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Hopkins Legal
Physicians aren’t the only people carrying beepers around the clock.

blank Katie Bell
From left: Lawyers Nancy Gregor, Jeff Natterman, Meg Garrett, Susan Longley and Barbara Ayres make up Hopkins' team of on-call attorneys.

Meg Garrett is a plain-spoken, no-nonsense woman with lots of war stories. When she speeds through her nearly weekly risk management presentation for physicians and other health care providers, the audience pays close attention. She covers myriad issues—medication errors, wrong-site surgery, advance directives—while providing assurance to the crowd, many dressed in scrubs, inside Hurd Hall.

“If something bad happens in the middle of the night,” she says, “we want you to contact us immediately. We’ll work through it.”

But Garrett doesn’t treat patients herself, even though she trained as a nurse and has a master’s in counseling. She is senior counsel for the Johns Hopkins Health System Legal Department, and she and four of her attorney colleagues share 24/7 on-call duties year-round.

There was a time when Garrett, a 22-year veteran of Hopkins, shouldered the on-call duties solo. About a decade ago, she built a three-person team, which still meant that each member carried the beeper four months a year.  But since November 2006, when the group grew to five, the burden has become more bearable. “We are getting older,” says Garrett, “and it was exhausting.”

In fact, the on-call attorneys answer 500 calls a month, any time of the day or night, in addition to hundreds of daily
e-mails. Susan Longley, a former trauma nurse who is now risk management and general affairs attorney at Johns Hopkins Bayview Medical Center, says the calls have increased significantly since the lawyers began their “lecture circuit,” explaining to groups throughout Johns Hopkins Medicine about their roles as urgent care legal advisers.

The most common calls they receive involve consent, which can become particularly tricky in pediatric cases. “It may seem like every one of your kids is being taken care of by parents who are in the middle of a divorce,” Garrett tells a group of physicians. “Mom says, Don’t tell Dad. Dad says, Don’t tell Mom. The whole thing is a mess and you get stuck in the middle.”

“We get a lot of those calls,” adds Barbara Ayres, senior claims representative who investigates medical malpractice claims and is the newest member of the team. (Under Maryland law, both parents have equal rights to information about their children.)

Other situations are more challenging. There have been disputes in the intensive care units among families over life support, suspicions of child abuse or neglect, violent patients in psychiatry and families who insist that more measures be taken after a patient is clearly deceased. “The bottom line is,” says Garrett, “it’s a very intense environment.”

Garrett’s most often repeated advice to health care providers when the unexpected happens is to apologize to patients and families and assure them that there will be an investigation. “Our philosophy here at Hopkins is disclosure, but when we make disclosure, we look to be accurate.”

Like other members of the team, Jeff Natterman, associate director of risk management, who was a respiratory therapist before he decided to go to law school, has a specialty—in his case, dealing with product recalls and regulatory agencies. The on-call work, he says, can be stressful, “especially at an academic medical center. It wouldn’t be doable without the team.”

The five members say they operate like a small practice. “We’re like a mini firm, like an ER of practicing law,” says Nancy Gregor, senior counsel with 31 years experience in health care law. “This is real world, real time. You don’t have any idea what the next call is going to be.”

Sometimes, Garrett adds, the caller doesn’t want to hear her instructions on the other end of the line. “They just want to practice medicine. They’re tired of regulations.” Still, when a physician called saying that he had forgotten to get consent for his anesthetized patient, Garrett told him to wake the patient and have him return the next day.

Health care law, Garrett says, is changing all the time, and much of it is gray. “So please, go through us. We’ll guide you, we’ll follow the process.”                 

— Mary Ellen Miller

To contact the legal department, call 410-955-7949.



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