"LIABILITY CONCERNS FOR AT REUSE PROGRAMS" WEBINAR

~ MARCH 20, 2012 ~



CAROLYN PHILLIPS: Good afternoon. We're glad

you're here with us today.

According to my watch it's 2 o'clock p.m., and

that's our starting time. And we do want to be mindful of

your time.

So thank you so much for being with us today. And

we are excited to go over this presentation of Liability

Considerations and Solutions For Assistive Technology Reuse

Programs.

You're going to hear some stuff that you may have

heard before, but you'll also hear some information that

we've learned over the past six years as we've moved

through all of this together.

And feel free to ask us questions if you have

questions. Know that this is also a dialogue where you can

interact with us, and we can also continue the conversation

after we finish today. So feel free to give us a holler,

and we're happy to help you.

We're excited also to have Dr. Lindsey Bean with us

on today's webinar where she'll go over some of the real

things that happen right on the ground. She'll be

explaining how she's able to avoid some liability and

really consider liability as she is operating her Paraquad

program in St. Louis.

So, Lindsey, we're glad you're with us.

And I'm going to turn this over to my colleague,

Liz Persaud. And she's going to talk us through the

logistics of how this room operates, just as a refresher.

And once again, thank you so much for being with us

today.

LIZ PERSAUD: Hey, everyone. This is Liz with the

Pass It On Center. And it's so great to see so many folks

on today. We appreciate you taking time out of your busy

schedules to join us.

As Carolyn said, we do have an exciting webinar. I

know oftentimes people are like, oh, liability. But

Carolyn makes liability exciting. So we're really pleased

to have her on. You guys are honored to have her talking

about liability solutions for AT reuse programs.

So I just wanted to do a quick refresher of some of

our housekeeping tips when it comes to the webinar

platform.

As many of you can see -- hopefully see the

PowerPoint slide there in the beginning. It should be our

Pass It On Center logo, the title.

If you're having difficulty seeing that, you can

look over to the left-hand side of your screen. There are

two green arrows that are circling each other. And that's

just the refresh button. So you can tap that and refresh

it.

We, over here, Carolyn and I, will often be

refreshing the screen. So hopefully you guys will be

moving along with us as we push the slides.

Over on the right-hand side of the screen we have a

public-chat area. As you can see we were doing some sound

checks earlier, just saying hello to some folks as they

were coming in and out of the room.

That's a great way to interact with folks,

especially if you do not have a microphone to be able to

vocally speak with us.

So if you are interested in chatting with us,

sending your comments, or asking us any questions

throughout the webinar, just type in your question or

comment in the white box. It's right under the emoticon

button under the public-chat area.

Just type in your question or comment, press

"enter," and it will pop up, and we'll be sure to be

looking over there and keeping track of all of those

questions.

Underneath that you'll see a list of the folks that

are in the room. We've got moderators on here, and we also

have the participant list. So you guys can take a sneak

peek at who's joining you throughout this webinar.

I wanted to let y'all know that we are recording

this webinar today. And we have our great friend and

partner, Kimberly Griffin, on with us. She's our

transcriptionist. So Kimberly will be turning the audio of

this PowerPoint into written transcription. We'll get the

PowerPoint up on the Pass It On Center website. And so all

of you should be able to access that within about two to

three weeks for being able to reference back to our website

and our knowledge base and all of those details.

So thank you, Kimberly, for being on and helping us

out with that.

If you guys are using any screen readers or need to

adjust any accessibility options, what you do is, over on

the left-hand side, click on "options," click on

"accessibility," and there's a whole menu of different

options that you can work through to specify your

configurations to your needs.

If any of you are using a microphone and headset,

the way that you would do that is you would press the

"control" key, or over on the right-hand side you would

click on the microphone.

And what that does is that raises a hand. It puts

a little picture up beside your name of a hand being

raised, and that lets us know that you want to talk to us

or ask us a question.

So you hold down the "control" key, or you can

press that button. But just make sure that, when you're

done speaking, that you release the "control" key and that

you release that button from being pressed. And that

allows us to answer your questions and allows other folks

to ask any questions as well.

So I think that's the quick condensed version of

our housekeeping tips.

Just wanted to let y'all know that we are offering

credits for this webinar.

If we can move to the next slide, it has some brief

information on -- oh, here's our topics. So I'll just go

through these topics really quickly. And then after that

we've got our credits.

So today we're going to be talking about developing

policies and procedures. Carolyn will be talking about

that, some experience, some tools that y'all will be able

to utilize, as well, too.

Also some liability issues to consider. Oftentimes

folks need to look at the big picture. And so we'll be

able to refresh your memory today, share some of that.

We'll talk a little bit about the FDA and some of

the policies that they have and what can benefit y'all.

And then also a checklist that we've developed here with

the Pass It On Center.

And as Carolyn mentioned, Lindsey Bean-Kampwerth,

Dr. Lindsey Bean-Kampwerth, is on with us from Paraquad,

and she'll be talking about their perspective and how

policies and procedures have benefited them at Paraquad.

So after topics, now let's jump into credits being

offered, because some of y'all have sent me e-mails in

regard to that.

Unfortunately for today, we are not offering CRCs,

but we will be doing that for our future webinars.

But we are offering CEUs through the AAC Institute.

So what you need to do is visit the AAC Institute website.

It's just www.aacinstitute.org. And there's a specific web

address there for y'all to click on to take you directly to

their CEU page.

You just follow the necessary steps that they have

displayed there to receive your CEU verification form. And

if you have any questions, you can contact Morgan Ball, who

is the CEU coordinator, and there's her e-mail address

there. It's ceus@aacinstitute.org. And as always, y'all

can always contact me at the Pass It On Center, and I can

help you with that process.

The next slide just shows that we have an

evaluation at the end of this webinar. So I just wanted to

throw that up there, and we'll show it again at the end.

But it's really and truly about five minutes or less. If

y'all will just take the time to evaluate us, we are using

your feedback as we're implementing our webinar list for

this year. So we're really excited about the list that

we'll be introducing to y'all soon on the website. So feel

free to take that time and just give us your feedback and

let us know what you're interested in seeing for future

webinars.

And if we can actually have folks that are on here

just type in your name and your organization in the

public-chat area, that helps us to keep track of who's on

here; it helps us offer our credits, continue doing that;

and to get, you know, your information so we can collect

all of that for improving our webinars.

So with all that being said, I am now going to pass

it on to Carolyn to continue with the subject matter at our

webinar. So thanks y'all, and let us know if you have any

questions.

CAROLYN PHILLIPS: Excellent. Thank you, Liz. You

do such a great job with all of that introduction and

walking us through all the logistics here.

So please do let us know if you have any questions.

And as I said, we do see this as a dialogue and an exchange

of ideas.

One of the things that we know -- and we've said

this to many of you before -- is that reuse does change

lives. And hopefully that's in a positive way. And we've

seen that again and again.

We also know that reuse is born out of a concept of

need. Very few people I think, when they were little,

said, "When I grow up, I want to run a reuse program." And

if you're one of those people, let us know, because we

would like to talk to you, which is cool.

But we do know that it fills a need. And a lot of

times what happens is folks develop programs out of that

need, out of serving that need. And so it's that idea of

meeting the need and then filling in the gaps when it comes

to the policies and procedures and all of those more

logistical types of things that some of us get very excited

about and other folks don't get very excited about.

So we're going to talk to you about why that's

important. And it really is. I've got a picture up here

of a gentleman who received a reused scooter from one of

our reuse programs. And there's another picture that we

have on our brochures where he's actually reaching out from

a manual wheelchair to the scooter, and you can see how

happy he is.

