider health care community.
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Speaker 2:Hello everyone, and welcome today's, uh, GC Roundtable podcast. Three years later, after the Covid, um, emergency, I have with me today to, um, speakers that have been with me for the last three years during this once a year. Uh, Dave Rowan, and Rich Corman. Dave, do you wanna introduce yourself to the audience?
Speaker 3:Yes, thank you Sarah, and Rich, happy to be with you on the program. Again, name Dave. I'm the Chief Legal Officer, actually the, and also the Chief Governance Officer at the Cleveland Clinic. Uh, I've been with the clinic about 28 years in that position.
Speaker 2:And Rich, why don't you introduce yourself.
Speaker 4:Thanks, Sarah. I'm looking forward to having this conversation with you and David. So, I'm Rich Corman. I'm Chief Legal Officer and General counsel for Ara Health. Uh, Avera Health is, uh, Catholic Health System based in Sioux Falls, South Dakota. We own lease and manage 37 hospitals in South Dakota, Southwest Minnesota, north Northwest Iowa, and northeast Nebraska. We employ about 20,000 folks and have operating revenue just north of 3 billion.
Speaker 2:Thanks. So, I'm Sarah Swank from the law firm of Nixon Peabody in Washington DC and we've been doing this podcast, um, three years in a row. The very first one was taped, believe it or not, I believe, on April 1st, 2020. So April Fool's Day 2020. Uh, we had three. I had asked three of my friends and to join me to talk about what was it like, you know, in the midst of, of starting, uh, lockdown for the Covid Pandemic. And we've done one of these podcasts every year since. So I'm welcome you both back to talk about this. Um, you know, in, in doing this, one of the things we, we focused on is, um, is, you know, our response to Covid, um, as well. And, you know, now looking back, you know, three years later, what was your, what was like the biggest concern or what was on your mind during that time? Like, especially when we look back, you know, over, over these years? Um, Dave, I'll, I'll start with you.
Speaker 3:Okay, thank you, Sarah. Um, I think it's, when you look back, it, it's hard to really put yourself back at a time when there was so much uncertainty, so much, uh, concern about how we were gonna deliver patient care, how we were going to take care of the caregivers, and then all of the personal issues with regard to how you would deal with Covid. And of course, uh, now you look back and you say, well, there were spikes and it was very difficult. But at that time, uh, we had to pivot all of us looking at, uh, p p e. And I think many of us probably didn't know that acronym, uh, at the start of it. Uh, I think people were very scared. Um, and I think one thing that, that we did, and I think we're not alone, is communicate to all of our caregivers, communicate to directors, trustees, try to participate in the public health, uh, environment and, and work with regard to all of the issues. Um, I think that, that caring for caregivers, the community, uh, patience, of course, uh, we've got other topics with regard to how you deliver, uh, uh, legal services during this period of time. But I think it's just easy to forget about how much unknown, how many unknown issues were out there. And we were all trying to cooperate. So I'll leave it at that for now, sir.
Speaker 2:Yeah, I can say that's, I mean, we all wanted how to put it. Even like when we did this last year, we wanted to say, okay, maybe we won't need this. Maybe we won't need year three, or after year one we're like, maybe we don't need year two, um, to come back and talk about it. So it, you know, it has been three years, um, and it is hard to put yourself back right at that time. It's really hard to put yourself back going. We didn't really know, like we were sending people home, you know, we were closing down restaurants, we were closing down, um, surgeries. Um, at that time we were, uh, off position office buildings. And it's, it's hard. It's almost like you don't, it's not, it's hard to put yourself back at that moment cuz we're, we're somewhere, um, very different right now. Rich, how about you? What was some of your, like looking back, what were some of your biggest concerns in, in response to this pandemic?
Speaker 4:Well, just to build on what, uh, you said and what Dave said. Uh, well, I can put it in the category of pretty much everything. Uh, obviously I mentioned we're, we're in South Dakota, so we were watching what was going on on the West Coast and then on the East Coast knowing full well that, uh, the full force of the pandemic was gonna hit us, um, sooner rather than later. And, um, it really hit us hard in, um, South Dakota at least, um, for Rivera because our, uh, nursing home in Sioux Falls was the, uh, first location where, um, a death from Covid occurred a little over three years ago. So once that occurred, our biggest concerns had to shift, you know, not only taking care of patients, taking care of our caregivers, but also taking care of the organization as well. Cause I, as I assume you both remember, we stopped doing elective services, um, for months. And, um, obviously that, uh, hit the bottom line real quick. I remember being asked, uh, by, uh, my president and CEO to find all the, um, master trust and denture documents and, um, see how many days of cash we needed in order to maintain our compliance, um, with those, uh, covenants within the master trust in denture. Um, I remember, uh, as well, uh, being called, uh, pretty much 24 7, 7 days a week, um, during that time, just because everything was new and we all needed to come together in order to make decisions. Uh, but looking back, it's remarkable. That is three years ago, and here we are, obviously three years later. And, uh, we think we are in a better position now. Hopefully, um, we'll never have to deal with another pandemic again. But if we do, we believe we're in a better position three years later.
