The following is a transcript of my interview with Professor Lucy Hodder, JD. To find links to the audio files and more information about the interview, please click here.
These transcripts are made possible by a gift from the NNEAHE.
Bonica: Welcome to the Forge, Lucy.
Hodder: Thank you very much, I am happy to be here.
Bonica: You went to Princeton University and studied politics. Why did you choose Princeton and what is a major in politics like? It's not one I am familiar with.
Hodder: I have no recollection as to why I chose Princeton. It's where I had always wanted to go and it was far enough from home that I felt like I could get there but was away and I was recruited to row, so that was a big part of it.
Bonica: So you were an athlete?
Hodder: Yes, They had a phenomenal team and the women rowers there were standout and fun and welcoming.
Bonica: Did you do it all four years?
Hodder: I did. I was the co-captain of the varsity women's crew and my freshman boat won Nationals and so I had a great time. I was blessed to come a few years after the women had made huge strides with Title IX, so we actually had a coach and a locker room, so I really benefited from the women before me.
Bonica: Politics, why did you choose politics as your major?
Hodder: Basically, I loved constitutional law. I had a constitutional law class in high school, loved it. In high school going into my sophomore year I was the victim of a pretty harsh crime and for whatever reason it arose sort of a sense of justice and a curiosity about our system in me. My senior year I interned for Judge Rya Zobel, who was the first woman on the federal bench in Boston. It was in the federal district court there. She was wonderful. I got to be in her courtroom. I sat in on this massive patent case she was doing between Kodak and Polaroid and I organized all her notes.
Bonica: This was in high school?
Hodder: This was in high school. That was my senior project. She was new to the bench. We started aerobics classes in her chambers. I just had a wonderful time with her, so she became a bit of a mentor and opened my eyes to practicing law. She had been the first woman partner at Goodwin, Procter and Hoar. She was a real trailblazer and a phenomenal judge and person.
All of those things led me to be curious about politics and politics was the government major at Princeton. I basically opened the course catalog as I advise all college matriculants to do and simply circled every course that interested me. It turned out those courses added up to a politics major. I was able to take history and religion and politics and sociology and philosophy and they all added up to a politics degree.
Bonica: Given your internship, I am guessing you probably already knew you might want to go to law school going into undergrad? Is that true?
Hodder: I definitely had a sense of it. My senior year I went and volunteered in the prison in Trenton and met this guy named Uncle Yuley, who was just a relentless con-drug dealer-drug user and we just asked him everything about his life. I definitely had a sense of wanting to go out in the world and learn more about justice and American politics and the American system. It was simply a curiosity. It was just what I wanted to do. It was not really intentional, as much it was just my passion.
Bonica: You earned a J.D. at Georgetown University Law Center Cum Laude. What was it about being an attorney in particular that appeal to you because you could have gone and done straight academic research on justice studies or something like that, so why law school?
Hodder: I really liked the power of the courtroom and the power of the judicial process. I saw that as a way to affect change. My first introduction to law was through the judge's courtroom and I actually substituted for the filing clerk, her filing clerk for a period of time. Litigation seemed like a natural thing.
At Georgetown, my memories of law school were not much about the classroom, which I did not really like or appreciate at the time, but a lot about everything else that went with it. I did a number of clinics. I actually did street law clinic, which is a really amazing clinic at Georgetown where you go and teach basic legal theory and practice around things, torts and commercial law and civil rights either in the classroom for kids. But I taught at Lorton, which was that DC prison at the time. It's since been closed down. It was in Virginia. It was not racially integrated. I had a big classroom of about 40 men from DC and taught them street law and it was just an amazing experience.
Bonica: What does street law mean?
Hodder: The first class we opened up with a question about if you have Aids, it was during the AIDS epidemic, what are the ethical questions and the legal questions around whether or not you disclose to someone you might be intimate with? We talked about that. We talked about writing checks and loans and what that meant, commercial obligations. We talked about civil rights. It was a great dialogue.
Bonica: You were doing this while you were in law school?
Hodder: Yes. Then I also did the domestic violence clinic where you actually represent clients with domestic violence petitions and DC was one of the earlier jurisdictions that actually had a domestic violence statute that was in the very early years that it was recognized. I got to do that. I was co-chair of the Equal Justice Foundation. I was responsible for all the speakers in the fall. I really did a lot of outside of law school. I worked for a civil rights attorney, who did desegregation cases, so I had a lot of fun that way mostly because the classroom was not something I really appreciate it that much at the time.
Bonica: How did you have all the time to do that? I thought to law school was one of those things where it's all-encompassing classroom work?
Hodder: It is, but the clinics were part of my classroom work and the jobs I just found both helpful because they helped me pay for law school and so you made time for them.
Bonica: In what ways did the experience of law school surprise you? It's one of those things I think a lot of liberal arts people think, "Well, I will probably go to law school," only with a vague idea of what that might entail. When you got there what kind of was like "this wasn't quite what I expected."
Hodder: I was so philosophical coming out of college and then I taught for a year in Switzerland that I was much more philosophical about justice in law school and there were a lot of people who were there to crank it out and get a job, so it took me a while to re-orient to that. I think what I was surprised about how is much I have drawn from what I did in law school for my career. It was a really, ultimately a really wonderful experience, especially to be in law school in DC because we had access to so much enrichment through the political community there. I ultimately loved it.
