Listen to the Podcast: COVID-19 GC Roundtable - Part 6
In the sixth podcast in this series with counsel on the front lines of the coronavirus pandemic, Sarah Swank, Counsel, Nixon Peabody LLP, speaks with Robyn Diaz, Senior Vice President and Chief Legal Officer, St. Jude Children’s Research Hospital, and Lisa Vandecaveye, General Counsel, The Joint Commission, about managing a legal department during a pandemic. The podcast discusses issues that arise with remote working such as cybersecurity, employee morale, and how things might change in the future. In addition, speakers talked about how surveys are being conducted in light of the pandemic. From AHLA's In-House Counsel Practice Group. Sponsored by PHIflow.
AHLA Producer: Support for AHLA comes from PHIflow, a leading provider of artificial intelligence contract analytics tools for healthcare legal departments. When a nationally recognized health system needed to quickly identify and extract renewal clauses including evergreen and automatic renewals within 10,000+ agreements, they turned to PHIflow. The results: 10,000+ contracts were analyzed within 30 days with a confirmed 99.9% accuracy rate. To learn how PHIflow can quickly solve critical contract issues for your organization, please visit www.phiflow.co.
Sarah: Welcome everybody to today's edition of GC Round table. Uh, we are going to talk today to Robyn and Lisa I'm very excited. Um, my name is Sarah Swank from the law firm of Nixon Peabody in the Washington DC office. Lisa, why don't you introduce yourself to the audience?
Lisa: Well, thank you, Sarah. Hello everyone. Thank you for joining us today. Um, my name is Lisa Vandecaveye, and I am currently the general counsel, uh, for the Joint Commission, uh, located in Oakbrook outside of Chicago.
Uh, I have been involved with healthcare for over 30 years, uh, primarily representing hospitals and health systems. And in addition to that, I've been active in the American Health Law Association for well over 25 years and actually had the wonderful opportunity to serve on the board, uh, for many years. So thank you for having me today.
Sarah: Thanks. Lisa and Robyn, why don't you introduce yourself to the audience?
Robyn: Sure. Thanks, Sarah. My name's Robyn Diaz. I'm currently the Senior Vice President and Chief Legal Officer for St. Jude Children's Research Hospital in Memphis, Tennessee. Uh, there, I oversee legal affairs technology transfer, compliance and internal audit as well as government affairs.
And before joining St. Jude, I was in house with MedStar Health in the Washington DC / Baltimore region. And prior to that, I was in a, I was at a law firm in the Washington DC region. So, um, I've been in the healthcare industry for about 20 years and excited to be here today.
Sarah: Great. Thanks Robyn. So I'm going to just jump right in.
Um, so Lisa, what is it like managing a legal department during COVID-19? Um, and how much of your time are you spending on those issues? And I know it's a little bit of a loaded question cause you're at the Joint Commission, but you're also a general counsel and have a, have a legal department that you are managing as well.
Lisa: Well, thank you, Sarah. Um, uh, it's a, uh, interesting question. We have a really great legal department at the Joint Commission. Uh, we have 10 folks on our team, um, and, uh, we're a very good team. We work very well together. Uh, we work together and, uh, we play well together. So probably the biggest challenge for our team has been, uh, the method of communication where, and the frequency of communication.
So, um, yeah, in the crisis situation, since we're all remote and we've been remote for several months and will be remote, at least through September, is we've had to communicate more. Uh, and, uh, be more deliberate on our communications. We're used to just pssing each other in the hallway and chatting about something.
So we've made a conscious effort to modify how we talk to each other and when we talk to each other. So for example, uh, the department has a 30 minute call, uh, three times a week, uh, just to touch base. Uh, well, what's going on? What happened today? What do you need help with? What can we do better? Um, and then, um, every two weeks or every other week, uh, we have a two hour department meeting in which we do a deeper dive. And talk about some of the complex issues that we're working on. And then we answered questions. And then in addition to that, I have a one on one with every member of the department, um, every other week. So, so one of the lessons I think for me, me and COVID has been to communicate, communicate, communicate.
Um, it's so critical that, um, we talk to each other and we help each other through this very difficult time. So I did mention, we like to have fun. We do have informal happy hours, virtual happy hours, and just talk to each other about how we are, how our families are. Uh, we've had a baby shower, virtual baby shower.
Uh, we have a book club. Uh, uh, we're currently reading, uh, Talking to Strangers by Malcolm Gladwell and we've had a relocation party. One of our attorneys moved from Chicago to Utah. So, um, we work hard at maintaining our relationships, and, uh, we also have an informal policy where we can call anyone at any time.