Speaker 2:Yeah, I I mean, it's, that timeframe just strikes me as, at least as a, an attorney of like, you know, you're in the morning looking at something, you think you know what the answer is, you're trying. And then even like a couple hours later, going back and like checking a government website or looking at something and the answers changed within a day. I mean, we used to think, okay, we, I, one of the reasons why I gravitated to health law was I do like that it's tied to people and tied to that system. I also intellectually like that things change in healthcare and that there's a new challenge to like, take a new regulation and figure out what does that mean or the public policy behind it. But that usually doesn't happen in the matter of, of of days. Definitely not in a matter of hours. Right? I mean, that's, um, did you both have that? Did that feel like, I mean, I I, it's almost hard to, uh, imagine, but I, that's just, it felt like 20 years of health law was kind of up in the air, um, especially with, uh, a lot of the, a lot of the waivers.
Speaker 4:Oh yeah. So true. Um, Sarah, you know, essentially, uh, back then it was take care of people, take care of your patients, take care of your staff, and we'll figure it out afterwards. Um, you know, and working with our partners in the states where we operate and the, uh, those governmental authorities, you know, everyone was just in a mad rush to take care of people as they came to us for services. And, uh, the idea of slowing down just never came to fruition. In fact, in working with our clinicians and what you said, um, from the legal standpoint, clinician wise, it changed. You know, we had morning noon and, um, afternoon briefings and each one of those briefings there could be a different clinical, uh, uh, uh, treatment protocol, um, for the same patient, um, cause of what's been learned over the past few hours. So it was, uh, quite a time and, um, you know, once again, hopefully we won't have to live through that again. I dunno. David, did you have that experience?
Speaker 3:Um, absolutely. I think as we reflect on this, that, uh, again, the rapid approach of all of this and how, not only within the hospital system, but just the effect on society at large. I mean, information was, it was, uh, a short supply and it was that black swan event that affected everything. We look back, uh, that there was thing, there were things that will not go back to where they were. And I'll try to listen. We all know that. I think that, uh, the, one of the things that we found you as, as an attorney, I came in about every day, um, because we had to meet in our bubble and go through things, but at the beginning we had a, b and c teams were what, uh, teams that would rotate because no one knew whether someone was gonna become incapacitated over a time that became different. But you, I, I always found that being in with the, the key executives really was, was the only way that you could really fully cooperate, uh, at least when you got the C E O and others working there. I think our caregivers too, I mean, the frontline caregivers who had to be in there with all that fear, um, and yet providing services, one thing we did was we made a decision early on that we would not lay off caregivers. And that at least took away some of the, the fear of the economics. But again, people were going in, and I'm gonna speak about a few, there were good things happening too. And I think, Sarah, you mentioned with regard to innovation, it was a time that I hoped that, you know, we don't fully go back to the old fully regulated approach. Regulators were being very accommodating. People were doing their best to figure out if they could have one ventilator covered, two patients. And I mean, I have to give our regulators a lot of, uh, kudos for that. Um, we were in a state, primarily in Ohio, also in Florida, where there was a lot of government cooperation and collaboration among, uh, healthcare systems. Uh, it was, there were good things in a bad situation, but, uh, it, it's, it's really hard to to think. It's only been three years ago, it seemed like, as you said, Sarah, we've lived several, almost lifetimes over that period of time.