Bonica: After graduating from Georgetown, you were a clerk for the Honorable Martin L. Feldman in the US District Court in New Orleans, Louisiana. What does it mean to be a law clerk? You hear that phrase. What is that?
Hodder: Being a law clerk is … I highly recommend it for anybody in law school. Basically what you are is you are the drafter and the eyes and ears of the court. You basically sit in on the motions. You sit in on the arguments. You sit in on the trial and you prepare all the documents for the judge. It gets you right in the middle of everything. You do all the research. You read the briefs. You draft the opinions.
I actually ended up in New Orleans on recommendation from Rya Zobel, who was the Federal Judge at Federal Court in Boston. She gave me, including herself, a list of judges who had courthouses that were very dynamic, where the law clerks actually did not just sit off in a distant room but really participated because it's a learning experience.
Judge Feldman was renowned. He is a wonderful man and he worked at the Federal Judicial Center, so he trained judges. That's why Rya Zobel knew him. He also trained a lot of our judges in the New Hampshire at the time. One of the things when you apply to work for a judge, to clerk for a judge, you are honorbound, I don't know if it's the same way, to accept an interview and accept a position to any of the judges you apply to if they offer it to you. He, of course, figured this out, so he called first. I went down to New Orleans and he offered me a clerkship first. That's how I ended up in New Orleans and it was absolutely wonderful.
Bonica: The big question here though is who makes the best [banees 00:09:43]?
Hodder: Well the best banees are definitely Café Du Monde. It is Café Du Monde, the best [poi bois 00:09:53] are definitely Mothers on Canal, yes a great place to eat. I met my husband down there, too.
Bonica: What kind of cases came to the District Court that you got to see? Is there a special kind of case he handled?
Hodder: We did all kinds of cases. Interestingly, the cases I remember most were not based on the facts but based on the law, especially as a young law clerk, there were very complicated issues around subject matter, jurisdiction and the choice of law. We did a lot of Jones Act and a lot of cases with [Stevedor 00:10:36], so there were a lot of maritime cases there. It was right after the oil boom, so we did a lot of maritime cases, a lot of civil rights cases, employment cases because that was just at the beginning of Title VII.
Bonica: Which is what?
Hodder: Title VII is the antidiscrimination statute in employment and sex harassment cases were just beginning to be litigated at that time. Then there were criminal cases and your average diversity jurisdiction disputes, so just run-of-the-mill civil cases or tort cases. There were a couple big, big tort cases we did, yes. It was really interesting.
Bonica: From New Orleans you went to San Francisco to work at the firm Brobeck, Phleger & Harrison as an associate. What kind of law did you go into practicing?
Hodder: I sure did. It was really hard for me. After my second summer of law school I worked at Hale & Dorr in Boston where I grew up and also had an offer to work at Brobeck. The decision about whether to stay in Boston, which I knew I should do, or go to San Francisco was a really, really hard one, but I had always wanted to … I loved San Francisco. I had worked to their a couple of years for summer jobs in law firms out there in college and I really wanted to see the world a little bit more. I had already accepted a job there before I clerked, so when I finished clerking …
Bonica: That meant you took a year off to do the clerking?
Hodder: … Yes, almost all firms do. They want you to get that experience. I was already committed to go to Brobeck. I had met my husband down in New Orleans and he was going back to Chicago to finish up medical school, so I went to Brobeck and ended up … I honestly don't know how I ended up there, but I was sitting, my office was on the same corner of the building, looking out over the bay at the end of the Market Street with the Labor and Employment Group.
Oddly enough, the Labor and Employment Group had … The only women partners I think were in the Labor and Employment Group or some of the few and it was actually a very natural fit. Some great, great attorneys there, I learned an incredible amount. They did a huge amount of training. It was right when the Americans with Disabilities Act was passed, the FM, Family Medical Leave Act, so there was a lot going on. California has a labor and employment code that's about 2 inches thick. We went off to training. We went to a trial advocacy training. It was a really great place to learn how to be an associate.
Bonica: As an associate were they training you to just do all different kinds of law or was that something they were pushing you in a direction toward?
Hodder: I could have done all kinds of law, but I just ended up working very closely with the attorneys in the Labor and Employment Group. Again, I still did some maritime interestingly enough and one of the attorneys on the floor did a number of asbestos cases, so I helped with the litigation in the asbestos cases. But I primarily did labor and employment.
Why I loved that practice is it was both litigation, so you did litigation and discovery and depositions, but it was also advice, a lot of advice. It was advising employers about compliance and educating about the implementation of laws in the workplace, drafting policies, answering questions. The learning I got there around how to quickly turned a new set of regulations into advice for your client was instrumental in my subsequent practice.
Bonica: You did some pro bono work as well during that time.
Hodder: I did.
Bonica: Tell us a little bit about that.
Hodder: It's amazing when you can connect with attorneys who are committed to pro bono. Having worked and co-chaired the Equal Justice Foundation, which was about lawyers going into public interest law, I felt pretty guilty I was at a big law firm. We would bill 2000 hours. We had dinner at the firm. It was not public interest law.