So I hope that wasn't a long winded answer for a short question, but, um, uh, that's how we are operating differently now.
Sarah: I think you have a lot of people that are going to want to come work for you. It sounds fun. Um, uh, Robyn, um, how much time are you spending on, on COVID-19 matters and how are you managing your legal department?
Robyn: So we are, um, largely remote, but we do have to have to have an onsite present, presence in large part because we have regulatory and other case related documents that still come in by mail or FedEx. If somebody has to be here on occasion to get them. And so we were on a rotating schedule where all of us are remote the majority of the time, um, but there's someone on site, uh, just about every work day. And, and I have been onsite generally about two days in the office and three days at home, most weeks since about mid March. And meetings are almost all by WebEx, but I did have one in person yesterday, which was sort of strange onsite, three of us in a large conference room, physically distanced and wearing masks. And I guess that's the new normal. Um, and I would say in terms of COVID, what's been interesting for me is that I am part of my organization's incident command, you know, emergency operations group. And so when this all started, we were having three incident command calls every single day, 8:30 AM, 1:00 PM, 4:00 PM. And so my schedule could, could essentially start to fill up just from those incident command related calls, let alone from the other, coronavirus related matters that we had to handle, you know, terminating contracts related to cancel, canceled events. Um, loads of questions about regulatory flexibilities around things like telehealth and how to handle those.
Um, so, so it's morphed a little bit over time, and now we're down to just one incident command call a day, which is nice. It leaves a little bit more time to get some other things done. And I've had some of the same challenges that, um, Lisa has had in terms of managing the teams. So with the team being mostly remote, it's figuring out how do I get a handle on everybody's workload and morale and progress toward goals.
I have 12 direct reports, um, because I manage other departments aside from legal. And so trying to find time to speak directly with all of my direct reports. Um, can be a little bit challenging. Uh, and one thing that we love to do as a team is celebrate together. So birthdays, baby showers, like Lisa mentioned, and that's something we haven't been able to do.
We have been giving each other Uber eats, gift cards for birthdays.
Um, and so have really enjoyed that. And I think I'm going to steal Lisa's idea about the virtual baby shower, because we will have someone on our team who needs that soon.
Sarah: You can even learn from each other while you're talking on the podcasts. One of the things Lisa talked about, I was thinking about this Lisa and Robyn. I don't know I was, when I was in house, I had a mentor once who said most of your legal work where you're going to hear from your clients it's going to happen in the hallway. Now, of course, we don't want that to happen all the time because you don't want to be caught in the cafeteria having a confidential conversation. Or I used to say, I tried to escape to the bathroom, but then there started being more women executives and they could come find me in there. Um, but, but, you know, you can't have those hallway conversations, um, in the same way, if you're socially distancing with masks or your team's off site, um, and same with your clients.
So how do you, um, so Robyn, how do you stay connected? And so make sure you have a voice in a seat at the table when you, uh, and that you're hearing what's happening, um, in the same way, or can you still in the same way when we're not, when you're not all together?
Robyn: That's a great question and it's definitely true in house, but that is often how you get brought up to speed on things is someone remembers when they see you in the hallway and they stop and fill you in.
Um, so, so it is challenging and there can be communication gaps. I have noticed that, um, a lot more people are just, uh, texting me or shooting me an email and saying, "Hey, can you give me a call when you get a chance?" And so they're bringing me up to speed in those ways.
I'm also getting pulled in just on lots of committees that I might not necessarily be on. If I would if we were all onsite, but because, um, we're all remote there are a lot more task forces and committees that are meeting regularly by WebEx. And so I'm being pulled onto those. So an example related to coronavirus is, there was a, um, there, there, it was instill as a task force on bringing people back. So for administrative staff who had been largely at home, some have started coming back, um, at least part of the time. And so of course, a group talking about how do we do that the right way. And now there's a working group focused on remote working. So for those employees who are going to stay remote for the long term, what do we have to do in terms of our institutional policies? And, um, how do we make sure that we're thinking about career progression and goals and morale, and so that those folks don't feel isolated from the institution? So, so one solution I think, has been that there's a little bit more structure, structure even right now, because that's the only way to keep the dialogue going is by setting up these committees and task forces.
Sarah: So Lisa. Are you, you're at the Joint Commission, you've got your staff, 10 people. How do you divvy up the work and how has the workload changed from pre COVID-19 and post COVID-19? And have you changed how you staff matters in your organization?
Lisa: Hmm. That's a really good question. Um, yeah, we've worked together, um, a very well developed team and, um, COVID has changed everything.
