Bridging the Gap Between Healthcare Administration & Law

After developing his career in both healthcare administration and law, Sam Germana built an integrated legal department as Trinitas Regional Medical Center’s first general counsel

When Sam Germana learned that Trinitas Regional Medical Center was searching for a general counsel, he knew it was the opportunity he was waiting for. As general counsel, he would have the opportunity to bring together the legal function and the management function of healthcare.

Sam Germana, Trinitas Regional Medical Center

“As a lawyer in-house, you can’t be in a silo,” Germana says. “You bridge the gap between administration and law by having one foot in both areas.”

Germana had experience in both legal and administrative functions when he joined Trinitas—a 554-bed Catholic teaching hospital—in 2002. He began his career in healthcare while still in college, when he took a position as a therapy aid. At the time, he was studying to become a psychologist, but he found himself drawn to the administrative side of the house. He worked his way up the administrative ladder, earning a degree in health services administration before attending law school.

Eventually, Germana became Trinitas’ first general counsel, and he approached his new role with a manager’s eye, seeing his task less as that of creating a legal department and more so as that of managing a function. “I had to figure out how the legal department could be seen as approachable, helpful, and a service,” he explains. “I don’t treat patients. I’m not a doctor. I’m not a nurse. I’m here solely as a service to assist those who are doing the main operational work that this hospital does—treat patients.”

His mission was to integrate the legal function into the business, and he accomplished that through a personalized approach. Like a physician, he made rounds, asking his colleagues what tools and support they needed to make their work easier. “That’s the way you become approachable—by approaching,” Germana says.

Every two weeks, Germana attends the new employee orientation, where he introduces himself and the legal function to new staff members. He encourages employees to call him with any questions or concerns. “Once a couple of people check in and ask questions and find that you want to help, that spreads very quickly,” Germana says. Through these orientations, Germana has been able to meet almost every employee.

He also uses these orientations to create a culture of compliance at Trinitas. Healthcare is a highly regulated industry, and Germana’s goal is to make the business’ goals work within the framework of those regulations. “Compliance is like doing your taxes. You want to get every penny you’re entitled to, and you don’t want to be a cheat,” he explains. “It’s not just looking out to make sure you don’t get in trouble. It’s a proactive way to get the maximum return that you’re legally entitled to. When you put it that way, it sounds like a positive thing.”

Germana has brought much of the legal department’s work in-house, but part of his approach is to acknowledge what he doesn’t know and to seek outside help when needed. This is especially important in such a lean legal department, which is made up of three people—himself, an assistant, and a risk management director. Previously, the insurance function was housed in the finance department, but during one of the company’s reorganizations, Germana and his colleagues determined that the function would work more efficiently if it were housed in the legal department. Although Germana understood the basics of the insurance function, he knew that he would need outside help to maximize Trinitas’ return on investment.

He decided to work with an outside firm that, while more expensive, would ultimately save Trinitas money. “We worked out a fee negotiation scale, and due to their ability to look at our risk management program, we were able to save in the first couple of years over $1 million in premiums,” he says.

Over time, Germana’s assistant gained experience in the insurance program, and Germana was able to bring the role in-house. He promoted his assistant to take on the insurance responsibilities and streamlined the function into a department that already handled compliance and risk management.

After practicing law for more than two decades, Germana knows what to expect when it comes to the legal function. But integrating with the business is an ongoing process. Once a week, Trinitas’ president and management team meet to discuss the health center’s future strategy and current issues. Vice presidents from across the organization weigh in with their input on how the organization can maintain, improve, or correct its course if needed.

These meetings offer a prime opportunity for cross-functional collaboration. Instead of limiting his suggestions to legal issues, Germana offers input on issues outside of his department. “If even 20 percent of my suggestions are helpful, then it’s worth the time just to tell people what’s on my mind,” he says.

His legal training and hospital administration experience give him the foundation to succeed in his role, but it’s the little things, Germana says, that ensure he effectively integrates into the hospital’s operations. “You’re not the busy lawyer with the briefcase running around from place to place with your head down,” Germana says. “You make eye contact. You smile. You see a gum wrapper, and you pick it up. If someone’s lost, then you ask them where they’re going.”

Photo: John Mazurkiewicz