In the tenth podcast in this series with general counsel on the front lines of the coronavirus pandemic, Sarah Swank, Counsel, Nixon Peabody LLP, speaks with Charles Whipple, Senior Vice President and Deputy General Counsel, Wellforce, and Joseph Clamon, JD, Chief Legal Counsel, University of Iowa Health Care, about how the pandemic has affected their jobs and lives. The speakers discuss how their hospitals are managing the pandemic response, including how they are dealing with patient load and planning for the future, and supply and workforce issues. 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.
In the tenth podcast in this series with general counsel on the front lines of the coronavirus pandemic, Sarah Swank, Counsel, Nixon Peabody LLP, speaks with Charles Whipple, Senior Vice President and Deputy General Counsel, Wellforce, and Joseph Clamon, JD, Chief Legal Counsel, University of Iowa Health Care, about how the pandemic has affected their jobs and lives. The speakers discuss how their hospitals are managing the pandemic response, including how they are dealing with patient load and planning for the future, and supply and workforce issues. 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.
Hello everyone and welcome to the General Council round table from A H L A. I have two great guests with me today. Um, Charles and Joe. Um, Charles, why don't you introduce yourself to the audience.
Speaker 2:Uh, thank you Sarah. I'm Charles Whipple, deputy General Counsel for Wellforce, which is a healthcare system just north of Boston, including Tufts Medical Center, merose Wakefield Hospital, and Circle Health. I've been with that system. Well, Wellforce is a relatively new system. My prior system I've been with about 20 years, so very much looking forward to the conversation today.
Speaker 1:Great. Thanks Charles and Joe.
Speaker 3:Hi. Thanks for having me. Um, I am the Chief legal counsel for University of Iowa Healthcare, uh, which is an academic medical center comprised of the Carver College of Medicine, university of all physicians, university of Iowa Hospitals and clinics, uh, and is a regional referral center here in the Midwest. Look forward to talking with everyone.
Speaker 1:Great. And so full confession, I've known both of you for a long time, but you guys just met each other, so this should be a fun conversation. Hopefully we, we even make friends on the podcast now. Um, so, so let's start with this. Um, Charles, you and I have chatted because, um, about remote working and going into the office. Why don't you tell the audience a little bit what it's like to manage remote teams and how your day looks, uh, or has looked since covid.
Speaker 2:Sure, Sarah. Yeah, certainly everyone's been adapting to having to manage remote workforces or working remotely themselves. I think those of us in the healthcare space have had a little different experience than, than some others. Uh, because some of the work that we do does require us to be onsite, even in the legal department. Uh, I do have a, a risk management department where, uh, in the outbreak of the first surge of covid, they were on site the entire time. And I still actually came into the office every day, uh, enjoying the benefits of reduced traffic, um, uh, flow on the, on the, uh, highways, uh, outside of Boston here. I think one of the challenges that we all find is while you made have company like working from home or working remotely, I think we're all just living at work. Uh, the amount of time that people are spending, uh, in healthcare systems responding to the pandemic is extraordinary. Uh, and when you used to have a break between a meeting, uh, zoom calls are just on top of each other. There is no downtime between, between Zoom calls. I see Joe as shaking his head. Yes. So he knows, uh, he's living the same thing, which is Zoom calls start early and they end late. Uh, or I think right now my system, uh, being a relatively new system, I have three different, um, video conferencing platforms that I can utilize and I'm often very surprised when I actually just have a regular conference call with no video. It throws me off. Uh, but so everyone's available now all the time, pretty much, which is, uh, kind of the standard for he for healthcare. But it, it seems to have just taken it to a new level because you never know in the legal department, uh, with the regulations that were being passed and changes, whether it's a CDC guidance or, or a CARES act getting passed or different interpretation. I mean, literally there were just different interpretations of how to deal with, with, uh, FEMA reimbursement dollars that came out. There were some on Friday and some more on on Monday today that dealing with our finance department trying to figure out where we classify FEMA reimbursement dollars in which fiscal year, cuz we're a ten one fiscal year. So it, it's just the, uh, level of work, uh, has dramatically increased. And it's 24 7 now, pretty much. Joe, have you ever had the same thing?
Speaker 3:Yeah, I have. And I, you know, I agree with a lot with your comments. I think it's not just about, um, uh, the continuous needs of your client, which are absolutely true. It's also about, um, supporting your workforce. These are difficult times that, uh, are challenging for all of your workforce, both in the legal department and the rest of the frontline workers, et cetera. And so we've had a lot of discussions that this is a marathon, not a sprint, and how do you do that? Cause if you're, uh, on Zoom 24 hours a day or, or putting out work where proclamations come out from state government and you've got only a few hours to turn it, cause the client needs to know, uh, what change this means for their operations. You've gotta meet those client demands, but you also have to be sensitive and understand that you're, your, your team is facing challenges and how you lead your team. You know, one of the things I think a lot about is as we've gone into the fall, I think every state, every county, every school district has a little different approach to, to how they're doing schooling and how you help your team, uh, both balance work and, uh, personal obligations for schooling or, or taking care of dependent adults or, or what it is. So we've tried to be very flexible. We've tried to be accommodating and realized that we can't plan long into the future. We know we're in the new normal, but, but you gotta figure out that normal's still shifting under our feet.
