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Tufts University President Tony Monaco, in partnership with the Massachusetts Department of Education and the Massachusetts Emergency Management Agency, presented an informative webinar on April 8, 2020 based on what he has learned in working with two hospitals and two cities to address the needs they face as a result of the pandemic.

Slides from the webinar are available here.

A mathematical modeling tool to connect hospitals to nearby college campuses is available here.  Provided by the Metric Geometry and Gerrymandering Group (MGGG), a Boston-based working group led by Moon Duchin of Tufts University and Justin Solomon of MIT.

Student and Comunity COVID-19 Support
Operational, Legal and Risk Considerations for Colleges and Universities

As of April 1, 2020*

For questions or additional guidance, contact covid19@tufts.edu.

In the spirit of assisting other universities and colleges as they seek ways to help relieve the strain on their local communities and hospital systems, Tufts University is providing the following outline that institutions can consider when entering into agreements to share their residential halls, grounds, and other campus facilities with hospitals, cities, and other entities in the fight against COVID-19. This effort is in keeping with Tufts University President Anthony P. Monaco’s call for universities and colleges to collaborate with local partners to help hospitals from becoming overwhelmed by COVID-19 cases.

I. Operational Considerations:

  1. Approval and endorsement of the senior leadership for community support.
  2. Establish a Community Support Working Group.
    1. Recommended internal representation: Medical, Legal, Community Relations, Communications, Facilities, Public Safety, Dining, Student Affairs, Auxiliary Services, Emergency Management
    2. Group should schedule regular conference calls throughout the course of community support
  3. Establish one point of contact to field/track all requests and issues arising from your cities/towns and hospitals/health care providers.
  4. Types of support that may be requested: off-site testing facility (parking lots, quads), housing, alternative treatment sites, medical supplies (there may be more).
  5. Categories of populations to consider housing on campus (there may be more):
    1. Students – healthy, non-symptomatic quarantine; symptomatic isolated
    2. Healthy health care workers and first responders (may become exposed or sick – need isolation units on hand for them)
    3. COVID-19 patients formerly hospitalized, too well to be in hospital but still need minimal care (can be housed communally)
    4. Non-COVID-19 ambulatory care patients requiring low-level but essential medical services
    5. Homeless or community persons who require ambulatory care or quarantine/isolation from their vulnerable community
  6. Understand your capacity, limitations, and risks related to resources you might provide.
    1. Inventory student housing for isolatable units with bathroom.
    2. Inventory parking lots: consider adjacencies, bottlenecks, neighbors.
    3. Inventory dining halls, gyms, or other facilities that might be of use.
  7. Identify the level of service you are willing/not willing to provide and limitations. This might vary depending on population to be housed. Strong recommendation: For the safety or your students/staff and health care personnel and patients, the community user provides as much as possible with their own trained workforce in the areas of:
    1. Custodial cleaning and disinfection, IT, food, facilities, security/public safety, trash removal, repairs, mail service, parking
    2. Consider access that such occupants may have to other resources of the university or other campus areas.
    3. It is vital that your key departments identify limitations to service.
      1. Consider fully staffed, essential staff, and degraded staff due to illness.
      2. Consider necessary training and access to any necessary PPEs.
  8. Major Phases – internal and external communications are critical during each phase
    1. Student Consolidation phase
      1. Determine students who will stay on campus during de-densification.
      2. Identify best location to consolidate considering:
        1. Separation from potential community residents/patients
        2. Dining availability/proximity – have a back-up space
        3. Individual vs. community bathrooms
        4. Individual rooms vs. apartments
        5. Quarantine & isolation area
    2. Space Assessment for Community Partner Use
      1. Identify remaining available space
        1. Details are important: elevator or first floor access, apartments/suites/traditional dorm style/single-use bathrooms, food prep areas, communal rooms/bathrooms.
        2. Consider proximity to neighbors, student population, access (key, card, etc), parking.
      2. Risk and Risk Mitigation (see also the section on Legal and Risk Considerations)
        1. Each key department should identify two types of risk; risk to people and risk to support.
          1. Risk to people includes things like exposure to COVID-19.
          2. Risk to service includes lack of service providers, facility problems, etc.
        2. For each identified risk, provide a mitigation strategy. It is vital that leadership understands the risk they are taking and steps they are taking to mitigate it. It must be noted where there is no mitigation strategy.
    3. Request Vetting phase
      1. Decision making process – Deconflict populations you are considering housing with State emergency management to prevent double-working a request
      2. ‘Applicant’ Needs assessment/tour – You can try to anticipate needs, but it is up to applicant to ultimately determine if your space meets their requirements. Get this done early. If an in-person visit is not possible, a phone call or “zoom tour” would work.
      3. ADA accessibility needs of occupants
      4. Assess electrical capacity needs for special medical equipment or air conditioning
      5. Capacity assessment – How many people does the applicant need to house? Consider keeping the groups consolidated – don’t mix building use if you can help it.
      6. Community Partner Management – Aim for fewer partners; explore whether one larger partner could be point or umbrella for smaller ones.
      7. Determine up front what happens if a healthy occupant gets sick – isolation unit or move off campus?
      8. Should healthcare workers have a safety protocol to follow after returning from the hospital, but before they enter the buildings?
      9. Determine the exit strategy up-front, including adequate time for any alternative treatment sites to be wound-down and prepared for hand-back to host institution.
    4. Initial setup phase
      1. Level of service delineation (see also the section on Legal and Risk Considerations):
        1. Which aspects are you going to run, which are you going to turn over?
        2. Routine and deep-cleaning responsibility for rooms & common spaces
        3. Providing food: Recommend food for students only. Health care providers may prefer to provide patient dining services due to special dietary requirements.
        4. Security for patients
        5. Visitor policy
        6. Linens and toiletries 
        7. Laundry – make machines in the building free for use?
        8. Wireless access
        9. Mail service
        10. Parking
        11. ADA accessibility/food allergies
      2. Legal agreements (see also the section on Legal and Risk Considerations)
      3. Welcome packages – Consider providing a welcome package similar to what you give conference guests, including emergency contact info.
      4. Access
        1. How do workers/patients access the building?
        2. Do you allow visitors/food delivery?
      5.  IT
        1. Will you allow access to your network?
        2. Will you service the network in the occupied buildings?
      6. Point of contact/tracking of groups – Assign one or two points of contact for each group to make reports to the Emergency Operations Center or other appointed staff member. This is critical if a resident’s status changes from healthy to ill. You will need to know this if you have to enter the building/room
      7. Modifications to building – Will you allow them?
      8. Exit strategy agreement – How do you reclaim your spaces?
        1. Recommend setting a deadline that allows spaces to be cleaned and prepared for residents.
        2. Agreement should allow either party to cancel the agreement.
    5. Ongoing management phase
      1. Liaison to partner group – Identified for University and Residents
      2. Tracking
        1. Who will report changes in student status and to whom?
        2. Reporting mechanism for residents
      3. If work required in building by University
        1. Who will perform?
        2. Protocols for work in buildings with sick patients
      4. Document process for next time.
    6. Closeout phase
      1. Similar to end of year
      2. Deep cleaning
      3. Communicate to your future residents