Um, but there's some things that don't change. I think, um, Robyn was very articulate. We still have contract issues, uh, in our case we still have survey issues. Um, so a lot of the work is the same. It just has this new twist and it's, COVID.
Um, so what I find is that, uh, you know, sometimes, uh, like Robyn, you know, we have a lot of task forces. I have daily meetings with the other officers and, um, when there's a complex issue, because I think, uh, what has struck me the most is that, um, and I'm probably going off on a tangent, so I apologize. But is that, um, you know, we all have a lot of experience, but nobody has experience with a pandemic. And so, uh, when you're an attorney, you're also a counselor. So we spend a lot of time talking, listening, um, advising. And, um, I think my advice and I say this to my department, I say it to my peers, to my boss is that we haven't done this before. So we need to be kind to each other and we need to figure out how to do it because together we'll figure it out. And, um, that sort of resonates with me and through the department.
So we do, we still are doing, the same things every day, but we just have this complication in that we're not in the office. Um, there's a lot of anxiety, so we have to be attuned to that. So from an assignment perspective, um, I don't think the assignments are too much different. Um, other than we do have these, uh, quick research issues. We still have the rushes that come in. Um, we have a lot of task force. One of the task forces that we have is we're reinventing the survey process. Uh, it's virtual, uh, it's moving to a complete virtual model. Um, CMS has not approved it yet. They've only approved it for initials and for labs, but we're moving very fast at it. And it's very exciting, but it also has some very interesting legal questions. From a data security standpoint. So for example, our entire department spent over an hour this afternoon talking about the data security issues using a separate platform. Um, so, um, so I guess to answer your question, it's, it's just more complicated, um, and you just have to be more thoughtful. Um, and as the general counsel, um, I find that I'm talking less and listening more. Because I don't have the ability necessarily to see someone's face during the meeting. Um, and I listen for cues and then I follow up and make calls to people, uh, to see if there's an issue, um, and allow for some space for people to share if there is a concern, because they don't have that ability to come to your office and knock on the door and say, "Hey, can we talk about that?"
Sarah: Do you think, between, you know, these technology changes, and we do have the technology, like, I guess luckily during this pandemic to be able to do a lot of the communication and like the transformation of processes, um, and communication. Do you think that these, some of these changes will, will stick? I mean, in the beginning of the pandemic, they heard a lot of people saying going back to normal, like, we're going to get back to normal. Um, and now I, you hear a little bit of a different message. You know, we want some of the things to stay the same that are go back to some of the things that were previously, but there are a lot of things that could change and be better or more efficient or some kind of hybrid. Do you think any of those things that you've discussed, Lisa will stick in some way?
Lisa: Oh, I think so, Sarah, uh, definitely, um, the, uh, I'm very excited about the option of a virtual survey. I think it's much more efficient. The organizations that we're working with on the virtual surveys really like them and so we're partnering with them. Um, and I think there's just a great opportunity here, um, to create a new process, uh, but still maintain in the same level of the gold seal.
Robyn: And Sarah, I would say from a provision of care perspective, we're going to see telehealth stick. You know, it, it had been somewhat adopted in the U.S. Not all that widely adopted reimbursement, um, is a challenge, but I think it's a great patient satisfier. A lot of patients see, now that it's an option and think why would I go sit in a waiting room at a physician's office or a hospital if I can just do this by telehealth.
And so, um, that's one thing that I know a lot of, um, GCs are dealing with right now is what happens when the regulatory flexibilities with respect to telehealth and, and how do we continue this? Because we know that it's important for our providers and for our patient populations.
Sarah: So Robyn, one of the things I've heard, um, working in the telehealth space, um, previously, and now, obviously, I feel like everyone is working in that space, that it's necessary given the potential exposures and the need for active care, is I've heard some providers say, you know, they want obviously the reimbursement, some form of reimbursement, whether it's tiered or something to stay, but even in the absence of it, in some ways that it, it may still stick. I mean, because of the patient satisfaction and the ability to access care, um, I'm hoping reimbursement would follow that if we can show cost efficiency, quality, you know, that it's getting the right care to people that it's, you're not making, for example, in your case, you're very vulnerable patients and family members that may have to travel big distances for appointment, and they may, you know, might not have to come into a hospital at that moment, or they may have to do you, do you, do you see it? Even if, even if the government went all the way back, which I hope, I really hope we don't see, do you, do you think it's that transformative? These last three months of telehealth.