I did search out the partners who were doing cases and ended up working with this wonderful partner who did a lot with education and we did a big education case trying to ensure … It was a long time ago, but it was about access for immigrant children and their ability to access education. I think it was about transportation, as well as other issues, which it was a case I had left after drafting the complaint, but it was ultimately successful.
Bonica: Did the firm support that? Did they allow you to do that on firm time or was that like, "OK, after you have billed your 2000 hours, then you can work on it."
Hodder: Yes, it was after you billed your 2000 hours. I also litigated a case and I can't even remember what it was about. It was about rulemaking in the prisons. I litigated a case. I had to go down to Sacramento and do a trial. It's funny. It was a funny foreshadowing because I remember going to talk with attorneys for the state of California who represented their Department of Corrections because we were bringing an action … I think it was on behalf of an inmate about some kind of rules and they had not implemented the rules and we won. It was really fun.
I went to the office building that housed the attorneys for the California Department of Justice, all of whom represented the Department of Corrections and I did not think much of it. But it was a whole building full of Department of Corrections' attorneys and that was very funny. When I ultimately came to New Hampshire and was at the Attorney General's Office and I was the Department of Corrections' attorney and that was one of my clients. I had six other agencies.
Bonica: The whole building …
Hodder: Yes, the whole building versus …
Bonica: 1/6 of your time. You were in San Francisco for about two years and then you took a position as the Assistant Attorney General in the Civil Bureau for the New Hampshire Department of Justice here in Concord. What made you decide to leave San Francisco and private practice to come to work in the state of New Hampshire and for the state of New Hampshire?
Hodder: I would love to say it's because I always loved New Hampshire. I did not want to leave San Francisco. I had a fantastic job. I was being very well trained, loved San Francisco. I had met my husband when in New Orleans and he went to finish up medical school and we're commuting back and forth. I thought I had convinced him that doing his training in San Francisco would be wonderful, but he was a Dartmouth grad and had always wanted to do his medical training at Dartmouth. I remember the phone call where I was looking out over the bay and he was saying if I put in as number one Mary Hitchcock Memorial Hospital as his residency site, he would get it. He knew he would get it.
I did some panic calling of a couple of my friends from Georgetown, many of whom as it turns out were from New Hampshire, so I was in the same law school section as Jill LaPlante, who is now the Chief Justice of the Federal District Court here. They immediately said if you go to New Hampshire, you have to work at the AG's office. It's where everyone starts in New Hampshire, best place to work. So I called the Attorney General's office and Jeff Howard was the new AG. I flew out in March for an interview and was offered a position the morning that Rob had to put his choice in for residency picks so that's how it happened. So off we came in 1993 and got married and drove across the country and started work.
Bonica: Nice, what does the Civil Bureau do?
Hodder: That Civil Bureau, basically it's the attorneys who represent the state and they do all of the representation of the executive branch agencies in New Hampshire.
Bonica: Why does the state need representation like that? What kind of thing would you be representing the state in?
Hodder: I had as my area of expertise, I did a lot of the employment, as you might imagine, but I represented Health and Human Services and the State Hospital and the Division of Mental Health and the Banking Commission, the Labor Commission. It was helping them interpret the laws, so they were constantly questions about what the law means and how they should interpret it and how they should implement their rules. Then there was litigation. There was a lot of litigation.
I think within the week I got to the attorney general's office I was in the New Hampshire Supreme Court arguing a case. The state is sued frequently and some of its administrative issues, administrative law issues, there's an appeal from a decision of an agency and some of it is there are a number of lawsuits around someone from the State Hospital, for example, is released and then hurts somebody. The state sued for releasing the individual or someone falls at a state park or there are all kinds of ways the state is in litigation. Then big cases, we had big cases around Medicaid funding. There were so many different issues that would arise.
Bonica: How big an organization is the Civil Bureau?
Hodder: The attorney general's office are the attorneys for the state. In New Hampshire different from other places, the criminal bureau prosecutes all the homicides and they do all of the criminal appeals. The Civil Bureau represents all of the state agencies on the civil side. Separately, there is a department of transportation that represents just the department of transportation because they do a lot of imminent domain and a lot of work around highways and byways and then the department of environmental services. That's how the attorney general's office is set up. It's small. There are very few attorneys doing all the work for the state and I don't think the size has changed all that much since I was there that many years ago.
Bonica: What was the work like, especially compared to where you were coming from?
Hodder: I have to say it was a really excellent way to transition to go from private practice because I treated my agencies and my commissioners like clients and they really appreciated that. I called them back. I answered their questions. I helped them through difficult situations and so my learning as a private practitioner was very helpful transitioning to the public sector.
It was different in the pace. I had a lot of jury trials. I had a lot of judicial trials just in front of the court. I argued that the New Hampshire Supreme Court, I don't know, potentially between 15 and 20 times, so it was common to that I was there arguing, which was phenomenal. It was an incredible way to get litigation experience and have no fear about any issue that might be brought before you.
Bonica: It still sounds like you were general, you were really general. It sounds like you are doing all kinds of different things.
Bonica: When did you start getting interested in issues around healthcare delivery? Was that later in your career?
Hodder: No, it was back then. I represented the State Hospital. I represented the Division of Mental Health and Developmental Services and there were lots of issues around Medicaid funding and institutionalization. It was right after the de-institutionalization of the Laconia State School, so there were a lot of issues around the treatment and levels of care and funding. A lot of what we did was making sure the agencies were following their proper administrative procedures. I got involved in healthcare pretty early there and did a lot of cases involved with healthcare delivery.