Speaker 1:Right. So, so Joe, um, uh, wanna follow follow up on one thing. Um, uh, so on this idea of sh of uh, the idea that everyone has different schooling arrangements or care obligations or work work styles, um, how, how have you personally managed all those items? I mean, people have listened to my podcast. I think my, my twins who are, are, um, rounding towards six here. Um, I think they were will look back and be like, you were talking a lot about us during Covid<laugh> on these podcasts. Um, I dunno whether they'll like that or think they're famous or what, but, um, but, uh, you know, uh, how has that, how has that impacted you personally? How have you personally managed that, um, as well and do you have any stories about managing that?
Speaker 3:Sure. I I think we're all juggling and playing 52 card pick up as fast as we can. You know, um, I have a spouse who's also a lawyer who's got just as demanding of a client. Um, I have a, a child, uh, who who who, who needs to, to have food and, and clothing and well cared for and, and, and some time with their parents. Um, uh, and so all that, and, and I've got a team that, that has families and all that in different family situations, you know, um, on top of, uh, COVID, there was recently, uh, a derecho storm that went through, um, the Midwest that, uh, affected a lot of people, um, left a lot of people without power, without, uh, their homes. Uh, and so we even had team members who needed to find homes and we needed to figure out how they could safely be in homes and how they could get to work safely while not worrying about, uh, what happened to them. Uh, so we've really, the storm on top of, uh, on top of the pandemic have really been trying to figure out how we sustained this. And, and as we go into, you know, rising covid levels, we need to make sure that we have staffing, uh, and we have all those sustainability. So a lot of our work as a, as a group and as a team is focused on how do we do this long-term sustaining cuz this is our new normal. And, and, and that's absolutely true for me personally, as much as, as much as the next person.
Speaker 1:So Charles, um, this idea of keeping departments motivated, you know, it's something that we, I talked about on this podcast over the summer, knowing that we were gonna go into fall and winter and it might end up being, um, even more difficult or more, uh, time consuming, or we just might have, uh, what they call now covid fatigue, whatever, that that can be defined in, in several ways. And one of the things we talked about was what people personally did. Did they go on vacation? Did they go out and run? Some people started meditating, um, in full, here's my covid disclosure and confession. Here's my covid confession. Um, if you look at h l a connections this month, I'm the member spotlight. It says, I went on vacation. I didn't really take that full vacation.<laugh>, full confession did not ended up working a lot of it, um, for really good reason. Really interesting, um, project that's gonna help the country, that kind of thing. So I I, I'm, I'm totally happy to have done it. But, but what have you done to try to, to motivate your teams and, and also like for yourself, what, what have you done, um, to try to keep that, that energy level going as we go into, as we're in fallen going into winter
Speaker 2:Caffeine,
Speaker 1:<laugh>, how much full
Speaker 2:Confession? Uh, no<laugh>, um, no, it is, uh, it is a, it is a marathon. It's not a sprint in keeping people involved. I think the fact that we, in Massachusetts in the Northeast we're on the front end of the first wave, you know, basically all their schools got shut down. Everyone was living at, uh, all their kids were home and so forth, and people to work through that. In the summertime, we did have some, uh, reduced, uh, volumes of, of, uh, infection rate and patient loads. So it gave people a little bit of a break, uh, but not a lot. And we did encourage people to take, uh, some time off, even though travel restrictions prevented them from really going anywhere. And certainly, uh, the commonwealth of Massachusetts, uh, put in some fairly strict guidelines for what states you could or could not travel to. And if you traveled to them, you had to, uh, quarantine for X number of days, uh, when you came back or get a negative covid test. Uh, but it is a, a challenge to keep with school. Now, starting up again, a lot of my staff have, uh, school-aged kids. And so really working and being flexible for them to have, uh, work from home remote as opposed to coming into the office. Uh, me personally, for the summertime, I decided to have shoulder surgery, so I couldn't drive for six weeks, uh, which was a nice way to learn how to work from home and actually stand in the shoes of all of my staff who wanted to work from home, because I have, uh, for the longest time steadfastly been like, you know, I need to be in the office. I need to go there. People need to see me. Uh, and to know that I'm there to support them. Um, and so having to sit at home and figure out how to work from home for six, six weeks was, uh, was, uh, eye opening, uh, managed to get some stuff done. Now when people say, I, I need to work from home, I'm not quite as, uh, skeptical<laugh> about the productivity, uh, because people are getting their, their work done. So it's, uh, it's a, it's a tough balance and I, I think our concerns right now are this, uh, rising, uh, in infection, infection rate. And we're gonna go into next surge. Uh, we do feel much more prepared for this surge. And all of the incident command calls that I've been on in the last few weeks, you know, before everyone kind of got caught flatfooted with not having, uh, enough p p e and so forth, you know, we've been monitoring p p e days on hand, uh, using the burn rate from, from March, April, you know, to identify days of PPE on hand and so forth. So I, and people feel more prepared to actually deal with it. And we've learned a lot about the disease and how to care for that disease, but that does not necessarily help with the mental fatigue, uh, which we're still struggling to figure out how to get our, all of our staff to take some time for themselves because they're, they're dedicated and they, they want to be here. So it's not something we've figured out yet.
