Sarah Virani never expected that overseeing a hospital’s security team would fall within the job description of a chief legal officer. “People tilt their head a little bit when I tell them that security is under the legal portfolio, as opposed to under facilities management,” she says. But at CAMH, where mental health care requires close coordination between clinical, legal and community systems, the structure makes sense. “The relationship between our mental health legal framework in Ontario and police is very nuanced, and police involvement in mental health care can be very delicate,” she explains. That nuance and the integration it demands is exactly what drew her to the role.
Virani’s approach to leadership isn’t about staying in predefined lanes. “One of the things that I’ve done… is gone and sat with security dispatch. I’ve walked the campus with our security guards,” she says. Her reason is simple: “It’s important for me to see what they’re encountering day to day… otherwise I can’t effectively lead them.” It’s an example of how she brings context and direct experience into a legal role that often remains high-level in other institutions.
That instinct to go where the real work is happening has shaped her entire career. She began in litigation, representing health professionals and hospitals in regulatory and civil proceedings. Then came a pivot – one that, by traditional measures, she wasn’t supposed to make. Virani applied for an in-house corporate counsel role at SickKids without prior corporate experience. What got her in wasn’t a textbook resume – it was her understanding of healthcare risk. “I’ve seen what happens when the risk doesn’t get managed and things escalate. So let me be the person to put the contractual safeguards in place,” she said at her interview for the job.
From that transition, she gained not just a new skillset, but a new orientation toward in-house legal work – one focused on practicality, and systems-level thinking. Later, at a boutique health law firm under Kate Dewhirst, Virani deepened her experience in privacy and risk management, while observing how legal advice could push forward rather than hold back. Dewhirst, she says, is “the most creative lawyer I’ve ever met,” and the takeaway was lasting: “Sometimes there are risks… but we still want to proceed, so we have to be innovative whilst remaining pragmatic about how we’re going to manage those risks.”
That principle is central to Virani’s work at CAMH, where innovation and collaboration are built into the hospital’s strategic direction. “CAMH is very focussed on moving mental healthcare forward at the moment,” she says. That requires a legal department that can keep pace – not by saying no, but by helping leadership get to yes. “Our job as lawyers is not to point out all the risks and then say, I don’t recommend you do this. It’s actually to be an enabler.”
This approach reshapes the core of legal operations. Risk is inherent in healthcare – and unavoidable in mental health and research – but it’s not a barrier. She describes a process where she outlines the top ten risks her institution might face. “Of these 10 risks that we’ve identified, how many are palatable to us?” she says. “Which one or two … might be deal breakers?” Once that’s clear, the task shifts to designing around the obstacles. “Can we find a way to either minimize this risk, work around it, be creative with what we’re doing?”
It’s a way of thinking that’s also guiding how her team works with others. Relationship-building, not just legal review, is at the centre of her leadership. “Becoming that trusted advisor… to people on the front line who are doing this work day to day is a huge component of the efficacy of a legal department,” she says. That trust, she argues, isn’t earned through hierarchy – it’s built through relevance and responsiveness. “You have to know what the day-to-day issues are and be the person who gets involved in problem-solving… in order to really help move the organization and its mandate forward.”
The work is not just internal. CAMH, unlike most hospitals, employs in-house litigators and handles its own mental health proceedings. “We’re one of the only hospitals in the country that has litigators on staff. Most outsource it,” Virani notes. Even so, external counsel is part of her toolkit – used selectively, either for highly specialized matters like construction and municipal law, or as a release valve when her team faces capacity challenges. What she values in external partners is not pedigree, but practicality. “The most important thing is not the prestige of the firm… What matters is that our external lawyers have an understanding of who we are, what we want to achieve… and… can support our teams… in a manner that is cost-effective.”
That same pragmatism informs how she approaches equity and patient rights. For CAMH, these aren’t abstract values – they’re baked into clinical programming, research and legal processes. In working with Indigenous communities, “we are thinking about the seven [grandfather] teachings and how Indigenous traditions affect the way people come to the table,” she says. That includes accounting for the OCAP principles – ownership, control, access, and possession – which challenge settler legal frameworks. “For Indigenous communities, [ownership of their information] is a community asset,” she says. “Without that contextual information, we are not advancing equity.”
It’s a perspective she’s working to embed across her team, and one she believes reflects what healthcare law needs to become. It’s also part of her advice to younger lawyers exploring nontraditional paths. In-house roles, she says, demand flexibility, the exercise of good judgment, and a tolerance for variety. “You have to be the kind of person who is open to … learning about new things and having to… wrap your brain around it and deliver the advice,” she says. Not every lawyer is built for that. “Some… are very good at a few things, and they want to be excellent at just those things. Being in-house requires a lawyer to bring in a bit of a business mind with the legal principles… and fuse that together to arrive at advice for the organization.”
At CAMH, where law, policy, care, and advocacy are deeply interwoven, that fusion is non-negotiable. For Virani, the role doesn’t sit at the edges of the hospital – it moves through its centre, navigating risk, enabling innovation, and walking the halls alongside the people doing the work.