Speaker 2:Yeah, I know. It's interesting cuz I think, um, before we did this podcast together in April, um, the very beginning of April, I had done one before, uh, with the C d C on this new thing that didn't really have a name and wasn't a pandemic yet. And, um, going through what, what would that look like if you looked at like sar, like SARS or, um, Ebola or these, um, other public health issues. Um, but those public health issues didn't impact us, like you said, Dave, like in such a way, like it impacted, um, the healthcare system, but it impacted all our, our ourselves, our lives, our community, the world, right? So it's just a very different to think that's where I started on one of these podcasts, one or, or a webinar, I think it was a webinar. Um, and then to see where we are, it's been, uh, it's, it's, we've got, it's a, it would never, you would never have hoped or thought that this would happen. I I do like your positive slant on it. Um, and a lot of that you did come from the public health, uh, emergency, um, being declared and, and the waivers that were put in place and some of the relaxation of or, or changes, uh, at the state level as well. Like, you know, for example, around telehealth and licensure, um, again, another public health waivers was that, you know, ha coming to an end or be ending. Um, you know, I was on, we were on a podcast once and I was, uh, uh, one of these podcasts and somebody said, well, I have a list on the corner of my desk and it's got all the waivers,<laugh> and everything we've been doing trying to, you know, track it, one of the general counsels. Um, and so what, what are some of your concerns with, with the end that the public health emergency ending,
Speaker 4:I guess, concerns? Uh, well, to echo what they just said, that we go back to the old way of doing, uh, um, you know, healthcare, I suppose, you know, let's keep the flexibility. Let's keep, um, you know, the delivery of healthcare fluid. You know, let's deliver healthcare where the patient is, be it in, um, uh, our hospitals, our clinics, our nursing homes, their homes, their offices, wherever the patient is. Let's, uh, devise systems and maintain the systems to make sure that the healthcare can be delivered to where that patient is. That's firstly, and also secondly, uh, another concern that, uh, we have, uh, here at, I don't know, David, if you do or Sarah, you, your clients. You know, we have a whole group of, um, employees and also caregivers who have not known anything other than delivering healthcare under covid 19 public health emergency. So as we come out of the public health emergency, you know, the items in which that will come back to life, possibly some more state regulations or, uh, better regulations that will see the flexibility maybe, uh, uh, go away for certain, um, interactions with patients will come back. So we'll have to make sure that those new nurses and staff understand, uh, uh, those issues, those concerns and be ready for it as we come outta the, um, public health emergency.
Speaker 3:I think that's rich, well stated. I think that, uh, that, uh, in our own staff and the law offices and like, we've got new people who come on, um, and we'll turn to the hybrid ME method and how we, we deal with all that a little bit later. But with regard to just frontline caregivers, uh, they are, they have done such a wonderful job. Uh, burnout is something that, that we, we all talk about. And I think that, that as we come out of this emergency, I mean, I'm sure we're all dealing with nursing, uh, shortages, the economics that, uh, we're now almost every hospital is under financial stress. And so that coming out of what we're, we're facing new challenges, I think that, uh, telehealth, uh, probably we all see that it was a, that was really important at a time when people didn't wanna come into the hospital. I think the, the utilization has changed since people did come or started coming back into the hospital. And I'm, I'm sure you're, uh, I mean we are full, uh, but all those changes in technology and other things coming about, there really isn't any opportunity to catch one's breath. Uh, because the financial challenges regard to the fact that we've had waves, uh, in last year of, uh, everybody being busy, I think on the innovation side. Uh, and just speaking to the training and opportunity for some of the, the newer lawyers, I think they were trained and to take risk, uh, with the right kind of people looking at that risk, I think it was a time for practicing lawyers to experience something that probably gave them a lot of, uh, professional growth because of the fact everybody was stretched. You had to have people exercising judgment and the collaboration on the legal side among, uh, let's say competing hospital systems inside, outside council. Again, there were a lot of very good positives, again, in a very bad situation.
Speaker 2:Yeah, it's interesting cuz I was speaking with a group of law students at GW who had asked me to come speak around telehealth and, and access and equity and, and I was, so, I was on this amazing panel and they had sought me out because of an article I wrote for a H L A on digital health equity. They were the ones that were out looking at where, where's the future of communication? Where's the future of healthcare? And I just thought that was so interesting that they were the ones that are researching and thinking about these issues, whether it's, again, it could be telehealth, ai, these kind of cutting edge, you know, legal issues where it intersects with technology and healthcare. And I have to imagine that that came out of, you know, being a law student during the pandemic or, or, or law law student like, or applying to law school. And I just thought, I thought that was so, so fascinating that they were researching it and taking it like it was a topic. I, I don't know. I think about back in the day around like maybe an environmental issue or a other, you know, whatever other issue and really taking it to heart like, this is a legal issue and we need to like research it and think about it. It was just really, uh, gave me a lot of inspiration for the, the future of, of health law and, and practicing law.