Speaker 1:How about you, Joe? How do you, um, with this idea of, uh, covid fatigue and, um, how have you tried to balance it and how have you tried to, um, help your staff balance it?
Speaker 3:You know, I, you know, I think with regard to my team, I think the thing that I've done is tried to show flexibility cuz everyone's situation is different and is changing, you know, um, there was a lot of tension in the state of Iowa between, um, certain school districts had a certain way they wanted to go about it. And the, the state government wasn't in favor of that. And so they were still negotiating up until the very last moment, uh, what school would look like. And they even actually went to court over it. So, um, you know, trying to be flexible, we couldn't make plans knowing what that would look like for them, um, in, in any way, shape or form and, and what have you. As for myself, you know, I I think just like any, uh, uh, couple with, uh, two careers, uh, you have to show flexibility. And you have to, you have to say who's on first today and, and do your best. Cuz you know, I always hear parenting is, you know, 50 50 and, you know, I think it's more, uh, 90 10, cuz you can't, you have to be present in your kid's life. You have to be present. And it's just a question of which of you is present in that moment, cuz you can't sort of be present in your kid's life. So the, the challenge is when you're tired and you're fatigued or you're thinking about, um, that regulatory change that came down as being present in your family's life and being present for them and the challenges they're facing, um, and then finding time for yourself and, and then it's a race against the clock in that respect. But, um, you know, I, I think one of the things that's really been good, um, is, you know, I've really encouraged people to assume positive intent. Assume that people are trying their best, assume people are doing everything they can to bring their best every day. Um, and, and as cheesy as it sounds, you know, be kind, talk less, listen more, um, you know, and then just follow up and say, I heard this question. I, I just wanted to follow up with that, that sort of kindness and listening that, you know, we all learned early in school, but can feel harried when we've got assignments. Sometimes taking that deep breath and just listening and being part of the team is, is a really valuable exercise that I, I hope people remember.
Speaker 1:I think that's a good lesson just in life right now, is to, to go in with the, the idea that people are coming with good intentions. Um, so one of the things I think we should also talk about Joe, uh, i is, uh, testing and school openings. Um, and you know, I, I'll just say personally on a personal note that I think trying to decide what to do with my children for kindergarten was probably one of the most challenging decisions I made in my life. Um, harder than deciding whether to go to law school, what career path to ha I mean, it was honestly took a and that, and there, and I'm having talked to other, um, uh, parents that even that, that first week of school, whether it was you were on Zoom hybrid or in person, was, um, took a lot of mental energy that, you know, a lot of us are high going high energy, high performing people, but it definitely was a little bit of a, of a drain. You have another perspective, and actually, uh, Charles does too. You, you're, you're at a university where students came, uh, on, and, and we'll talk to Charles in a minute. He, he lives in Boston that has a lot of universities and a lot of schools. Joe, why don't you talk a little bit about, um, you know, coming back, the school, coming back and, and testing and innovation and, and what the university, uh, worked on.
Speaker 3:Sure. So, um, uh, university of Iowa is, uh, about a 30,000, uh, person campus, uh, so large like, uh, many big 10 universities. Um, and, and like manys, this is a college town, so the university is a huge part, uh, of what goes on here. So the university was very well prepared. It, it obviously had put a lot of time and energy into, to coming back. It, it understood that it was, uh, not a straightforward decision. There were people who wanted, um, a hundred percent online. There were people who wanted a hundred percent in person and they came up with a, with a hybrid model based on size of class and, and risk. And they came up with accommodations for people so that there was a way for people to meet their individual needs. Um, but it was challenging. It was a lot of work. Um, uh, but even with all that preparation, uh, what ended up happening here at the University of Iowa, um, was, is that there was a very significant increase in case rate, um, upon arrival of the students. And so the University of Iowa Healthcare in Collaboration University stood up the clinic right in the heart of campus in 24 hours notice, um, and, uh, immediately started testing, you know, three people every minute. And, and, and ended up touching hundreds of people in collaboration with the university to get on top of it and get on top of it fast. Um, the other thing we set up was we set up, uh, uh, our home treatment team, uh, which is a really innovative way for us to give the kind of, uh, equipment that people need, um, to, whether it's pulse oximeters or, or blood pressure cuffs so that they can monitor their care and check in, and then the home treatment team from the university checks in on them, um, on a regular basis, uh, to make sure that they're okay so that they can be identified before early if they need inpatient care. But it keeps more people at home where they're safer, uh, and makes more beds available, uh, for those who really need it. Um, we have a very high daily census before Covid, uh, kind of hospital where, uh, we run almost full every day. This was a really proactive way to both keep people safe, keep people at home, and get beds available, uh, for the people who needed it. And we've really worked hard to collaborate with our, uh, other community health partners in the state and in the region, um, to make sure that they have what they need, whether it's information, whether it's equipment, um, so that we could collaborate and keep people hopefully in their hometowns to, to avoid spread issues there. But it, it's a constant innovation, it's a constant, uh, working with our clinical teams. And, and it's really kind of the fun part, which is when someone says, Hey, what about that? You come with an open mind and say, Hey, I hadn't thought about this way, but, but let's get a, let's get the right people around the table and see if we can't think of a new way to provide care that might not just help for Covid, but might change the way we do things longer term.
