Leading Legal in Health Care

Leading in-house legal functions in a hospital means contending with not just the usual in-house tasks—reporting to the board, labor and employment, regulation and compliance—its all of that while also being in the service and business of care. Financial decisions can quite literally mean life-or-death. In this story, we speak to two lawyers at leading health care institutions—Laura Peabody, chief legal officer and general counsel for Mass General Brigham, and Jorge Lopez, Jr, executive vice president and general counsel at Memorial Sloan Kettering Cancer Center—to understand what it takes to excel in such a role and how the job and business is changing today.

Caring for patients while trying to sustain the business

“Health care is a wildly regulated industry,” says Laura Peabody, chief legal officer and general counsel at Mass General Brigham (MGB). “I once charted all of the regulations, and it was almost impossible to fit it [all] on a page,” she adds. In the last eight years, Peabody has continually balanced the challenge of “figuring out what the business can do without taking on too much regulatory risk” while continually stepping back and asking, “What’s the best thing for our patients?”

“When you have all these competing interests—the wellness of the patient, our commitment to the community, teaching the next generation of clinicians, MGB’s mission—that is a really complicated analysis to do for any health care institution, but even more so with a system this size,” Peabody says. MGB is an integrated health care system with 16 member institutions—including 12 acute and specialty hospitals of which five are Harvard-affiliated, nationally ranked teaching hospitals—and a number of community hospitals and specialty clinics across New England. MGB is also a $2.7 billion research enterprise with significant funding from the National Institutes of Health. Across MGB, they see nearly 2 million unique patients annually.  The work is especially challenging in the current environment where hospitals are facing significant financial headwinds.

If your business is patient care, you have to understand the laws that apply and the culture of the care providers.

Laura Peabody, chief legal officer and general counsel, Mass General Brigham

To manage the legal function, Peabody’s Office of the General Counsel comprises 33 lawyers, with department heads managing corporate, labor and employment, litigation, and interaction with industry, among other functions. While the legal department is integrated, each hospital has its own “go-to” lawyer so that each hospital president has someone familiar with their own intricate nuances. Her department also has a lawyer on call 24/7 to answer questions that have clinical significance for patients, such as those refusing treatment or leaving the hospital against medical advice when they have a communicable disease.

“My approach to being an in-house lawyer is that the lawyers must be involved in the business,” says Peabody. “And if your business is patient care, you have to understand the laws that apply and the culture of the care providers.” Peabody’s business has been patient care for more than three decades. After starting in commercial litigation, she worked in the health care group of a Boston law firm and eventually went in-house—first on the insurance side (Harvard Community Health Plan, Blue Cross and Blue Shield of Massachusetts, and Harvard Pilgrim Health Care), and then Northwell Health, the largest health care provider in New York, before returning to Boston to join MGB (formerly Partners).

At MGB, “no two days are the same,” says Peabody. On one day, she’s figuring out how to get reimbursement for transporting patients on the ferries from Martha’s Vineyard and Nantucket where the process for reimbursement is not clear. The next day, she and her team are helping their clients manage and facilitate the full clinical and administrative integration of Mass General and Brigham and Women’s Hospital. Over the last two years, Peabody and her team have also been supporting the unwind of the Dana Farber/Brigham and Women’s Cancer Center and the development of the MGB Cancer Institute.

If leading in-house involves constant decision-making in uncertainty—balancing risk with reward when information is murky—leading in-house through a pandemic provided a trial by fire in that role. “My clients are hospitals, and people were dying in hospitals. Nobody knew why,” she says. “It was very hard to figure out what was the best thing for us to do to save the most patients we could and still protect the health and safety of our employees.” Legal was frequently called on to collaborate with clinical staff on issues of health care equity, among other challenges.

Peabody remembers a call from an infectious disease head who had just received a box of Remdesivir, which at the time was a promising cure for people with COVID symptoms. “But we didn’t receive enough doses for all of the patients who were on ventilators. Moreover, there were no instructions from the manufacturer on how to use it,” she says. “How do you decide who gets it and who doesn’t get it? We ended up giving it back to the Commonwealth so that they could distribute it. There were so many horrible calls like that,” she adds.

We’re building technologically enabled care, which is going to be the future of health care.

Laura Peabody

On top of these life-and-death circumstances, MGB had to continue treating individuals not suffering from COVID. That’s where the new horizon of telehealth came in, yet learning how to treat people remotely in an industry that had never done it before was a challenge. “It was like building the plane while it was flying,” says Peabody. For instance, MGB needed to obtain licensure waivers for its doctors treating patients outside of Massachusetts virtually. Before the pandemic, telehealth visits across MGB were approximately 1,200 to 1,500 per month on average. Within five months of ramping up telehealth operations during the pandemic, MGB clinicians completed more than 1 million telehealth visits.

