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William H. Colby, General Counsel, Truman Medical Centers, Kansas City

As general counsel for the busiest emergency room in Kansas City, Bill Colby likes to quip: With 108,000 patients, 600 doctors and 4,000 employees, what could possibly go wrong?

The answer, of course, is plenty. Colby leads a four-lawyer staff that oversees the legal needs of the two-hospital system in the urban core of Kansas City. It’s a potent brew of potential legal issues, ranging from constitutional arguments to labor law to the Affordable Care Act.

“Hospital law is as varied a practice as I think you can find,” Colby said.

Colby, who became the hospital’s top attorney in 2009, came to the job with an unusual set of credentials. He had a long history with top law firms, including about 14 years at Shook, Hardy & Bacon.

But he’d also made a national name for himself representing the family of Nancy Cruzan in the first right-to-die case heard by the U.S. Supreme Court. The southwest Missouri woman spent seven years in a persistent vegetative state after a car accident in 1983. Although the Supreme Court ruled 5-4 against her family’s wish to remove her feeding tube, their divided ruling allowed for a new trial, which the family won. She died in 1990.

Bill Colby. Photo by Karen Elshout

Bill Colby. Photo by Karen Elshout

Most of Truman’s issues aren’t quite that controversial. But Colby, who went on to have a lengthy career writing and speaking about right-to-die issues, said the debates he’s had on those issues remain useful to this day as families cope with the process of their loved ones’ injuries and deaths.

“When I can provide comfort to those people that the decision they’re making is not only legal but right, and when I can help focus that discussion on what the patient wants, I’m glad to have that background,” he said. “After 30 years of talking about right-to-die issues, I’d better have some clue about how to navigate them.”

In some sense, that’s Colby’s approach to most challenges Truman faces. As a safety-net hospital that handles some 12 percent of the uncompensated care in the state, Truman frequently runs into conflicts between the various laws and regulations under which health care facilities must operate. For instance, Truman in September closed its behavioral health emergency department and transferred patients elsewhere, largely due to state and federal regulations.

Colby said it was too difficult to maintain that emergency room separate from its regular ER and keep both up to par.

“We just got to a point where we thought we needed to step back and figure out what was best for the patients, but also what was best for the ongoing health and licensure of the hospital,” he said.

The hospital is also caught in a bind under the Affordable Care Act, which will eventually phase out federal payments that help safety-net hospitals deal with the costs of uncompensated care. States were expected to expand their Medicaid programs to fill that gap, but the Missouri Legislature has refused to do so.

Colby takes comfort, however, that he can usually find a workable solution so long as the focus is on what’s best for the patient. The point of a general counsel at a hospital — or anywhere, for that matter — is not to tell an organization what it can’t do, but what it can.

“You come to a lawyer in that little sliver of life where the rules aren’t working and the social compact has broken down a little bit,” Colby said. “What we do is help people figure out how to … get back out of that place where the rules aren’t clear and help them come up with good business solutions.”