Speaker 1:Yeah. It's interesting to see if one, any of these innovations will stick, like telehealth or home health or, or payment reform might come out of this as well way we were, we were working on these issues before. They're not new, it's just feels accelerated. Um, so Joe, one of the things I also wanted to ask was one of the things, you know, as, as schools reopened and, and, um, and actually throughout this whole, the whole, um, pandemic, there's been something called I saw the, the World Health Organization called, it was like, it's like an info pandemic or an info map or something. It's a, the idea that we have so much information coming at us that it's almost, um, overwhelming or that people are, you know, read the news every night. And we're even, there's been studies on the, the health, how that impacts your health, not just your mental health, but your physical health. How did you, how did you the organization, um, ensure that there was communication and transparency as, uh, before the school opened or during the, this timeframe? How did you communicate with the community, the students, your workers, and um, your board? How did you keep that, that communication going without, with, without the, this kind of information overload, fatigue that we're hearing
Speaker 3:About? I, I think it's a great question cuz I think it's a balancing act and you try and get the information that's actionable at the right time to the right people, uh, in a usable form as opposed to trying to get all information to all people all the time. And they're trying to sort it, uh, the wheat from the chaff of what they're supposed to use there. So it's really trying to have focused, directed communications. Uh, and, and we try to be very transparent. Um, uh, most of our communications, if not all, I, they're almost none, I can't think of are up on the web, can be borrowed by other institutions. I know they've been borrowed by the institutions. Cause we view it from a public health perspective that we're all in this together. Um, and so it's not like there's something proprietary. And we saw other academic medical centers around the country and borrowed from them and they borrowed from us. And our teams, our infectious disease treatment teams work together, um, collaborated in that respect. We have good relationships. Um, we were on the phone frequently with government, uh, state government, federal government, uh, working with them, helping them understand what we're seeing, helping, uh, them understand why they're making the calls. They were, um, working with public health, working with, uh, other hospitals. And I, I think it's a sort of always two way. If you assume you don't have all the answers and you don't assume somebody else has all the answers, but two brains are better than one, you're gonna, you're gonna come out ahead. You know, I had calls with our academic medical center, general counsels and say, what are you seeing? What issues are you seeing? How are you working both on the legislative front and on the interpretive front? Um, and then I think the other thing, you know, as lawyers, we're always chained, trained, um, you know, make the narrowest decision on the holding, uh, and, and don't make decisions before they're ripe or, or don't make decisions when they're mood. And some of those principles kind of applied, which is, um, you know, there's enough legal issues, you don't need to make more. And, and you don't need to in any way, shape or form make decisions before we're ready with full information. Um, and so we were always very transparent with our employees about what we knew, but also what we didn't know. Um, and, and tried to be honest and forthright that, that some of this we're figuring out and some of it's gonna change. And when it changed, we explained why it changed, um, as opposed to being Omni and Omnipod. And apparently we were trying to make a little bit more teamwork. And I, I think that's been positive. Um, but, but as Charles referred to, you know, we're now going into a new uptick. We're going into a new wave. Um, it sets different expectations, it sets different situations. It requires different communications. And so we're trying to modify our communications to meet the moment.
Speaker 1:Great. So Charles, um, how have, you know, in response to what Joe said, how are you, how have has your organization worked on communication? You are in the Boston area, which has several colleges, uh, universities and obviously a urban, uh, community. You talked a little bit about the school, some, the schools going, um, remote and being in that first kind of wave of, of covid now that we're headed towards, uh, winter. And I don't know whether it's gonna considered a second wave or we're in the wave. I'm not really the same wave that that seems, um, to change. But how are you keeping up with the communications and, and preparing, uh, for the winter?
Speaker 2:So it is really that communication overload. I mean, you can't communicate enough on this. And, and one of the challenges that our organization has, has found, and some of the other organizations, healthcare organizations in Massachusetts has found, um, you know, as staff get more accustomed to dealing with covid patients and in and exposure and so forth, they actually, you know, they need that little break and they become a little lax maybe when they get into a break room or something like that. And so the messaging regarding masking and so forth has really taken a, a new uptick in a, in our system. Uh, there, there was an outbreak in one of the, uh, hospitals in Massachusetts that was center around a break room. And it's getting people to not get, people get desensitized. And, and we're not through this yet. We, we know a lot more about the disease than we did in the first, you know, wave of this back in March and April and May. But we still don't have vaccines. We don't have therapeutics. We have different ways to treat patients now, but it's still highly contagious and people need to be ever vigilant with respect to that. I, i, a point that Joe brought up that I'd like to go back to is the level of cooperation among, uh, competing healthcare facilities. Boston, Massachusetts, uh, is, uh, we got six academic medical centers in a very small state. And everybody just said, how do we get this done? And they all had multiple meetings, uh, a day a week with their infectious disease teams, meeting with state government and federal government and, and working together and being collaborative and, and sharing resources. It, it wasn't, uh, everyone was in it for the public good with respect to this, which was great. Um, you know, a little confusing with, uh, Joe being at one university in Boston, there are dozens of colleges and everyone picked a slightly different way to take care of their, their, uh, their students and their staff and so forth. I have, I have two college-aged kids. Uh, one goes to school in Massachusetts, one goes to school in Connecticut. Um, one has, they're both at school, but one is doing remote learning at school with some in-person labs. And the other one has in-person classes while at school, whereas other schools are all remote, um, and not having kids on campus. So the lack of consistency among that makes it a little challenging. But even with the universities in, in the Boston region, I know our system has a app for, uh, attestations. When you come into the office, you make sure you sign in and have your attestation about not having symptoms so you can come into work. Um, that code is up there available for, for other school, for schools and other healthcare systems to, to use. And we've worked with some schools to assist them with adopting that app, uh, for attestations as well as for rapid testing, uh, of their, uh, their, of their students to, uh, have their protocols for contact tracing and so forth.