And part of the reason why this program that was

able to help out and get this scooter to this gentleman is

still around and has been around for 25 years is because

they have covered themselves when it comes to liability.

They have considered it in a very thoughtful and

proactive way. And so they're able to continue to serve

folks. So that's what we want for everybody to do, all of

our partners across the U.S. and in our territories.

So basically reuse does increase access to and

acquisition of assistive technology and durable medical

equipment in underserved regions. And it really promotes

increased independence and more participation in education

environments and workplace and community. We know that all

of that is true.

And so that's what all of our focus should really

be on when it comes to figuring out what does work, what is

it we need to consider with liability and so forth.

So I'm going to have Liz -- just so everybody will

be on the same page as to what we're talking about when we

talk about reuse, I'm going to have her go through the

definitions because it's important that you're aware what

type of liability concerns do you need to be thinking about

with each of these activities.

And all of these activities actually have somewhat

of a different checklist when it comes to things you want

to consider with liability.

So, Liz, take it away.

LIZ PERSAUD: Thank you, Carolyn.

So as Carolyn said, just a quick refresher on the

definitions of AT reuse activities and what they include.

So we've got device exchange; device loan;

reassignment; refurbishment; remanufacturing, which we

don't recommend, and we'll talk about that in detail in

just a few moments; and then we have recycling.

So if we jump to the next slide, that talks about

device exchange. And many of you are familiar with that

because there are many AT act programs that have device

exchange networks, if you will.

And these are more of the program websites that are

very similar to eBay and Craigslist, newspaper ads, things

like that.

And what that device exchange consists of is

matching donors to users without intervention. So that

doesn't involve the AT act program or the reuse program;

it's just an outlet out there mainly in the form of a

website that folks can get on, post items that they are in

need of, post items that they have that they want to sell

or that they want to donate; and then they directly

interact with other folks in the community.

On the Pass It On Center website, on the far

right-hand side, we have a page called "Find AT," and that

has an updated list of all of the device exchange programs

that are in the country. So definitely check that out.

We tried to create one place that y'all can go to

without kind of hunting and pecking around all over the

Internet. So it's a great tool for your convenience.

Device loan is providing a device on loan for some

period of time or indefinitely. And this usually helps the

person make an informed choice or to provide an interim

solution. So this is equipment that's been taken in by the

program that is loaned to somebody at an indefinite period,

short term or long term.

And that, again, can help somebody make a decision

if they are in the process of maybe working with insurance

or other funding streams out there to find out what

wheelchair would work best or communication device or any

other piece of equipment, whether it be a walker or

scooter, and to help them find out what works well for

them.

But then also there are times that folks are in

that waiting process of navigating the funding streams,

working with their insurance companies, and they have to

wait for quite some time. As we all know, that process can

take months and years. And so they need something in the

meantime to help them be mobile and to get around their

environment. So device loan can definitely be a solution.

So the next one is reassignment. And that is

making donated devices available to new users. So what

that really and truly is is the program taking the

equipment in and then reassigning it to somebody else on a

permanent, permanent status.

So somebody comes in, and they need the equipment.

And then we have the equipment, and we reassign it to them,

and it's theirs.

Refurbishment involves repairing, restoring donated

devices to working order. So let's say you get a

wheelchair in or a walker in, a shower chair, and it's

maybe missing a little rubber stopper on the leg of the

shower chair to keep it safe from moving around. That's

where we would use some parts that we have in warehouses,

in storage to get that into a working order. Or we would,

you know, tighten up some nuts and bolts and get it to

working order so it's safe for the person to use it.

Remanufacturing is actually taking equipment and

turning it into something that wasn't originally intended.

So believe it or not, we've seen some really interesting

pictures out there of folks taking crutches and turning it

into stools. And we definitely do not recommend that.

That is not approved by the Pass It On Center or any other

component out there.

We don't recommend that because it's not safe.

It's not safe to take equipment and to, you know, take a

Jazzy chair and put on wheels from an Invacare or a

Permobile wheelchair. Those are parts that are not made to

be working together, and it's not safe to do that.

And then the last definition is recycling. And

what that is is breaking down unusable devices into spare

parts or disposing of them in an environmentally

appropriate manner.

So oftentimes we use the example of recycling

plastic bottles and turning that into carpet. So turning

it into something completely different than what it was

intended of being.

And we need to pay attention to that definition,

because oftentimes when folks are interested in starting

reuse programs, they say, "We want to start a recycling

program." And [ ... audio skipped] talk to them about what

that looks like and say to them, "Oh, are you going to be

taking this wheelchair and turning it into carpet or

turning it into plaster for the walls?" So we really need

to be mindful of what recycling means.

And a lot of the reuse programs across the country

will accept donation fees to properly dispose of equipment

that they can no longer use and to keep it out of the

landfills and keep the environment safe.

So those are the definitions, and we definitely

have that on the Pass It On Center website.

What kinds of reuse programs exist? There are all

different types of programs out there. Some accept and

refurbish durable medical equipment. Some accept and

refurbish just computers and just digital devices.

We recently got a request from someone wanting to

know about iPads and what folks are doing, if anyone out

there is refurbishing or reassigning any type of reuse

activity of iPads. So I'm actually going to be sending out

an e-mail very soon to folks to get some detailed

information on that. So just wanted to throw that out that

if anybody does have information on that.

Some programs are dedicated to sharing AT in school

settings. Sharon Alderman with School Swap in Vermont is a

leader in that in our country. So just in school systems.

And some received donated medical supplies solely

for redistribution. And we've seen larger programs like

Paraquad. We're going to be passing it on to Lindsey in

just a few seconds here. And then we've seen some smaller

programs that work out of "loan closets" that do just

reassignment or very small refurbishing sanitization.

The next slide that we have focuses a little bit

more about the tools that we have on the Pass It On Center

website. So if you want to learn more about reuse or if

you are operating a reuse program and you want to know how

to take it to the next level or you want to focus on

something that you maybe haven't focused on before or

improve a part of your program that you're working on, the

Pass It On Center website is a great tool to get started.

So we have lots of free tools on our website that

we created that we want to offer to y'all.

So Indicators of Quality. It's an online tool.

It's a way that you can measure your program, the way

you're operating now. You can sign on into the Indicators

of Quality -- we call it IQATR -- build an account and

answer a series of questions. And at the end of the

questions, if you will, it takes you back to our knowledge

base, which is basically a one-stop shop for information on

assistive technology reuse and durable medical equipment

reuse.

We have policies and procedures in there. We have

examples of business plans. We have articles. We have

webinars. We have videos that link back to our YouTube

channel. So lots of great resources on there.

We offer webinars just like this one every month,

last Tuesday of every month, 2 o'clock to 3:30 eastern

time. And we have all that listed on our website.

We have a reuse location database. If you go to

"reuse locations" on the Pass It On Center website, it's a

map of the country. You click on the state that you're

interested in finding a reuse program. And what it does is

pull up all the programs in your community that focus on

reuse. So it's a great way to hunt for information in the

community as far as reuse.

Find AT, mentioned that. That focuses on the AT

exchange.

And NEED AT is something that we have been

developing for a while. We're getting very close to

launching it. But it's a -- it stands for National

Equipment Exchange Depot of Assistive Technology, and it's

a website that will crawl or hunt for equipment that is out

on Google, that's on eBay, that's on Craigslist, that's all

over the Internet.

So it's one place that y'all can go to to type in

the information that you're looking for, how to locate

equipment, and then you can find it. So a lot of great

tools on our website.