I was also married to a physician. It's a unique experience when all of your friends are out in the world and you are married to someone who is in the hospital at 48 hours stretches while you are having children. You are tied to the healthcare system really closely when you are in that kind of a situation. I think it was coming from both sides.
Bonica: You served with the Civil Bureau for about four years and then you left to go back to private practice with the firm of Rath, Young & Pignatelli here in Concord. What made you decide to leave government service?
Hodder: My mentors, Jeff Howard, was one. He was the Attorney General who hired me. His advice when he hired me and I was coming from a big law firm was to stay at the AG's office four years, five years max. Four years was our commitment and I took that advice to heart.
I think his advice is really well taken, which is in public service you offer your skills and your services and whatever assets you have to the public service. If you stay too long, it's sometimes hard to remember what it is you brought to the job, although I have complete respect for those who stay in it. But the advice I had gotten was go in, offer everything you can, learn everything you can and then take on private sector but always keep an eye open for when you can come back and that's been really good advice because it keeps you very well grounded.
Bonica: What drew you to Rath, Young & Pignatelli specifically?
Hodder: Rath, Young & Pignatelli was a fantastic firm and I didn't really mean to go. I mean I loved the attorney general's office. I had had my second child by then, had done a ton of litigation. Litigation was little bit hard to continue with with two children and a husband who was still doing his medical training, which lasts forever.
I had a friend who I sang in the Concord Corral with who was an associate at Rath, Young & Pignatelli and she kept pushing, pushing, pushing. Sherry Young was a partner, had started the firm. It was one of the very few firms that had women in senior leadership and she just kept trying to persuade me to come work with her.
At first I said no because I taken a part-time position at the AG's office. I was working three days a week. She said, "That's fine. You can work three days a week for us," knowing full well that three days would be four and ultimately five, which is what happened. Then I …
That's not true. I had one child, so then I was pregnant and I said to her, "You can't take me now. You can't hire me now. You are off the hook. You do not have to hire me now." She said, "No, no, no, this is perfect. Come to Rath, Young & Pignatelli. You can work for a little bit, have your baby, go out on leave." They gave me a fantastic leave, "Then you will be ready to go." At that point I could not say no. That's where I went and it was an absolutely wonderful place to work.
Bonica: You were the chair of the Healthcare Practice Group. When did that happen? Did that happen right away? Were you hired into that role or did you evolve into that?
Hodder: No, evolved into that. I did a lot of employment work there. Almost immediately after I got there Annie Custer, Annie McClain Custer, who was one of my colleagues, just a phenomenal colleague, she had a government relations issue with an orthopedic practice who was building a surgical center and had an adverse decision out of the blue at the Certificate of Need Board. She just dragged me right into it and said, "It's administrative law, come help them," and I jumped in.
It was a big case. It was a big controversy and just from there on out I was representing physicians and facilities. It became very naturally for me. I had a passion for supporting providers and their ability to practice and be financially stable and survive in the healthcare world. There were a number of really fun developments in healthcare going on right then. There was the Stark and Anti-Kickback Regulations were becoming more complex, so it was a fun time to be practicing in health care. Annie Custer and I developed the practice. She did the government relations side. I did the legal side. She was the first chair of the Healthcare Group and then I took over.
Bonica: What does it mean to be a chair in a law firm?
Hodder: We mentored the associates who were practicing in healthcare. We developed and marketed our business. We basically oversaw that area of practice and made sure we were going in the right direction, up to speed on all the law and administrative issues and working our clients the best way we could with the best service we could.
Bonica: What does it take to be a successful healthcare attorney?
Hodder: Practicing in healthcare, first of all, is multifaceted now. There's no end to what you can do and which direction you can go. At that time it was understanding what the practice of medicine meant and protecting the practice, whether it be a hospital or facility or professional from the business side because they were the practitioners. It was really helping them figure out how do we structure ourselves so we can continue to focus on the patients, which was becoming more and more of a complex business proposition.
For healthcare, it really was understanding regulatory structures really, really well with an incredible attention to detail, understanding the financial world of medicine and in healthcare and putting it all together for your clients.
Bonica: You were not doing malpractice kind of work?
Hodder: I did some malpractice but no, my focus was … Our firm had a very strong malpractice defense focus through Mike Pignatelli, but my focus was in representing providers and facilities from the corporate healthcare compliance side.
Bonica: You were looking at how do you structure your business, how do you do administrative kind of things? Not necessarily getting into this provider made an error or something like that?
Bonica: Your CV lists you as a shareholder. What does that mean?
Hodder: A shareholder is just the modern word for partner. At some point the concept of partnership changed because of liability and it became a shareholder, so I was an owner in the firm and had a seat at the table and participated in the firm's financial distribution methodology and successes or failures.
Bonica: Can you talk a little bit about that process and how that works for people who are not familiar with how law firms operate and what does it mean to be a partner?
Hodder: Absolutely. Being a shareholder in a law firm is every law firm is slightly different. The way what goes along with being a shareholder and it's really important for attorneys who are starting at law firms to find out what that means, find out how the attorneys are compensated. It's important to ask. I think we spend a lot of time trying not to worry about whether it matters and it does matter.