Robyn: I do. Um, and so one example that we've seen is a lot of our telehealth visits have been in the psychosocial services areas. So some have been primary medicine, but a lot of them, the majority really have been, um, psychology, social work, even discussions with our child life team. And those are, those are pieces that make our institutions special. It's a way that we really give patients the highest quality care and we make them feel comfortable as comfortable as they can get with their, their clinical circumstances. Um, and if a patient is far away, you know, we have our, our service areas really the entire country. And so if we have a, um, patient in Illinois and we're in Tennessee. There's no reason for the patient to have to come to campus to have a discussion with their psychologist, right? So, um, now that's becoming the new norm that they know that they can do this through telehealth.
They can have a discussion with their social worker, um, uh, child health, a child life specialist can walk a young patient through what a procedure might look like through an image of a doll and showing them what, what would happen to the doll, um, during that procedure. So it's just something that is not going to go away and we will have to figure out the reimbursement as it goes along.
Sarah: Yeah, I think that's great, Robyn. Um, and one of the things, you know, you and you and I were were talking was, you know, the idea of we have reopening happening and we're seeing, you know, we're seeing spikes in different cities that we didn't think we would necessarily, or I didn't, I'm not a public health expert, but we're, we're, you know, I'll give you an example, Aletheia, if you're listening um, was on the podcast and she's in Arizona and at the time it was very quiet. And now obviously we're, we're seeing that it's, it's not. Um, and so, you know, hospitals and physician offices and, and other health care facilities are reopening too, but we're also trying to make sure that people have the access to the care that they need. And some ways it didn't close. Obviously if there's certain procedures and certain populations, they still need to go into the hospital. Um, one of the things you told me about Robyn, was like what it was like to go from, like the parking garage to your office, if you were onsite. And I laughed because having worked at a hospital that for those of you who did not work in the hospital, that could still take you a while, even depending on where your parking was and your office was because you'd be in the basement next to the server room or something.
Um, but, but, um, but why don't you tell us a little bit about what it's like to to go into the hospital now as, as an employee, um, and some of the procedures that are being put into place to protect the patients and the other workers at the hospital and medical staff.
Robyn: Sure. So, so I think like most hospitals we have, um, pretty significantly restricted visitors and, um, onsite, um, vendors, the vendors are only those, those vendors that are essential come onsite.
And we of course do allow parent guardian visitors, but not extended family coming to visit because of the coronavirus related precautions. And so that's one significant change is just the decrease in access to campus. And then we are, we're actually a research institution so we have bench scientists in addition to, um, clinical areas. And so we have separated campus. We're a little bit more like a university and we've separated campus into clinical and non clinical areas. And so the non clinical staff literally can't get into the clinical areas. They have different, what we call badge buddy, is a different color badge and there is security everywhere, making sure that people stay in their zones and that's really to protect patients.
Um, so under normal circumstances, we have one cafeteria for the whole campus and that's something that was really important to our founder, um, that, you know, the physicians, the staff all ate in the same place with patients and families. And it felt like a community, but we can't do that right now. And so, um, the cafeteria is limited to patients, families, and clinical staff.
Um, and we actually have a staff COVID screening process where we are screening asymptomatic staff. So if you're symptomatic, there's a special place where you go to be screened. You call occupational health, and you are tested offsite. But if you are asymptomatic and you're just coming into work, we actually have a, an app where in the morning, before you leave your house, you're supposed to answer a couple of questions and you either get a green, yellow, or red screen.
Red means stay home and call occupational health. Green means come on in. And yellow means come in, but you need to be tested today and testing is a mid nasal swab. So, um, you, you just, um, have a swab stuck up your nose and twirled around a little bit for five seconds or so, and you get used to it over time. I've had it done close to 20 times now. It's just something you get accustomed to, but it's part of life on campus now for employees. And in fact, the one thing that I thought was really interesting recently was we came back to campus after a couple of days away and now all of the doors on campus, including private office stores, like mine have signs on them with occupancy restrictions and other rules.
So my office door, which is in the administrative area and nowhere near patient care has a sign on it that says, um, masks must be worn if anyone, if any additional person enters aside from me. So if someone drops by, we both have to be wearing masks and it says maintain six feet of distance. So it's just a different world. Um, and it's a little bit more complex than it used to be.
Sarah: Right. So this is a great transition, but Lisa, so you talked about the process of surveying, potentially changing, um, and you know, the standards around the joint commission when we look at like an all hazards approach and we looked at like, you know, prepare this and infection control, um, you know, you hope to everyone kind of got it.
Right. And then I'm sure that there are people that don't, but the people got it right. And now we're looking at it through a whole different lens. I mean, we did not have people, you know, hospitals were meant to clean. Be cleanse clean, clean down the hospital are meant to do actually these things. They were supposed to have certain ventilation, if they could.
