Illustrations by Barry Falls.

Healthcare

From the ICU to BU Law

A former nurse ready to transform the healthcare system pursues a new calling.

Within weeks, things had escalated. Camacho recalls the growing sense of dread she felt as more and more patients with serious respiratory symptoms deluged the hospital. Doctors, unsure of how to treat the new illness, intubated some patients and put them on ventilators, straining the ICU to the brink. “As a large academic medical center, we got admission after admission because we were also trying to help smaller rural hospitals,” she recalls. As the number of COVID patients grew, “we moved all the non-COVID patients out of the medical ICU, and the MICU [Medical Intensive Care Unit] became the COVID ICU.”

If life inside the hospital was chaotic, the world outside offered little respite. Although she normally commuted to work by public transit, Camacho began taking Uber rides after hearing of fellow nurses being threatened and harassed on the train. “People were scared when they saw nurses in scrubs,” she says. “They thought you were spreading COVID.”

Over the next two years, Camacho concedes that “there were many breaking points.” But one shift in particular is seared into her memory. “I’m wearing the gown, the N95, the goggles, and I’m with a patient who is ventilated, prone, and paralyzed,” she recounts. “Their oxygen starts going down, and I’m yelling for help in this negative pressure [isolation] room. I remember feeling like it was just this patient and me. Does anyone—like, not just in this unit—but does anyone in the world care about what’s happening right now? This is not okay. What’s wrong with the healthcare system? How did we get here?”

In August 2022, after five years as a nurse, Camacho made the painful decision to leave the profession she loved. She had chosen ICU nursing because she wanted to support patients through what might be the most vulnerable moment of their lives—“I see it as a privilege to be trusted that way,” she says—but the challenges of the healthcare system became overwhelming.

“The pandemic served as a magnifying glass to the systemic issues that were present in our healthcare system since way before COVID,” Camacho says. “We need better access to preventative care services, we need to address violence against healthcare workers, and we need to have real policies that actually address social determinants of health for vulnerable populations.”

Take, for example, a type 1 diabetic patient who comes into the hospital with skyrocketing blood-glucose levels. “How did they get so sick that they end up in the ICU for days? Because they can’t afford insulin. Because they lost their insurance. Because they live in a food desert [without access to healthy food],” Camacho says. “How many patients just fall through the cracks? There are so many policy, public health, and healthcare-adjacent things that lead to that situation. As a nurse working in the ICU, I could only be reactive. But what was always so glaring to me was the preventative measures that weren’t taken that let things get to that point.”

Camacho left nursing burnt out and frustrated but also determined to do something about it. Prior to COVID, she had considered becoming a nurse practitioner, but she had also met several nurse attorneys who opened her eyes to that potential pathway. As a step toward making a decision, Camacho had already enrolled in online classes at Loyola University Chicago to earn a master’s in bioethics and health policy. Courses were taught by physicians and nurse practitioners—but also attorneys—and as she learned more about health law, something clicked for Camacho.

“I thought, how can I advocate for my coworkers and patients to make resources more equitable?” she says. “I didn’t leave nursing because I hated being a nurse. I loved being a nurse. These two worlds can mesh—I can use my experience to advocate for change.”

Camacho came to BU Law specifically for its health law program and because of Boston’s reputation as a hub for healthcare and biotech innovation. The first year was rocky. “I definitely had survivor’s guilt,” she says. “I went from spending 12 hours keeping humans alive to spending 12 hours reading a casebook from a hundred years ago,” she recalls. “At one point, I was sitting in a torts class on medical malpractice, thinking, ‘Was this a huge mistake?’”

An advisor suggested that she speak with LARRY VERNAGLIA (LAW’94, SPH’94), a healthcare lawyer and BU Law lecturer in health law. Camacho took Vernaglia up on an offer to sit in on his corporate healthcare compliance class. “It was all 2Ls and 3Ls, but they were talking about healthcare and HIPAA compliance and what it means for nurses and doctors, and I realized, this is exactly why I came here,” she says.

Vernaglia, a partner at Foley & Lardner LLP, encouraged her to apply for the prestigious Mayo-Foley Health Law Fellowship, which gives law students the chance to intern over two consecutive summers with in-house counsel at the Mayo Clinic and outside counsel at Foley. After graduation, fellows are given the opportunity to join the firm as a full-time healthcare associate.

Camacho took Vernaglia’s advice, and in February 2023, she was selected for the fellowship—or, as she calls it, “the dream gig.” As a bedside nurse, she had often consulted with the hospital’s legal team, but now she was on the other side. During her 1L summer, she rotated through all four of the Mayo Clinic’s legal departments: health law, employment law, litigation, and business law. It was the first time Camacho grasped how the business side of the hospital facilitated important aspects of patient care. “Healthcare is a business”—a phrase that had once exasperated her as an ICU nurse—took on new meaning.

Last summer, Camacho continued the fellowship at Foley’s Boston healthcare practice group as a summer associate. She was initially nervous about working at a big law firm, but the collegiality of the Foley group reminded her of the team environment she had loved as a nurse. The fellowship gave her a chance to work on substantial projects: She assisted with diligence on complicated transactions, and she reviewed a compliance program for a large national healthcare organization, poring over interview notes with key leaders and drafting recommendations. Most importantly, she could work directly with clients, finally able to bring her empathy and clinical knowledge as a nurse into her legal work.

“There are very few specialties where the business, ethical, and legal issues intertwine as tightly as they do in healthcare,” says Vernaglia. “And Frankie’s lived experience in direct care brings a rich background and perspective to our work as lawyers. Her classmates defer to her on clinical issues and really look up to her.”

Health Law Director and Lecturer LAURA STEPHENS (’95) believes students like Camacho play an important role in deepening the connection between medicine and law. Although many of BU’s health law students have significant backgrounds in healthcare—for example, those with experience in scientific lab research and premed students who became interested in bioethics or health policy—a smaller proportion have the kind of direct clinical care experience Camacho possesses.

“Frankie went into nursing for the right reasons, and now she’s pursuing law for the right reasons,” Stephens says. “She has two professions, and she’s using her clinical expertise to strengthen her future work as counsel. That’s important because clinicians need to comply with the law in their practice, and lawyers need to better understand the kinds of problems that clinicians face every day as they comply with those laws.”

Camacho hopes to see even more synergy between healthcare providers and health law attorneys. “It doesn’t make sense that practice and policy are so siloed,” she says. “There’s a legitimate conversation to be had and a lot to learn about how one job affects the other.”

Vernaglia believes that Camacho’s dual perspective as a clinician and soon-to-be lawyer makes her a particular asset on cases that have clinical issues or medical ethics components. “We see issues around patient-informed consent, for example, or right to refuse treatment, or the new reproductive health issues in the clinical environment,” he says. “Making decisions now—it’s a very fraught political environment. A well-trained and educated clinician who knows what their rights are, what the patient’s rights are, what the law really says, is a valuable co-counsel.”

As a third-year law student, Camacho is still figuring out where she wants to focus her efforts. “We are talking about people’s lives at stake, both patients and clinicians,” she says. As she navigates the future, she is certain, at least, of her North Star.

“I’m a nurse, but I’m also going to be a lawyer. I made this switch in order to make systemic change, but the hospital was where I was raised, so I naturally gravitate back to the patient,” she says. “I hope I never lose that. I hope I’m always thinking about Frankie the nurse. What would she be concerned about for her patient? And what could we do better here?”