Speaker 3:Well, I think Sarah, I mean just to jump in is that, I mean, we, we saw racial disparities with regard to vaccines and at the same time as other social relations were out there that really, the idea that racism is a public health emergency, uh, was I think, uh, really recognized by almost everybody in the healthcare field. And I think that's a another good that has come out of the pandemic, uh, to just see firsthand that we have to do more for our communities, uh, no matter where you're sitting. And so I think it is that inspiration. We've got a, uh, a medical school here on campus and to see the interaction of those students, uh, we don't have a a law school here, but I mean, to see them interacting on issues that I think we all see as, as emerging ones, we have to really address, uh,
Speaker 2:Yeah. This concept of a underserved community. And I know Rich, you, your, your organization's been working on telehealth for, for years. You and I have no, like, worked on telehealth for years. Um, and, and I'm sure Dave's organization as well, but um, like this idea that there are underserved communities, um, was I think addressed in telehealth before in that we were looking at, there was some, there was, there was some ability actually to, to do telehealth and get reimbursed for it in rural communities, uh, but in a very different model, right. Than what emerged very quickly during the pandemic.
Speaker 4:Oh, yeah, yeah, definitely Sarah. Great point. You know, the idea of, um, bringing healthcare to where the patient is, you know, as we all remember during those times when lockdowns were occurring and folks are just staying home and not going to get healthcare, uh, we expanded our ability to reach those individuals where they were as best we can. And so that, uh, healthcare could continue. Um, seeing a doctor was not something, uh, where you needed to jump in your car and drive to a clinic. You could see your doctor virtually. And I think that served all involved in that relationship very well, um, because we didn't see a lot of, uh, uh, increases in, um, you know, maladies outside of Covid of course, um, because of the fact that, um, our clinics and other locations either were not open or had, uh, uh, less hours available for the public to come in. Um, and continuing that innovation, um, through the pandemic also, uh, um, occurred. You know, we have a, a very strong now hospital at home program. Once again, we bring the services of the hospital to, um, the patients wherever they are. Um, because, you know, as Dave, uh, said, you know, I, their facilities are full. Our facilities are full. So we need to ensure that once somebody is ready to leave the hospital, uh, they, they remain, um, under our care for however long it takes. Um, under our hospital at home program, we're also instituting and working on putting together a virtual nursing program where, you know, that will once again meet the patients where they are so that the care can still be delivered. So even through, um, you know, I guess, uh, well, I dunno if chaos is too strong of a word, chaotic environment at the beginning of covid, opportunities exist. And, um, you know, the innovators and those who think about how to do, uh, uh, care delivery different, um, came to the forefront and, um, thankfully they did so that healthcare could still be delivered to wherever those patients were.
Speaker 2:Yeah. So, so Dave, do you think that these changes, these innovations are, are going to stay, these virtual models that are expanding and, and other changes that were really opened up because of the public health emergency and some of the waivers? Do you, do you think they'll stay?
Speaker 3:Well, I think that, that there will be one thing. You can't go back on the fact that, that, uh, certainly telemedicine, virtual medicine, new technologies are going to continue to evolve. Evolve. I mean, yes, I think it's gonna be difficult. Some cases the waivers fall by the wayside, be it state or otherwise. However, it's a trend that the world is getting smaller, as we, kind of a trite phrase. But, but I think that over a continued period of time, virtual healthcare, like anything else is going to continue to grow and evolve the economics, uh, for stat, uh, where there aren't enough caregivers, uh, nursing shortages, doctors, others. And so I think that while there, some of the waivers will fall by the wayside and we kind of go back, uh, there's a clear trend that when you've got all kinds of things, and I'm not gonna try to explain or I couldn't explain really how AI is going to affect everything, but there's a technology wave that is coming and it's continuing to force change. Um, and it may not be just simple telemedicine, but it may be very complex and it's going to happen.
Speaker 2:So it's interesting cuz um, you know, some of the waivers really, uh, were focused on testing, testing centers, like screening. We come from towel waivers, for example. Um, being able to, you know, put a tent out in the parking lot so they, you know, you don't have everyone crowded into an emergency room or setting up, like I said, a testing, uh, testing site or, um, a vaccination site. Uh, do you, like, do you think that, that, do you think some things with the waivers ending, do you think that that just gets integrated back into healthcare? So for example, do we think, um, I don't think we can have tents in the, in the parking lot, but I, for tele purposes, but more like, do we think that like vaccinations will go back into the physician office or will or pharmacies or these other locations, do we think, um, testing, uh, or we went from no testing to, you know, drive up testing centers to, you know, over the counter testing to, I mean, I don't know what, like, uh, some of the waivers, you know, maybe testing will be done differently, um, or, or, and will be co you know, we know there's gonna be some coverage. Like how do we think that those, those types of things will, will change or integrate back into healthcare?