They were certain that those proceeds and now, um, the idea that a COVID positive patient would be maybe going through the hospital to go get care. You know, it's not just prepared in response. It's like, what we're living in now? How well, how do you adopt? I mean, obviously one of the adaptations is to go virtual with surveys so that you're not putting surveyors at the hospital. What are some of the other things that you think have changed or how do you feel like they've stayed the same?
Lisa: Well, that's a good question. Uh, we have started to, um, deploy surveyors out into organizations. CMS has approved that. Uh, I think it's now been about a month and, uh, we have a very detailed process for determining, um, uh, where a surveyor can go, uh, are, uh, research team put together a database, uh, in which we evaluate, was it 3,700 counties in the country, uh, based upon five different factors.
So what's key is, uh, the organization needs to be ready. So there's a whole, uh, dialogue with the healthcare organization and, uh, about a month prior. Um, and, uh, we, uh, uh, request the organization to tell us, are they ready? Do they want us onsite? Um, and then we begin the process of determining is it safe, uh, to be onsite visits, safe for the surveyor to be onsite.
All of the surveyors have been trained, uh, very extensively. We have had surveyors onsite doing surveys the last few weeks. Um, and, uh, we consider ourselves to be visitors, um, the campus of the healthcare organization and we will abide by the rules of that organization. Um, and at the same time, uh, conduct our business, which is to evaluate the the healthcare and the quality of services. Uh, we're committed to helping the organizations, um, uh, improve quality, patient safety and, uh, and to partner with the organizations to, to do that. Uh, we have established a very robust website. Um, in addition, um, our standards interpretation group has developed what we refer to it office hours and, uh, we do that every single week. And we've had over 10,000 participants, uh, listen, ask questions, participate in those office hours. So, um, the, the survey process is moving forward. Uh, now, with the changes that have occurred with the uptick in cases we're taking surveys back down again. Um, but, uh, we're working very closely with the health care organization so that it can be a collaborative experience. Um, and again, each organization is different depending on how they were impacted by COVID and what waivers they may have in place. So, as you can imagine, it's a very complicated process, but, uh, we're working hard to get the surveyors out there to help the organizations that have requested it and, um, need to have somebody onsite.
Sarah: Yeah. It's got to have felt, it felt to me the changes came obviously very rapidly and March felt a little bit like a whirlwind and that, uh, and then all of a sudden it felt like coming up for air a little bit with all the changes and looking at even CDC guidance changing, maybe being modified because there was, um, not as much PPE if we needed or we, or there was a change in evidence based medicine around wearing masks or not wearing masks. Um, you're seeing like state changes and the phases, and even within the phases things are staying at a phase and moving, um, how do you, Lisa, how do you keep track of 50 states worth of all these local counties? Even just to have a surveyor walk into a hospital or not?
Sarah: Or go somewhere. It may depend on a local public health entity all the way through to the CDC guidance and, and impacting their own actual survey and their work and the lens that they're looking at it. How do you, how do you look at all those and, and keep it and keep track of everything?
Lisa: Um, the research team has developed a database in which they're getting direct feeds from, I think it's the New York Times and from the Atlantic. Uh, who are, those two organizations are tracking every single day, every in a different way. And then we've established a third feed into the database, which is monitoring off of the governor's database, which provides us with daily information about what's happening in each state. Um, so, uh, then we use Power BI, uh, to, uh, evaluate, you know, uh, to determine what the based upon all of these factors, whether it's safe to go into that area. And then we bird's eye it. We look at it from a bird's eye, and say, "Okay, does this makes sense?" So, um, we're using artificial intelligence, uh, to come to a first level decision. And then after that, uh, we have, uh, several account executives, uh, several people evaluating it before a decision is made to deploy a, uh, a surveyor.
So, um, it is a very complex process, but the two key issues is we're committed to helping healthcare organizations, organizations, improve quality and patient safety. And we're also committed to assuring the safety of the surveyors.
Sarah: So Lisa that, I think the audience will really appreciate how that decision is made, especially those that work at hospitals or help counsel hospitals.
Um, Robyn, I won't put you on the spot and tell you, make you ask, ask you what you think about that. I'll instead ask you, um, what, what, how do you keep track of all the changes and did it feel fast and furious to you in March and, and then, you know, how do you keep abreast of what's happening and, and, and keep your board and your executive team apprised of what's happening?
Robyn: It definitely felt fast and furious in March and throughout April, I would say. Um, and one of the most challenging things for us was looking at executive orders from the governor. So, you know, you get lots of summaries from the various law firms about the federal changes, so that helps a lot, but you rarely get great summaries, frankly, about state law changes.
