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Hospital general counsel enjoys diverse workload

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In-House Counsel

After spending 12 years in the health-care field as an X-ray technician, an in-house counsel for a hospital network in Indianapolis seems to be in the right place.

Shelley Fraser has been at Community Health Network for almost two years after hearing about the job from a neighbor of someone who worked in Community’s legal department. At that time, she’d been working for the firm now known as Taft Stettinius & Hollister for about five years, where she practiced health-care law.

shelley fraser Shelley Fraser, in-house counsel for Community Health Network in Indianapolis, went to law school to pursue a practice in health-care law after being an X-ray technician for 12 years. (IBJ Photo/ Perry Reichanadter)

Her main interest in going to law school was to practice something in the field of health care, so she enjoyed that job where she had experience with transactional and regulatory work in the health-care field.

But she was also excited for a new opportunity and ready for a change where she could focus on just one client. She also saw potential of being able to spend more time with her family – she was pregnant at the time – and spend less time worrying about billable hours and business development. She added this doesn’t mean she has any less work – if anything she might have more work – but it’s also faster paced and more focused because she only has the one client.

Today, as assistant general counsel to Community Health Network, she splits her time between an office at Community Hospital East and another office at Visionary Enterprises Inc.

“VEI is essentially the innovative development arm of the network – it owns and manages numerous ambulatory surgery centers, manages physician practices, and owns and manages real estate in addition to many other business ventures,” she said.

Each of those offices also has a member of the legal department who is there full time – Karen Ann Lloyd is at Community Hospital East, and Karen Turner is at VEI. The three of them oversee the legal issues of the network that includes 11,000 employees around central Indiana. She also said the three attorneys work well together, and she never feels isolated.

“It’s more of a team environment,” she said. “We don’t collaborate on everything, but we always support each other.”

There are five hospitals, plus more than 90 sites of care, which have a wide range of legal issues, she said.

In her role, she continues to work on transactional and regulatory compliance, but she and other general counsels also address tax, employment, mental health issues, and even criminal questions. She said the work is diverse and no two days are ever alike.

While she doesn’t often use her clinical background in her day-to-day work, she said it does help her understand how a hospital works, including the importance of focusing on the needs of patients.

She also said as a member of the risk-management team for the hospital network, even though things have changed since she was in the field, when she works with nurses she at least has an understanding of what they do because of her background.

While it doesn’t happen every day, from time to time she is able to affect patients’ lives directly – something she misses from her time as an X-ray technician. This usually only happens when she receives a call from the intensive care unit regarding a patient who is incapacitated and a decision needs to be made about the patient’s treatment, even if there’s no clearly defined person who can speak on behalf of the patient.

They’re never easy choices to make, she said. She can tell the physician the ethical or legal ways to handle the situation, but there isn’t always a clear answer one way or the other.

She has also learned about mental-health legal issues as the network has a number of patients with these concerns. For instance, the legal aspects of the commitment process, such as when someone can be constrained; what happens if the person needs medication but cannot give consent and who can give that consent; guardianship and power of attorney issues; the network’s role in cases involving child protective services and adult protective services; when mental-health records can be released; what records can be released when it comes to alcohol and substance abuse; duty to warn issues when it comes to issues like HIV reporting; and what can or can’t be shared in therapy sessions involving support groups.

While most of the physicians and others in the network have seen a lot of these firsthand and know many of the answers themselves, she said, “They already know the easy answers. By the time the question gets to me, there’s some kind of twist to it that’s unusual from what they usually see.”

She said among the issues she’s seen, some of the harder ones to address involve forced medication and consent issues, including controversial procedures or even when the issue of patient sterilization arises.

The hospital network has also worked with court programs. While those programs run on their own, she said the legal department has reviewed some of the forms to make them in compliance with what can and can’t be disclosed to the court regarding mental-health issues.

She added a number of people who work for the hospital have been there 20 or 30 years, and can also provide institutional knowledge when needed. Or when changes need to take place – as they have under health-care reform over the past couple years since Fraser started – others in the hospital can serve as a good reference when it comes to what has or hasn’t worked in the past.

“As the health-care industry is being revamped and redesigned, it’s a great opportunity to improve processes,” she said. “Our goal is to have better patient care and better access, and we’re analyzing how to make those changes over the next couple years.”

Among those changes are how to make records more high tech and in compliance with the Health Insurance Portability and Accountability Act, but because the hospital network is already connected, one concern is if the requirements are somehow different from what the network already does.

Fraser remains in touch with her mentor, Dave Bromund, a partner at Taft Stettinius & Hollister.