Being a shareholder simply means you are part of the financial workings of the organization. You can also vote on the direction of the firm and its governance. You are part of the board of directors essentially. Our firm, one of the reasons why I loved it, it had a financial distribution methodology which I thought was very fair. It was very fair because basically your practice area you developed was what funded you.
Yes, you shared expenses with your partners and yes, you shared some clients with your partners and figured out how to make that work, but it was not based on hours. It was based on what the business was that you brought in and accomplished. You had to work really hard, but if you had a year where something tragic happened and you were not working as hard, you made less money. It was a very equitable way to practice together. I had phenomenal colleagues and we supported each other quite well. But it's important I think for lawyers going into the practice to understand how that practice works.
It's very important, first of all, if you are going to become a shareholder you need to have a client base. That means you have to develop a client base and that means you have to develop a client base when there are lots of smart, hard-working attorneys doing the same thing. You have to somehow figure out how to differentiate yourself and what it is you offer clients that they would be willing to pay for that makes you different in some way and that's really hard.
I think the best advice I can give is the advice I got always from one of my favorite clients, which was you have to do what you are passionate about because if you are not, you are going to be banging your head against a wall all the time. You really have to love what you do and that passion will make it easier for you to convince clients. They will see that. They will see that you care about them. They will see you know more about what their issues are than others and being a good advisor to them is really important. That's why I loved private practice because if that means a lot to you then it works really well.
Bonica: Say there is an element of selling here and you are kind of an entrepreneur. You have to get out and find your clients, so it's not just show up, work really hard. It's also a lot of networking …
Hodder: Absolutely and there is never a day when you're practicing healthcare that is the same. There's never a day where the issues are the same and that is difficult. I used to love it when someone would call me with an employment problem. I would be like, "Ah, okay we got this." That is one thing about healthcare. It's constantly changing and dynamic, which also is what makes it so much fun.
Bonica: You were at Rath when the Affordable Care Act was passed. How did that event affect your practice?
Hodder: It was wonderful and I talked to a lot of my students, which probably translates to other professions that if you pick a subject area where the law is constantly changing, it's forever great for you. You are constantly reading new regulations and advising clients about new regulations and figuring out how they can morph and meet those new obligations and that's both fun and rewarding based on the relationship you have with your client.
At the time I was also lucky enough to be the legal update designee for the Medical Group Managers Association in New Hampshire, so every month I got to update them on what was going on. I have this long history from 2007 of updating around the Affordable Care Act, so I tracked it really closely. It was a lot of fun to watch it all happen and then to be right in the middle of implementation was fascinating. I was not observing it from any kind of political space. I was observing it from "what does this mean for our healthcare clients' space," which was very interesting.
Bonica: You were with Rath, Young & Pignatelli from 1997 - 2013 or about 16 years. In 2013 you left the firm to be the legal counsel to the governor and senior health policy advisor in the office of the governor, who was and still is Maggie Hassan. How did you come to the role?
Hodder: If I look back too deeply I will think of what was I thinking? I wasn't really thinking. I had no intention to leave the law firm.
Bonica: It seemed like you were doing very well.
Hodder: I assumed I would be practicing there for the rest of my life. I had a booming practice. It was going extremely well. She asked me to be legal counsel. It first came through Pam Walsh, who was her chief of staff, and I had never considered doing something like that. I remember talking with Tom Rath, who is just an amazing mentor and I said, "I think she is going to ask me to be her legal counsel. What do I do?"
He said, "Well, we are a political law firm. You practice in the New Hampshire Bar. When a governor asks you to serve you have to be hard-pressed to say no. Why would you say no? That's what we are here for. That's what we do in New Hampshire. We are stewards of the bar. We are stewards of New Hampshire. You worked at the AG's office. When a governor needs you to serve then you should say yes and we will support you."
They were wonderful. The firm was wonderful about it. I had every intention to go back there. I still think of myself as part of that law firm. It was a totally sudden spontaneous decision. I felt like she really needed someone who understood healthcare because there was a lot going on in the state at the time. It wasn't just implementing the Affordable Care Act that had to happen. There was a federal US DOJ action against the state for our mental health system. The managed care Medicaid system that was supposed to be in place was a mess. There was a big Medicaid program for the hospitals that was in the middle of a lot of controversy. There was just a lot going on that was hugely problematic in the area of healthcare, so I said yes and she is also an amazing governor and lawyer, so the fit was really good.
Bonica: She herself is a lawyer?
Hodder: Yes, she is.
Bonica: The governor has an attorney general. She has a whole department of justice. Why did she also need her own legal counsel in her office? Why not just tap that organization?
Hodder: The department of justice represents the whole state. I was a liaison to them, so it was a constant communication, but they don't represent her. If she were sued, we would have an attorney there helping, but I was her legal counsel. She had to make decisions every day that she needed counsel and advice on. She had to review pardons. She had to review all the legislation presented to her by the legislature and decide whether to sign it or not. There were multiple legal issues that came up frequently.
If I needed help I would call the DOJ or the attorney general and we were in constant communication, but he was not her legal counsel. It's actually a position that is articulated in the Constitution for her that she will have that position …
Bonica: At the legal counsel.
