continue um of the consumer, what we vuld to do, are the patient consumer to get that to that point that we are actually identifying client patients. what would a physician have to look like. how would a physician have to communicate in their authentic way to consumer if that was ultimately the goal. when we survey our patients consumers, what we found are some things that are not going to surprise many of you. there were really three major things. the first one was all of our patients were very interested in access and access was defined by 24/7 access that was defined by where they were located, it was defined by how you alu me to engage whether it's electronic engagement or some of the form. we have over 600,000 of our patients that are on my chart, they're using electronic means to communicate ultimately with their physicians. 60 of the 600,000 are actually over 100 years old. the notion that people aren't using electronic engagement is

false there. so access was important, transparency was ultimately important, cost, how do you create cost certainty within the environment and then thirdly, how do we ultimately leverage technology. so when we think about payment reform, we think that as we move to e val -- value-based care business, we'll have to leverage access, we'll have to leverage technology and transparency and by doing that we feel like we'll be more effective in making our communities healthy. >> so we started down the journey of delivery system reform back in 2006, massachusetts. we started with three foundational pillars. the first one was cost containment. the second one was sustainable access. and the third one was quality. all of those wrapped up into value, frankly. and so i come from a system, at least, towards health care the last six years, roughly, we literally took the pillars of

value, providing the highest quality care and burned down a bankrupt system. our chairman, essentially, took it over and said, look, guys, we'll go down the path to fully integrate the entire system, hospitals, emergency rooms, home care, ambulances, and we'll put the entire system in full down side financial risk on the commercial side and we'll try to now to integrate all the services that for our providers. so what did that lead to us for us. it led to two fundamental things that i define in delivery system reform. for the providers it led to better care delivery at the patient point of care, right? our physicians, our mps, our pas, all of our assistance, all of our providers should be incented to drive the best care possible. we should all be driving toward the best care possible as soon

as the patient engages you wherever they have engaged whether it's on the cell phone, urgent care center, et cetera. can't re -- and so our commercial side, which is full down side risk, allows us to create those incentives for our providers. on the patient side, which is the second foundational concept we should talk about, it's a little bit different. you've got to -- you want to -- but on the regulatory and reimbursement side you've got to recognize that there are three fundamental sets of consumers. there's a commercially insured, which probably most of us are, lots of difference incentives and lots of different things we can do to engage patients in their care. medicare, it's a little more challenging. they're very very strict rules around what we have to operate carefully to engage those patients. medicare aco models are helping us get there with some waivers to engage patients, but not as easy, frankly, the incentives

are not allowed for patients or providers to move toward that full spectrum of valley. there's medicaid. medicaid right now we're launching with it the state of massachusetts and medicaid aco that's going to allow that patient population in a different way. that population doesn't have cost incentives, doesn't have interductbles, their consumption of care is very different, their incentives are nonexistent. well e we'll try a whole new set of engagement tools to try to engage that population in a different way of care. >> so a couple of things that i heard early this morning and you guys notion patient engagement. i can tell you from the investment side, there was a great deal of emphasis and excitement on how you can drive quality and out come, but, frankly, you know people are experimenting with different things, what have you guys seen in terms of innovations and

technologies that are driving quality and out come. what has been working and what have you seen on that end. i educate them about their care practices, variations delivery that we have across many of our opposition offices.

>> we think it's a shared engagement. we think it's best engaged with our system. we have a responsibility, as well. so when we look at the new pair dime, clearly, we think that the

new pa it's going to be driven by consumers to better understand our population and i shared with you the research that's done that led us to understand the segments. the better we understand, the better we can ultimately and engage them. most recently, consumer attitude study that we did -- but also put focus, that shared with us various information, clearly, millennials use their phones an awful lot and you would expect that to be the case. you would also expect that most of the information that they would get, they would get it from the internet. what we found that when it actually came down to how they prefer to get their actual information from physicians and clinicians, they've gone old school, they want to actual ri talk to a doctor. they want to talk to a physician. carl, our ceo spoke earlier, he talked about, as we looked at that population as well, what we know to be true is that they

value respect, equally as much as they valued medical treatment. so what that means to us, is that we have to really develop strong relationships with our patient population, but more than anything else, we really have to know who they are. we have to know how they prefer for us to interact with them. we found that some of our consumer patients actually did not have a preference on whether it was a primary care physician, or whether it was some kind of clinician within a clinical office. we found that some of our patient population prefers for us to interact with them through technology. when it comes to engagement, for us, it's really about understanding who the consumer is, understanding what their preferences are and based on that, we feel like we have the best engagement which ultimately results to better quality health care. >> can i just peel back the question, right? technology is important, but i think even more important is what's our objective. if our objective is to try to

drive better care management solutions in the context of a cost containment/high quality performance objective, then i think it makes sense for us to explore the right tools depending on the segment of the population, let me explain. under medicare aco model we were able to identify about 10% of our population, our users, we have roughly 100,000 lives, about 10% of the population is literally 80% of our expense, nursing homes -- technologies like patient, but care navigators, literally in the nursing home and weekly in the patient's homes by calls and et cetera, engaging the patient to try to mitigate the use of the ed and the sniff inappropriately. huge and massive savings, by the way, better out comes in a quality score, you want to do it

in a way primary care physician, or doctor is trying to work with you on. that took a whole different set of strategies and the -- on the technology side to try to get patients that here into the protocols that they were talking to their doctors about. so, i guess, i just step back and say, let's talk about technology in the context of what makes sense. it's not about a revenue model, it's about a cost model, how to get to the right out comes using the right set of techniques. >> i'm thinking more from the context of the cost model than the revenue model, i'm thinking about employers and their expenses for health insurance. from the standpoint of engagement, i can agree 100%. people have a good experience, they'll go back and participate in the game and whatever it is you want them to do. from an employer standpoint,

there are three main areas to focus on from an engagement, the decision points, how they select their health programs in the first place and you get the decisions so they know the doctors they want to see for the prescription medications that they need to take are going to be covered at the highest level. and what's the best trade off costs for -- between payroll deduction and out-of-pocket cost. when they're in the system, how do they remain healthy, how do they not need to receive care and a lot of the technologies that we talk about earlier the activity monitor, we're a metrics driven society, so just some awareness of health and health behaviors is really important. i think they do serve some positive purpose just by getting people aware of their health behaviors, where in the past, i don't think they really thought about it as much, they're so important. third, what they actually need to seek care, what do i do.

in that case, i believe a little bit of going old school, a lot of technology to help access and compare providers and compare alternative treatment choices, that's great. but in the end, a lot of patients, they're not making decisions truly on cost and they have a hard time understanding and believing the quality metrics, having some assistance navigating the system is really important. i actually believe that whether it's, the, you know, employers responsibility or the health systems or the carriers, the members, the patients, they need more navigation to help them through the system, especially the most complex care which is where 80% of the cost is going to come from. getting some handholding advice to understand where to go and how to pull together all the information to receive the best care and personal care is really important from an engagement standpoint. >> one point about -- really

around technology. let me be clear about something, in health care, the best technology is going to be an assumed fact in this industry. and so we spent $700 million on electronic health records. and let me tell you what's the new paradigm. you'll have to strat jazz patients, those that are healthy, those that are not, you'll have to strategyize patient. you'll have to be able to do that to be competitive in the business. what differentiates health care systems and what the consumer will tell you is about how you make me feel. so it still gets back to the authentic relationship, if you're going to retain patients, grow patients, if you're going to really create a remarkable patient experience, it will be around the authentic relationship that you create.