And then we have a screen shoot here of our

website. Most of you are familiar with it. If you haven't

been to our website before or it's been a while, we

definitely recommend just jumping on there, playing with

different tools.

If you have any questions, you can certainly get in

touch with myself -- Liz -- or anybody at the Pass It On

Center.

And then the next screen shot is just a home page

of our knowledge base. And we wanted to show these two

screen shots to y'all so you do have an idea of shaping

your policies and procedures.

As we're providing these tools and resources to you

today, know that all this information is in the Pass It On

Center knowledge base on the website and that you can

utilize those examples of policies and procedures that are

on there to really shape up your program and really get

stellar outcomes when it comes to building your policies

and procedures.

So with all of that being said, I'm going to pass

it on to Carolyn now so she can talk a little bit more, and

then we're going to get it over to Lindsey.

CAROLYN PHILLIPS: Excellent. Thank you so much,

Liz.

And as Liz was saying, all of this is really to

guide you through just what the definitions are. And then

I'll be referring back to that. And then also giving you

tools.

Really, when we first starting having these

conversations five years ago, six years ago, and then even

three years ago, we didn't have all these tools. So now

you actually have things that you can put your hands on

today in order to write these policies and these

procedures, see what other states have done, learn from

each other.

And as my friend, Dr. Kathy Laurin in Montana,

says -- use the case -- "Copying and steal everything, but

give credit." So feel free to do that. That's what our

knowledge base is built on.

Zachary, I see you have a question up there, and

we'll go back and answer that in just a moment.

Let me just define what policies and procedures are

and what we're really talking about with this. And this is

the foundation you need to build on when you're thinking

about liability and really protecting yourself.

You've got to have this stuff written down.

Whether it's on a website, whether it's on a Wiki, whether

it's on a piece of paper, you need to do that.

So policies. Those are high-level guidelines. A

policy is really a plan of action to guide decisions and

actions. It provides ground rules for effective

interactions. They reflect high-risk areas of care.

So what is your policy for intake of equipment?

What is your policy for working with individuals? Do you

work with specific populations? What is your policy; are

you a loan program, or do you do refurbishment? And

thinking about those more defining, high-level type of

defining factors.

Policies are usually based upon accepted and

well-defined norms or standards of practice. Norms and

standards articulate what's to be done, who is served, and

what resources are needed. So that's what we're talking

about when we talk about policies.

And when I see well-written policies -- and we have

lots of those now on the knowledge base to refer you back

to -- that helps because that helps you avoid liability

issues. And when we say that they are based on accepted

and well defined, you want to make sure that your team

accepts those. And so these are policies that have been

vetted, that folks are paying attention to.

And the next thing is procedures. So procedures

delineate the processes and activities. So your policies

are that high-level thinking, and then your procedures are

exactly how you're doing it, day-to-day operations. How

are you going to implement the policies, in other words?

Procedures are usually based on professional

guidelines when they are all available. And as you know,

we are all pioneers in this reuse area of durable medical

equipment and assistive technology. So we are the ones who

are actually providing a lot of those professional

guidelines.

The procedures are step-by-step guidance. So we

see checklists, and we see forms in this -- in your

procedures. We see sanitization, step-by-step, even

pictures sometimes or videos that are used. And same thing

when it comes to delivery of products.

And we'll talk about this in more detail in just a

moment. But when you're outlining those for your exchange

programs, your procedures are going to look different than

if you are outlining these procedures for your reuse

programs where you're actually putting your hands on the

equipment.

So I'm going to turn this over to Lindsey Bean

and -- so that she can give us some examples of how she has

used policies and procedures. And they have one of the

best-run reuse programs in the country. And I want to make

sure that y'all have time to learn from her and see what's

really happening on the ground.

So, Lindsey, I'm going to turn this to you. And

then I'll grab it right back from you.

And this is an example of a policy, and then you'll

see procedures woven throughout this and then how that

really does provide quality services. So you'll see

indicators of quality throughout this.

So, Lindsey, take it away.

LINDSEY BEAN-KAMPWERTH: Hello everyone.

So to give you a little basic information, we are a

DME program, reuse program, that refurbishes equipment. So

we accept it and do the refurbishing.

I am part of an independent living center. So we

are part of another bigger organization basically that has

about 40 programs. So that's one benefit that they have a

lot of policies and procedures already established that we

can use some for like hiring and for volunteers and things

like that.

So keep that in mind, kind of. If you're going to

be part of a larger entity or -- I see that you guys are

having a hard time hearing me.

Is that any better? I tried to move it a lot

closer to me. Let me know if that's better or not. Okay.

I'll talk really quick, and I'll try to talk really loud.

So just as I was saying, to keep that in mind.

Yep, I got it as close as I can get it.

So you can click on the next slide.

One of the things that's pretty valuable to our

program is -- when that slide switches -- is we have an

occupational therapist on staff doing the equipment

matching, which is I.

So just as Carolyn was talking about having

everything basically folded in and throughout everything

you do. So we're thinking about it from when you get the

donation to when we're distributing the equipment.

I'm going to kind of basically focus on the

matching part. So I'm doing the matching. And with any

mobility device, the OT is meeting with them.

So we do have trained staff. We will train our

staff on the other items, such as commodes or shower chairs

or benches or reachers.

You can click on the next one.

The next slide is basically all gathering the

client information. So most of these forms -- I think all

of them, actually -- are on the Pass It On Center knowledge

base, so if you would like to see examples of them.

You can click to the next slide.

The first one is the AT referral form. And that

one can be very -- it's huge because you're trying to get

your information on your person, all the basic information,

basically what they're here for. And that can be done over

the phone, or sometimes it's the first time that you're

meeting with them.

You can click on the next one.

But some of the things that we really do consider

is: Have they tried to get a new device first? What do

they have now? Do they already know some of those pieces

of information, like their seat width or depth for a manual

wheelchair? And really what are they going to be using

this for; is it out in the country, or are you just using

it inside your home?

It's a lot to consider.

Also their home consideration. Do they have steps?

Do they have a ramp in place? Do they have transportation

to get a power chair home to them? Is there any other

special considerations we need to know about? Do they have

a caregiver to offer help, or is it just them?

We take the measurements of the person, do

basically a brief eval with them, getting those

measurements. And then we pull those options that we think

are appropriate from our current inventory that we have

ready to go.

So you can click on the next --

So what we do when they're here, we require them to

come in. That's one of our requirement policies, is if

they're getting a mobility device, we need to see them. We

want to make sure this device fits them appropriately.

So you can click on the next one.

Basically we're going to go through a skills course

with them. And if they don't have those skills, we will

train them on it. And there will be some pictures coming

up.

But the first thing we want to do is modify and

adjust the equipment. Now, by modifying it means we're not

adding new parts to it or anything like that; it does the

footrest need to be lower or higher, does the Bailey axle

placement need to be moved forward or back, things like

that.

You can click on the next one.

Then we go through this great delivery and

instruction form. So we want to know that the client knows

how to use the device and is safe using the device. So we

go through this checklist. Basically, usually how I do it

is we go through it with them, and then I have them do it.

So making sure that, if it's a manual wheelchair, they can

remove the armrests; they can remove the footrests; they

know how to fold it; they know if the tires are air or

solid. All of those types of things.

And we actually have them sign and date it that we

reviewed that with them. And it's a nice checklist to go

through. So it doesn't take a long time to do as long as

they're catching on to that.

Kind of on the flip side, you know, we'll do some

training with them if they're not getting it. Like I said,

I've got some pictures.