Hodder: I'm not sure it's the Constitution or the law, but it's a mandated required position for her to have legal counsel. I was always somewhat envious because in Massachusetts I think they have 15, 10 in Massachusetts and five down in DC for him but anyway.
Bonica: For the governor.
Hodder: She has one, yes.
Bonica: And she had you.
Hodder: Yes, she has one.
Bonica: You were not just doing health law. You were advising her on the whole scope of whatever she was working on that needed legal interpretation or advice?
Bonica: Can you give some examples of things you advised her on that stand out in your memory from that time?
Hodder: I can't because it's confidential. I will say there were just a lot of different issues that always arose. Issues around her power and authority in emergencies and what her ability and control is. That came up especially in the Ebola outbreak. There was an issue around a legislator who had killed some ducks in a parking lot and it turned out she has some affiliated responsibilities with the Nashua Police Commission, very tangential so that came up and that was a really interesting unlikely scenario.
Then a lot of obligations around the Affordable Care Act, what kind of exchange we were going to implement, relationships with state agencies, a lot of issues that would come up around legislation because she might have to sign it, so tracking that and figuring out what could be done around legislation. She was very active in union disputes that were going to threaten the stability of the state. At the nuclear power plant there was a union dispute, then there was a big issue with Market Basket.
Also, issues around all of the litigation that impacted the state, the mental health lawsuit she was integral in helping resolve that. There was a big issue at a medical facility that she was very much involved in, setting up commissions to investigate, so she set up the Managed Care Commission.
She was instrumental in Medicaid expansion, drafting the legislation and figuring out and interfacing with the federal authorities around what was possible or not possible and working through the very complicated issues around the benefit to the newly eligible population under the Affordable Care Act took a huge amount of leadership from her and our office to implement.
Bonica: In that example you said "drafting legislation." Did you have a significant role in the process of drafting it?
Hodder: I would say we were integrally involved, yes.
Bonica: Why did she pick you?
Hodder: I never asked her that. I think we had had a long-standing connection when she was a senator and I had always been very supportive of her, so we knew each other and I don't know, my experience in healthcare? My commitment to public service previously? It was a good fit.
Bonica: You served the governor in this capacity for about two years, at which time you came to the University of New Hampshire where you currently have dual appointments in the School of Law and the College of Health and Human Services, which happens to be the college where I teach. Why was it the right time for you to leave the governor's office?
Hodder: It hearkened back to the advice from the attorney general. When I said yes to the governor I said I will do it two years. There was no way I could commit to more than two years. I approached it like a political peace corp. and then I stayed a little bit longer, so I went through two budgets and that was another big thing the governor obviously is responsible for is drafting a budget, so all of the legislative drafting that goes with that fell under legal counsel.
I knew two years were all I could muster. It was a 24-7 job. I dedicated myself to that. I was not even going to think about what it meant in my life to give up everything because I knew it was going to be two years, so that in my mind was what I had taken on. I could have stayed for much longer, but …
One of the things that happened when we were trying to implement Medicaid expansion, which is now the New Hampshire Health Protection Program, is it was very, very new. We were trying to figure out public-private options. We did not have anyone we could go to who was not representing a client with an interest around public policy matters involving healthcare. I found that to be a little bit frustrating. I thought we really should have a legal focus at one of our healthcare institutions.
I think the dean here at the time was a huge advocate of that, as was Ned Helms, and so they wanted to bring health law into health policy. The law school and the university were now under one roof, so it made for a unique opportunity. I actually delayed. They really wanted someone to start a year before and they wanted me to take that on.
Bonica: What is your position at the school of law? Can you tell us a little bit about what it is you do on a day-to-day basis here?
Hodder: I am blessed to be a little bit of a hybrid. I have a hat in a number of rings here, which is a wonderful opportunity for me. The question is keeping them all afloat or on my head at the same time is interesting. My obligation to the law school is I am here 50% of the time and I am tasked with starting and overseeing a certificate in health law and policy program.
As part of that, the certificate in health law and policy is a certificate for J.D.'s and there is a certain required number of courses they need to take in healthcare. Along with developing the certificate program, I also develop the courses that make up the certificate program, two of which I teach. I am a professor teaching in health law here at the law school as well. Developing that program and helping the students and making sure they have connections to the outside world.
We have a wonderful career office, as well as a residency placement office. We have worked very closely together to make sure the students who are pursuing healthcare have contacts for summer jobs and residencies during the year and also connections for careers subsequent. I've developed the curriculum to track the American Health Lawyers Association Curriculum, which you really need to go practice in healthcare.
We are trying to make sure they are ready to practice and we are also trying to develop more of a connection with our intellectual property side. We have a very strong intellectual property program here at the law school and there are a lot of startups and high-tech companies who are in the healthcare space, so we are trying to figure out how to train our healthcare attorneys to help in that regard as well.
Bonica: The certificate, is it a thing that students who are here earning their J.D. will typically pursue at the same time or if it's something people come back and do after they are graduated?
Hodder: Right now, they pursue at the same time. We are looking for ways to make it accessible to subsequent J.D.'s and also to other masters programs.
Bonica: What special considerations are there when teaching health law? How is it different?
Hodder: Health law is a practice area. It's an industry. It's different. Contracts are important for health law. Commercial law is important for health law. Antitrust is important for health law. It really is pulling together all the different types of legal training necessary to implement in an industry. What I have to do is make sure the students understand the industry and can therefore apply the more generalized areas of law they have learned to that industry.