just as other industries. other industries segment extremely well. they understand that every patient that they connect with have different attitudes, different believes, different ones, how they want us to interact with them. so health care, if, you know, when you think about the aaa, when you think about cost, when you think about all of those things that are ultimately important quality, those things are going to be essential, but for us to grow, retain, create stickiness, it's going to come from the heart and be authentic. >> you mention electronic medical records, we heard it a few different types. i want to toss out one personal viewpoint, we need a better way for electronic medical records to be the possession of the member. i think that the provider systems and electronic medical records, we need to have a better way for that to be portable and that information to stay with the patient for a longer period of time. i've heard it done myself, i

should have that records of that care to take with me so i can see other providers or if i moved to another state, it's easier for that to come with me. i think that's something we'll see in the next 5, 10 years where it becomes more standard than an individual has there historic information with them as they move around. >> and i want to touch on you, you mentioned, first, how you navigate the system and how you make the patient feel, i can tell you that, you know, one of the reasons that's why it's in this space the health care experience is really bad. it's a lot of opportunity there. earlier today we've been talking about the consumerization of health and so many things are getting easier. point a to point b is easier. everything seems to be getting easier, the health care in experience in many ways does not. kind of pulling on the thread of who owns that patient experience, who owns that experience on try to help the consumer navigate through that. usually when i look for a doctor

the first place i go is my insured. that's the introe way into my experience, then you get lost there. so maybe you can walk through that a little bit. how do you think about that? >> yeah, so, you know, that's a hard one because, you know, no offense to the health plans and their representatives in the room, but, you know, health insurance carriers have a very low, you know, consumer rating from members. and they're concerned about whose best interest they're serving. the provider systems more and more we're seeing members that they're not assuming that the doctor's word is gospel, they're willing to debate the providers are acting in a way, i think there's some question about that right now. so where is that most objective unbias opinion is going to come from. i'm not sure the great answer to that. that's one of the problems and you have a system where the dollars flow in a very different way in consumer decision is

made. lots of different places to a certain extent, once they're in the system, i think that the navigation probably starts a provider. health care happens where the patient and provider come together and that probably is the start. >> i'm a big believer, i'm going to say a few controversial things. the first thing is we have not incentivized the industry to move to value. we are still in massive mix mode of reimbursement. there's fee for service, there's bundled payments, there's

organizations, they're shared savings, they're down risk, et cetera. you have over 32 payment models of medicare is now exploring. you have the commercial which have over 150 across the nation. we're still in a very big mix, but underlying all of that, until we move toward a paradigm that pushes all of us towards the right place, good quality, cost, we'll get continue to have this conversation part one. part two is, when you look at how the -- the patient is going into the health care delivery system on the commercial side, you're right, you go and say what's my insurance benefit. often, the plan design is not truly aligned with a high valued out come that you're seeking. what do i mean by that, in boston where we have some of the world's best medical centers, the quality that those academic medical centers deliver, at least on paper, according to medicare is the same as community hospital 25 miles down the street. but the perception of the

quality at boston is better. that i get reimbursed 70% higher than the community hospital which drives the premium higher. you'll say i'm going to go there because it's better, you're not making a value driven decision. how do we move the regulatory and plan design environment so that patients understand that exchange of economics. the third part is, directly on us as providers as payers. we've got to socialize data. data today is competitive advantage. until we socialize data, eh, ehr, zmr, reimbursement, price, quality out comes in a very public way that we together can work through that is a public value, that's another challenge that i'm not sure we're going to be able to bridge to get to the world of consumer engagement in a more meaningful way.

>> i think it's a very complex question, to some degree i've responded to it earlier on the surface, i will tell you that it is shared. it's about patient engagement. it's about what we are doing to better understand our consumer so that they're receptive to navigate in our system, is the technology, providing access in a more broad definition. in addition to that, however, it is being revolutionary, it is how can we create those operational models that best suit the needs of the consumers. one of the things that we're working on and really speaks to the payment side, is our strategy around bundles, whether it's the medicare, bcbi, when you're in essence creating transaction or procedure certainty as well as cost certainty. and so we see that is just another pathway of better engaging the patient population.

what we're doing is we're create ago bundle to say here is what it will cost you, we're creating partnership within the system with providers and clinicians to say this is what this process will look like, whether it's knee replacement, pneumonia, whether it's congestive heart failure, it's the experience post, it's that 90 days what happens, who are the skilled nurse and facilities that we should go to. who are the home care facilities that we should go to, as we begin to go down that path, we're moving in a direction that we know that we're going to be in an environment that we'll have to managed risk. these are some of the thing that is we're doing today because we know cost certainty and procedure certainty are ultimately important buzz we started down this path, we have over 40-skilled nursing facilities across our system that are working together today. we have over 40-home care systems that are working together today. in a more complex way, that's how you begin, as well, to talk about engagement, who owns that,

we own that. we want it to be easier for our patients. we want to be remarkable patient experience, and so that's just part of that very complex model of really moving in a very garage wall way for from a fifa service industry to value-based industry. >> that clinical integration is important, when you talk about budling payments, the -- bundling payments, they think in bundles, they don't think in terms of -- that's the way mindset. you're meeting a consumer where they're coming at it from. >> i'm going to push back on that, right? because we should be thinking about population health, right? we shouldn't be thinking about bundle episode or episode of care, our job, i believe, clinicians is treat a community, treat a population, right. for thinking in that direction and we've got to be tying together both the out comes, the community health, social determinants of health as part

of an overall strategy from our patient. and so when we think about an episode of care, let's say knee replacement, that's not truly s enterprising or looking at the person's over all health. we'll incentivize the patient. what's happening in your home. let's take a look at the medicare patient's home. let's take a look at the type of social supports they have around them. maybe they're using the emergency department that's where they go for their social space. and so we've got to think about persons over all health as we try to engage the discussion on value and incentives for patients. >> i would probably disagree with that because i think bundle, in essence, is population health. so when you think about population health and you think about the triple aim, if you think about experience, certainty, if you think about cost, the baseline to doing bundles is to reduce over all cost. and so think about cost, think about the experiences, think

about quality. and so the baseline model of creating bundles, pla particularly if you look at medicare is all about reemissions, making sure the patient is not coming back into the system. i do agree the population health is much broader, you can get into strats fiing patients and look population and leveraging within a population, the bundle strategy is an element of population health. i think bundles are our future. think about other industries, bundles are our future. the reason you do that is because price certainty, quality, it's because of out comes. so i disagree. >> full disclose sure i'm an actuary, so i'll declare, on average you're right. >> want to move forward to kind of predictions.