So keep going. You can click the next one.

So we have a mobility skills course. And basically

we'll do some scoring. So this is the other part of us

making sure that we know the client is safe.

Scoring is based on the completion, safety and task

instruction. And safety is our main goal. If anyone is

getting a 2, that we had to somehow physically intervene

before they caused harm to someone else or themselves, we

decide that day is not the day to take the device home with

them.

And we offer training, and it's free. And as long

as they're willing to work with us and can get back to us,

we'll work with them on all these things.

So the next one we'll start to show you some of the

pictures of the skills course that we have. And not

everyone needs to have this exactly. There's a lot of

things that can be used around your building or wherever

location you're at.

So basically we have curb cuts. So we have a

little built-in curb cut. We have a picture of some stairs

on there. So we have four stairs, I believe. We have two

ramps -- well, actually three ramps. So two ramps: One is

the 1:12 ratio; one is the 1:20 ratio, so that is not as

steep; and then we also have a cross-slope ramp, so instead

that's sloping sideways, which if any of you have been in

St. Louis, most of our sidewalks are sloping towards the

street and can be a major risk if people are ending up

having to push in the street.

And the last picture is we have some thick-grade

carpet that we have people push over because we all know

pushing on tile is much different than the thick-grade

carpet.

You can click on the next one.

The next one is just a layout, which if you guys

have any questions about it, just please let me know. It's

in the midst of an accessible gym. But the picture does

show where our stairs are, where our ramps are, where we

have some turning radiuses. We have a sand pit and a

gravel pit. And then most of it is our offices and then

some other places for equipment.

And if you go to the next one, it's an actual

picture that shows a three-inch curb, a 1:20 ramp, the 1:12

ramp. And then we also incorporated some potholes. So we

can peel up the floor and make some pretend potholes.

Because that's the same thing in St. Louis, those are

everywhere.

And the next picture shows our turning radius. And

so it's just basically we made that five-foot turning

radius like a bathroom, but we used different colored tile.

You want to stay on the red tile, which is the inside

circle, and then the orange is the outside delineating that

five-foot turning radius.

So the next slide is just talking about that

training, which I touched on a little bit: device usage,

the breakdown and transportation, cleaning and maintenance,

and then safety.

And then if you go to the next slide, we do offer a

90-day warranty because we do have repair technicians on

staff. So they are evaluating all the equipment. Manual

chairs get a 14-point check. And, you know, if it's not

working for them, we want the best for them, so they come

back, and we will fix it. And if they need more training,

like I said, that they can come back.

There's much more to liability than that. And

Carolyn's PowerPoint is great. That was just one feature

of it. I'm sure she'll talk about the FDA and some other

things.

But you can sign up with the FDA to get some

e-mails e-mailed to you to consider that part. My e-mail

is lindsey@passitoncenter.org. So if you guys have any

questions, please feel free to e-mail me. I'm more than

willing to help.

And I think I'll turn it back to you guys. Thank

you.

LIZ PERSAUD: Hey, can everyone hear me? This is

Liz with the Pass It On Center. We were having some

technical difficulty with sound, but I think I'm coming

through better now.

So wonderful job, Lindsey. I just wanted to say

thank you for giving information on Paraquad's matching.

You guys are definitely a leader in the country when it

comes to that. So thank you for sharing your policies and

some details about your procedures and policies for

matching.

We had a question earlier from Zachary Thompson

that we wanted to go back and address.

So, Lindsey, if you're still on, that would

definitely be something that would be addressed to you.

But Zachary asks: What about modifying a device to

meet an individual's specific needs? What does that fall

under?

And Zachary, that's something that's -- it can

depend. It depends on what specifically you're talking

about. So if you wanted to type in any details, we'll be

happy to answer your question, and we can answer it a

little bit more later if it's something more in depth that

you need some technical assistance on.

Oftentimes that can fall under refurbishment. But

again, it just depends on the unique situation. So I'm

going to release the mic. If Lindsey's on, she can maybe

answer that question more in depth. And then I'll pass it

to Carolyn.

CAROLYN PHILLIPS: Hi, everybody. I just want to

make sure that everybody can hear me. And it looks like

you can.

And then I see that there are a couple of questions

here about who pays for the repairs. I think that's the

question; is that right? Yes. Okay.

And then there's another question about what if a

consumer cannot come to the site, how do they access

equipment. Is that it? Okay. And then we have Zachary's

question too.

So I'm going to jump in, Barbara, and just tell you

that, when it comes to Paraquad, they do pretty much

require that folks come to their site in order to get that

equipment. That's their policy. And you can get a lot

more details about that directly from Lindsey and the folks

at Paraquad.

Oh, good. Lindsey, so if you want to answer that

question. Folks were asking two questions: Who pays for

the repairs; and then also, if someone cannot come to your

site, how do you handle that?

So I'm going to pass this over to you, Lindsey, and

then I'll jump back on.

LINDSEY BEAN-KAMPWERTH: Okay. So the question

that I'm -- what if a consumer cannot come to your site.

So typically, if it's a mobility device, we require

that.

If it's absolutely, positively unable to happen, we

ask if they're working with an OT or a PT, and we

collaborate very closely with that OT and PT. And they're

the ones that come in and -- either they will take the

paperwork to the client, but they're the ones that are

signing off that they are going to show them the

instructions and all that.

It doesn't happen often. I think probably maybe

three times it's happened.

The other option is there may be two times I have

actually gone to a hospital or to a rehab facility to do

the eval with the person there. But it's pretty rare

because we're sticklers on wanting to see the person.

And then how do they access equipment? So

typically I think that question -- they'll be calling and

telling us typically what they need. And we'll let them

know if we either already have it cleaned, sanitized and

ready to go.

And if not, we can look in some of our donations

and see if that's something that we can get ready within

the next week or two.

I think that's what you're asking with that. Tell

me if I'm wrong in the chat box.

And then for the repairs, for any repairs that are

being done to the reuse equipment, we get funding to do

that, basically, from -- part of it is the United Way, but

then part of it is just the funding that we have.

And then clients can come in and get their current

equipment repaired. And we can bill Missouri Medicaid and

Medicare for those repairs or self-pay, or the VR sometimes

pays for repairs. So there's like that.

And now I'm reading Zachary's comment. From that

example -- I see Liz is raising her hand.

So, Liz, if you want to handle it, you're fine.

But I'll try to take a stab at it.

I think it's from -- we're talking about taking a

manual chair and adding just a regular old motor to it or

really crossing things. But there are -- you know, the

frames of manual or power chairs or whatever, there are

different seating systems that are compatible with that.

But you don't want to start modifying the device beyond

what it's measures were.

You guys can correct me if I'm wrong on that one.

CAROLYN PHILLIPS: Okay. Lindsey, you're exactly

right. And that definitely does answer that question.

Zachary, so just so you heard the answer -- and I

want everybody else just to hear the question -- is: One

example is a little person who needed a wheelchair, right,

but couldn't bend her left leg; and a group you work with

modified a Jazzy mini refurbished to have a leg rest hard

mounted to the chair so she could use the chair without

pain.

So once again, you want to make sure that you're

working within what that chair was designed for. If that

chair was designed to have a hard mount, then absolutely.

You can do that.

And that's where you want to have folks that are

well versed, well-versed techs, and also continue investing

in their training and their education so that they know

what the specs are.

You don't want to, for example, change the speed of

a wheelchair so it can go significantly faster, faster than

it was ever tested; or make it so that it does something

like flies.