Um, sometimes you'll get a, uh, a state survey type document, but, but not necessarily. Oh, Tennessee's governor issued this executive order yesterday and here's our law firm's summary of it. Um, and so our governor issued about 15 executive orders in a fairly short period of time. And so, um, our executive team would want to know, you know, within a couple of hours what's relevant to us from the executive order, send us out a summary. And we were making changes in, um, you know, the provision of care with respect to some of those executive orders. There were certain regulatory flexibilities that, um, were permitted through the executive orders. So they were very significant for us. Um, and so people wanted to know right away what, you know, what's the outcome of, of that.
And now it's slowed down, but now the focus is on are they going to be extending those flexibilities? And what happens if they don't. Um, so just lots of changes with regard to, let's say, supervision requirements for certain categories of clinicians to, um, you know, where care can be provided, as opposed to just in your traditional bricks and mortar facilities. So, so there's a fair amount of anxiety about that. And so we're doing a lot of work on the government affairs front as well, trying to, um, speak to the governor's office and, um, work with our state general assembly on, on trying to see if we can get some of those regulatory flexibilities extended or perhaps even made permanent in some way.
Sarah: Yeah. There's a lot of, uh, discussion on the role of the executive order, the role of from the, from a governor, the state legislature, and the judiciary branch, and where that, where that fits in a state of emergency. And there's sitting on some advisor to look at, what, what does that look like? And did they get this model a model the model role right, which was never intended for a pandemic like this, because like, I think Lisa you said, no one ever imagined it. Even people that were doing preparedness thought of like a bioterrorism or a one day event, but then you recover from it and not something that was months or longer than that. Um.
Sarah: Right? I mean, so it's and a lot of the things that are helpful to healthcare entities, the waivers are tied to those executive orders. Um, and some other things that are not healthcare to a hospital, or like beyond like licensure are also in those executive orders. So like what's an essential business. And so they, so they you're right. They have, there's a lot of potential advocacy that a healthcare entity might be working through and there's going to be, it's gotten rather politicized as a, uh, as well we've seen in certain states.
Robyn: And even if you only have, you know, our, our primary facility is in Tennessee, but, um, our patients are in other states. And so we've had to look at the executive orders from other states because, you know, let's say our physicians want to do telehealth. Well, the fact that um, there's a waiver from CMS doesn't help them with licensure issues, clinician licensure issues in other states. So, um, it, it, you know, there were times when we felt like we're looking at every state's, um, executive orders to see if they have given us any regulatory flexibilities. And it took a while for the various, you know, law firms or associations to come out with, um, 50 state summaries and they did, and they were very helpful, but, but for awhile, you know, the in house community was sort of winging it on that front.
Lisa: You know, Robyn it is really complex because we're in 50, you know, we're in 50 states, we have employees in 50 states. And then on top of that, we also have an international division that does accreditation in 80 countries. So, um, the complexity of the issues has been, uh, fast and furious.
Sarah: It's interesting because there are states that are in phases, like there are any phase, like, we'll say phase two, right? It just plays one through four. Like to like full, we'll say open back to normal phase four, or they're in phase two, let's say, but within that they're stepping the phases. And so you might think, okay, I got it. And then like on a Saturday you're like, oh wait, you know, um, I've actually drafted something for somebody and looked and said, great and then like, let's say I send it out on like a Friday, you know, I turned it around 24, you got it. Right. And then on Monday, like something else happened in that state and it was within the same stage and you're like, wait, why did that. Maybe another discussion happened. It's like, you know, it'd be interesting to be a fly on the wall in those discussions about like, why didn't that come out with that? They seem to go together, but.
Robyn: Or there can be a new ordinance that comes out unrelated to changing the phase. So um, in Memphis, Shelby County we're in phase two, we were ready to move to phase three and that was halted. Um, and, but in the middle of phase two, the city council passed a masking ordinance. And so, you know, that was a 12 page document that came out with unbelievable complexity about when you have to wear a mask and when you don't have to wear a mask, um, and how they're going to try to enforce this. So it, it, it definitely does go beyond the stages or the phases sometimes.
Sarah: So Lisa, the international component. Do you want to talk a little bit about, about what that's like.
Lisa: Well, it's, uh, it's, uh, it's interesting. Uh, it's actually quite fascinating because each of the countries are so different than then you have areas within the countries that are different. Uh, so, um, we have done, uh, a virtual survey. Uh, we are doing virtual surveys in other countries and, um, uh, the complexity with regards to the platform to do those surveys, uh, it's it's interesting. In addition, um, the standards and the application of those standards, the cultural norms, um, are all unique. Uh, we have, uh, we were moving were quite quite a bit of activity in China that now has changed again. Uh, as of last week, uh, our China division, uh, continues to, uh, provide some services.