i'll give you an dote. you pick up your iphone, you order some guy, he takes you and maybe it's not emergency, takes you to the doctor to the off going. on the surface you look at that and goes that crazy, no one will do that. there are some many things that we'll do today. i want to throw it to you guys in the five or tenure of crazy predictions, what do you see in terms of ways that health care will be delivered or just delivery system innovation is generally that, again, right now might not be something that we would think work. >> so, let me just start off with that. i thought we saw great presentation earlier around wearables. i'll tell you that's a big part of the future of health care that people will have real time data that a physicians can monitor and look at and ultimately can anticipate and predict, population health is all about predicting and keeping

communities healthier. i think that you'll see a shift from the type of hospitals that you see in communities today. i've used the term that the in the future we may not call hospitals, hospitals, they may be institutions of wellness, we'll move from the large hospitals that you see today, to the more smaller hospitals, that are consumer friendly and they'll focus on 80% of relevant conditions that are needed to be met within those communities. it will look different, feel different, they may have wellness facilities as part of the facilities themselves to encourage people to, again, engage long before they ever need them. i think medical education will look different in the future. we talked a little bit about what we're hearing from our consumer populations, we clearly know they want to be respected. how we train our doctors in the future ultimately are going to be different. we'll be looking for people that can build authentic

relationships. we'll look for people -- it is the consume i patient will see you now. i think that education will be different from an life standpoint. what i found interesting as, you know, leading wealth management business for bank of america, one of the things we were really good at, from a 30-year standpoint how you accumulate the wealth, how do you retain your wealth and how do you transfer your health that's estate planning. that's estate maturity, there were a lot of deliberate discussion about what happens in death. we do not do that well in health care. i think from an education standpoint, we'll put more emphasis on how we do empower our consumers. giving them an opportunity to have a choice, to make a decision. to select family members to help them with those very difficult decisions. it's not just health care and country in general. that's an opportunity for us -- much better job of helping

individuals talk about death and moving on. lastly, this is the action of a challenge i want to say, we have a real opportunity, the millennial group, that 18-35 to 36-year-old group, we have an opportunity to use wearables and other kind of things of connectivity that we can take entire generation and make them healthier, we can eliminate or minimize diabetes. we can impact high blood pressure and we can impact obesity. >> i guess i'm looking ahead. i hope we get to a place where people and the united states, wherever they live, can access high quality care wherever, regardless of where they live and regardless of whether they have medicare or medicaid or commercial insurance. i'm looking forward to a time where people actually have proactive health planning that happens between your care planner, your care navigator, your primary care physician, your specialist and your health

coach. i'm looking forward to a time where providers are paid for those things rather than what we're doing today. i'm looking forward to a time where providers, community health centers, ymcas and employers meet together to think about the employee's wellness and by the way, we're paid for that, right, to plan ahead. i'm looking forward to that time. i think we're far from there. but i do think that in terms of the move to value and down side risk values, are helping us to learn how to actually get to that place. and i hope it's not in the far too distant future. >> i know we're running short on time. i'll talk about trend rates. but steve jobs said, you know, we always over estimate the amount of change that 12 months. things may not feel that much different. we'll feel some gradual shifts

in direction, i think the whole system is going to be a lot different than it is today, the use of data, mobile health technology is going to have a huge impact. it will be kind of a different approach, i think, employers are, you know, grasping at the concept that it health care is local. it's going to move at different pace and different forum where they have members. health care is personal. we're dealing with five generations in the work force. we're dealing with differences between, you know, income and background, race, gender, ethnicity, personality, et cetera. and health care ultimately, good health is good for business. healthier employees are more engaged and more en -- they generate better business results. it's kind of hard to prove, but i think they're -- adopt that mindset and really focus on how to maximize the health of the

population and hopefully through the delivery system we'll bring in the cost control and higher quality that we're looking forward to. >> you know, i agree with you, i had a boss who had a quote that he thought it was important, hemming way quote that said all things happen in the same way gradually and suddenly. i think that's probably true. thank you all for joining us and that's it for this panel. >> thank you. [ applause ]

. very nice to meet you. thanks for trying to listen to a little bit of different than what you heard today. i am going to talk about a little bit of health care, it will be more about things and i will -- i work -- i work as associate director of cyber physical systems -- this is doc bureau and we have about 3,000

scientists, engineers and also close to 2,800, also, mobile prize so you can kind of see that we really focus, so why are we -- >> cyber physical systems is iot.

it's a hybrid system system of physical components of connectivity that virtually everything you see these days kind of fall into this category, smart vehicles, smart health care, smart sensors, anything with the word smart that means you have something with a cyber component on it. by the way, please do not -- do not get confused to cyber security, that's not cyber physical, there's a whole different world and i'm not going to talk about cyber security today. so why are we talking about iot and cyber physical systems, which is cps. 2, 300 years ago, revolution changed our world. simply what it did is they came up with a new way to manufacture the goods in the products. and then 50 years ago, 40, 50

years ago, this internal revolution has completely changed our lives again, what did it do, it changed our way of doing things, using internet or pc, if you will. for example, we didn't have to keep our long hooks any more, you have xl spreadsheet, which it does a beautiful job and you have a financial software that can take tax return, for example. so if you combine this industrial revolution with internal revolution, that ends up with a cyber physical systems, now we combine physical with cyber and that becomes the next revolution. so, by the way, i can't believe it's 80 degrees here and in mid october in dc. i'm from boston, it never happens over there.

okay. i was brought in. i came into dc about three years ago. okay. i was brought in to work on iot. i was -- they gave me -- they hired me as white house presidential university fellow to work on cyber physical systems. and three years ago was a lot of time -- it was about the time that all of this buzz around iot started to come up. by the way, iot is not new, okay. it's been around for probably decades, more than two or three decades. it was called m 2 m at some point. it was called smart systems. it was called all this -- it was all these different names, so why are we hearing all this buzz about internet of things. so it comes down to the cost issue, the sensors, which you have to pay hundred bucks to get a decent sensor to measure in

temperature, now you can. i'm not talking about the whole product, i'm talking about the sensor. now you connect it by a couple of bucks, which is truly impressive. and also you can kind of see the sensors and collected data, mono sen sore and mono data that creates a new opportunity for us, so let me just go through what iot is, we already talked about, you know, general of all of this in previous presentations this morning. iot is really four layers, okay, there's the hardware layer, the physical components, sensors, and radios and chips that you can touch, sometimes this is as large as a car, airplane sometimes, on top of that, you have communications, essentially, you connect these

things through wi-fi, cellular network, whatever you can think of as a connectivity, now, a lot of people think that iot is the bottom layer, that's wrong. there are two more it's truly important layers that really adds value both from commercial perspective or also from research perspective on top of that. there's this data analytics layer. this is where you take the data collected from bottom layers and extract it for information. by the way, there was one thing with one of the speakers that speaks -- that spoke an hour ago, data, a lot of people say data is real currency. it is extremely valuable. i do not agree. data has 0 value.

it's ones and zeros, there's no meaning, if you have a bunch of one and zeros, that doesn't mean anything. the value is created when you extract action able useful information out of this set of the data. that's where data analytics comes in. that's where the real value and business value is created. on top of that, there's a service -- this is the most important and this most valuable layer. this layer makes the decision based on the information through all of the sensors wearables and all these things you have to make a decision what to do with it. it's not a visualization. you have to take on action. when you take on action, that's where 90%, more than 90% of the value the systems is realized. if you look at the information flow, it's not just the monitoring, actually, is also taking action, meaning that you are coming back.

