60 Minutes recently featured a story on Senator Tom Coburn. He’s an
ob-gyn family physician from Oklahoma who also delivered babies. He vowed to serve only two terms. He intended to be a citizen-legislator and return to full-time medical practice upon retirement from the Senate.
Senator (Dr.) Coburn was recently diagnosed with prostate cancer. Because of that, he’s retiring from the Senate two years earlier than intended.
For years, Dr. Coburn delivered babies when he returned to Oklahoma for the weekend. Senator Coburn ruffled a few feathers in D.C. by calling out “pork” in bills when he saw it. For example, he was the town crier – drawing attention to the Alaskan Bridge to Nowhere. This irritated some of his senator colleagues. The payback was an ethics investigation to see whether his weekend practice of delivering babies constituted a “conflict of interest.”
Coburn was mainly interested in keeping his skills up-to-date. He was delivering babies for free. He paid his professional liability premiums out of his own pocket.
In May, 2008, Senate Ethics Panel sent a strongly worded ‘final determination” memo threatening Coburn with Senate censure if he did not stop delivering babies for free. Dr. Coburn was working at Muskogee Regional Medical Center, and in 2007, that institution changed from a public to a private institution.
Coburn still did not understand what the conflict of interest was. Coburn’s spokesman, John Hart, wrote:
“Just as parents don’t choose him hoping to sway his vote, parents don’t choose to receive his services at a particular hospital because Dr. Coburn has somehow endorsed that hospital because he is a senator…”The committee has shown us zero empirical evidence to back up this flimsy claim.”
Has Sen. Leahy provided an improper endorsement to Warner Brothers for appearing in Batman?” Hart asked. “Will millions of Americans now see Batman not because it features stars like Christian Bale or the late Heath Ledger, but because Patrick Leahy, a distinguished U.S. senator, has offered his illustrious endorsement to this motion picture?
“If Sen. Coburn can only deliver babies for free at a public hospital, shouldn’t Sen. Leahy only be allowed to donate his notable thespian skills to a public entity like PBS?”
…Hart estimates that Coburn has delivered dozens of babies since last receiving an ultimatum from the Ethics panel in 2005. Coburn has received no compensation for his work and paid “tens of thousands of dollars” out of his own pocket for medical malpractice insurance and other costs related to his medical practice, Hart said.”
At a medical meeting in 2010, Senator Coburn said he had stopped delivering babies because his medical malpractice premiums were too high – particularly in view of the fact he received zero income for the deliveries. It’s unclear whether the Senate Ethics Committee forced the issue further.
Even when a doctor wants to provide free or reduced fee care for patients, challenges loom. The Anti-kickback statute (AKS) prevents providing any inducements for referrals. Providing free care to Medicare or Medicaid patient might be interpreted as a “loss leader” for more expensive services, even if you are not the direct beneficiary.
[W]here the Medicare and Medicaid programs require patients to pay copays for services, you are generally required to collect that money from your patients. Routinely waiving these copays could implicate the AKS and you may not advertise that you will forgive copayments. However, you are free to waive a copayment if you make an individual determination that the patient cannot afford to pay or if your reasonable collection efforts fail. It is also legal to provide free or discounted services to uninsured people.
It does not appear that Dr. Coburn will practice medicine again. That’s a pity.