We've heard all kinds of great ideas that people

have on how they want to modify wheelchairs. But you don't

want to create a liability issue by creating a new product.

So does that answer your question, Zachary? And if

not, then we can definitely address that more.

I'm going to keep going with -- excellent. Okay.

Thank you.

And if you do have any more questions about

Paraquad, please contact Lindsey.

And, Lindsey, thank you for joining us.

So as Lindsey was going through -- part of why we

wanted to bring Lindsey on is so that you could see the way

that she had organized explaining about her organization.

On her slides, the first slide she started out with

said an occupational therapist will match all the

equipment. That is indeed a policy.

And then she broke it into the procedures. So this

is exactly how you do it: We go through step by step a

consumer intake, and we go through a checklist of matching

the equipment to the individual.

So it's organized. So when you're writing your

policies and procedures, you want to have an organized

approached. You want to have a table of contents. You

want your policies and procedures numbered and grouped.

An outline form makes a big difference so you want

to use an outline format. That really does help folks when

it comes to organization.

If you have it online, make sure you have a print

copy of it. And I would bound that. And I would also make

sure it's easily accessed so that everybody can get access

to it.

If you have folks that are on your team, practice

what you preach and make sure that you have it in

accessible formats for everyone. And I believe that all

the way through everything we do. And as I said, use the

Internet. Put it online. And use your -- just check that

out.

But also do some searches. Use our knowledge base,

and see what other structures that companies in your state

have used for policies and procedures. You obviously may

be doing something totally different, but you could at

least steal their structure if you want or use their

structure, borrow it.

Montgomery College EDU actually has a very cool

policies and procedures the way they've laid it out. So

there's a link there for you to check out and go there and

see what they've done.

So getting started. You want to have an outline of

the subject areas. If you go to our knowledge base, you

can find all of this as far as some of the subject areas

you want to consider. And you could go through it step by

step.

You want to start with a rough draft of your table

of contents. Then I would suggest you pick a subject area

and you dive in.

For policies, for example, make sure that you're

addressing those by writing them down. And then

procedures, same thing, with specific tasks.

So here's an example of policies and procedures in

the table of contents. You'll see chapter 1 in the policy

binder. Chapter 1 is the organizational structure.

Chapter 2, governance. Chapter 3, insurance. Chapter 4,

user services.

And then the example here is within that you would

then have -- I mean underneath all of these you would

actually have procedures.

So for the procedures under "user services," you

could have client intake. There you would also have an

example of your form so that folks do know exactly how you

do that. You would have step-by-step how you have folks

enter your program.

And once again, I would make sure that your

language, whatever language you choose to use, that you use

that throughout. Some people say "client." I feel like

that's really medical. Some people say "participant."

Other people, they use other words.

What I would not use is "patient." I have seen

that recently. Somebody had me review their policies and

procedures. And throughout the whole document they had

"patient." And I was like, you know, I wouldn't use that

term.

Equipment matching under "user services." How are

you matching equipment? What is your policy, and what is

your procedure? And your policy often will be dictated by

your funding.

Some of you asked a question about, well, if the

person can't come pick up the equipment, what is the

policy?

Barbara, that was a great question. And you would

want to cover that within your policies and procedures.

Some people have a policy that says "We will not

deliver equipment to someone's home. We will deliver the

equipment to an independent living center as long as the

independent living center has someone who is trained to

then disseminate the equipment appropriately and make sure

that the person is trained on it."

In Georgia we have used that model, and it's been

great. We love working with our partners, our independent

living partners and other partners in Georgia.

Training and technical assistance. How are you

going to train people on the equipment? And you should

have examples of your training within there. Your

technical assistance -- if you have a technical assistance

number, have it in your policies and procedures guide.

Delivery. And then also what are your follow-up

standards?

And then your website operations. The reason why I

put that in there is because, if you were operating an

exchange program, you still have user services that you

need to consider when it comes to website operations.

Are you asking personal, confidential information?

Who has access to that information? What type of

information? Are you abiding by HIPAA? Things like that

just when it comes to considering what you have on your

website when it comes to your exchange program.

So here's a sample policy. This is the policies

for the board of trustees. This is the example from

Montgomery College. Once again, remember this is not

reuse, but it just gives a very fine, nice look.

So they've numbered the policy. And then they have

the chapter where they've actually numbered the chapter.

It says "Personnel Modification No. 001." And then the

subject, which is "Personnel Files." And then they have

used Roman numerals.

So No. I is "In the day-to-day operations of the

College, employees must," and it goes on to talk about how

you should legally safeguard the information.

No. II it goes on about personnel records and it's

detailed information about exactly how these are to be

handled.

And then No. III, "The president is authorized to

establish procedures to implement this policy."

So it tells who, what, when, where, how, basically.

And that's what you want to see. That's a very well

written sample policy.

So a sample procedure. So work flow for intake,

for example. And here's just -- very simple. "For each

phone call, ask if they're an initial contact or a repeat

call," if it's a repeat call.

You use the initial telephone intake or follow-up

form as appropriate. And you would read from a script. We

often suggest that people have a script for folks that

are -- especially volunteers that might be operating their

reuse program.

Because you don't want people going off script, and

I mean really some folks can go way off script. There was

a group that I was working with where the person who was

answering the phone was literally -- and I hope I don't

offend anybody here -- but they were literally trying to

save people's lives and convert them to Christianity. And

I was like, "No, that's way off script."

So you want to make sure that you have a script and

that folks stick to that script because they were calling

to get reused equipment; that was the goal.

So then you would enter the data form into the

computer. I would encourage everyone to take advantage of

the technology. There's all kinds of databases that we

have available in our knowledge base.

And that will save you a lot of headache if you are

using technology to support you, whether it comes to

knowing who has what equipment.

There was a recall that just was announced this

week on equipment. And so you can instantly go up there,

see who has that equipment, and contact those folks. That,

by the way, is on our homesite. It's right on our front

page on the Pass It On Center. And we also have that

listed within on our Pass It On Center website.

So then the next thing is "Create a new file if

it's an initial telephone intake, or file in an existing

file." So that's very -- you would think that that makes a

lot of sense. A lot of us would just know to do that. But

this makes it clear, which is great.

So another example of policies and procedures. And

these are numbered. So "4.100 Client Intake." And then

"1. Client intake shall be conducted by telephone and

documented." That's the policy. And then "A. Work Flow

List." That's the procedure. And then "Forms." And then

it goes on down that way.

So this will help you avoid liability issues

because you can go back and point to problems that you

might have in your flow of the way that you're operating

your business or your program or project and say, "Here's

where we're having some problems. Here's where we're

getting hung up," if you will.

So I encourage folks to use checklists, whether

it's -- we have a 14-point checklist for wheelchairs that's

on our website. It also goes with a really great video

that goes through that. So we're using a multimedia way to

explain how you do that.

Checklists can be expansive and look at every

possible issue when it comes to liability. So you want to

consider that.

And use a rubric for developing and writing

policies and procedures for the organization over time.

It's intended to provide -- and we have our checklist that

we're going to -- that we can show you and let you use.

It's intended to guide you in developing your policies and

procedures for your organization and identify pitfalls and

action items that could help you for mitigating liability.

If you go on our website and use the tool that Liz

was talking about early on in your discussion, which is the

Indicators of Quality, IQATR, that is basically our

checklist, and it will -- it's an interactive tool.

And I encourage folks to either use that just as a

person who is operating a reuse program or for boards of

directors who are redefining their reuse program or

thinking about creating a reuse program.