i'll give one example, about 16, 17 years ago at mit they developed a ring sensor. it's a finger ring. you have batteries, a cp. you have wireless, you have optical sensors. it detects vital signs, heart rate and blood pressure in a finger ring and you carry it 24 hours, wherever you go, if there's seems to be a problem, then you get alerted. >> tles a echnically, this is r

tough to put everything through this small ring and then actually, you know, go first, most of the customers and -- will use this ring is essentially either patients or, you know, people who needs monitoring, so they're not goib to be use to changing battery replacement battery every day. once you have this, it has to go for month or years. that's challenging. all right. but in addition to that, the issue is much bigger than that. so when i was brought in as a fellow, i was given a task to figure out why we are not seeing -- why we are sew x -- seeing growth in our world. we see incredit mental growth. we talk about it. there are a lot of wearables. we do not see the critical

momentum like cell phone industry enjoyed for the last 20 years, okay. why is that? what concluded at the time was, it's because the iot and cps landscapes is truly fragmented. given example, medical examples come to medical devices. a lot of the technology they're using could or can come from transportation system or personal, you know, smartphones, for example, or from disastrous response system. they're all developing these things that do not have a lot of -- they do not share a lot of the acknowledge and experiences. so how do we encourage collaboration and create tangible benefits and creates economies, that's really the core of the question. i'll give an example, what it means by collaborational

example, you have a huge accident pile on the highway and what happens, somebody is going to call 911 and ambulances are going to come. they'll start calling hospitals around and who has the vast available, who has the right surgeon and doctors available. they're not available. they're going to call another hospital because you have 30 injured people. as a mess, all right, in this example, what do you do today is literally user drel phone. that's what it's a command center. this was exactly boston marathon incidence a few years ago and they did a job to take care of the situation with a given, if a given limitations and systems. but we believe, we could have done better, if you had a system

that could coordinate and orchestrate and also connect this difference emergent response system, triage a system availability of the hospital resources and availability of the traffic, ambulances, obviously, they want to all come in and they're faster, can traffic system. if you had on something like this cross sectoral collaboration. so a few years ago, we created a challenge. it was a collaboration program to bring industry, academia to encourage with specific goals like saving lives, creating more jobs, creating more businesses, and improving economy. that was very success program.

and after that. >> institutionalize it and create program called a global city themes challenge. and the goal is pretty simple, we want to create economies, whatever we do in iot, health care, disaster and transportation and environment because without economies of scale, it will be just science fair going forward. it's going to be just bits and pieces here and there. we only create model. we won't even bring in cities, why, because cities is a unit that you experience your life every day with. all right. so with a partners with the cities, transportation, health

care environment, we want to create teams and create a measurable impact. so currently, we have about 100 teams in total, over 120 cities from all around the world participating over 300 companies universal nonprofit participating. so what do we do. this is actually smart city, a capacity built in program, but health care is controlling important part of it. if you go to any city and if you go to the health care department or the environmental department, they work with a companies, obviously, and they work the hospitals, those are extremely fragmented and they come with their plans one by one. essentially the plan in new york city doesn't ask for the -- it's not designed to work for a plan or in san francisco. the problem is, if every city has a different plan and different home grown solutions,

you're going to never get the scale. cities are not happy because they have to reinvent the wheel over and over again, companies are not happy and they cannot sell the products more than once. it has to be customized and it's a database, data analytic system and that is a big problem. so how do we address this issue. we address this issue through a concept of action clusters. so instead of each city, working with each company or university. we want to bring in multiple cities, get them around, pull them around the same topic of shared interest, transportation, timeless vehicles, health care, air quality, asthma issues, and also we want to bring in companies and universities to pull the ground around the topics. so out come of this effort will naturally, because it was developed by multiple cities and

multiple companies will be reply ka -- reply kabl. we've done this for one year. now next step we want to go with super coasters, what does that mean. so i'll go to more of a health care example here we go at the health care. it's related to other sectors, as well. every sector transportation, water, and health care has specific solutions. but each solution by itself cannot create a real synergy, you have to bring them under one umbrella. that's what they're doing, multiple clusters get together, create super cluster and can create a blueprint that can apply to any city. i'll give you a few examples of what happened in the last three years out of this 450 teams. close look -- closed loop health

care mass general hospital collaborating with a bunch of companies and universities as well, essentially, this is example that was also addressed in previous presentation. there's a set that you collect at home. you have a whole health care system when you have a heart attack. you're brought into the hospital and a hospital goes through all of this test again, in you -- if you had access to bay the set that you've collected for last three years, wouldn't it be great that you can figure things out a lot easier. so that's the concept, how do you actually try to coordinate different -- the home health care system to different hospital systems, bottom left,

it shows, this is really about the skill, product on the top right. installing fall detection sensors into a senior living facility. you probably know this it's not because they are sick, they form the ground. they cannot -- they don't have a muscle and strength to get up. they fall there, stay there for three days. they die. okay? and simple full sensor -- detection sensors can solve the problem. if you can detect it send an emergency signal. >> i cannot do this by myself,

we do it with partnerships. national foundation, ita, gsa. also, companyies all the companies work together. this is international and global activity. one thing i want to make sure we understand, the u.s. cannot do this by ourselves. it's not right that we do it by ourself. whatever we come up with, may not work. there's no economies of scale. we have to do it globally. we go through this process and the way we matchmaking. next week, tuesday and wednesday, we are going to have a global kickoff super cluster

conference. at the grand hyatt hotel. if any of you are interested in health care, we will have a separate health care session. either i was perfect or you -- this was not exciting at all. thank you very much. ♪ >> it doesn't look like me at all. i'm randy johnson at the u.s.

chamber of commerce, i'm just a lawyer, i'm not going to pretend to add to all the information people provided today. i'm proud of this summit, it's our fifth one. and my goal on this, five or six years ago, was, if we can bring together a lot of smart people and talk about a lot of technological advances, and move the beuhl forward a little bit on disease treatment, wellness programs, we can call it a day and go home. we earned our member's dues. on a personal basis i've experienced a lot of -- i lost a sister, two sisters and a brother to cancer recently. both under 70. i also had prostate cancer several years ago, i picked up a tid bit here in one of these meetings which gave me the information to reject a recommendation several doctors gave to me. and steered me in the proper

direction. listen to joe biden the other day on npr. and he -- what happened to the cancer moon shot. it's moving ahead. but we have information in silos. haven't we moved beyond that by now. it's a little frustrating when some of these issues keep getting repeted. we keep hammering away on it and hope we can move forward. i would be remiss not to mention we have another event. we're not buying lunch in between, there are good delis around the corner. looking back and looking forward. essentially it's a way of saying, what's going on with the

a aca. if we can establish that, maybe we can talk about solutions, as we go into this next year, regardless of who wins the white house, that's important. jennifer lim for her help on this, and hillary crowe with the foundation. the labor and immigration division. they're great events. and thank you for all your work. >> i did mention, we're going to form a company, as they get around the one child law over there. we're going to get a kickback on that. thank you for coming, i hope you can stay around for the afternoon, it's going to be a great event. a little more twist, a little more policy, a little more tips.