The other half of my job is working with the institute. They are an applied research institute and it's been wonderful for me because the entire other area of healthcare from what I saw in private practice where I was very facility-professional focused. The institute really does some incredible work around population health and patient centered care and thinking around the delivery of services from a much more public health standpoint.
Bonica: This is the Institute for Health Policy and Practice?
Hodder: Yes, one of the things I make sure, not to complicate everything, but my health law half is teaching at the law school and developing the certificate program, but I am also the health law mind and expertise now for the institute. That means my health law students can have access to some of the programs and projects we are working on at the institute and I am hopefully bringing the two worlds together a little bit more. One of the things you learn, especially in medicine, is how important interdisciplinary learning and teaching really is.
Bonica: Students here in Concord are now having an opportunity to work on projects with IHPP from …
Hodder: That's the hope, yes.
Bonica: What do you see are the most important policy issues you are dealing with in either of your roles now?
Hodder: I think of one of the most important things going on in healthcare since the Affordable Care Act is how to deliver care in a more efficient, rational way while maintaining the quality. That's a description of what we are trying to achieve with payment reform. We are doing a lot of projects around payment reform. It's a broad category, but how do you make the system work better and more efficiently for the patients we are serving? I'm doing a number of projects on that.
As part of that, we are working on and I had students integral in helping with a guide for consumers around healthcare coverage for mental health and addiction and also the Mental Health Parity Law and how that applies and benefits patients. We are working on a lot of issues around confidentiality as it pertains to the integrated care delivery and trying to work on how the system can have mental health and addiction and healthcare services all seamlessly provided to patients in more of an integrated way.
Bonica: I'm going to ask a personal ask for me. What advice would you give to professors like myself who teach in health management, where should I be putting my emphasis and where should folks who teach the management side be putting their emphasis when it comes to law?
Hodder: I think there are two really important issues. One is understanding compliance around quality and regulation. That's critically important for anybody going into healthcare, it's really understanding what compliance means in this world where payment is contingent upon meeting quality objectives. Compliance takes a lot of forms, but that's extremely important.
The other is understanding the healthcare industry from the financial perspective. What makes it tick? What is insurance? How do we actually deliver this product to the patient and what does it take to get it there? I think sometimes if we lose sight of the way it all works we can try and make changes that are not sustainable or you squeeze one side of the balloon and it comes out the other, so it's really important for them to understand the industry from the insurance and payment perspective because that's what everyone is grappling with right now.
Bonica: Let's transition and talk a little bit about leadership. You have been a leader, both as a manager, as well as a leader in the sense of influencer a lot of your career. What would you say is your leadership philosophy?
Hodder: I think leadership is something you earn as you pursue your passion with excellence and determination. It's something that has to grow up with you and it takes many different forms. I don't have a prescription for it. I just know if you are passionate about what you do and you dedicate yourself to doing it, you will be a leader in some way.
I think what's most important, especially for young, eager lawyers is to remember you cannot dictate how you will lead. It has to flow from dedicating yourself to what you care about and keeping your opportunities open and taking them when they offer themselves to you and remembering that the leadership has to fit with your personality and your professional passion.
Bonica: What's the difference between leadership as with authority, where you are actually a supervisor with formal authority and being a leader who influences without direct authority?
Hodder: I think they are two different things and both of them are hard. I think leadership with supervisory authority is one where you need to spend a lot of time caring for those you are supervising and you really are captain not of yourself but of a ship.
I think with regard to influence you have to be patient and careful with how you use that influence. I think it can be used in all different kinds of ways and picking what works best is a critical piece. It's also incredibly fun to be able to look around and figure out what are the problems here and how are we going to fix them and how are we going to make things better and how are we going to use the years of experience and the years of political capital to make things work?
Bonica: How did you learn your skills in influence?
Hodder: I think it was from years of public-private service and I think it was a combination of the two. It was having really strong mentors and watching the way they do it in a variety of different ways. Between Sherry Young and Tom Rath and Annie Custer and the governor, all very different forms, Jeff Howard, I had some incredible mentors who influenced New Hampshire in very significant ways, mostly subtle.
There are a lot of people who made huge change and are not the ones who are the elected officials. That's one of the things I have learned to appreciate in New Hampshire that there are a lot of unsung heroes who have a great degree of influence and they use it wisely and carefully. After you have been around long enough you know who they are and a lot can happen.
Bonica: You have mentioned mentors a couple of times. It sounds like you have had some really good people who have performed that role in your life. Can you talk about what a good mentor does?
Hodder: I think a good mentor, first of all, I think everyone finds their own mentor in their own way. I don't think anyone can adopt somebody else's mentor if you know what I mean. I think it comes out of being in the right place at the right time for each other in terms of what you are teaching and what you are there to learn.
I think a good mentor is there to be a guide and support through thick and thin and to offer a way of being a professional that you find also works for you and to make it fun. I think every mentor I have had I have had a lot of fun with and it's never about them. It's always about the success of our client or the success of the issue or the success of someone else you are working with. It's never about them and that's what makes a good mentor.
Bonica: Have these mentors always been supervisors or have they been people outside of your immediate chain of command?