Uh, but that has, uh, been limited now. Um, but it's, um, it's, it's the same kind of issues, but they're a little bit different, uh, with, uh, laws being obviously different also.
Sarah: Right. And the other thing we have is that we weren't sure if the virus was going to be seasonal or not, and we're in it. Where public health officials are looking across the world and our own country to see areas that might be true. Like we would have thought might have quieted down if it was, if COVID-19 reacted more like a, like a flu virus and we're not quite seeing that, but we do know that the flu season does come and we know that schools are about to open in some form or another. We believe, you know, we're starting to think guidance on what some of the universities and colleges for adult students are gonna look like.
Um, we've got a lot of states coming out with what a school aged kid school might look like. And we have all these kinds of factors coming together at the same time. Um, why, what does the next six months look like? Like what, where if you had a crystal ball, um, Lisa, like, what do you think? Well, like we're in June, what is December, January going to look like? Or, or are we going month by month, but trying to, I don't know if I know the answer, but.
Lisa: Well, I think about this because I have a tendency to like to plan for things and, uh, it's very difficult to plan and, uh, I have to give the lawyer's answer, which is, it depends. Uh, it depends on what area of the country you're in, what area of the world you're in. And I think as I mentioned earlier, we just have to be nimble and, uh, we have to be prepared. Uh, prepared in the sense that we have to prepare for what's going to happen next, not knowing what that is.
Sarah: Robyn. How about you? What do you agree with Lisa? And then what does that look like preparing when you don't know what you're preparing for necessarily?
Robyn: Yes. So we've been talking about this a little bit because we haven't really seen a peak here. And actually one of the bigger studies that's relied upon frequently in the media, it just came out with a change um, prediction, that we won't see the peak here until October. Um, and so it, it is constantly morphing for us and we just know that we're going to see increased numbers of, um, COVID positive patients from community acquisition.
Uh, and so we, that is the new norm and it may not ever reach a peak for us in terms of our patient population and, um, bed occupancy, for example. Um, but we, we just have to get accustomed to it and we have to get accustomed to it, not just on an inpatient basis, but dealing with our outpatients because they are going to continue to need, um, cancer care, and pediatric hematology, and pediatric infectious diseases care. Um, and we have housing facilities for patients. And so we need to think about how we deal with that in the longterm and how we kind of change the norm in our housing facilities to, um, deal with new infection control risks. So, um, it's just, uh, being flexible, knowing that none of this is certain, and as we've seen with some of these states that have now become hotspots, um, where there wasn't much, um, Coronavirus in the past, that the story can change pretty quickly. And so, um, we need to prepare for that, but, but this is the norm for the foreseeable future and we'll just have to adjust to it.
Sarah: So, you know, One of the things that, um, I think Lisa, you touched on in the beginning with this idea of, of being kind and kindness and kind of collaborative and, and knowing that we have a lot changing in the law, that our colleagues are going through a lot and or personally like, sitting in a, you know, a lot of us at home working during a pandemic. Um, there was an article that came up and talked about like psychologists and psychiatrists who often treat trauma victims and that they themselves were living in a, uh, going through some trauma or some stages of grief by just sitting at home, doing telehealth during a pandemic, right? That there was a, that, that we are we're going through this together, um, and that we need to be, he's supportive of each other. I mean, one of the things I like about AHLA is that it's been a place where I've connected to people, people maybe that I didn't even know as well, I've gotten to know better during this time. I feel like people very collaborative. I've heard it across health systems. I've heard it across, you know, agencies, accreditation, law firms, that we kind of all need each other, that the answers aren't there.
Have you Robyn or obviously start with Lisa, have you, have you felt that, um, you know, I, I felt like AHLA was a place where I felt mentored and that I had people that I had mentored and it felt like a really collaborative place, but I feel like it's been a place I've really turned to.
Lisa: Uh, yes, uh, I'm uh, this morning I recorded a session for the in-house counsel meeting the virtual meeting. I think AHLA has done a great job of pivoting to, uh, to, for the membership. Um, the fellows I'm coordinating the fellows coordinating committee and chairing that. And we're preparing for a two hour virtual meeting with all of the fellows, a couple of hundred attorneys. And, uh, so, um, AHLA, uh, is just a great opportunity to mentor and to collaborate. Uh, I'm in contract with somebody, um, virtually every day from somewhere else in the country or in the world, um, and many of those folks are AHLA members. Uh, I feel very comfortable reaching out and feel very fortunate that I can reach out to colleagues and, uh, ask questions. I have a lot of attorneys that call me and say, so what do you think? Uh, how do you think this will play? And I feel very comfortable that I can trust those individuals that I can talk off the record and help them work towards solutions for their client. Um, and at the same time, uh, move, meet on the needs of patient safety and quality.