i think you'll find it interesting. thank you for coming. watch c-span's live coverage of the third debate between hillary clinton and donald trump wednesday night. our live debate preview starts at 7:30 p.m. eastern. the briefing for the debate studio audience is at 8:30 p.m. eastern. and the 90 minute debate is at

9:00 p.m. eastern. watch the debate live or on demand using your desktop, phone or tablet. listen to live coverage of the debate with a free c-span radio app. download it from the app store or google play. in the morning, a university panel discusses american election processes. sylvia burwell will talk about the upcoming affordable care act open enrollment. watch live at 10:20 a.m. east n eastern. different approaches, universities are using to deal with sexual harassment and assault on campus.

from georgetown university law center, this is just under two hours. >> okay, everybody if we can get start started. i'm going to briefly introduce the folks on the panel and turn it over to them. this panel as you see in your materials is on harassment, abuse and fair process, we have nancy canalupo. we're happy to have nancy back. along with william kidder, who is associate vice president and chief of staff in the office of the president at sonoma state university. they're going to be presenting. their paper is below the surface

of the water. sexual harassment by college faculty. we have brian pappas, who is -- he has a complicated title. associate director of the adr program. his paper is abuse of freedom, balancing quality and efficiency in faculty title nine procedures. and then we have kelly bear who is director of the uc dave igs family protection and legal assistance clinic. she's talking about the brainstorming about the law school clinics to provide assistance. we have alexander brodsky, who is a j.d. from yale. and she'll be talking about a rising tide learning about fair disciplinary process from title ix. where do you guys want to start?

>> i think i am supposed to start. so bill and my paper was -- the idea of it was really anywhere yalted by bill. because he was following several of the prominent faculty harassment cases that were occurring on institutions on the west coast and was head of the process at a former position. similar to research that i had done some years ago, with regard to peer harassment. it quickly became obvious to us

that there were several reasons why looking at the case law and the ocr investigations was not going to work in this context as it had in the peer harassment context. and so in the interest of time, i'm not going to go into all of the reasons, suffice it to say, we decided we needed to cast the net a bit wider. and we ultimately decided to look at three sources in an effort to map the problem of sexual harassment. in in the workplace, in educational institutions and occasionally in the criminal context specifically what we were looking at there was, we were looking at research on the

ha harms to combat sexual violence. we looked at the incidence rate of faculty sexual harassment, particularly faculty sexual harassment of graduate students, i'll explain that focus in a second and then finally we looked at the amount of serial harassment. a single harasser, who harasses multiple victims opinion our second category was looking at private lawsuits and ocr investigation resolutions. in cases that were brought by victims that had been harassed by faculty. there are close to 140 of these cases total. the third category was news stories regarding accusations of

harassment by faculty, i'm going to talk about the social science research and the court cases and ocr investigations. the necessary steps schools should be taking to address knack you willty sexual harassment. there's relatively little social science data the recent activity that's been spurred by the white house task force to survey their students about sexual assault and sexual harassment on campus. has started to gather some of this data. we have some faculty harassment on graduate students. and some of the large -- the largest survey that's been done

as far as we know to date is the aau study. and so that's with 27 colleges and universities, major research institutions across the country. and you can see from the chart that the rates of sexual harassment reported by graduate students is quite high. it's especially high for transgender and gender none conforming folks. that is followed by women graduate students. you can see that harassment is happening at the hands of faculty or other university employees. again, with the highest percentage of transgender and nonconforming students. and with women students next and men students last.

i said earlier i would talk about why we are focusing on graduate students. and basically, we decided to focus on graduate students because our feeling. at least some of the social scientists involved in these surveys have articulated similar reasons. our feeling was that graduate students are uniquely vulnerable to faculty harassment, and that's because of how closely they work with faculty. the length of time they're often in their graduate programs and the importance of their relationships with faculty members in terms of the graduate student's future careers. we're also aware that graduate students are quite literally the pipeline to the profession for almost all of the disciplines in academ academia. to the extent that certain groups of graduate students face more harassment and hostility,

that is likely to affect the demographic demographics. the aau survey data is corroborated by some other smaller surveys or smaller or older surveys. the extent to which a few faculty members are harassing multiple students. so since we couldn't really find any studies on that question. we looked at studies on serial harassment and sexual aggression, which is a social science concept that measures similar kinds of conduct to sexual harassment.

and there are only a few of those studies that deal with serial harassment in the workplace or with repeat sexual aggression between university stude students. even though that body of research is relatively small, the studies that are available pretty much agree that serial harassers and assailants account for a lot of the sexual harassment and violence that is occurring out there. mainly what the social science research doesn't capture for us, though as legal scholars and attorneys, is how much of what social scientists measure as sexually harassing or sexually aggressive conduct is sufficiently severe or pervasive enough to constitute sexual

harassment as a legal matter. on the severe end of the sexual harassment spectrum, when we're talking about sexual assaults, sexual violence this is not as much of a problem, because on the severe end one instance of sexual assault for instance is generally agreed to constitute sexual harassment sufficient to create a hostile environment as a legal matter. but one sexist remark in class or even several such remarks will not constitute hostile environment. it could conceivably show up as a data point in the social science surveys. to address the gap between the social science literature and legal standard, we look at the court cases brought by plaintiffs alleging sexual

harassment by faculty involving a complaint or complaintses of faculty sexual harassment. we looked at 68 court cases and 65 ocr investigation resolution letters. all of which took place after 1998 when -- and we selected that date simply because that's the year that the supreme court decided the jebser case, which is sort of the modern era of title ix and sexual harassment. of those 133 cases, we found 46 cases where a faculty member was accused of engaging in conduct where there is enough detail

about the conduct where we determined there was a claim of severe or hostile environment that was directed at a student. >> we looked at the conduct alleged to see what the faculty harassment of the students looks like. you know, who exactly is it doing the harassment, who are they harassing. how are they harassing them, and how are others reacting to the harassment. we found a couple general themes. so the first is on the slide. 57% of these cases involved unwelcome sexual touching ranging from hugs and kisses to sexual groping. coercive sexual intercourse, forcible rape and the kinds of physical assaults and psychologically abusive and controlling behavior that is

often associated with domestic violence. you're probably thinking, or you may be thinking well, that's probably more of that unwelcome touching is sort of incidental contact like someone putting their arm around someone or giving a student a hug who didn't welcome it. in fact, if you look at the other bars on this chart, you can see that the greatest -- the most sort of violent or most severe forms of sexual harassment actually get the most -- the most cases are in those categories.

and we only had a few cases that we found where it was just something like a hug or a kiss or something like that. the other thing we saw, because i'm already out of time is with regard to serial harassment. so these -- this is the statistics on serial harassment, or the basic percentage on serial harassment was 62% of the cases involved serial harassers. and this -- you know, again, this was conduct that was alleged by the students or the plaintiffs in the cases. and this was very much weighted on the side of the court cases as opposed to the ocr cases.