Speaker 1:So one of the things also that's been discussed is the idea of, of flu plus covid. And, and you, you, you know, I've read articles, um, and opinions where people say, well, we're doing all these precautions, so there's not much chance of the, of a bad flu season. But I've also heard, wow, even if the flu season was less, but we also had covid patients that could decrease, uh, capacity in the hospitals. Um, and also people may be less likely to seek treatment or want or comfortable going into an, an office. Um, and others say, well, look, we have access to telehealth, so maybe people will, you know, uh, be less inclined to go into these settings or maybe more sensitive to these kind of symptoms and be staying home just generally more because of it. So there's just a lot of, you know, get your flu shot. Oh, we're starting to run outta flu shots. We didn't get our flu shot. Uh, and in the three of us have been in, in healthcare a long time. I, I remember being in house during some really bad flu seasons where we were, had our fingers crossed that we would just hit April<laugh>, that April would come. Cuz we knew the flu season that that flu in that case would dip down. We know we now know c covid, it's not seasonal like that. Um, I know I personally got my flu shot, um, on Friday. Uh, what, what do you, what do you think about preparing for flu and covid and, and has it, you know, we, every year we've thought about, you know, when you're in house you think about flu and flu shots. And again, each year can be different, but how have you dealt with it or thought about it or, um, had to advise on on on flu and covid? I'll start with Charles.
Speaker 2:Well, we've always had, uh, mandatory flu shots for our, for all of our employees and so forth. That being in healthcare, the state of the commonwealth of Massachusetts actually, uh, put in place some new, uh, guidelines mandating flu shots for anyone under 18. Uh, I'm sure we're gonna have some good court challenges with respect to that. But, uh, there is a concern obviously about the two diseases, uh, merging into the same process. And in, and in a lot of the things that our organization is talking about is just actually acc access, access to sufficient supplies, uh, to be able to do flu shots and do covid testing, uh, the reagents that are necessary and so forth. And, you know, there is still some debate that I've been sitting and listening to about whether, you know, are we gonna bother testing for flu or covid if it's one or the other, since the symptoms are very much the same. But a lot of it's focused on getting preventative flu shots for everybody, uh, whether it's all the patients, uh, for the employee physicians and all the staff. But actually just getting the supplies to be able to do that is, is one of the, the challenges. Uh, there's, you know, I think I see Joe shaking his head. There's been a run on, uh, a certain gauge needle, uh,<laugh> in the entire country related to potential vaccine, uh, development. But we also need that for doing a few other things such as, you know, uh, preventative flu vaccine. So it's, it's a challenge for sure.
Speaker 1:I had heard the reagents were used. Some of the reagents are used for other types of testing, such as STDs and other tests. So they're, it, it's interesting cuz there's, um, a ripple effect on the supply chain still, even though we're not having, at least at this point, the same p p e discussions. Um, although I will tell you, having this kind of national view, it seems different in different places in different parts of the country. Um, o on those, on those issues, cuz I, I hear different things from different people about, we have this, but this is low. And other people are like, no, this is low and I have this, it's, it's really quite interesting. Um, Joe, how did, how about you, uh, flu plus covid, what are you thinking about that and what are you working on, uh, around that and how is your community responding?