Fortunately, this technology is now standard operating procedure for many clinician/patient interactions. “We’re building technologically enabled care, which is going to be the future of health care,” says Peabody. When COVID hit, MGB had no real-time dashboard enabling it to display all of its med/surg and ICU beds across all of the hospitals. Now they do.

“COVID was the hardest challenge of my career up to then. Today, however, it is worse,” says Peabody. “In addition to the financial issues, it’s become very complicated under this [presidential] administration because current regulations and policies have made it difficult to do what we’ve done in the past,” she says. “Sometimes it’s not really clear. Everything’s an analytic and a risk assessment in an unpredictable environment.”

While much of the administration’s attention seems focused on university funding, MGB still receives more than a billion dollars in NIH funding. When President Trump issued an Executive Order barring diversity, equity, and inclusion objectives in all federal grants, Peabody’s team partnered with MGB operations and clinical teams to comb through every research project and ensure her client was fully compliant.

When I have a bad day, I just walk through one of our hospitals and say, OK, I know why I’m putting myself through this.

Laura Peabody

For months now, they’ve been preparing for the Executive Order penalizing health care institutions that provide gender-affirming care to minors. “We decide how much risk we’re going to take on in the best interest of our patients,” Peabody says, explaining that you cannot just “pull the plug” if somebody is in the middle of hormonal therapy. They also had to “analyze what the law was should ICE show up at one of our hospitals asking to see a patient or their family.”  “What do we do?” asks Peabody. “What are our legal obligations and what’s our policy?”

Peabody knows she’s not alone in how challenging the environment has become today. In the U.S. health care system generally, “we’re at a point now where the reimbursement to providers to take care of patients does not cover the cost of delivering the care,” she says. If 50 percent of patients are covered by Medicare or Medicaid (MassHealth in Massachusetts), those reimbursements have remained flat from year to year, but MGB’s labor, operations, supplies, and medicine costs continue to rise. “You don’t have to be an economist to understand that that is not a winning formula. For us, we’re trying to figure out how to live in a world where your primary business is, essentially, unsustainable.”

It doesn’t change the stakes for Peabody, who thrives in this mission-driven atmosphere. She says:

This is the most dedicated group of people that I’ve ever worked with in my career. I’m inspired every day by what our clinicians and scientists do and the hoops they jump through to take care of patients. Discovering new therapies and cures, improving the lives of people who suffer from illness, and healing people are top priorities for MGB and its staff. That’s what they care about. That’s first on their minds all the time.

For those looking at Peabody and her job as a possible career path in health care, she has this to say: “You can’t be the kind of person who has a list and expects to check anything off on it,” she says. “You have to be flexible and able to change course at any minute. You never know what’s going to show up.” But that’s also what makes Peabody’s work exciting—and worthwhile. “When I have a bad day,” Peabody adds, “I just walk through one of our hospitals and say, OK, I know why I’m putting myself through this.”

Expanding access while mitigating risk

No one would have been surprised if Jorge Lopez, Jr. had stayed at the law firm Akin Gump all his life. After starting as an associate immediately after law school, he made partner in 1993 and worked his way up to lead the health care practice. After 30 years, he could name some of the leading cancer centers, hospitals, and pharmaceutical companies around the country among his clients. He even declined a job in President Clinton’s Department of Justice to stay at the firm despite always having an interest in policy and mission-oriented work.

But in 2015, Roger Parker, Memorial Sloan Kettering (MSK) Cancer Center’s first and only general counsel, decided to retire after more than four decades. Lopez felt the call to apply for the open role of one of his most important clients. Or, he reflects, “I thought, if I don’t apply, they’re going to be pissed at me.” He never thought he’d get the job.

Today Lopez is celebrating his decade-long tenure as executive vice president and general counsel at one of the world’s leading cancer centers. “I truly was a believer in the mission of the institution,” he says. Advocating for MSK and others like it in Washington, D.C., before Congress, he says, “I had seen [the mission] up close.” He knew exactly what he would be fighting for.

MSK has a unique corporate structure: there are three independent institutions—Memorial Sloan Kettering Cancer Center, Memorial Hospital for Cancer and Allied Diseases, and Sloan Kettering Institute. While each has different foci (from patient care to research), they have the same board and obviously feed into one another. “We view it as our secret sauce that we’re not just offering run-of-the-mill cancer treatment; we’re offering leading-edge cancer treatment that is informed by all the research that we do,” says Lopez. The unique structure and specialized mission has kept the work interesting for him.