but it was a high percentage in both areas. so with that, i will pass it along to bill. >> thank you, everyone. i want to thank margaret and robin for hosting this important conference today. so this is sort of an odd partnership in some ways for a paper. normally, i publish a little on the side in areas related to affirmative action. for me, sort of stretching outside my comfort zone. this is several orders of magnitude different than my previous efforts in that regard. >> in my administrative life. i have had this separate professional experience life, working for many years in a provost's office. working as a chief compliance officer, over seeing a title ix

office. including the last two cases in the university of california system that went all the way to the board of regents. i don't discuss those two cases in this paper. it animates my reservoir of experience. and how i analyze the cases and work with nancy on this paper. >> nancy talked about a couple spheres of evidence. one being the social science. we don't have time to get into that in great detail. there is some interesting social science in this area. another being the cases and ocr complaints you used. because these are all confidential. and unlike in almost all litigation, the fact that there was litigation is public, even

if it's a jane doe case. even in those circumstances, most faculty misconduct cases, whether for sexual harassment or other kinds of misconduct are entirely outside the sphere of public knowledge. except when there are media reports. so we looked at that as a separate sphere of data collection. these are just cases, big cases in the news in 2015 and 16. you know, we could have easily filled up 15 bullet points instead of five, if we had the time and the inclination. but just to kind of give you a flavor of what's been going on at many leading universities around the country. so to start with uc berkeley. they have basically had a total catastrophic meltdown over this issue over the last two years. for example, last summer, i was

testifying in defending a faculty termination case in federal court. at the same time this whole controversy was playing out in summer 2015 on the berkeley campus. marcy was on the short list for a nobel prize. he had a 20 year track record it looks like, at least of some degrees of complaints about his groping and unwelcome sexual advances, and so on. that was just one case where the anemic disciplinary response by the campus was regarded within the uc berkeley community and within the broader community as morally repugnant, basically. over 20 of the people, one was

unfit to return to duty. second case at uc berkeley, unfolded in the spring of 2016. that involved the dean of the uc berkeley law school. the second dean by the way at berkeley to resign amidst a sexual harassment scandal. dean towdry had had an executive assistant, there was a title ix investigation against him, that substantiated violations, very anemic sanctions at least thus far. he received a 10% pay decrease a salary cut for one year, that was his initial sanction.

until the case blew up in the media. there was significant blow back within the community. he had allegedly put his hands on his waste. sort of this repeated kissing and -- >> there is a third major case at berkeley, that involved the vice chancellor for research he was also found to have groped the breast of his middle manager. and engaged in other similar kinds of misconduct as was described by the law deemed. as if to punctuate or symbolize the cultural problems on the

berkeley campus with respect to enforcement of ethical norms. the assistant vice chancellor that fleming was found to have sexually harassed. she herself had been fired for sexual harassment related conduct and she did that behavior after the conduct by vice chancellor fleming. that's the berkeley case. i'll move more quickly through the others. northwestern, we have some northwestern folks here at the conference who probably have a lot more facts on the ground about that. but professor ludlow in the philosophy department was alleged by two separate students, one graduate student, one undergraduate student to have had nonconsensual sex with those students.

the first time around in the disciplinary process, he received a modest sanction of i think he was withheld a merit increase of $3,000. the second time around as the case progressed and he lost his lawsuit against the students in the university. he resigned as he was circling the drain of a termination proceeding. >> university of west virginia, school of medicine. it's important in discussing this whole topic to make a mental note that in the stem sciences and in laboratory, scientific laboratories, there are particular constellations of vulnerabilities, with regard to sexual harassment of graduate students. of under graduates, of post docs, and this is also true in a medical school context, the chair of the neurosurgery

department he was found to have sexually harassed two staff nurses and an assistant at the medical school, that resulted in a $1.3 million settlement, so they paid the $1.3 million settlement, and yet the university still maintained this individual, dr. cohen as the department chair and did not sanction him. yale university, we have several folks with yale ties here, i won't get into all the cases, one of the cases that came up in recent months is around -- his conduct toward a recent graduate, there's a lot of blogging about that in philosophy and ethics spheres. in other cases, the university of colorado, at boulder. in that case, there is an

outside committee by the american philosophical association that found systemic abuse issues there, that's just kind of a slice of what's going on at some leading campuses. when will colleges and universities do fire faculty for sexual harassment, and those cases are litigated. what are the outcomes. >> it's a little hard to read, we have some print copies there, if you want to read the cases really it's the weight of the cases and the pattern that matters more. by a 3-1 ratio. these are all cases involving tenured faculty. so if -- there are a lot of other cases we excluded that

would have padded the stats. if we focus on these cases, basically by a three to one ratio, the universities have been able to successfully defend their termination of that faculty member. the common themes. each of the cases that involve a university losing, it's kind of like the tolstoy line about how happy families are alike, and unhappy families are each unhappy in their own way. there's some salient due process issue or they didn't follow their own procedures, we can get into that more if we have time for q & a. those are the kind of evidence that we looked at. this is all driving to our

conclusi conclusion. we don't have a comprehensive ability to -- everything is confidential. and we only can get pieces of that. maybe based on the abf data about a fifth of cases are dismissed right out of the gate. one fifth are settled in the resolution process. another fifth are in the summary judgment position. and only a small amount of cases are like in civil litigation would go to trial. the date de we've looked at both the uc data and

impressionistically from other sources bears that out. a small fraction of the universe of cases that involve investigation. those cases are a modest fraction of the total universe of cases that we think are what's going on. many of these cases are never reported. to the issue of sanctions. >> kind of came up with this constellation of factors. some of this is rooted in sociological theory. it teaches us is when ethical

norms are being transgressed, being violated. that's the most conspicuous moment when the norms become most salient for the population. for the student population, other members of the academic community. it's those moments of a case like jeff marcy or graham fleming it's most important for the academic community to communicate through disciplinary sanctions. a number of universities have an institutional culture. for example, at ucla, not speaking to their over all culture it is the case in the last 50 years, they've never had a faculty termination proceeding

they've never had a termination proceeding, the same is true of harvard university dating back to last week, but 1638, they have never had a faculty termination in that four year period. there's a 19th century example where a professor killed another professor, but went to the gallos with his tenure intact. so in addition to the issue of leadership, the research shows that leadership is a salient factor in terms of creating a sense of confidence of enforcement of title ix, when there is a conspicuous absence it has the syndrome of other negative consequences. underreporting of incidents.

retaliation to those who do report incidents. a chilly retention climate. this is especially so within stem fields. with respect to ocr and litigation, some of these very campuses that i talked about are the ones that you could characterize as being embattled on issues around sexual harassment and title ix, i'll leave it at that. "am not trying to check my

e-mail i also want to thank the conveners, my remarks are really going to blend nicely with nancy and bill's presentation. i need to start by commentary on my power point skills. i needed some language, but nonetheless, my power point skills, anyway. widespread misconduct, ineffectual response. complain ends are unhappy, because their complaints are not being taken seriously. they're feeling revictimized. on the other side of that,

respondents and their supporters feel the ocr requirements are unlawful new rules, limited right to a hearing. i say the traditional setting in which they would have the other party present. and so you can see in the ocr's q & a document from 20%. can include an investigation toward a lower standard of proof what i'm arguing here is that faculty have arguably a greater property interest in continued employment. especially since there's c contractual guarantees.