Speaker 3:Yeah, so, um, we have just like Charles described, looking at things like, uh, having panels where it's fluid, um, covid tested together so that, uh, you reduce the use of swabs and reduce the agents. So it's just one testing. Um, looking at ways you can de be more efficient, both in people's time to reduce burnout, um, and in use of supplies. Um, you know, I I think, uh, there was the initial p p E issues, but I think there are ongoing important complex questions about, um, procurement contracting for law departments, um, access to the right resources force, mature contracts, and what it means when somebody can't deliver, um, opportunities to enter into more, um, guaranteed arrangements and, and what those protections look like if you enter into new arrangements with distributors as they'll make certain protections. You know, I think a lot of us, uh, spent some long weekends, uh, in the beginning doing some innovative things to try and get p p e to protect our people, putting our people first. And, and now the question is, well, what do you do longer term to secure the supply chain? I've had a lot of conversations with my peers about what does it mean to secure the supply chain but also be cost sensitive for just in time, uh, resources and where's that balance point and where's the right point economically? And um, the nice thing is I, uh, I think I'm sure like Charles, I work for an institution that puts people first and it's gonna put safety first. Uh, and so, uh, we'll worry about the cost part, but it, it, it's there. We're gonna do the right thing by our people. We're gonna do the right thing of our patients. But I think we haven't seen yet the full demand on the systems. We haven't seen the full demand. I don't think any of us can predict exactly what a full flu season looks like. Um, uh, I say this semi I jest, but also truthfully, I have a, a young child, young children, uh, in daycare, what have you come home with all sorts of little bugs. So I've had more than my fair share of, uh, covid test cuz it keeps looking like I have covid when really I just have a a a cold from a small child. Um, so there's nothing more pleasant than a, a good covid test up periodically to make sure you're okay. But, uh, really just a kid's cold. Um, but yeah, you know, these are all supply questions and they're all the right right questions about how we do this. Um, and so, um, you know, the state here has put in place a statewide testing system. We have our own, uh, testing system as well. Um, and, and we're trying to work together with others. But, um, I think it's a really significant issue long term of what does it mean for procurement contracting and what does it mean for, uh, the balance of just in time versus, uh, adequate resources. I don't think this is a short term issue
Speaker 2:To touch on Joe's point there, you know, the p ppe, the supply chain disruption that occurred in the spring, I mean, yes, it was significant and dramatic, uh, in the healthcare industry, but if you think back to what states were surging back then, it is a small percentage of the states that are surging right now. So while there have been some lessons learned and emergency, uh, procedures with respect to supply, uh, securing, securing supplies, that system's gonna get tested. Uh, it had a great stress test before it didn't do well. It's gonna get tested even, even more I think in the next month or so, uh, with the rate of increase that we are seeing across the entire nation. Before you had, you know, eight to 10 states that we're surging and now we're 40 odd states that are surging. And so those who have been through it before I think have, um, you know, the Northeast California and so forth have done a lot of work to ensure they have an supplies, adequate reserves and so forth. But I think that there are some other states that, that didn't suffer early on that are, are going through that right now, trying to ensure they have, uh, adequate p p e uh, and standards. Yeah, there's, so it's a, it's a challenge that we're gonna be facing. And, um, I, I also have injured multiple covid tests because my wife is an elementary school librarian. Uh, so she was a little, a little apprehensive of going back to school and her school is in a hybrid mode, so she's like, oh, great, a bunch of third through fifth graders that's gonna be so safe.
Speaker 1:<laugh>,<laugh>. Um, yeah. And my, and I, I have, my kids are mostly in person, I would say, we'll say it's full-time in person is defined differently now, but they're, they're in person. And, uh, I have to say though, I haven't gotten sick yet. I'm gonna knock on lots of wood right now. I don't know how that's happened cuz I've talked to a bunch of other people who've been at home with their kids waiting for their COVID test to come back and, you know, depending on where you are and what test you got, that is either 24 hours or few hours, like minutes, hours or a week. So, um, so one thing, other thing I wanted to talk about, um, a couple things, but one is like, so we have, you're talking about surging and supply chain and we know the holidays are coming and we have fatigue. So now I'm gonna do another math equation. This is Sarah Math, uh, f covid fatigue plus the holidays and going inside<laugh>. Um, if you're in a warm climate, maybe you can still be outside, um, or may, uh, but in some of these colder climates, you know, I saw somebody post a picture, uh, it can be very cold in the northeast, even now, I think, Joe, you said it's snowing there and people are trying to have like an outdoor socially distancing, you know, birthday party with, you know, less than 10 people. And then you see grandpa in his like park<laugh> and his mass shivering and you're like, oh my, what are we gonna do? What, how is, how are we gonna do the holidays in, in these colder climates? And are, is this going to mean people are gonna go inside? Um, Joe, you can tell us it is snowing there right? Today,<laugh>,
Speaker 3:It's snowing in October here. Yes. Not, not exactly the holiday. Uh, you know, please, please come visit Iowa right now. But it luckily it's not sticking. Yes. Um, but um, you know, at its most basic, so we have drive through testing, so now we're building warmer, uh, facilities that are permanent longer term cuz we just had, you know, air conditioned tents that we're keeping everyone cool and now it's let's build structures that have heating and all the things necessary to protect our people long term cuz we're gonna have that through the winter or however long. So there's actually a clinical element to it of how we make sure we deliver care safely, uh, in this sort of drive through environment. Um, there's also the, like you said, the personal element. Um, we as a leadership team, uh, all signed to pledge to to, to show the right behaviors, uh, in our personal lives, uh, with regard to, you know, keeping distance, wearing masks, um, keeping, uh, social, uh, appropriately. And, and we've all put that forth as leadership. Um, that may mean we have to make some choices with regard to our holidays that, that aren't what we're used to, uh, and wouldn't be our first choice, but just the, the right thing to do to model the behavior that, that we think is the right thing to keep our each other and our loved ones safe. Um, that, that's luckily fallen on tremendous support and, and people have stepped up. And I think that's, I guess the point I wanna make, which is, is that one of the best things is people keep stepping up. People keep doing the right thing. And, and I know people are tired and I know it's hard, uh, but I I I'm amazed by the resiliency of people to, to do the right thing. I think that's gonna be tested in the coming months cuz people want it to be done and understandably. Um, and that will be tested, but, but you know, the faith in people and that people will try and do the right thing if we give them the ability and the resources. Um, but I, I do, I think it will be sorely tested.