I also have encouraged whole teams of folks who

operate a reuse program to do this together so that they

see maybe where the gaps are within their organization.

So if you go to the IQATR, or if you look at our

checklist here, you'll see some of the liability issues

have been addressed. The cool thing about the IQATR is,

once you go in and you answer those questions, it will

point you directly to resources within our knowledge base.

And we keep that updated, so you get that instantaneous

technical assistance. And it's really nice because it's

relational that way.

So within organizational structure, you want to

consider: What's your legal status?

Some folks -- I'm looking at this list here. Some

of you are independent reuse programs, and that's great,

and you're a 501(c)3. Some of you actually just do reuse,

and you don't really have an organizational structure.

Some of you are under an organization that's religious

affiliated, whether it's a church or synagogue or a mosque.

Others are operating underneath a university. Others are

operating underneath another government agency.

So we see all kinds of structures. So what is

yours? And you want to make sure that you're abiding by

the legal status.

The reason why this is important is -- and I've

actually seen this where people will give out donation

receipts for the IRS, and they don't really have any legal

right to do that.

So this also helps you figure out what kind of

insurance do you need to cover. If you're within a

university, you may not need as much insurance as you would

if you're just a 501(c)3 that's doing this independently.

It also helps you figure out what your staffing

model should be. Who do you report to? Do you have a

board of advisors? Do you have a board that can hire and

fire? So what is your organizational structure?

And then that leads naturally to your governance.

And also how you manage your documents. And what is your

management overall? So all of that is important to

consider.

Those questions that I just asked, they flow

naturally into different types of insurance that you want

to consider. If you're running an exchange program, you

want to consider insurance different -- different insurance

than you would than if you're running a reuse program

that's doing refurbishment or reassignment, which is

another similar activity, but it's another activity.

So do you have insurance for your boards of

directors? Do you have key-person insurance? If you are

the only person who does reuse in your organization, what

happens if something happens to you? Will that be your

legacy, or is it going to not exist anymore?

Also do you have insurance that will cover

volunteers? We have a lot of these programs that are

wonderful programs that are operated by volunteers. And I

would encourage you to protect yourself and know that there

is insurance out there for volunteers, and make sure that

you're covering yourself.

If you have equipment that you're either picking up

or you're dropping off, are you -- do you have insurance on

the person who's driving that car, even if it's their own

car. Or if you have a car that is your organization's, do

you have insurance on that?

Facilities. Making sure that -- do you have folks

that are coming into your facility. Often I don't let

folks -- I recommend folks don't walk around the warehouse

where equipment is being brought in and hasn't been

sanitized yet because there are things that you can catch,

little bugs and stuff. So you want to make sure that

you're not passing those things on. And so having

insurance for your facility.

Having insurance for your inventory. There's a

group that I was working with recently that gave me a call

because they had a flood. And they said, "Carolyn, a year

ago we didn't have inventory insurance. We went back and

got inventory insurance. Didn't think we were going to use

it. And we were able to buy a whole new -- a whole bunch

of new equipment because we were flooded, and all that

equipment was insured." And so they were very thankful

that we even talked about it. So inventory insurance.

And also property insurance and all of that.

So in your policies you want to think about who are

you going to insure, for what activities, and you also need

to make sure that your activities reflect what you're

covering. So that's the deal there.

In human resources we've got a lot of things to

consider here, which are legal compliance when it comes to

work, fair labor laws, discrimination laws, OSHA, all of

that. Whether you have a subcontractor or an employee.

Those are all very important to consider. And if you have

subcontractors, do you have agreements or do you have

contracts? All of those things. Employees. You know,

there's all kind of things that you need to abide by. Same

thing with volunteers.

You want to have job descriptions for everyone that

works with you, whether it's an employee or volunteer.

That's new to a lot of folks because they're thinking,

Well, if I have a volunteer, why do I need to have any type

of job description for that person?

I tell folks that, to avoid liability issues, you

want to make sure that you treat those volunteers like an

employee in some ways.

I encourage folks -- Joanne Willis taught me this

early on -- that you want to interview your volunteers.

You want to treat them like an employee as far as the way

that they would go through a process.

And I even encourage folks to have some sort of

evaluation process with volunteers so that they know, Hey,

you're doing a good job, and here's what we accomplished

because of you. It doesn't have to be as formal as you

would have with an employee.

Same thing with finance and accounting. You want

to avoid liability issues. And this is one of those areas

that can get really sticking. People are curious about

budgets. And this is important whenever it comes to

figuring out what is your return on investment and some

other things that lead to more solid program operations and

sustainability. So you want to consider your policies when

it comes to budget.

You also want to think about, when it comes to

accounting, your policies and procedures there. Fair

valuation. How are you valuating your equipment as it

comes in?

Money-handling procedures. There are some groups

that I'm working with that now say that they will not

accept cash for anything. There are others that still

accept cash and say, "We won't accept a credit card for

anything." So making sure that you have a policy and then

you have a procedure that backs that up.

And then it gets to our user services. I was going

to go back to the exchange programs. It's important to

very clearly state on your exchange websites money-handling

procedures, exactly how you're doing it, and if you want

people to use, you know, a specific service or if you're

just letting them do whatever they're going to do. Your

name is associated with that, so you want to make sure that

your policies and your procedures have covered your

organization and your name and your reputation when it

comes to all of that.

So user services. Your client intake. I would

encourage y'all -- we have countless examples now on the

knowledge base of client intake forms. As I said, I don't

use the term "client" so much but participant intake forms

or participant forms or however you want to call that.

User services when it comes to equipment matching.

And once again, when it comes to our folks that are doing

exchange, I would encourage you to have and go through and

look at our indicators of quality. Use that tool and know

what you should be putting up on your website when it comes

to buyer beware or donor beware.

You know, how should you match the equipment

appropriately, and knowing that you're giving the right

equipment. Because even though you're providing just the

service for that matching, that exchange, it's important

that you still realize that your liability doesn't stop

there. It would be even better if you pointed them to

resources that would help everyone be more informed.

I think also on a bigger level that helps us with

the abandonment of assistive technology issue that a lot of

people have talked about.

Then what are your training services when it comes

to users of your equipment? What is your technical

assistance policy?

You heard Lindsey. One reason why we wanted to

have her talk first is so that you could hear what some of

those policies are. And she was very clear about you can

get up to nine months or up to a year, or you can follow

up, and you can come back, all of that, delivery of

equipment. And then follow-up and follow-along services.

And then, once again, your website and making sure

that you're addressing all of that.

Program operation, which includes safety. And also

this is where the FDA jumps in, which is the Food and Drug

Administration. They have policies when it comes to some

of the things that we're going to talk about here, and so

we want to make sure that you're aware of that.

So do you have policies when it comes to your

facilities and your acquisitions and donations, evaluation

process, storage. So all of those things you should have a

policy about it, and then you should have procedures.

For example, with sanitization: This is exactly

what equipment is sanitized; this is how we sanitize; this

is the specific tools that we use. Sometimes I'm seeing

folks even putting pictures in there.

Lindsey showed a diagram of what her room looks

like, the layout of her room, when it came to matching the

equipment to an individual. She has a similar

picture/graph that shows how you sanitize equipment. So

using those, once again, to avoid liability issues. You

want to make sure that, if you have somebody that comes in

that might not be -- English may not be their first

language, that they can see exactly how you do your

policies and your procedures, and they know that every

piece of equipment is to be cleaned, and this is how it's

to be cleaned. So making sure that all of that is

delineated.

Same thing with storage. Some folks, the way they

store the equipment is very detailed, and that's great.