they often receive less safeguards. universities may be infringing on shared governance issues when they work to apply administrative solutions and create consistency with faculty processes. there's potential there. and we need to design processes so that these things can exist. how do these processes relate my analysis of these examples it's not easy looking at these processes and figuring out what happens when, how does this work? >> my audience for this material is frankly law faculty it's hard to understand these issues with a lot of indepth study. we take our typical understanding of criminal law, we can end up with less than new answered understanding.

of how these processes work together. my goal is to have greater engagement of the entire -- >> my first slide, they did an excellent job of explaining misconduct. i'm going to skip this one as well and talk about some research that i did, when i completed my dissertation, some examples that i learned from a variety of different -- faculty staff misconduct was much more prevalent. much more sexual misconduct was not really on the radar, toward 2014, when my data collection concluded. i saw that switch. here's a quote, i threatened to put a policy together banning faculty student relationships, you would have thought i called

every faculty member on this campus a pedophile. i have students running around here, marking on a chalkboard naming the number of professors they've bagged. one in particular, had a habit of inviting students to co author. when they're on the job market. this offer always came with an invitation of sexual acts. if i say no, i will lose this professional opportunity. i've had any number of the faculty members come to me -- there's a saying, in order for a tenured faculty member -- the student has to be dead at the time. it's a horrible saying, in some institutions it's true something

has to be that bad for something to go through the processes, for the claimant to see a positive outcome in their favor. i had many people share that quote with me. the first time i heard it, i was surprised. >> one of the issues you see when you get into the nitty-gritty of this work -- in terms of the university's liability interest. i do think at the end of the day, it's in the interest of the university, and i think being able to stand up and help them see that is important. so when we think about due process rights, students do have a property and liberty interest. it's less settled than that of faculty. they need some kind of notice, some kind of hearing, it's not much different for faculty. only circuits disagree on the extent of that. there are three models i see out there currently. that's an investigation model, a hearing model, and a hybrid of the two.

under the investigation model, the administrator or investigator determines the sanctions. this is the satisfies the hearing requirement under ocr. and they use a preponderance standard. you have to meet certain standards for review. contrast that with a hearing model. what you get from an investigation is a charge on the preponderance standard, with a hearing before a panel or administrator who determines the outcome of sanction. with an appeal to an administrator that must meet grounds for a review. they'll use a little bit of both in order to effectuate a resolution. now, i want to be clear with what i'm about to show. i'm not saying the students should have less or faculty should have more. i'm saying we need to be aware of these things, and i want an

educated group looking at this, and seeing what ways can we do this. let's look at indiana university. there's more process for students. the investigation leads to a charge. they will get a hearing if they want one. the adviser is to remain silent. they do get confrontation through questions that the panel has to go through the panel to be asked. and then they use a preponderance standard. faculty have an investigation model. this is the title 9 process. they can identify witnesses. goes to a decisional officer who makes a decision issues the finals, you can appeal to a faculty board of review, or to the provosted chancellor, you

have to meet the grounds. they also, include the grounds on the right. witnesses aren't called during this proceeding, there's no revisiting the findings of fact. there's very little confrontation at that phase. but the silent adviser in this process, may read the party's statement. now there also can be a faculty recommendation there. as you're going to see as i go to another example, that becomes more of an issue, how do these policies work together if an administrate everyone policy says this person should be dismissed and then you go to a faculty process in which there's a clear and convincing standard. how does that work. that leads us into some of the shared governance questions. at kansas, i had to disclose i went to the university of kansas. students have more process than faculty, unless you're facing

dismissile. administrator finalizes this, they can appeal to a guaranteed hearing. they can directly or indirectly question any statement, it's managed by the panel. the panel has the authority to tweak that and make sure it's not revictimizing. the result is a recommendation confirmed by the vice provost. they request appeal the hearing, there's not going to be a hearing during that appeal. if it's less than dismissal it can go to a faculty rights board. the board can proceed without a hearing. they can say, we don't need to have a hearing on this. the appellant has the burden of proof. the administration violated procedures that impacted rights. there's no restriction on confrontation if they get to --

if that hearing is accepted. the result is a recommendation that's going to be confirmed or changed by the chancellor. in 2011, he's a faculty member at kansas who is found to have sexually harassed a student. the sanction going through the process, two weeks no play, denial of a yearly raise and pay for and complete the training. he appeals this to the faculty rights board, they say, we don't need to hear this and so he sues. the handbook said he'd be able to go to a hearing. the hearing as the university of kansas argued this at the initial level was that opportunity to do that. and they won. they won at the appeals level. what we would normally conceive of that. no grounds for appeal required, provost must prove full confrontation, no restriction on

council's participation. how do the -- how does the -- how do the processes square, if you have someone go through both. this is really the tension between the hearing and the investigation models. i think it's interesting that we have lawyers being in charge of how this developed. it was more the administrators who did this flew their professional networks lauren adelman's work, are the processes we're creating, if we look behind them, are we doing what the law wants them to do, are they simply vehicles for avoiding liability. are they actually creating adherence to what the law wants? my evidence suggests a swing first toward formality. we want more, we want to avoids

lawsuits. we want more traditional process. in in the wake of the dear colleague letter. we can't make that decision or even a recommendation, we can only decide if it's worth a hearing, it's insulting. students and faculty can't serve on those panels until they have two hours of training on title 9 for me. there was push back between those offices. title ix really changed dramatically in 2011. i'm wondering, and i'm seeing a little bit of this a swing toward investigation. i want to talk about why, it's hard to train panels to understand the nuances of this there are efficiency concerns. if you want to do this in a certain way, how do you provide a hearing to everyone. if you can provide a traditional

hearing to everyone, what does that say about how many complaints are coming forward. there's not a requirement to do this. the law does not require more than an administrative process. the law is clear that universities are under the same obligation as the courts the requirements are clear on the due process issues. you get -- you default to the greater risk here, and both are unacceptable. are we getting to what will address the problem and not just playing with liability. the key is execution in my mind. and typically these have been administrative university decisions often not codified because they change every year. to go through a full faculty review is difficult as you're creating best practices and i think it's a good thing. the system is learning as it goes through.

what happens when these processes conflict. the policy conflicts with title nine. it conflicts on the everybody den sherry standard. that's what bill was talking about with his situation. he reaches an agreement on what the penalty is. he's resigned and they're going through a faculty process. it's very real the university didn't handle this well. it's interesting to see what's going to take place. the investigator presents the report, before a panel, you can meet individually with the panel. i want to highlight that, there are a lot of ways to get confrontation without it being revictimizing. the outcome's appealable also guarantees some traditional hearing form of confrontation.

faculty don't have that i was able to find them on a website that says formal investigation reports are written in a report, you may meet with the investigator separately and have your adviser present. and then you have an appeal to the vice provost on paper. i'm not critical of them for not having it codified, it just wasn't easy to find. how do they work together. that human resource is requiring clear and convincing evidence the online policy doesn't reference that. does that mean they didn't reference -- hr 76 suggests a simultaneous process, we're talking about an offramp to a simultaneous process, if there's a procedural issue. sexual misconduct is governed under their policy.