At Akin, Lopez honed an expertise around Medicare, fraud and abuse, and the Affordable Care Act (ACA). Being the GC of a major health care institution, he found, has a much broader remit. Some of that is the nature of the job, and some of it is how he’s run the department. In 2023 the American Lawyer recognized his in-house team as one of the top five legal departments in the country. In 2025 Corporate Counsel named Lopez as a finalist for general counsel of the year. In the last decade, he has grown the team to its current complement of 24 lawyers (plus a number of nonlawyer professionals), a size large enough to perform work that, at many other institutions, is mostly farmed out to law firms. “One of the things I said when I started was, ‘I want to build the best hospital in-house legal department in the country,’” Lopez says. “And really, I don’t want to be immodest, but I think we’ve largely been able to achieve that.” The team is structured “like a law firm” with seven practice areas: litigation, corporate, regulatory, privacy, IP (which includes research contracting), labor and employment, and government relations. They aim to do about 75 percent of MSK’s legal work in-house, where, he says, outside counsel is largely pricing itself out of its services.

It’s really not just that we’re specialized in cancer; it’s that we’re specialized to treat the kinds of cancers that rarely get seen.

Jorge Lopez, Jr., executive vice president and general counsel, Memorial Sloan Kettering Cancer Center

“I’m constantly learning all these new areas that I really knew nothing about,” Lopez says. Medical malpractice litigation, for instance, is a big part of the job. He was never a litigator, but to work in life-or-death situations, as a hospital does, means being exposed to such risk. MSK perhaps takes on even more risk, says Lopez, because of its discrete focus on cancer.

“It’s really not just that we’re specialized in cancer; it’s that we’re specialized to treat the kinds of cancers that rarely get seen,” he says. The interweaving nature of having homegrown experimental research extend into lifesaving treatment—which presents its own liability challenges—and seeing some of the more difficult cancer cases means that they see “a lot of end-of-life situations,” Lopez says. “We’ve made huge progress in treating cancer, but patients do sadly die.” This means medical malpractice and wrongful death cases sometimes land on his desk. For that, a patient relations team works “hand and glove” with his legal team.

MSK’s unique focus also means a different kind of payment structure and business model. This was not new to Lopez, who brought a deep foundation in policy, regulations, and the business around Medicare, Medicaid, and insurance to the role. “If you’re an academic health system with multiple disciplines, you can rely on some parts of that institution feeding the cancer business,” Lopez says. Even more important, “because of the deeply specialized nature of our oncologists,” Lopez says, those same cases that are difficult and offer a lot of risk and liability might also be incredibly expensive.

The nature of risk has changed.

Jorge Lopez, Jr.

For MSK, government relations is not simply about funding. It’s about access. For instance, a major success of Lopez’s tenure has been advocacy at the state level to require Medicaid and ACA plans in New York to cover services at MSK. In 2022 the New York legislature passed a budget that would require Medicaid and qualified health plans to include in their networks all willing National Cancer Institute–designated hospitals. What this means is extending the best care to those who might be able to least afford it.

This is a reinforcement of the mission Lopez cares so much about, an important reminder when so much of the role has been “bouncing from crisis to crisis,” from conflict-of-interest challenges to COVID to federal restrictions around research funding. While so much of the GC job—as well as being a lawyer in health care—is “risk mitigation,” Lopez says, he feels “the nature of risk has changed.” There was always internal risk, but now external risk has exploded. “It’s coming from so many different sources now,” as well as becoming harder to manage, he says. There are situations, however, when you have to plunge ahead, while mindful of the risk, “even if it means you might be doing something that perhaps would be riskier than what people were comfortable assuming a generation ago,” he says.

Today’s health care landscape is unfortunately “a battle for scarce resources,” Lopez says, something that will both keep his job interesting and make it harder. “It’s really, how are we going to allocate these resources? Who are the winners? Who are going to be the losers, and how do we make those decisions? That’s going to be hard.”

A crisis of care

Leading an in-house legal department is challenging in every industry: every day means new crises in this increasingly complex regulatory environment. But leading legal at a hospital means trying to keep the business in compliance and afloat while also trying to keep people alive. Both Peabody and Lopez communicate the delicate balance of trying to save lives amidst a shaky financial future for health care. As Lopez asks: Who will be the winners? Who will be the losers? And how do we make those decisions? With patients in the mix, that’s going to be hard—and everything is at stake.