Speaker 1:I think what would be good, um, one of the things I think about is that we, we, we know it's hard and we say it out loud, I think that's actually part of modeling and being a leader, like saying, we know that this is not easy. Like you, like I know I won't see my family, right? And, and, uh, other than maybe on a zoom call for Thanksgiving, for example, and, and saying that that's not easy, you know, and, and, and saying that out loud I think is helpful. And then supporting each other and saying like, you can do it, right? Like on those days where you're like, think, you know, I've talked to a lot of people that say, you know, they, for example, they may have parents who, um, have healthcare issues and you can't go help them, you know, uh, and, and how hard that can be, uh, and, and saying, oh, you know, normally I would go see them for Thanksgiving and that would lift their spirits, but I can't this year because they're, I can't travel, for example. And, and I've heard, I've heard that multiple times. Um, so I think when you say that, I think it, part of this podcast and why I thank you both for being here is, you know, as we talk about it, I think that helps e everyone, you know, if we feel like we're a, a set community, you know, doing this together, and you've talked a lot about both of you about cooperation and, and that Charles, um, would you like to to add to that?
Speaker 2:Uh, yeah, I think the most, I the thing that we kind of get by with is like, we have to say it out loud. I agree. And it's, it's okay to not be okay. And people need to understand that no one's gone through this before. And, you know, I am re reminded constantly as to why I got into healthcare law. And I think most everybody gets into healthcare because they wanna help people. And as Joe said, people keep stepping up and it's bringing people back to those core values as to why they, why they wanted to become a nurse, why they wanted to be a doctor, why they, why they wanted to, to work in a healthcare system. I mean, so we're lawyers. I mean, we could go work for firms. We, we work in-house for healthcare systems and we do that by choice because that's how we give back. I'm a chronic asthmatic. I I was diagnosed as a very early age, um, and I had great doctors and nurses who let me do play high school sports and do triathlons and marathons. And I said, okay, I'm gonna go into healthcare. I wanted to be a lawyer, I knew that, but I'm gonna do healthcare law because these people help me tremendously. And, and we do this every day and people step up and they help out. And, uh, we have to try to keep their spirits up as we go through this because you can, we, um, I'll probably give away a little too much here, but we all develop really six sense of humor when working in-house at a healthcare system because if you don't develop that defense mechanism, uh, we don't deal with the fun stuff<laugh> most of the time. And we have to be able to, to have, uh, some humor in our, our job and, and help people get reinvigorated and, and recharge with that. I mean, so, uh, this, this, this, uh, Friday I get to do reverse trick or treating, uh, which I've been doing for years, where I dress up in a costume and I wander around and hand out candy to our staff and they try to figure out who, who is this guy? And then they figure out that it's the general counsel for the healthcare system. Like why is he giving us candy? And Oh yeah, he came to, he came dressed like George Washington last year and he came dressed like this the year before. Uh, this year I'm, we have a office park that a lot of our offices, it's called Unicorn Park. Uh, I'll be an inflatable, uh, unicorn on Friday handing out candy to our, to our people. Uh, because what's better than having the head lawyer dress up in a costume to make you laugh because you need to have a break. And that's how we recharge.
Speaker 1:I'm gonna need a picture of that Charles
Speaker 2:<laugh>.
Speaker 1:I'm probably gonna wanna post it on LinkedIn or somewhere. I don't know. We'll see. We'll figure it out. We'll definitely have to at least share it among us.<laugh>. Um, that that's great. I really, I appreciate that and I appreciate that you're gonna be a unicorn. Um, so, um, speaking of unicorns, no, that's a very odd transition and that's all for your benefit, Charles of the vaccine<laugh>. Just kidding. Um, uh, let's, well actually, let's honestly, seriously talk about the vaccine. So there was, um, so when this first started, the things having been in-house, having done bioterrorism preparation, H one N one, all those things, the, the first thought I had, I went through all the different prep and then I, I zoomed right forward to like vaccine or shots. And, and a lot of people said, oh, the production, but I actually went right to the distribution, um, because that seemed like that would be to distribute across the world, across our country, across each state, and in each community is how I, you narrow it down. How, how would that work? Right? And, and, and had Homeland Security had h h s and had others start thinking about that, that I went right to right to that and had, and was actually out speaking about it so that people would start thinking about it. And there was recent announcement around some of the distribution plans looking at pharmacy chains. Um, but ultimately when I, when I think about it too, I think about healthcare providers. Um, I think about, or will it be, you know, my, my parents remember getting like polio vaccines and going to tents and, and or having people go to school. And so, um, we are not sure when this, what the vaccine will be out. Obviously there's been a lot of discussion about it. The trustworthy people are not trusting it, some people are trusting it, some people, uh, wanna slow down some of the clinical trials, some people wanna rush some of the clinical trials. Um, obviously there's a lot out there, um, in, in thinking about the role of, of a hospital or an academic medical center, um, the vaccine de development and distribution. Uh, i, is that on your radar? Are you talking about that in some of your meetings? Um, or are you, are you keeping tabs in on its development and, and what's happening at hhs? Um, Charles I'll start with you.