“Shelley was an important member of our health and life sciences group,” he said via e-mail. “We were sorry to see her move on, but understood that she was getting a great opportunity at Community. While she was here, she had a quiet confidence and maturity beyond her years in practice that clients loved. Some of that was due to her background in the health-care industry, but much of it was her great personality. She was a great problem-solver and saw issues from the client’s perspective. Again, this may be due, in part, to her prior industry experience. Her success and rapid progress to more significant and complex work came from her own hard work, solid critical thinking skills and good sense to ask the right questions.

“Shelley also showed her own initiative to get involved in the leadership of the American Bar Association’s task force on women’s issues,” he added. “She was passionate about helping women with breast cancer and focused her pro bono efforts on this cause.”•

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  1. California Sex Offender Management Board (CASOMB) End of Year Report 2014. (page 13) Under the current system many local registering agencies are challenged just keeping up with registration paperwork. It takes an hour or more to process each registrant, the majority of whom are low risk offenders. As a result law enforcement cannot monitor higher risk offenders more intensively in the community due to the sheer numbers on the registry. Some of the consequences of lengthy and unnecessary registration requirements actually destabilize the life’s of registrants and those -such as families- whose lives are often substantially impacted. Such consequences are thought to raise levels of known risk factors while providing no discernible benefit in terms of community safety. The full report is available online at. http://www.casomb.org/index.cfm?pid=231 National Institute of Justice (NIJ) US Department of Justice Office of Justice Programs United States of America. The overall conclusion is that Megan’s law has had no demonstrated effect on sexual offenses in New Jersey, calling into question the justification for start-up and operational costs. Megan’s Law has had no effect on time to first rearrest for known sex offenders and has not reduced sexual reoffending. Neither has it had an impact on the type of sexual reoffense or first-time sexual offense. The study also found that the law had not reduced the number of victims of sexual offenses. The full report is available online at. https://www.ncjrs.gov/app/publications/abstract.aspx? ID=247350 The University of Chicago Press for The Booth School of Business of the University of Chicago and The University of Chicago Law School Article DOI: 10.1086/658483 Conclusion. The data in these three data sets do not strongly support the effectiveness of sex offender registries. The national panel data do not show a significant decrease in the rate of rape or the arrest rate for sexual abuse after implementation of a registry via the Internet. The BJS data that tracked individual sex offenders after their release in 1994 did not show that registration had a significantly negative effect on recidivism. And the D.C. crime data do not show that knowing the location of sex offenders by census block can help protect the locations of sexual abuse. This pattern of noneffectiveness across the data sets does not support the conclusion that sex offender registries are successful in meeting their objectives of increasing public safety and lowering recidivism rates. The full report is available online at. http://www.jstor.org/stable/full/10.1086/658483 These are not isolated conclusions but are the same outcomes in the majority of conclusions and reports on this subject from multiple government agencies and throughout the academic community. People, including the media and other organizations should not rely on and reiterate the statements and opinions of the legislators or other people as to the need for these laws because of the high recidivism rates and the high risk offenders pose to the public which simply is not true and is pure hyperbole and fiction. They should rely on facts and data collected and submitted in reports from the leading authorities and credible experts in the fields such as the following. California Sex Offender Management Board (CASOMB) Sex offender recidivism rate for a new sex offense is 0.8% (page 30) The full report is available online at http://www.cdcr.ca.gov/Adult_Research_Branch/Research_Documents/2014_Outcome_Evaluation_Report_7-6-2015.pdf California Sex Offender Management Board (CASOMB) (page 38) Sex offender recidivism rate for a new sex offense is 1.8% The full report is available online at. http://www.google.com/url?sa= t&source=web&cd=1&ved= 0CCEQFjAA&url=http%3A%2F% 2Fwww.cdcr.ca.gov%2FAdult_ Research_Branch%2FResearch_ documents%2FOutcome_ evaluation_Report_2013.pdf&ei= C9dSVePNF8HfoATX-IBo&usg=AFQjCNE9I6ueHz-o2mZUnuxLPTyiRdjDsQ Bureau of Justice Statistics 5 PERCENT OF SEX OFFENDERS REARRESTED FOR ANOTHER SEX CRIME WITHIN 3 YEARS OF PRISON RELEASE WASHINGTON, D.C. Within 3 years following their 1994 state prison release, 5.3 percent of sex offenders (men who had committed rape or sexual assault) were rearrested for another sex crime, the Justice Department’s Bureau of Justice Statistics (BJS) announced today. The full report is available online at. http://www.bjs.gov/content/pub/press/rsorp94pr.cfm Document title; A Model of Static and Dynamic Sex Offender Risk Assessment Author: Robert