Speaker 4:Well, I, I tell you, Sarah, based on those couple of examples that you provided, uh, you know, we, um, at Avera over the last, you know, year or two, especially when vaccines were coming out, um, the first round of vaccines, uh, that we were offering to, uh, you know, our own workers, you know, we wanted all those workers to get their vaccines either at their clinic, at the hos, at a, at a, uh, an employer, um, facility at an ARA facility. But as that went on, you know, we, we decided that really wasn't the best way to do it because, you know, we, we'd rather have our clinics seeing people who need to be seen. So then we worked with, um, pharmacies in our communities, and that's where, um, folks went because, um, I, I think in most states, pharmacists can, uh, um, um, you know, provide, um, vaccine injections. And so we just kinda needed to be more flexible in how to accomplish that for the betterment of, you know, our communities and also our workforce as well. And, you know, that is continuing because more than likely this fall when the flu vaccine comes out, you know, we require of course the flu vaccine to be obtained by everybody, but we're gonna be a lot more flexible on where those flu vaccines can be, um, obtained. Um, so that, um, you know, not one place or not, uh, is overwhelmed by those seeking the flu vaccine.
Speaker 3:I think, Sarah, that during the, we, we've talked a little bit about collaboration. I know that, uh, the hospitals in Cleveland, um, got together and put together a joint testing facility. We collaborated with a regard to providing caregivers to, to staff that. I think, yes, uh, some of that kind of falls, by the way, say, but I think the right kind of collaboration only within all antitrust laws and alike, uh, there are things that have continued. And I think the other thing is that with state and local governments that, I mean, there was a, was a real void with regard to, uh, sufficient public health efforts. But I think there has been, uh, I'm happy to see things continue both at the state level and local jurisdictions to try to address, uh, healthcare disparities. Try to, uh, look at how we can rationalize limited resources at times, such as testing, something like that. I think that, uh, I think though that kind of the refreshing collaboration with, uh, st local governments, I think much of that, at least where we are, is continuing. And, uh, as Rich said, I mean, who knows what's gonna come at us the next time around. Um, and I, I'm gonna come back to vaccine development. I mean, I think that, uh, the, the vaccine programs, if just look back and forget all the politics, but if you look back and say, if they had not been, if the, the number of vaccines had not been available and really not readily available, but eventually, so it's hard to see how this would've played out. It would've been, I think, very different. So I think that that science research element that is critical and important. We had started a pathogens institute, uh, before Covid, but it pivoted and, uh, I think many others are, are again, looking and trying to anticipate what could come the next time. And again, part of the collaboration and with government, federal state, uh, in our case, the, the state helped us put together an innovation district with, uh, several local hospitals and, uh, the universities. And again, good things hopefully will be much better prepared the next time around because there'll be something, hopefully it's not as bad, but, um, yes, the waivers will change, but I think that, uh, people are collaborating and the government in many cases understands and it tries to assist, in my opinion.
Speaker 2:Yeah. I, to to highlight, you know, the Consolidated Appropriations Act of 2023 did extend, like Rich, what you were talking about, the acute hospital care at home, some of the telehealth, um, programs for through these are through Medicare. So we do have some reprieve, I guess until December 31st, 2024, as they, as Medicare is able to look at some of the data around these programs and, and come up with a, a use case for them and a viability, uh, for them to continue so that there may be hope for some continued tra like continued transformation of, of, of how care's delivered. One of the things I also thought we should, we should talk about, we did talk about, um, last year was this, what was at the time sort of a, I don't wanna say a new phenomenon, but something that was really starting to get attention, which was this idea of a pan, a twin pandemic around, um, uh, behavioral health. And from what I've seen, you know, with, with clients in the, in the communities that they serve, is that this is something that is occurring, and it's something that's on the minds of, of a lot of hospitals right now, uh, with emergency departments, um, with, uh, you know, the idea that there's, um, what we, what people call borders, people that are this, there's no place to, to get placed into a mental health, uh, bed or even people boarding because there's not an acute bed. Um, at the time, uh, this was something that I guess was anticipated we could say during the, during the pandemic as people may be coming in with Covid, but as the covid numbers were sh shifting it, it appeared that this, this, the same, the same, uh, phenomenon or, or, or issue was still occurring. Is that something that, that you all have been working through or have comments on this idea of a, of a twin, a twin pandemic or the idea that there's, we're gonna have, um, a behavioral health, uh, epidemic, I guess, um, that was probably already around before the pandemic, but may have been more acutely become, you know, I I guess more in crisis after the pandemic?
