When a doctor faces suspension due to conduct or
incompetence at a large hospital, there’s a long list
of other doctors of the same specialty who can take
over. It’s a different story when that doctor is the
only general surgeon at a critical access hospital—a
rural facility with as few as 25 beds and five doctors.
Recently that very thing occurred, and that’s where
Sarah E. Coyne came in.
A surgeon faced a disciplinary process, which
usually requires review by a subcommittee of the
hospital’s medical staff, but was not possible in this
case. She sought an outside surgeon to review the
situation through a neutral, external peer-review
service. “It had to be somebody that was rural also,
because practicing surgery in a rural setting is just
different,” she says. “You don’t have all the fancy
equipment and supplies that you might in a larger
hospital.” She likewise helped arrange for an OB/
GYN surgeon at the hospital to act as both a mentor and proctor to the suspended surgeon while
they completed the correctional process.
Coyne, the national chair of Quarles & Brady’s
health law practice group, is out-of-house counsel
for many rural hospitals. She helps them with challenging issues, given their limited resources. “We
have to be creative and be able to scale things down
in a way that works,” she says.
She guides staff through the ways to comply with
laws, such as the obligation to report unprofessional conduct. When a doctor reports another for
wrongdoing, it can be rough on workplace culture.
“They have a tiny medical staff; everybody knows
everybody; everybody trained everybody; and how
this can work in a way that they can sleep at night
has been a real challenge for us,” Coyne says.
In the early ’90s, Coyne spent four years as an
occupational therapist for neurologically impaired
patients. She became concerned about patients
driving without restrictions on their licenses and
researched ways to do something about it in the
law library. She enjoyed the work and, on a whim,
applied to law school.
“I started working in health care and found it
easier than it might have been if I hadn’t been
steeped in the culture of hospitals and the medical system,” she says. “It gave me a lot of context
and operational knowledge that allowed me to be
practical a lot sooner than I otherwise would have
been with legal advice.”
Sarah E. Coyne
QUARLES & BRADY
Sarah E. Coyne helps rural hospitals apply big health care laws
to small-scale operations BY CHRISTINE SCHUSTER
HIPAA, the 1996 act governing medical privacy,
is designed to work for hospitals of all sizes, yet
it presents challenges to Coyne’s clients. “A huge
hospital system might be able to purchase a
complicated electronic medical record and imple-
ment it and devote tons of resources to make it go
smoothly. That’s not going to be possible in a little
hospital, yet they still have to check all the boxes.”
How do you apply system upgrades without a
dedicated IT staff? Coyne works to find physicians
who are interested in IT and willing to volunteer
their time. She has even enlisted hospital CEOs
to sit at the help desk after hours to fill the role of
technical support workers.
“Physicians are—I don’t mean to stereotype—
generally not in love with the idea of changing the
way they document,” Coyne says. “They’d much
rather be treating patients, and it’s kind of a fight,
to be honest, to get physicians to jump in and do
what they need to do to learn how to use it.”
Coyne, too, has to be readily available at all times.
“It’s a way of practicing law, and an area of law,
that there just isn’t a lot of background in,” she
says. “We had to make up our own rubric.”
The Rural Wisconsin
Health Cooperative is a
collaborative network of
small hospitals. Coyne
is a corporate partner
to the organization, and
often visits these spots.