When Pauline Fox decided to retire in 2012 after thirty-five years in law (including fourteen years as the general counsel for The Permanente Federation), she zealously approached her new freedom. Before retirement, she had worked nonstop while also raising a family of four children; after, she climbed Mount Kilimanjaro with her two daughters, and took classes in painting, ceramics, photography, paleontology, crocheting, and horseback riding. She became certified in scuba diving, volunteered at an animal rescue foundation, and served on the board of a disability rights advocacy organization. Most satisfyingly, she spent autumns in Saratoga Springs, New York, cheering on her daughter at every game of the Skidmore College women’s soccer team.
So when a former colleague from The Permanente Federation called Fox in early 2016 to ask if she’d be interested in returning to her old position, she didn’t exactly jump at the opportunity. “Are you crazy?” she remembers responding. “I’m enjoying my retirement, thank you very much.” But the colleague, whom Fox had selected as her replacement when she stepped down, was insistent: she was taking on a new position in Colorado, and The Permanente Federation was also in the middle of a major reorganization. They needed someone with Fox’s experience, someone who could hit the ground running. They needed someone, even if only temporarily, to train someone new.
And so Fox agreed to come back for three months—but it took her only about two weeks to realize that she wanted to return full-time. (In April 2016, Fox was appointed executive vice president, chief legal officer.) “I was still having fun at my job,” Fox says. “I came back ready to roll, way more energetic about the work. It taught me the value of getting away and doing something else with your brain for a substantial period of time.”
Fox’s earlier years at The Permanente Federation had been focused on substantial ground building. Having previously worked in commercial litigation for nearly twenty years for Pillsbury, Madison & Sutro, she’d moved into healthcare with a role at Kaiser Foundation Health Plan. She joined Permanente Federation shortly after it was created in 1997 to represent the national interests of the Permanente Medical Groups, partnering with Kaiser Foundation Health Plan and Hospitals. Owing to the long history and breadth of Kaiser Permanente—which has grown to become the largest managed healthcare organization in the United States—her new role required juggling responsibilities across member groups with varied cultures and histories.
“When I first joined, I was the sole in-house lawyer for ten medical groups,” Fox says. And though Kaiser Foundation Health Plan and Hospitals have since become increasingly nationalized, at that time each group had grown up in an era of regional autonomy, with separate and distinct cultures. To her, it was important to respect these disparate cultures and not eliminate all of the differences to make them like one larger medical group. “There is innovation that comes out of being different, and the trick is to figure out what variation should be eliminated, and what variation should be respected,” Fox says.
To do this, she built legal functions at each medical group and provided support for different boards of directors by highlighting the areas they focused on to see if they wanted to move in different directions. She also focused on putting together resources and manpower where it was lacking, and built an affiliation between their northern California and mid-Atlantic medical groups, both of which have since thrived.
Fox also did all of this while comanaging a few significant lawsuits that came at the tail end of managed-care litigation, one of which Permanente won at trial and one that was settled favorably, in addition to a wide variety of other legal issues. “I did pretty much whatever came in the door,” Fox says, including tax issues, securities issues, and human resources issues. Here, her previous experience in litigation gave her expertise across a broad array of legal topics. “My earlier career really prepared me to be a general counsel of a company,” Fox says. “That’s one of the reasons I love this job: no two days are ever the same.”
“That’s one of the reasons I love this job: no two days are ever the same.”
Returning to The Permanente Federation, Fox tackled her old responsibilities and took on new ones, as well. One addition was the company’s reorganization plan, which involved building a new structure where leaders of the medical groups assumed leadership roles in functional areas of the organization, such as IT. To assist them, Fox provides legal services and runs interference in various areas. She’s also working with Kaiser Permanente on its plans to open a new medical school, with programming that emphasizes practicing in a community-focused way as well as working with new technology, ensuring that it will have autonomy through bylaws, contracts, and structure. “What we hope it will do is look at medical education in a different way, emphasizing it in these days as a team sport,” Fox says.
For nine months, she also took on a second position at the company as a fill-in for the general counsel of the Colorado Permanente Medical Group, which involved everything from governance to rewriting its staff manual. While working two jobs was a personal grind, Fox says, it was professionally satisfying. “The work needed to be done,” she says. “And it was done in a way that moved the medical group forward.”
In addition to all this, Fox returned from retirement with a passion for teaching. “I have lived through this enterprise’s ups and downs, and to be effective in leadership, you have to understand where this company has been,” Fox says. She’s created two programs—KP 101 and KP 102—and teaches at Medicine in Management (a program designed to develop Permanente physicians’ leadership and management skills). The course she teaches focuses on Kaiser Permanente’s rich history and the importance of building resolutions and working out disagreements.
Having returned to the company after what she now sees as a valuable sabbatical, Fox is able to appreciate it from a fresh perspective. “It’s fun to work with the group of people who were there then and who are here now,” Fox says. “This is a group of people who are dedicated to providing the best service that we can. It is fascinating to see how that works as a lawyer, and gratifying to help those who are helping people.”
Hooper, Lundy & Bookman, P.C. congratulates Ms. Fox and is proud of our association with The Permanente Federation. With offices in California, Massachusetts, and Washington, DC, Hooper, Lundy & Bookman is the largest law firm in the country dedicated exclusively to the representation of healthcare providers and suppliers.
Holland & Hart LLP was privileged to partner with Pauline Fox in support of her vision for the delivery of the highest-quality legal services to The Permanente Federation and the Colorado Permanente Medical Group. Ms. Fox’s passion for her work and dedication to the people she serves inspires innovation and creativity, with the goal of ensuring that her clients are successful in delivering high-quality, integrated care to the patients and members of Kaiser Permanente.