And they make sure that they don't cross contaminate. New

equipment never interacts with old equipment that's about

to go out to a landfill.

New equipment that's been sanitized or equipment

that's been sanitized is in a different room altogether

than equipment that's going through a triage and it has

just come in. So making sure that you're taking care of

all of that and following appropriate procedures for all of

that.

And then the disposal and recycling. We want to

make sure -- and we say this all the time at the Pass It On

Center -- that we are kind to the earth, that we are folks

who have green projects, that we do recycle in an

appropriate way.

So you want to have policies that state that and

then also for procedures that follow that. And that can

help you with marketing because a lot of people donate just

because they believe in it as a core value as a citizen of

that community.

But it can lead to funding streams down the road.

There are several programs that are actually calculating

and letting folks know, "Hey, we kept 186,000 pounds or

tons of equipment out of landfill." That makes a lot of

people happy to hear. I know it makes me happy to hear.

So the only reason why they can announce that is

because they had a policy about that; then they had

procedures about it; and now they're able to report that

data. And it helps their marketing, and then it goes all

the way back to supporting their program.

The other thing about disposal of equipment -- that

is a liability issue, and I've actually seen reuse programs

shut down because of this, primarily in the computer reuse

programs -- is if you don't have a policy about how you're

going to dispose -- or what's appropriate when it comes to

disposal of equipment, then you can find your equipment

literally either in another country -- which I have seen

that happen -- with name tags on it, saying this property

belonged to the University of X, or even in riverbeds,

which is just not okay.

So you want to make sure your program does not do

that. Because recently -- well, in recent memory, even a

year ago, there was an expose on CNN about this. And so we

want to make sure that we are covering our liability and

that we are -- if we tell people that we dispose of things

appropriately, that we do indeed do that and that our

policies and procedures do follow that.

Liability issues when it comes to marketing and

public relations. I encourage you to have policies and

procedures around this, especially around the donations.

This is one of those liability issues that can be a sneaky

one where folks will say, "Hey, donate your" -- just like I

was saying -- "Donate your equipment to our program, and

we'll make sure we handle it in an environmentally friendly

way," and somebody donates it, and it ends up on CNN's

story, that's not good.

But the other is, if you say, "Hey, donate your

money to us, and we'll make sure that it goes to help these

specific activities," and then if it doesn't, you want to

make sure that you're covering that liability issue there.

There was a -- there's a group that I'm working

with right now that that is indeed what they're working on.

That's the problem, is that they had donors that donated

money, and that money did not go towards the activity that

they thought it would. So there's all kinds of lawyers

involved, and it's become a big mess.

And so they did not have any policies in place, and

they sure didn't have any procedures in place. And so I

would encourage you to think of those things. Very, very

important things to consider.

Same thing with consumer education. You want to

make sure, if you are giving equipment out, that people

that received that equipment have access to the guidebooks

for that equipment; if it's an iPad, that those folks know

how to use the iPad; if it's a Jazzy chair, just like Zach

was mentioning earlier, that they have access to all that

information.

And you can get a lot of that from different

websites. You can also go to our knowledge base and get

that information.

And then liability concerns. It's that whole thing

with looking at your outcomes and making sure that your

data that you're reporting is actually informing the rest

of your program but also that it's legitimate. I don't

like to hear anybody distort numbers. And so making sure

that all that's happening.

So liability issues when it comes to partners and

collaborations. My friend Jamie, who is in Louisiana --

and I'm not sure if she's on today -- but she's done a

great job when it comes to creating agreements and avoiding

any confusion because they're very clear.

You can find those also on our website. They're

very thorough. And it's part of her policy, and then here

are these agreements. And that does help avoid some

liability issues when it comes to folks -- you've got

something that they actually have signed, and you have

exactly delineated what it is they agreed to.

And then liability issues when it comes to disaster

preparedness and sustainability. And there are all kinds

of things that you want to pay attention to when it comes

to getting fees in, abiding by funding streams and other

things that have to do with ethics. And the more that you

can have that outlined, the stronger your program will be.

Because I think it all goes back to what we all

want to do, which is help individuals. And that's why

we're all here today.

So the FDA -- we did a white paper. This was a few

years back. But I wanted to point you to this because the

Food and Drug Administration actually has jurisdiction over

the manufacture and distribution of medical devices.

Believe it or not, I didn't think that's where it was; but

that's where it is. So some devices may fall under the

definition of a medical device.

So it's an instrument or apparatus or implement or

machine or implant or other similar or related article,

including a component part or accessory, which is, and then

it goes on here to talk about exactly what those are. So

to diagnose a disease or used for -- to help somebody when

it comes to just basically living their life or getting

around. We're seeing more of these devices coming up and

being used.

My daughter is using a Bioness right now. She's

training on it. It's actually an external prosthetic

device. And the FDA is actually the one who is regulating

that. The only reason why I know that is because we are in

this field.

So the regulation of these medical devices, you'll

find in the FDA that there's registration, the devices

listed. There's premarket notification or approval;

there's quality system regulation, investigational device

exemption for clinical studies, labeling, and then medical

device reporting.

So whenever we got that alert the other day that

said, hey, there's a recall on this specific piece of

equipment -- which I do have it in here, and I'll show that

to you in just a moment -- that came because they had all

this information, and they actually had to report it to the

FDA. And so the FDA is the one who actually was able to

give us that information.

And let me go to the next.

And so making sure, as I'm going back to tell you,

that it's important that you have an idea of who got what

equipment. And if you know who got what equipment, that

will help you sleep a lot easier at night and know you're

doing a good job, and be able to contact those folks so

that you can then replace it with something that's not on a

recall list. And it's just a lot easier.

So application of the FDA regulations. We've got

those outlined where it's relevant to any entity using a

medical device in a commercial activity. It may include

manufacturing, remanufacturing -- and this is why we're

saying, hey, don't do the remanufacturing -- distributing,

redistributing, packaging, repackaging, labeling,

relabeling.

Most activities of AT reuse do not qualify as

regulated activities. But some do. And so you want to

make sure that you're aware of that.

Another liability issue that you want to make sure

that you avoid is relabeling equipment. I've seen where

some folks will get an Invacare chair in, and they take the

Invacare name off that chair and they put their program

name on there. You don't want to do that because that is

relabeling a device. And so you want to make sure you

don't do that.

All right. If you have a prescription -- and some

of y'all do. Some of the people that you work with get

prescriptions for medical devices. So let's it's a

motorized wheelchair or that Bioness, which is the external

prosthetic device. Some people even with speech devices

get prescriptions.

It's approved only for dispensing under the

supervision of a licensed practitioner; right? And that

prescription follows the device, right? So it's important

to know that it doesn't -- you don't avoid liability issues

if you -- all of a sudden the liability issues don't go

away just because the person gave the device away.

So the FDA is still going to be involved. They're

still regulating all of that. And obviously the people who

created that equipment, it still is their device.

So I hope that makes some sense to you. So it's

important that AT programs that distribute devices that

require a prescription, that you're aware of that.

Some people are doing CPAP machines. And we've had

some folks that have even asked us about, you know, reuse

of oxygen machines or ventilators. Some of that is covered

under the FDA, and it's also covered under a prescription.

So you need to consider those things.

Even if it's listed on your exchange networks, you

want to be aware of those types of things. And some of you

have done a great job where you've said, "Nope. We're not

going to take that," and that's been what you have done.

And so that makes sense because you've covered that within

what it is that you want to do.

Does anybody have any questions for me right now?