Speaker 2:So we, we absolutely have had been having conversations about preparing for it and, and, um, trying to figure out what type of a rollout would be timeframes. I mean, we've already ordered, ordered, uh, made capital purchases of appropriate refrigeration or freezers that go to the right temperatures depending upon what type of vaccine we're talking about. So we've had to order multiple models to meet those guidelines to be prepared, uh, even though we're not exactly sure of when we're talking about, uh, this coming up. But, so it's a conversation we've had. Um, I think maybe Joe might have more insight in a, in a more of an academic setting, uh, than, than my system. But we're certainly prepared for it. Uh, but there is a concern about, uh, in our infectious disease, people are just talk, are are having discussions about, you know, how fa these trials running, how accurate is the vaccine? How effective is the vaccine going to be? And as it is, uh, I think we've seen a little foreshadowing in Massachusetts with the, uh, state mandate about children under 18 getting flu vaccines that, uh, the, the anti-vaxxer groups may just have to, uh, go to court to prevent themselves from getting vaccinated. Cuz I, I think that different states are gonna adopt different methodologies unless the feds are really gonna put some, uh, prescriptive guidance on.
Speaker 1:Okay. Yeah. Joe, so what are you seeing in your, um, organization and community around, uh, vaccine and vaccine distribution and preparedness?
Speaker 3:Yeah, just like Charles said, we're making the same sort of capital investment. Uh, our journey began, um, with getting, uh, f d a, uh, clearance for emergency use for things like Regeneron and remes avir and convalescent plasma. Uh, and that's where our journey began. And then, uh, we, um, are participating in the clinical trials for, uh, various vaccines. Uh, and so our active in that space, trying to make sure that the clinical trials have done right. And, uh, I think a really important part of that journey is to, to recognize both at the clinical trial phase and at the vaccine distribution phase, that there are disparities in healthcare. There are structural disparities in healthcare, um, and what can we do to make sure that, uh, all populations are appropriately represented in clinical trials, um, and, uh, that all populations are appropriately, uh, have access to vaccine. And so that's where a lot of our conversations have been, uh, in making sure that we not only have the infrastructure to deliver, uh, what we need to, but to do it in a, a way that addresses healthcare disparities. Uh, and so, uh, we've been, uh, you know, pleased with, uh, results coming in, uh, as I think lots of people have, we've been pleased that people are being careful and, and even if it means a, a brief pause, doing the right thing, uh, to keep people safe, uh, cuz safety first and efficacy second. Um, but I, I think, uh, timeline is anyone's gas. I, we obviously have whatever knowledge, uh, but it all depends on how the results come out. Um, I think we'll be ready at that time. We've been doing a lot of work, uh, looking at our distribution plans and making sure we understand, uh, how we should do it, but having make sure lots of different voices have a say in that to make sure that they're, like I said, uh, equitable and
Speaker 1:Appropriate. Joe, that's a, a great, um, hopefully that's something that when I think about things that stick after covid, the idea that clinical research trials, uh, take into account populations that normally wouldn't have access even to healthcare, nevermind clinical trials, is that it wouldn't be an amazing take away and, and lesson, uh, learned from this, I think. Um, so with that, I wanna thank you both for coming and I would love to hear Le uh, one item that you'd like to leave the audience with. Um, uh, Charles, why don't you go first?
Speaker 2:I think the thing that I would really like to lead people with is it's an endurance race that in, but you have to actually find some moments in that race that you can have a reflection on and, and understand the meaning and the power of the work that we're doing to help our public and our patients deal with this disease. And take a moment to understand that this is significant and that you can have an impact on it in a positive way. Do the best you can and have some fun even in the
Speaker 1:Darkest of time. Even dressed as a unicorn.
Speaker 2:Even dressed as a unicorn.
Speaker 1:Yes. Uh, Joe, how about you? What's a, uh, item that you'd like to leave the audience with?
Speaker 3:Building off what Charles said, you know, I think that one of the things I always try to remind people is it's a relay race and, and that, uh, you've got teammates and, and people have your back. And, and that as long as you're surrounded by people who have intellectual curiosity and who have work ethic and integrity, uh, we're gonna get there cause we're gonna get there together. Uh, and that, that when you're tired, pass the baton to someone who can carry it for a bit and, and then take them and give them some relief. I, I think that's one of the key things is, is that so often we hear divisiveness and we hear, uh, lots of things about, uh, I can do this or I can do that. It's actually the weed that usually solves the problem. And, and, and that's really a reminder I've always had of
Speaker 1:This. Joe and Charles, thank you both so much for joining, um, us today. That was an incredible way to end the podcast. Uh, thinking about we and, and, and being in this together and some really notes of, um, of maybe some positive outcomes from this. Uh, everyone thank you for joining us audience and, uh, we look forward to having you join Future podcast. Today is October 26th. Halloween is around the corner. Charles will be a unicorn. We still didn't hear what Joe is gonna be and, uh, we hope that you, if you're not a member of American Health Law Association, please sign up. There's also public health information out there that's free to everybody. So check out, check out the website. Thank you all.