Hodder: I would say they have typically been people I have worked with.
Bonica: With or for or both?
Hodder: I would say both, yes.
Bonica: Finding a mentor, how did you go about finding those mentors. Sometimes you were working for them. How else have you …?
Hodder: I would say it came early. I would say Rya Zobel was an incredible mentor for me and it was happenstance that I found her. I have been lucky to have for a long time worked in the legal profession. I would say also in New Hampshire our bar is very close and it's a wonderful support. I would not call them mentors, but I have had support structures throughout our legal community. Attorneys who I used to be on the other side with have become some of my closest friends and …
Bonica: People who you have litigated against?
Hodder: Oh absolutely. Over time I would not necessarily call them mentors, but they are absolutely instrumental in my ability to put one foot in front of the other. In that way we are really blessed to practice in New Hampshire because we have a bar that is very collegial and very respectful. There's nothing you can do without being held accountable for it and there's nothing anybody else can do without being held accountable for it. It's really wonderful to have that collegiality.
Bonica: Is that because New Hampshire is a relatively small state?
Bonica: It's not true everywhere?
Hodder: It is definitely not true everywhere.
Bonica: Do you see yourself as a mentor now for other junior leaders, either attorneys coming up or other people?
Hodder: Absolutely, I hope so. It's been wonderful watching some of the attorneys I have worked with when they were very early in their careers just blossom and go off to various places and really find their calling. That's one of the reasons I came here, too, was to help make sure lawyers and law students who are becoming lawyers who may not have the same passion for practicing, at least get some flair and some inspiration about what a wonderful profession it can be.
Bonica: What do you do for people who you see as mentees? What do you try to do for them?
Hodder: Try to figure out what makes them tick, what they are passionate about? Try and have them not to be afraid of the choices they are going to have to make and not feel like the step they take tomorrow is going to dictate the step they take five years from now and sort of look at his life in five-year chucks. Realize there are lots of opportunities you can pursue and re-direct later, but don't look back, jump in with both feet, make the most of the decisions you make. That's the most important thing. It's not what decisions you make. It's when you make it you put both feet in the water and make the most of it.
Bonica: You have had the opportunity of working in a number of different organizations and you have also provided advice and services to a large number of organizations, giving you some insight into organizational culture. What is organizational culture and why is it important?
Hodder: I would say organizational culture, you asked the question about mentors and thinking about organizational culture, I learned so much from my clients. That was probably the hardest thing about going to the governor's office absolutely was leaving my clients who I had worked with for years. Watching the way the different physician's organizations and hospitals worked as organizations taught me a phenomenal amount. I learned much more from their organizations than from the ones I work in.
The organizations that really respected governance and respected listening were the ones that worked the best without fail. We are not top-down, but were strong in terms of the respect for a unified governance and for the process to get there were the ones that were most successful.
Bonica: What book has most influenced your professional thinking about healthcare delivery and/or healthcare policy?
Hodder: It's funny. I read that question and I could not come up with an answer on a book. I do religiously read Health Affairs. I would say the articles in Health Affairs are what offer me the most sustaining, thought-provoking information, so I really love the writing there. In terms of just day-to-day, I read The Kaiser News, which is terrific. I really love the various books that track the ACA's implementation. I find those really fun to read because they are already historic.
Bonica: And you were working at the front-end of …
Hodder: The Bitter Pill is fun to read.
Bonica: The Bitter Pill, is that a book?
Hodder: Yes, it's a book. I tend not to read a lot of books about healthcare. I tend to read a lot of articles about healthcare.
Bonica: More timely.
Hodder: But I also highly recommend everybody read things that have nothing to do with what they practice.
Bonica: Why is that?
Hodder: I just think you have to get your head out of it at times. There's nothing like a good book that has nothing to do with what you are doing during the day to just take you to a different place and calm you down and put things in perspective. I highly recommend that.
Bonica: What advice would you give to young folks, young attorneys or maybe healthcare administrators who are thinking about a career in healthcare today? If they are listening what would you recommend, what kind of education? If they want to understand health law what should they be doing?
Hodder: I think it really depends. I think some exposure to health law. I know there are a lot of integrated curriculums that are available. The ACA offers us a unique opportunity to understand the delivery system by examining the ACA and the different facets of it, really understanding the delivery system from a global perspective, as well as a micro perspective. I think spending a little bit of time in a health delivery setting and realizing what our providers are doing every day also makes a huge difference.
Science has developed to such an extent. We humans have not. We are the same as we have always been with the same problems we have always been, but science has just taken off and it has really changed our expectations with regards to our professionals and made their lives a lot more complicated. I think both understanding the actual hands-on delivery from the professional perspective and then the macro in terms of what the financial delivery system is makes a huge difference.
I know people get in their silos and the nurse practitioner who just wants to know what the medication levels are appropriate for this presentation does not think the Medicaid program and how it works matters, but I think it does. I do think we all have to have a greater understanding of the delivery system as a whole to really make the change that's necessary. I guess I would say anybody going into healthcare, it is a phenomenally wonderful area to go into because there is so much need for change. It's never going to go away. We have to take it on so that it does not crumble and so there's a lot of hard work ahead.
Bonica: Thank you so much for your time today. I appreciate this.
Hodder: Thank you, great talking to you.