this is so complicated that it's not clear to me the shared governance went on in these investigations. it's hard not to any we need advisers to help you through. people can understand and help people understand what these steps are. what happens when they do conflict. if the title nine results result in dismissal, or does not. that's interesting to me. does that mean at berkeley they needed to negotiate the faculty process because agreeing to whatever sanction was imposed or how do they do that simultaneously. in kansas, the administration wanted to make the faculty processes conform but the faculty pushed back. penn state's hr policy gives the

panel some control to say this is victimizing. i think requiring clear and convincing evidence we need this if we don't have this, we're going to need procedural irregularities. instead of a standard that's criminalize i criminalizing. confrontation in the hearing. they even said, if you need more, there might be more required. use of technology. trog torys for people who choose not to attend. posing questions throughout.

i think more freedom for advisers would be helpful if those are trained advisers who understand these issues, it means they're advocating on their behalf, but with an understanding of what this process is and how it works. i believe it's possible for everybody d evidentiary standards. i don't believe it's all or nothing. we need to care about perceptions, because procedural justice matters how do we get people to come forward to report that matters. academic freedom tenure, we have a responsibility to report faculty predators. in some instances, they weren't

able to do anything about it. so they sort of pushed them to change what they were doing slightly. maybe it's not happening at the house, but at the coffee shop instead. i think law faculty have a very important role to play here. they have to understand the negative impact -- it's hard to have a conversation about it when we're talking about it on two different plains, i think it's possible, but nationally, we need to think about how to have that conversation. i'm not suggesting they need to be the same. i agree with the keynote earlier, different sanctions may require different processes i'm not -- the way i see this is

that earlier, one of our presenters said, it's not about the process, it's about the harm. i agree with that, i think for people to see the harm, they need to understand that some of these processes are being used in different ways. for me, the entry point might be, let's look at the processes, and let's understand how this is impacting everybody and how we can make some decisions ourselves. i'm happy to take questions. even if it's this one. thank you. >> i want to echo everybody's thanks for coming to participate in this symposium today. i feel like i already have learned a lot and have ten new projects i want to work on and

go home with the time i don't have. i'm excited about that, i think what i'd like to do now is shift the conversation away from talking about staff and faculty harassment. i want to shift the conversation away from talking about student writes. or students accused of misconduct start to think about what the rights are about the survivors i'll work my way around to talk about what i see as a potential role for law faculty in some of these cases. i started thinking about this project after reading the harvard law and penn law open letters, discussing the rights of the accused students and the rights of the universities. self-governance, academic need opens, what struck me as a clinician and as an attorney that previously represented sexual assault survivors i felt

as though there was this missing piece, there was no discussion about the rights of those students. there's discussion about the need for -- students and victims also have those same needs to council. or the same needs to certain processes and procedural safeguards and rights. that's where i'm at i'll start talking about some specific legal needs of sexual assault. talk about the work of current clinics. i think they may make a good fit. and talk about some additional rolls for those folks that are already at law schools and doing this work. for student survivors, a lot of whom are 18 or 19 years old. brian did a great job talking about how complicated these cases are.

i would say i agree, and would argue it's complicated for faculty and staff procedures. imagine what it's like to be 18 or 19 years old and going through this. >> the third is kind of during the adjudication hearing. we'll talk about each of those. the students i've been working with is information before they decide to report and the complete lack of confidential information. i have a lot of students i see at different schools who have

ended up in a system that they made no informed consent decision to participate in. i'm not going to get into that discussion except to say that as long as they exist, we have students that caught up in accidental disclosures, without having made the decision to engage in the system. depending on your state, in california, if you go to the hospital to seek medical care for sexual assault, that's reported to the police. some universities are now automatically reporting it to the police. without any information, you may find yourself engaged in completely different systems and not fully understand your rights. by having the opportunity to talk to attorneys before you make those decisions. before you decide who to talk to.

a victim can learn about each system, the pros and cons, what kind of relief might be available to them, what kind of detriments might be provided to those systems. a lot of our student survivors experienced more harm during the process than the actual assault. people engaged in these systems do so deliberately. i think prior to reporting a comprehensive legal screening system is key. that's because a lot of these different options are confusing and overlapping. they may implicate one another. for instance, the student who may need financial support through -- a student who may

have immigration issues. also may need to report to one or multiple systems. student who wants to drop out of school and is worried about the impact on their grades or loans, may need to report to the university. i think comprehensive legal screening will allow students to understand or think through all of the ways in which their legal rights may be implicated by the assault that happens. i think the other thing that can happen is during that screening, they can receive detailed information about their options. understanding that if you go to the police, this is what a police investigation looks like. in it every graphic gruesome detail, what the odds are that those rape kits will have any evidence that's used in any capacity, and whether or not

they'll be tested. until we tell students that, a lot of students feel betrayed when they're told to do a, b, c, to some extent the campus process, depending on the individual campus you're on, understanding whether they'll be subject to cross-examination. this is true for student who is may be entrusted in restraining orders. if if you get a restraining order, it tends to be a much quicker hearing. how might that impact your campus investigation. what sort of questions will be posed to you during your cross-examination. having all that information with a particular -- particularly looking at the privacy and safety concerns and thinking through those implications. most of the campuses i've worked

on advocates -- i have a great advocate i work with is getting frustrated. her role is not to give legal advice. she's more and more been put into a role because these situations are becoming so complicated. we need to work with advocates, but we need to recognize the limitation limitations we have. what are the chances of success to meet the goals that are actually identified by that client. that's one of the first, i think that's key, to have access to qualified legal council before those reporting decisions are made or accidentally triggered. the second step is during

investigations. . insuring investigations are appropriate. this both on -- i know everyone in this room has probably read reports about mistakes that campuses have made and how they've done their investigations. the department of justice has come out and talked about missoula, montana and what happened. if you have an attorney with you, hopefully that is someone that may help mitigate some of those troubling trends. instead of waiting for the report to come later, a victim to have to file a lawsuit against the university. actually address those issues as they come up during the investigations. some really obvious examples include students who have been asked to sign no prosecution letters. they believe that means they've waived their right to prosecute. there's no waiving away a crime

you experienced. this was something law enforcement was doing, and again i think they thought it was well intentioned. we have a letter proving this victim doesn't want to move forward, nobody can blame us, for a lot of our student survivors, they're not going to make that whether or not to engage with the criminal justice system a day or two after the attack. letting them know what the statute of limitations are, what their options are, i think is important. polygraphs, we still have some law enforcement that are asking victims and survivors to do polygraphs, it's not appropriate. in fact, it's not allowed in most states, but it's still happening. having an attorney with a student during that time is important. i think like i said, within the campus, it's important as well, when you have some campus administrators that perhaps well meaning, will have students, do you understand that you're potentially ruining the life of another student. have you thought about this, or taken responsibility for your role in this.

don't you think this is part of a hookup culture or these well meaning but really very harmful victim blaming statements that appear in a lot of these investigations. captions copyright national cable satellite corp. 2008 captioning performed by vitac