Contracts point out need for doctors to provide full disclosure

Let's say your doctor told you you'd need a new hip, a pacemaker, or a new heart valve.

And then let's say you found out the company that made those things paid your doctor $60,000 last year to consult on the design of the device he was about to implant in your body.

Would it change your mind? Would it, at the very least, raise questions?

Of course it would: Even the most trusting patient couldn't help but consider the potential conflict of interest. And that's especially true in this town, where doctors have put patients' lives at risk by reusing relatively cheap syringes or needle guides, all to save money.

That's why The New York Times story Sunday about a company called Biotronik and its relationship with a group of physicians who practice at University Medical Center got plenty of attention.

The company hired the physicians of Nevada Heart and Vascular as consultants on their pacemakers and defibrillators in 2008; shortly thereafter, Biotronik submitted the low bid on an RFP for those devices at UMC and was placed on a list of providers. Almost immediately, the Biotronik devices were used almost exclusively at UMC, comprising fully 95 percent of all devices implanted at the public hospital.

And while physicians must legally disclose to their patients any financial relationship they have with medical device companies, they have no such obligation to disclose to the hospitals where they practice. UMC Chief Executive Officer Kathy Silver confirmed in an interview that hospital officials were unaware Biotronik had almost cornered the market until Times reporter Barry Meier made inquiries.

A few things to note: First, there's nothing illegal about this practice, and, in fact, physician consulting contracts are fairly widespread. Second, doctors consulting with medical device makers have actually helped develop new, life-saving devices. And third, the Biotronik devices are well-regarded, having (thus far, at least) never been subject to a recall that might require a second surgery to install a replacement.

So why does it feel as if something's wrong here?

Silver says UMC changed its policies in 2010, and now requires all new physicians to disclose to the hospital any outside consulting contracts they have. Current doctors will have to do so when they come up for reappointment, a two-year cycle. That means UMC officials should know of all potential conflicts by 2012 at the latest.

"As a public hospital, we understand the need for transparency," Silver said.

But if transparency is so important, why not require all doctors -- new and current -- to disclose all outside business relationships to UMC immediately, and require immediate disclosure in the future? Silver says physicians have objected to demands for that information in the past, believing that it's none of UMC's business. If the requirements are too onerous, she says, physicians may choose to stop practicing at UMC.

"It is a fine line that we have to walk there," she said.

But knowing about those relationships -- and monitoring them to ensure nothing untoward is going on -- is an even more paramount concern. If doctors will have to disclose eventually, there's nothing onerous about requiring that disclosure to be made as soon as a contract is signed.

The issue could also be addressed by a state law that would require all doctors to make immediate and ongoing disclosure to any hospital where he or she has privileges, thus eliminating the competitive pressures that have stayed UMC's hand.

UMC is the valley's pre-eminent hospital, it's the only Level 1 trauma center and a community resource most won't appreciate until they really need it. It should also be a leader in medical ethics and full disclosure.

Steve Sebelius is a Review-Journal political columnist and author of the blog SlashPolitics. His column appears Sunday, Tuesday, Wednesday and Friday. Reach him at (702) 387-5276 or at ssebelius@reviewjournal.com.