Speaker 3:Sarah, I'll take a, a shot at that. I mean, I think that yes, there is that epidemic and it's been here during Covid. Uh, I think that there are not enough mental health, uh, resources available, uh, behavioral health beds in hospitals. Uh, I think, uh, and we see that manifest itself in many different ways. Uh, I think that there's in pediatric, uh, mental health problems that, I'm not gonna try to cite a statistic, but it's a, it's an astounding number of healthcare visits with a pediatric patients involve some kind of behavioral health issue, uh, because of all of the stuff that, all the matters that, uh, children, young adults had to go through. Um, and the difficulties there and there just are not sufficient resources. And telehealth services have helped. I mean, uh, uh, I think it's probably one of the bright spots with regard to the, uh, using telehealth systems, but there just are not enough resources. And while I applaud government in many different things, they're just insufficient financial resources to deal with the problems.
Speaker 2:Rich, I, one thing I, if you, I remember you said that just really struck me last year and it's actually stuck with me this for a while, rich. Was that the opening of your, of a facility in your system? And I, I think in, and if I misquoting you, I apologize, but I believe you said it was basically full when it opened.
Speaker 4:Yes, and it, and yeah, we were, um, fortunate to have a, a generous donor come forward and, um, work with us to expand our behavioral health capabilities. Um, and we were able to do that, uh, focusing first of all on, um, teenagers and, uh, the mental health needs of teenagers, but also we are able to open an urgent care as well that has really, uh, uh, been once again a success. Um, because as we all know, and I'm sure everyone listening to this podcast now, you know, there is a plenty of, um, individuals out there who are in need of, um, mental health services. Um, that's firstly, and also secondly, we were able to partner with, um, our competing health system and then our county and city governments on opening, um, uh, another like, um, behavioral health, uh, detox center in, um, one of our downtowns, which once again, uh, with the purpose of keeping, uh, those individuals out of our emergency rooms because honestly they don't belong in our emergency rooms. They belong where the specialized care is necessary. And when we've been able to, um, keep that open and active these past couple years as well, um, but it's still not enough. Um, and we all know that we need to do more and, um, hopefully that will come, um, as we move on in time. But we do need to do more in order to service our communities and the mental health needs of, um, those individuals in our communities.
Speaker 3:Rich, well stated, I'm just gonna, and Sarah, I'm just gonna add that yeah, that the violence that, uh, really exists, uh, against caregivers. I'm sure Rich, you see that as well. Um, and sometimes it's behavioral health issues, sometimes it's something else, but it's, it's really something that again, wears down or wears on caregivers, uh, with the violence that's either verbal or physical, um, that really is part of our lives as healthcare providers. And again, uh, it's stressful and a lot of the, the need is really, as you said, behavioral health issues that don't necessarily need to be in emergency room or hospital.
Speaker 2:I really appreciate you saying that. Cause I do think that is something that is something universal that is happening across our country. And, um, sometimes I think of it like, almost like trauma meeting trauma. So you've got somebody in a, whether it's a mental health, behavioral health reason for the violence or, or otherwise, um, but then you have caregivers who have been either through trauma or have had secondary trauma having cared for people in trauma. And we've got this, this, this meeting to together. And we've always talked about like deescalation in healthcare and all these different methods and, um, to do that. But I think at least it feels to me that it's not just the same as it used to be that this is something bigger than ju or at least there needs to be a ref. You could have a refresher on deescalation, but it's almost like going into yourself and understanding your own triggers or understanding trauma informed care. It's almost seems like there needs to be more training, education support for people, um, that are, uh, for healthcare workers right now than even before the pandemic.
Speaker 4:I would agree, sir.
Speaker 2:Yeah. Um, one thing to also to turn to is, um, you know, in this podcast we often talk about lawyers and ourselves and, um, and, and wellness. Wellness for ourselves and, and lawyers. And we, we've talked on, uh, over the podcast, over the pandemic about different things people did to for their own wellness. Um, and it was something that really, I don't know if US lawyers ever really talked about was like, Hey, we, we have wellness and we need to be there to help support people. We need to put our oxygen mask on sometimes so we can help our clients. Um, I'm just curious if anything there was any, like things that you learned about, like either work, I don't wanna say work like balance, cause I don't know if there is such a thing, but like, um, you know, about, you know, making sure that your, your wellness or things that you did like during the pandemic that either worked or didn't work for you?
