By Jeff Overley

Law360 (March 20, 2020, 10:16 PM EDT ) With New York City in the grips of the coronavirus outbreak, the general counsel of one of NYC's most prominent hospital systems spoke with Law360 about urgent preparations for a looming flood of infected patients and her advice for attorneys in areas that haven't yet been rocked by the public health crisis.

Beth Essig, Mount Sinai Health System's top lawyer, told Law360 during a 30-minute interview on Friday afternoon that health care institutions and government regulators have proved remarkably adept at finding common ground during the new coronavirus' relentless march across New York City — the outbreak's new and eerily quiet epicenter in the U.S.

Essig has four decades of experience with Mount Sinai, which has eight hospitals, hundreds of outpatient practices and more than 7,000 physicians. During the interview, Essig said that her peers in other hospital legal departments shouldn't hesitate to seek regulatory relief during these difficult days, and that ultimately, saving lives is more important than any technical compliance issue.

This interview has been edited for length and clarity.

How are new legal and regulatory issues playing out during this crisis?

The government at every level has been incredibly cooperative with us, and we are working together with them to modify and eliminate [certain] requirements so that we can be nimble and respond to the crisis. So right now, a lot of what we're doing is making sure everybody feels comfortable doing what they have to do in this crisis. And by everybody, I mean it's not just the lawyers — it's the executives, the nurses, the doctors. It's really amazing.

What provisions are you working with regulators to relax?

I'll give you an example. There are very material restrictions on how, when someone comes into the emergency room, whether you have to admit them and how you have to stabilize them. That's called the Emergency Medical Treatment and Labor Act, or EMTALA.

So the federal government is working with all the providers to make sure that there's nothing about that statute that will slow or impede front-line providers from providing care, transferring patients as appropriate to the right place for care, and getting testing done in the right place.

Also, in New York state, one of the very material things hospitals have to do is make sure that physicians are credentialed to provide services in the hospital. And the state and the federal government have very specific criteria for that. And just in the last 24 hours, they've made it easier and eliminated a lot of those requirements, so that we can move providers around the state and make sure that patients get the care they need.

There's a fantastic health care provider and government partnership in trying to make everything work. I've been doing this a long time, and seeing everybody come together — the state, the feds, the executives and the health care providers — is really great, and it's helping make things better.

I've been a health care lawyer for 40 years, and I am totally blown away and awestruck by the commitment and dedication of the front-line providers in our facilities. We're used to thinking of them as colleagues, clients, mortals — I think they're superheroes now. I'm just awestruck by their dedication and brilliance and willingness to just step up and put themselves out there.

Mount Sinai has 42,000 employees, many of them in settings with high coronavirus risks — what issues has that created for your workforce?

We've been lucky. We haven't even witnessed an elevation in people calling in sick. We have an incredibly dedicated staff. The thing that we're a little concerned about is if this takes a long time, how this commitment is going to have to be sustained for a while.

But there are no signs of burnout so far?

I would say absolutely not. It's still in the future when we will have what we're calling "the surge." It's not at all business as usual right now, but there isn't an overwhelming volume of these patients. I think in two weeks or three weeks or four weeks — who knows when and if the surge happens — then we'll be able to assess that.

But so far, I would say there's no hint of [burnout]. That's why I am so awestruck. It's not often that a lawyer gets the chance to be the one to say publicly, "Thank you." I've really been here a long time. I've been through labor [disputes] and other kinds of things, 9/11 and other tragedies, but the dedication and commitment here is unbelievable. It sort of puts being a lawyer in a little bit of perspective.

How so?

It make us feel that we're lucky that we're in jobs that let us help them. And I want to say also, major law firms, including Paul Weiss, have offered to volunteer. And not just pro bono work. Lawyers have reached out from all over the city and want to see if they can help. I think the legal community really wants to find a way to help.

It's very nice when your fellow professionals reach out and offer to help. I've had one lawyer at a law firm email me that he has a bunch of N95 masks. Those are the masks that prevent the [coronavirus] transmission. And he's going to mail them to me.

What steps is Mount Sinai taking to add treatment capacity?

We're doing a lot. One legal point is there's very substantial federal and state regulation on changing how you use hospitals, moving beds around, putting beds in different facilities in different ways. And all those rules have been suspended to enable each hospital to do the best it can. And I'm really struck by the trust between the providers and the regulators as they're allowing the providers to take the steps they need to take to make these decisions.

What's your level of confidence in the ability of Mount Sinai and other hospital systems to handle what's coming their way in this crisis?

I'm not an epidemiologist. But I have confidence that the lawyers are doing everything they can, and that nothing legal is going to get in the way of this hospital, or any hospital, doing the best it can.

What legal issues related to the coronavirus is Mount Sinai handling in-house? What's requiring outside counsel?

Right now, we're not really using outside counsel for anything related to this, despite the fact that we work with excellent outside counsel and they've offered to be helpful. We are managing it with our in-house staff. And the regular work of the legal department and of the huge health system, while it's a little bit diminished, it's still ongoing. The regular work of the institution is continuing.

So we have litigations that are pending where we still have outside counsel working on a couple matters. But with respect to the coronavirus work, it shows the value of in-house counsel. Because we know the people who [work here]. We know those people well and what their needs are. And because of that relationship, we're really able to help them move forward in a different way than outside counsel.

What advice do you have for general counsel at other hospitals, including those in areas with few cases so far?

Don't let legal or regulatory issues impede the work of your clients at any level, from the nurses to anybody else. Don't let the legal issues impede them, and don't be afraid to reach out to your regulator for the relief that you need.

And really always do the right thing. This is not a time to worry about legal consequences. This is a time to make sure that your clients can get done what they want to get done. And that's really been the legal department's attitude throughout. And that's part of why I think we've been able to really be helpful.

I've heard similar things from other lawyers who say it's important not to worry about every last compliance detail during this time.

I think the point is, don't worry about what the regulators are going to do — save lives, provide health care, be innovative, do what you have to do. We're here, as in-house lawyers who know you well, to help make sure you can do that. The people who are taking care of these patients, they have to know that they have to do what's right, and we will have their back. That's our job.

--Editing by Brian Baresch and Emily Kokoll.

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