Sandi Krul

For over two decades, Sandi Krul has counseled clients in business and real estate transactions. She represents hospitals, health care districts, skilled nursing facilities, physician groups and other health care providers and suppliers on all forms of real estate transactions, as well as mergers and acquisitions, affiliations, and other health care matters consistent with regulatory requirements, including fraud and abuse laws and the corporate practice of medicine.

She has managed hundreds of leasing arrangements, purchase and sales and other health care transactions of all sizes throughout the U.S., including hospital affiliation transactions in California, Idaho and Texas. She also successfully represented California hospitals in obtaining HUD financings ranging from $17 million to $200 million. This represents nearly half of all hospital HUD financings in California since 2012.  Many clients also seek her expertise on California’s newly adopted legal framework governing material change health care transaction notices to the state’s Office of Health Care Affordability (OHCA).

A considerable portion of her work involves deals at the intersection of real estate and business in which she counsels clients on topics such as Stark, the anti-kickback statute, co-location issues and other health care regulatory matters. These regulations can easily be unintentionally violated by general real estate practitioners. Sandi navigates her clients through these regulations to ensure this doesn’t occur.

She takes a systematic and levelheaded approach to her work, a particular asset when involved in contentious negotiations. Both a problem-solver and an advocate, she focuses on solutions that are workable for everyone concerned.

Her clients operate within a changing regulatory and reimbursement landscape focused more on value-based care and coordination, and placing new demands on them to work together with other providers for the overall wellness of their patients.  Sandi works with clients to operate within this new paradigm, including a particular focus on projects that advance health equity, such as street medicine and temporary housing programs, which enable her clients to deliver the best care to the communities they serve.

Sandi serves on the firm’s Board of Directors, and as Co-Chair of the firm’s Diversity, Equity and Inclusion Committee and Health Equity Task Force.  In keeping with her commitment to volunteer work, in addition to her leadership roles within the firm, Sandi is a member of the California Society of Healthcare Attorneys DEI Task Force. Some of her prior community service included her participation as a member of the Executive Go Red for Women Leadership Team for the American Heart Association in Los Angeles, member of the incubating board establishing the Greater Los Angeles chapter of Women in Healthcare, Chair of the Real Estate Affinity Group of the American Health Lawyers Association, Board member of Women in Health Administration of Southern California, and Board member of Vital Options International.

Representative Experience

Facility and Real Estate Acquisitions

• $24.25M acquisition of acute psychiatric hospital
• California rural hospital’s acquisition of several parcels of land for development of additional clinics and health care programs
• $62.7M acquisition of 6 California skilled nursing facilities in coordination with larger $700M multi-state Kindred portfolio sale
• Southern California hospital’s $28M acquisition and financing of medical office building
• Skilled nursing operator’s $6.1 million acquisition of northern California leased facility
• $8 million acquisition of an on-campus medical office building for a hospital

Leasing Transactions

• Negotiation and drafting of $36M long term lease for development of new Southern California hospital campus medical office building
• Representation of national health system in negotiation and drafting of $24M long term California rural hospital lease

M&A and Affiliations

• Multiple physician practice acquisitions and friendly PC management implementation in connection with Northern California health system’s foundation model clinic expansion
• Representation of rural health care district with ambulatory clinic strategy and implementation
• Several physician practice acquisitions on behalf of Southern California health system in connection with expansion of ambulatory care delivery services

Financings

• $200M HUD financing for construction of new hospital patient tower
• Representation of nursing home chain in $60M secured financing ($30M revolving line of credit and $30M term loan financing)
• $15M revolving line of credit for California community hospital
• Borrower’s counsel for a continuing care retirement community in connection with $105,515,000 public offering tax-exempt bond financing transaction through the California Health Facilities Financing Authority

Other Legal Experience

• Providing regulatory guidance respecting material change transaction notices to the California Office of Health Care Affordability (OHCA);
• Negotiation and drafting of professional service and related agreements for implementation of friendly PC/MSO arrangements
• Drafting and negotiation of utility, access and avigation easements
• Guidance on land use and zoning matters
• Construction contracts
• Advise on Stark, AKS and other health care regulatory compliance matters
• Provide legal opinions in support of financing transactions
• Negotiation of numerous cell tower agreements
• Represented health care provider tenant in navigating landlord’s loan forbearance, bankruptcy and subsequent restructuring in connection with bankruptcy workout related to multi-million-dollar proton treatment center facility.
• Assist in the development of Street Medicine Program.