J. McGrath, Michael P. Lasher, Georgia F. Cumming Document No.: 236217 Date Received: October 2011 Award Number: 2008-DD-BX-0013 Findings: Study of 759 adult male offenders under community supervision Re-arrest rate: 4.6% after 3-year follow-up The sexual re-offense rates for the 746 released in 2005 are much lower than what many in the public have been led to expect or believe. These low re-offense rates appear to contradict a conventional wisdom that sex offenders have very high sexual re-offense rates. The full report is available online at. https://www.ncjrs.gov/pdffiles1/nij/grants/236217.pdf Document Title: SEX OFFENDER SENTENCING IN WASHINGTON STATE: RECIDIVISM RATES BY: Washington State Institute For Public Policy. A study of 4,091 sex offenders either released from prison or community supervision form 1994 to 1998 and examined for 5 years Findings: Sex Crime Recidivism Rate: 2.7% Link to Report: http://www.oncefallen.com/files/Washington_SO_Recid_2005.pdf Document Title: Indiana’s Recidivism Rates Decline for Third Consecutive Year BY: Indiana Department of Correction 2009. The recidivism rate for sex offenders returning on a new sex offense was 1.05%, one of the lowest in the nation. In a time when sex offenders continue to face additional post-release requirements that often result in their return to prison for violating technical rules such as registration and residency restrictions, the instances of sex offenders returning to prison due to the commitment of a new sex crime is extremely low. Findings: sex offenders returning on a new sex offense was 1.05% Link to Report: http://www.in.gov/idoc/files/RecidivismRelease.pdf Once again, These are not isolated conclusions but are the same outcomes in the majority of reports on this subject from multiple government agencies and throughout the academic community. No one can doubt that child sexual abuse is traumatic and devastating. The question is not whether the state has an interest in preventing such harm, but whether current laws are effective in doing so. Megan’s law is a failure and is destroying families and their children’s lives and is costing tax payers millions upon millions of dollars. The following is just one example of the estimated cost just to implement SORNA which many states refused to do. From Justice Policy Institute. Estimated cost to implement SORNA Here are some of the estimates made in 2009 expressed in 2014 current dollars: California, $66M; Florida, $34M; Illinois, $24M; New York, $35M; Pennsylvania, $22M; Texas, $44M. In 2014 dollars, Virginia’s estimate for implementation was $14M, and the annual operating cost after that would be $10M. For the US, the total is $547M. That’s over half a billion dollars – every year – for something that doesn’t work. http://www.justicepolicy.org/images/upload/08-08_FAC_SORNACosts_JJ.pdf. Attempting to use under-reporting to justify the existence of the registry is another myth, or a lie. This is another form of misinformation perpetrated by those who either have a fiduciary interest in continuing the unconstitutional treatment of a disfavored group or are seeking to justify their need for punishment for people who have already paid for their crime by loss of their freedom through incarceration and are now attempting to reenter society as honest citizens. When this information is placed into the public’s attention by naive media then you have to wonder if the media also falls into one of these two groups that are not truly interested in reporting the truth. Both of these groups of people that have that type of mentality can be classified as vigilantes, bullies, or sociopaths, and are responsible for the destruction of our constitutional values and the erosion of personal freedoms in this country. I think the media or other organizations need to do a in depth investigation into the false assumptions and false data that has been used to further these laws and to research all the collateral damages being caused by these laws and the unconstitutional injustices that are occurring across the country. They should include these injustices in their report so the public can be better informed on what is truly happening in this country on this subject. Thank you for your time.

  2. Freedom as granted in the Constitution cannot be summarily disallowed without Due Process. Unable to to to the gym, church, bowling alley? What is this 1984 level nonsense? Congrats to Brian for having the courage to say that this was enough! and Congrats to the ACLU on the win!

  3. America's hyper-phobia about convicted sex offenders must end! Politicians must stop pandering to knee-jerk public hysteria. And the public needs to learn the facts. Research by the California Sex Offender Management Board as shown a recidivism rate for convicted sex offenders of less than 1%. Less than 1%! Furthermore, research shows that by year 17 after their conviction, a convicted sex offender is no more likely to commit a new sex offense than any other member of the public. Put away your torches and pitchforks. Get the facts. Stop hysteria.

  4. He was convicted 23 years ago. How old was he then? He probably was a juvenile. People do stupid things, especially before their brain is fully developed. Why are we continuing to punish him in 2016? If he hasn't re-offended by now, it's very, very unlikely he ever will. He paid for his mistake sufficiently. Let him live his life in peace.

  5. This year, Notre Dame actually enrolled an equal amount of male and female students.

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