Lawmakers consider barring gifts to physicians

Part of reform efforts after allegations of unneeded stent procedures

January 26, 2011|By Tricia Bishop, The Baltimore Sun

Maryland lawmakers are again considering legislation to bar gifts from companies to health care providers in the wake of allegations that a Towson cardiologist was "indirectly influenced" to perform unnecessary stent procedures by device maker Abbott Laboratories.

Vermont and Massachusetts have recently enacted similar laws, considered the most restrictive in the nation, that significantly limit the items sales representatives can offer to physicians, prohibiting trinkets, trips and most meals. They also require public disclosure of certain financial transactions.

The bans drew an outcry from industry officials, who tried unsuccessfully to repeal the Massachusetts law last year, saying it hurt business.

Maryland has weighed such conflict-of-interest legislation before, though it's never gotten very far. Last year's stent scandal, in which Dr. Mark G. Midei was accused of placing medically unnecessary coronary stents into hundreds of patients at St. Joseph Medical Center, has renewed interest in the laws, which are among several options being considered during this year's legislative session.

Dr. Joshua M. Sharfstein, the newly appointed secretary of Maryland's Department of Health and Mental Hygiene, outlined three legislative possibilities during a briefing Wednesday before the House Health and Government Operations Committee.

Along with the gift ban, medical professionals and lawmakers are talking about requiring the accreditation of cardiac catheterization labs, where stent procedures occur, and changing rules to enable oversight agencies to share information more easily.

Del. Dan K. Morhaim, who is a physician, said he plans to introduce a bill by the end of the week that would strengthen requirements for peer review within hospitals, a system in which doctors monitor colleagues' work.

After the hearing, the Baltimore County Democrat said he had an open mind about gift ban legislation but feels that new federal requirements are enough.

Beginning in 2012, drug and device makers have to record their payments to doctors and publicize them in a database by 2013 as part of federal health care reform. The federal rules do not prohibit gifts.

Sharfstein said the Vermont and Massachusetts laws have "important exceptions that aim to preserve the important ties between companies and practitioners that are necessary for advances in medical science." Doctors frequently collaborate with drug and device makers to improve products.

Hundreds of Maryland doctors and a handful of nurses have accepted payments from pharmaceutical companies in the past two years in exchange for promoting drugs to other physicians, according to recent company disclosures. The information was compiled in a database last year by investigative journalists at ProPublica, raising questions about industry influence over patient care.

Seven companies disclosed $258 million in payments nationwide from 2009 through the first half of 2010, with about $6 million split among 450 Maryland practitioners. Abbott was not among the companies included in the database.

The briefing was the second such seminar held before the House committee and is part of a statewide effort to improve physician oversight. Among the speakers was Robert Murray, executive director of the Health Services Cost Review Commission, who has been analyzing data for the Department of Health and Mental Hygiene as part of a year-old investigation into whether other Maryland doctors might be doing unnecessary procedures.

At least one Maryland hospital was selected — but not identified — for potential investigation based on preliminary figures, according to a September report submitted to the committee's chairman, Del. Peter A. Hammen. State health officials said at a November briefing that they expected to complete a data analysis within weeks and identify other facilities to investigate.

Whether they did is unclear. Sharfstein said in an interview that he would not comment on red flags that are raised. "But we will aggressively look into them," he said. If anything turns up, he added, the details will be made public.

The state's investigation was launched after a request from Hammen last year in response to The Baltimore Sun's coverage of Midei, who is alleged to have overestimated levels of arterial blockage as justification for expensive procedures to implant stents.

Midei has denied any wrongdoing and has filed a lawsuit against the hospital, alleging that it ruined his reputation.

A U.S. Senate committee also investigated the allegations against Midei, concluding in a report released last month that the doctor's lucrative relationship with stent-maker Abbott Laboratories, which threw parties at his Monkton home and praised his rate of implanting stents, might have contributed indirectly to the placement of unnecessary devices.

Since then, the Maryland Board of Physicians has charged Midei with violating the Medical Practice Act, and he is awaiting word on whether he will retain his medical license. An administrative judge is reviewing the case.

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