Sarah: Right, but I got a text message and if the person was listening last night, it was like, oh, I wish I wish we were live and in person right at our, at the annual meeting but, um, but at the same time. I think, I think the AHLA pivoted amazingly. And I also just, um, I've been the same way I've had people call me kind of off the record. Like and said, hey, can I just run some stuff past you? And I have, I recently started doing the same like, this doesn't seem clear, or like, what do you think? Or have you seen this? And I've did that before, but I think it's, it feels different. It feels different now. Robyn, how about you? Have you felt this sort of more collaborative, um, nature and have, has the AHLA been part of that, or, I mean, obviously you and I actually worked, worked in DC at the same time and kind of knew each other sort of right. Pass a million times with them, but, uh, and Lisa and I have, um, someone in common that is an amazing influence, so if she's listening or we'll make her listen to this podcast. Um, okay. So, I mean, I feel like it's really brought us together, but have you felt that same kind of collaborative, uh, difference in, uh, in our profession?
Robyn: Definitely. I mean, I think one of the most valuable things for me about conferences is, is that interaction that networking or the back and forth between a panel at a conference and the people in the audience. And so, um, the more that organizations like AHLA can do to get that interaction going, whether it's through, um, you know, webinars by Zoom, where there can be, um, an interactive period at the end with questions, um, whether, you know, um, hospital associations or state bar associations can get groups of lawyers together who might be similarly situated and can talk about circumstances that they're dealing with I think that's incredibly valuable. For me, some of the most helpful conversations I've had during the pandemic have been with hospital general counsels where, you know, we've gotten together as groups and said, Hey, have you seen this yet? Um, you know, what are you doing? Like, what are you doing in response to concerns about, um, PPE not being up to appropriate standards? How are you dealing with that? Just various questions like that to see if you can bounce ideas off of each other.
Sarah: No, that's wonder. I think that's so true. Um, and I think what I will do now is, well, I want to ask you both to give one thing you'd like to leave the audience with. Um, Robyn, why don't you go first? What? What's something that you'd like to leave the audience with about COVID-19 and in-house life now.
Robyn: Yeah, I think I would like to leave the audience with what I try to remind myself of, which is, um, that we're living through a pandemic. How many people can, you can say before this period of time that they had done that. And so be kind to yourself. It's a great learning opportunity, both about your area of the law. Even if you've been practicing for 20 years you're bound to come across some new things during this period of time and be kind to yourself about your life outside of the law as well. You know, take this time that you have at home that you might not otherwise have had to spend time with your family or focus on something new. I actually have started working on this meditation app that, um, I learned about during the, during COVID and I never would have done that in the past. It was something I probably would have thought was flaky, but it helps calm me down a little bit, um, at the end of the day. And it's just something that I can use to take some time to focus on myself.
Sarah: I think that's really lovely. I was just thinking I haven't, um, try to actually be outside. Part of me is worried that winter's coming eventually, but, um, but just, yeah, that being outside and like just even sitting under a tree and just relaxing. Yeah, absolutely. Um, how about you? How about you, Lisa? What's something that you'd like to leave the audience with.
Lisa: Actually while I have the microphone, a couple of things, one, I want to take an opportunity and to thank all the healthcare providers in the country and their teams, the general counsels, their teams, everyone that is just doing incredible work every day during this pandemic. Uh, I just wanted to say a heartfelt, thank you. Uh, to all of you, uh, and, uh, secondly, I want to comment that, uh, I, I am available. If anyone has a question or concern wants to bounce something off of me, uh, the Joint Commission is available. Uh, we will do whatever we can to help the health care organizations in the country, support those organizations. And I make that as an open offer to anyone who's listening.
Sarah: Lisa, thank you. I mean, I can't even ask of, uh, two better comments to leave this podcast with. Um, thank you everyone for joining us today on, um, June 26, 2020. I almost wanted to say March, but it is not March. It is June. Um, if you want more information about AHLA. Um, check out their website. They have a great, uh, resource on, uh, coronavirus and there's more podcasts. You can go back and listen to the other GC roundtable podcasts or podcasts on other topics. And thank you, Lisa. Thank you, Robyn, and have a great day.
Robyn: Thank you.
Lisa: Thank you, Robyn. Thank you. Thank you, Sarah.