And it looks like maybe we do. So I'm going to turn this

over to Liz so she can ask some of the questions, and then

we'll jump right back in.

LIZ PERSAUD: Hey, everyone. I'm just going to

read the questions out loud for you.

So Barbara Schultz asked a question a few moments

ago. And the question says: Liz mentioned Pass It On

Center will soon launch a website that will locate

assistive technology by calling eBay, Craigslist. Will it

also search AT4ALL in states?

And to answer Barbara's question: Yes. We are --

we are going to be doing that. That's one of the processes

that we're working on now, is working with some of the AT

act programs, AT4ALL, some of the other exchanges to get

permission to do this and to make sure that we have a

collaborative effort. So, yes, Barbara. To answer your

question, we will be doing that.

The next question is from Zachary Thompson. I'm

going to read this. It says: I have a question on

classifying volunteers. Most of the ones I deal with are

students doing service learning for classes or more

recently students on alternative spring break. What title

should they be given? And also would they be covered under

the college they are from, or should I talk to the

higher-ups about insurance? We have a warehouse full of

donated devices, at times 100 plus, but they are not

sanitized until a device is picked for refurbishment.

So I'm going to pass that question on to Carolyn to

answer since she's our expert.

CAROLYN PHILLIPS: Okay. Great questions. And I

appreciate you asking those. And I appreciate you, Liz,

reading those out.

So regarding the volunteers. And, Zachary, great

question. So that's a tough one because, once again, it

depends on what organizational structure you're in. And it

sounds like obviously there's an alternative spring breaks,

so you're within an academic environment.

And what I would do is I would consult with folks

within your legal department to find out, because I would

assume that those volunteers, if they are students, then I

would be willing to bet that they are already covered in

some activity -- I mean covered for some activities. And

so you may be lucking out there.

Honestly it would be good, though, to make sure you

do the leg work so that you can cover yourself so that you

don't leave yourself open to any of that.

And that's great, by the way. I think it would be

good to talk more about that alternative spring break.

That's really cool.

And then you also said you have a warehouse full of

donated devices, but they're not sanitized until the device

is picked up for refurbishment.

You know, I have seen programs that operate that

way, and it just depends. There's something to be said for

going ahead and cleaning that equipment so that you don't

have pathogens or different things, viruses and bacteria,

on it.

I can tell instantly. Whenever I walk into a

warehouse, my nose tells me how things are going for that

reuse program in some ways.

Because you don't want to get into having black

mold or different types of mold in the warehouse. And I

have seen that in chairs. I've seen it on chair seats.

I've seen it in different equipment.

So I suggest that folks make that decision: Do we

want to keep this equipment; do we not want to keep it? Go

through a triage. And then, once you've made those

decisions, then go ahead and sanitize the equipment that

you think that you want to keep.

So that should help you with your space. But it

also should help you with making sure that you're on top of

any of those other things, those yucky bugs that can hang

out there.

And it looks like we have another question.

Liz, did you answer this question?

Okay. So the question is, basically -- you read

this one out -- when do you declare a device old, right?

Because some members of staff want to keep it.

Now, I've heard this, and I've actually had this

battle myself with some of our team members where they just

love holding onto things.

And what I do, honestly, is, if it's no longer

being -- getting technical support, if it is so outdated

that the parts just -- it's just ancient, then I don't use

it.

Some of the AAC devices that come in, they're still

working. They're Liberators, and they weigh 800 -- I was

going to say 800 pounds -- but they weigh a lot. They're

considered portable, but they're huge.

And it's amazing that that technology was created

and that it's still used. But I cannot imagine anybody

that would want to use that right now when we have other

alternatives.

So often it's just having a conversation and making

a policy about saying, "We will only keep equipment for six

months," or, "We will only keep equipment, and then we'll

strip it down for parts after nine months." And just

really abiding by that and sometimes justifying -- having

people justify it, because space is something you want to

consider.

So I hope those answers helped. And let me know if

they did. And if they didn't, I can go into more detail.

And, Bob, you have a comment.

LIZ PERSAUD: Hey, everyone. I'm going to read

Bob's comment, which is very helpful.

Bob Rust with Touch the Future and ReBoot says:

All equipment should have visual inspection first. Then

all that passes cleaned for storage; the rest recycled.

And that's absolutely correct, Bob. We appreciate

you throwing that in there. And Touch the Future is a

great leader when it comes to policies and procedures.

That's Joanne Willis, the director over there, that Carolyn

mentioned earlier. And she is wonderful when it comes to

developing policies and procedures and just keeping

everything in line and tiptop.

So thank you, Bob, for that.

And then Hannah also commented and said: I like

the answer about technical support. If no one is available

to support the use, we should consider an alternative

device. We have a Liberator in the closet too.

Thanks, Hannah, for sharing too. We appreciate it.

CAROLYN PHILLIPS: All right. Well, I'm happy to

know that we're giving you justification to clear out the

storerooms. Let us know how else we can help you. We're

definitely there.

The main thing with the FDA regulations -- and as I

said, we have a white paper that is posted on our website

in the knowledge base. You can absolutely go there and

review that and educate yourself about all of that and

about how the FDA does apply -- how some of those

regulations do apply and understanding obviously the whole

thing when it comes to liability policies and procedures.

So what I would encourage you to do is really

understand and apply state statutes and regulations. There

are some states that actually have regulations when it

comes to reuse. Texas is one of them.

And there's some other states that don't have

anything. It's an area that either folks have not been

interested in creating some regulations, or they're just

saying, "Well, we'll abide by whatever the federal

government does."

So understand what it is that's regulated, and

understand how that relates to you. Some folks -- for

example, state statutes and regulations may govern contract

relationships and warranty promises for contractual

exchanges made through the exchange program websites.

Exchange programs should understand how these laws

may impact exchanges and inform consumers of these laws. I

mean that's what anybody would really do, you know, to be

ethical but also to avoid liability issues.

Reuse programs should also consult the state

statutes and regulations that are applicable to be sure

that you really are complying. And that's the main thought

there.

So, you know, you want to keep yourself out of hot

water when it comes to your state, when it comes to federal

legislation and regulations the FDA. But then also keep

yourself in line with abiding by your policies and all of

that.

Up here I have a screen shot of our website. And

there is the recall. If you go to our website, it's in the

upper left-hand corner. And this is "Essential Medical

Supply," and it's "Essential Rollator" that was recalled.

So I would check that out. And as I said, we do

have a place on our website where all of those things

are -- they're up there. And we do get these

announcements; not too often, but we do get them.

A few years ago there was an announcement about

batteries that caught on fire in computers, and we let

folks know about that too.

So there are guidelines about device

remanufacturing, just like we said. It's not just because

the Pass It On Center says, "Hey, don't do that." But you

could be violating some FDA regulations, which you don't

want to do.

So it is 3:27, and we are happy to answer any other

questions that you may have.

We have -- this PowerPoint, you'll have access to

it on our website. And I would encourage you to spend some

time looking through it, listening to it if you use screen

readers like I do, and talk this over with folks that are

involved in their reuse programs.

Consider what we've said here, and use it to tweak

your programs. Because I feel like our success is

undeniably linked to your success, and we are committed to

building this national network. And so we want to make

sure that everybody is strong, and we don't have any weak

links.

So with that being said, let us know how we can

improve. Fill out our evaluation. It's SurveyMonkey.

And we will -- Liz -- she's so on it. I was about

to say she'll post it in the public-chat area, and she just

did it.

And so I'm going to see if Liz has any other

comments or anything else that she wants to add or anything

else that folks have said. But do let us know if this has

been helpful.