Speaker 4:What worked for me is, um, first of all, just, just by chance, um, we bought a new treadmill, um, in the fall of 2019. And, and I've, uh, come accustomed to hopping on that treadmill and, and just walking and walking and walking. So that's been, um, um, very helpful, especially in the, you know, the cold winter months. Uh, but in addition to that, uh, I've been able to, uh, rely on, uh, you know, other health law attorneys in the area here where I'm at, but also, you know, we're members of national groups as well, you know, A H L A of course is an excellent resource. Um, but then also there are other, uh, general counsels that we have met, um, over the years. And, you know, a phone call is not a bad thing or even a text message. Um, you know, nowadays can just, uh, you know, have you dealt with this matter? You know, what's your opinion on this? Uh, you know, did you, uh, watch, uh, um, um, the football game last night? Just something to get a little more conversation, um, and activity in your life that may not be, um, related to your job, which I always thought was refreshing, at least for me, in order to recharge my batteries, um, from day to day.
Speaker 2:I think that's great, rich. I mean, a l a has really been that for me, um, as well. Obviously, rich, you and I knew each other before in a l a, um, but I think it's funny, I'm like, there's somebody out here if you're listening, would send me, he would send me pictures of his fire pit, like I had fire pit envy. I would choke. Like, just like these little things that make you laugh, that make you feel like you're part of a bigger community. And I do think that was definitely something that helped me through the pandemic was to know, you know, to do these podcasts or to like, go and talk to my friends and see what was happening out there. Um, I think that was, that's something I, I agree with Rich. Um, Dave, how about you? What were some things that you did or did or still are doing that continue that you kind of learned during the pandemic?
Speaker 3:Sure. I think that, uh, first of all, it was, uh, uh, I'm gonna, I've got a great group of, of attorneys, government relations people who, who really did a great job, uh, coming up with activities to stay close to their teams humor, one thing or another. So I like to hire well and delegate better. And so they did a great job from a standpoint of, of staying close to their, uh, teams. I, I think that, uh, when you compare, and again, I know it's, you can't, can't generalize too much, but if you look at what, uh, I was given the opportunity, which I loved being a counselor and being involved, uh, whatever inconveniences I had from time to time pale compared to, uh, the frontline caregivers. So I think that, uh, as Rich said, I think that people fought together, they worked together. We all had zoom calls with, with people from college or law school or that kind of thing. I got to know all of the dogs and pets that, uh, the members of the, the law department had. Um, and I think we coped. Uh, and I think that it was also a time that, uh, it was a time of great opportunity to, uh, do what we could to help the healthcare environment. And I think that, uh, it was a time for people and I think general counsels, but lawyers generally mostly can deal with a lot of stress and be calm. And that was important. And, uh, I'm not saying lawyers stand out because physicians and administrative people did the same thing, but that was rewarding on a psyche value. And I think that, um, now we all did more physical activity, some other things that, that help get through the day, so to speak. But it, again, I come back to what we went through as at least personally pales in comparison to what, you know, frontline caregivers and others had to go through.
Speaker 2:Yeah, I think that's something that's like a common theme with the people that I feel like I, I know and talk to is this idea that we were like, you support the caregivers. Like, our job is to help the people that help people, and that means we need to be strong for them and then support them cuz they're the ones going through the rough time. Mm-hmm.<affirmative>. Um, but I also think Dave, you and I like definitely like, chatting with you and having a good sense of humor is also helpful.<laugh> and, and, and wellbeing, right? I, I mean, I think that's huge. Um, not,
Speaker 3:Not on a podcast, but I know we all have our stories. We tuck away that, uh, other venues, uh, it was a time for humor among, uh, lots of other things. So,
Speaker 2:Yeah. So, uh, one other thing was, uh, um, I'm curious about like, uh, so cl people that work with me, like clients that work with me or whoever hear me say, oh, well you can't get back in your time machine, right? Because people, when we're, when we're doing a legal issue, we're kind of frozen in facts in a time right now and you're looking backwards and doing an analysis and then you're looking forward hopefully to fix and implement. And, um, but so I always say you can't get back in your time. You can't get it in your time machine and then go back and fix it. But if you were to get back in into your time machine, uh, what would you tell yourself bef like, you know, on April 1st, 2020 when you're about to do this PO podcast? Like what would you tell yourself? Um, I'll start with you Dave.