II. Legal and Risk Considerations:

  1. General Issues to Consider
    1. Make sure that the arrangements are reviewed by the university’s legal counsel before they are finalized.
    2. Make sure that you have a clear and succinct written agreement drafted by a legal counsel that spells out which party is responsible for what actions and resources.
    3. Take into account any special laws or special conditions that may impact the arrangement and address them in the agreement.
    4. Make sure that the agreement is with an entity or a governmental entity that has adequate risk management and asset coverage.
  2. Residential Arrangements – If residential or dorm buildings are being licensed for use, clarify the arrangement, legal concerns, and risk allocation, including, without limitation:
    1. Depends on state law, but preferable to use a temporary license to use, as opposed to a lease.
    2. Specify who is allowed to stay and for how long.
    3. Address inspection of the premises prior to occupation and afterwards for damages and which party makes the repairs.
    4. Clarify who provides security, check-in/check-out, cleaning and disinfection, trash removal, internet service, linen and laundry, repairs, parking, mail or delivery service, provision of supplies and food, and supervision of occupants and care of those who may be quarantined or isolated.
    5. Specify the term of the arrangement and the termination provisions and who takes care of moving the people out if they are still stick or if they refuse to leave.
    6. Specify if healthy occupants can use other resources at the university, if they are open.
    7. Make sure the agreement addresses the safety of students and other university community members.
    8. Specify that the university can move out anyone who poses any danger to the university community.
    9. What are prohibited uses? Prohibited uses of internet?
    10. What expenses must be reimbursed?
    11. Seek a clear protocol about how the other party plans to manage the occupants and any occupants who are quarantined/isolated.
    12. Specify any ADA accommodations that may be needed for special need population and who will provide any necessary expenses.
  3. Policies: Clarify what university policies would apply in connection with the activity (for example, no discrimination and no smoking in a dorm room).
  4. Dispute Resolution: Think about any need for a dispute resolution (for example, if one occupant has a dispute with another occupant or if neighbors have issues).
  5. Product Manufacturing: If products are being made (for example, 3D printer masks):
    1. Make sure that your design and process protocols are reviewed by the healthcare facility planning to use such products.
    2. Review whether the products need to meet the FDA or other regulatory requirements.
    3. Make sure that the volunteers are trained and supervised.
  6. Government Filings: Clarify what information you may need from the other party in order for the university to make appropriate government filings (FEMA reimbursement; Clery Act).
  7. Risk Management: Analyze risk management and potential financial and legal liability for engaging in the community support activity.
    1. Certain activities may have greater risks and liabilities (for example, housing patients).
    2. Review insurance policies (look at the carve outs).
    3. Review statutory protections – indemnification or immunity.
    4. Work with state legislature on legislation to limit liability.
    5. Seek insurance coverage information from the other party.
    6. Seek indemnification and hold harmless obligation from the other party.
    7. Seek waiver/release from those seeking support (including individuals).
    8. Analyze potential reputation damage arising from any support, especially if there are unanticipated consequences.

*No Legal Advice Intended

The contents of this memorandum are intended to convey general information only and not to provide legal advice or opinions. The contents of this memorandum, and the posting and viewing of the information on this memorandum, should not be construed as, and should not be relied upon for, legal or tax advice in any particular circumstance or fact situation.  The information presented on this memorandum may not reflect the most current legal developments or applicable laws. No action should be taken in reliance on the information contained on this memorandum and we disclaim all liability in respect to actions taken or not taken based on any or all of the contents of this memorandum to the fullest extent permitted by law. An attorney should be contacted for advice on specific legal issues.

Nothing on this memorandum is an offer to represent you, and nothing on this memorandum is intended to create an attorney‑client relationship.