Speaker 3:Probably some advice that, uh, from one of the board chairs that, uh, that this too will pass, uh, was hard to kind of, to see how we get through all of it. Uh, but I think that, uh, the fact that there was real resiliency, teamwork that would come about, I think that I would've never guessed that, that John, just looking at the, the law department, that people in government relations, that people would be able to pivot so quickly to do their job from home or on a minimal hybrid basis. Litigators got by lots of other people. Uh, while I knew people were very resourceful, uh, I think that, uh, that would've comforted a lot of people to know how quickly people could change from going into the office every day, which I continued to do basically into an environment that they were highly productive, cooperative, et cetera.
Speaker 2:Great. How about, how about Rich? If you got in your time machine, what would you tell yourself on, on April 1st, 2020?
Speaker 4:Oh, just probably echo what Dave just said. You know, be resilient. Um, really, uh, know that the upcoming days, weeks, months, and I suppose years, um, will feel like, you know, multiple days, multiple weeks, multiple months and multiple years. Uh, but knowing that through, you know, the teamwork, um, either through videos or through emails or texts will continue. And, uh, the focus of what we do here is to take care of people, take care of patients, um, but in the midst, um, all of that, you know, remember there are, um, opportunities, um, not only to improve the processes that we have, um, internally, you know, in doing, uh, just the legal work for the organization, but there's also opportunity, you know, as we've talked about, new ways of delivering healthcare to patients. So be open to those, be supportive of, of those and work to make sure those survive, um, not only today but into the future. But more than likely they'll be good for all the delivery of healthcare.
Speaker 2:That's, that's, that's wonderful. I, I, I say for myself, I was a, I guess some, I was, I feel like I got closer to people that I already knew. I feel like I met new people. I never thought I'd meet<laugh>, which is weird cuz we were not in person. And then I think my only like, uh, regret thing is, or a lesson, I think not a regret, is just keep the people that you know close, like make sure to keep in touch with them. Like you were talking about Rich, even if it's just a text message or a, a drop in every so many months just to see how everyone's doing. And I think that's something that really struck me, um, as important, uh, both, you know, not just personally, but professionally as well. Um, so I guess with that, I will like to say, you know, we're, I wanna thank you both for, for being here today to talk to the audience. I know that they have learned a lot from you over the years getting to talk about this subject. I was wondering if there's something that each of you would like to leave the audience with. Um, rich, I'll start with you.
Speaker 4:I tell you, uh, you know, what I, um, also told, uh, the, the rest of the Office of General Counsel here is, you know, don't be afraid to, um, find out or, uh, look for the backing, um, of the opinion that you're about to make. If it takes, you know, five minutes, five hours, don't guess. Be sure of yourself and be confident of your answer. And if you need assistance from someone else, there's always someone that you can call in order to get that confidence of what you provide to your client. Uh, because, you know, they rely on us and, uh, what we need to provide to them is good, solid sound, confident advice so that they can do their job in order to once again take care of patients where they are. So that's, I think what I would like to lead, uh, with folks listening to this podcast. You know, uh, uh, once again, don't guess, be confident and, um, find that resource that will give you that confidence.
Speaker 2:That's great. Rich, how about you, Dave? What would you like to leave the audience?
Speaker 3:Well, rich, well stated. Um, I've enjoyed being with you on this, uh, podcast along with Sarah. No, I I think that, uh, realized that healthcare lawyers, uh, have really a great opportunity to serve, uh, educators, researchers, and clinicians. And it's really a privilege to do so. And I think that the teamwork that we saw during Covid, uh, as continued and, uh, I think it's, it's really an interesting spot to be. And, uh, don't be afraid to take the right kind of risk. Uh, you've got an opportunity to grow. And again, I think it gives us the opportunity to do what a lot of lawyers really, ultimately wanna do is become counselors. And in my, my short phrase, Sarah, is plan for the worst. Hope for the best. And as I said before, I'll repeat it, this too will pass
Speaker 2:<laugh>. Great. Well, I wanna thank and thank you both for joining me and the audience today. Um, I, we, I hope we do get together and do another podcast. I, I hope it's nothing to do with pa uh, pandemics. Um, I really do wanna thank you for, for being here, for the audience, uh, and you've been able to really help people, um, with substantive uh, issues and also around their own departments and organizations. So really I wanna thank you both so much.
Speaker 3:Thank you Sarah.
Speaker 4:Thanks Sarah. And thanks Dan.
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 a H L A and the educational resources available to the health law community, visit American health law.org.