On the Take

Jerome Kassirer, MD wrote a book recently that he titled, “On the Take”. The book explains in detail the payoffs that doctors take with their relationships with pharmaceutical industries and other members of the medical industry.

There are sections in Chapter 3 that explain conflict of interest. Dr. Kassirer explains that “conflict of interest exists when an individual or organization is in a position in which professional judgment concerning a primary interest tends to be unduly influenced by a secondary interest, such as financial gain. Conflicts of interest become a problem when there is a reasonable chance that a person will fail to fulfill an obligation to another.”

One observer commented: “Conflicts of interest are institutional weeds. They take root below the surface and become pervasive problems often long before they show their ugliness.” The weeds in this case expose physicians to powerful temptations to make money at the expense of their patients’ welfare.

Just to have a conflict of interest is not immoral or unethical. It is, however, unethical to act on the conflict in a way that cannot be justified ethically and thus violates a trust. (Where were the basic drugs for the PFD for many years? Why were they not used? When I offered to buy the PFD ambulance and GIVE it back to the City, where was the project medical director supporting this? Who would not want a free ambulance for their city that could transport people in the city and intercept patients coming from outside the city when necessary?)

The conflict of interest statement sent to the IDPH regarding Dr. Hevesy receiving a salary from Advanced Medical Transport stated that there was no conflict of interest. Many PFD firefighters think this is not true. Many lay people think that this is not true. Emergency doctors at OSF think that this is not true. The statement even said that there was no potential for a conflict of interest here with Dr. Hevesy receiving a salary from the only paramedic and transport agency in Peoria that he directed. How could this be true that not even a potential for conflict of interest exists? The consequences to an individual who is suspected of having a conflict of interest can be serious.

I believe that Dr. Hevesy should not take a salary from AMT now and surely shouldn’t have when he was project medical director for almost a decade. (The current project medical director is under Hevesy in the OSF-ED and takes his orders from Hevesy regarding many issues. Hevesy and Andrew Rand and others keep AMT the only transport and advanced life support agency in Peoria.) Avoiding even the appearance of conflict of interest should have been very important to the AMT board of directors and OSF board of directors who all knew about Hevesy’s financial remuneration by AMT and his salary from OSF.

Public trust in doctors is very important for the medical profession and statements such as the one above to the IDPH would seem to erode the public’s trust if this were all exposed and understood. (Interestingly, the conflict of interest statement was undated and not signed. I wonder who wrote it? I have been told but don’t have proof.)

(Below is a post used earlier with the conflict of interest statement referred to above.)

Conflict of Interest

During the fall of 2001 many people told me that Dr. George Hevesy was receiving a salary from Advanced Medical Transport (AMT). This seemed unbelievable to me. They invariably followed up their statements with, “You know this is conflict of interest”. Another physician in the OSF ER screamed at me in anger about Hevesy’s conflict.

Hevesy was wearing many hats. He was the newly appointed Director of the ER at OSF and had been the project medical director (PMD), for about 10 years. As PMD he was in charge of all the ambulances in central Illinois—approximately 70 agencies. Hevesy was (and is) Corporate Medical Director of AMT. The following year, OSF-SFMC would appoint him as President of the Medical Staff at OSF.

I filed under the FOIA at the Illinois Department of Public Health in Springfield for a conflict of interest statement. The document arrived after many attempts and months of waiting.

Below are some excerpts from the IDPH statement regarding conflict of interest. It is not signed. It begins:

“In accordance with Section 515.320 j Scope of EMS Service, the Peoria Area EMS System is herein notifying the Department of a Stipend received by the EMS Medical Director from an EMS Provider in the System. Specifically, the Peoria Area EMS Medical Director, Dr. George Z. Hevesy, receives a stipend paid by an ALS provider, Advanced Medical Transport of Central Illinois.

The stipend is justly provided to the EMS Medical Director for oversight and consultation provided to this comprehensive EMS provider. This EMS provider accounts for the majority of the System’s EMS responses and interfacility transfers. Additionally, this EMS agency provides a unique regional critical care (inter-facility) transfer service under the direct medical control of the EMS Medical Director.

This stipend does not create an agreement or atmosphere which makes the EMS Medical Director answerable to or directed by the EMS provider. Nor has it influenced the Medical Director’s assistance of other providers.The Peoria Area EMS Medical Advisory Board and the Ambulance Board of Directors, consisting of representatives of the Peoria area hospitals, have reviewed the stipend and believe there is no potential or actual conflict of interest.”

The “EMS provider” stated above is AMT. I wonder what the PFD would say about influencing the medical director’s assistance with regards to the PFD? The Ambulance Board of Directors must be the AMT Board of Directors because there are no other ambulances in Peoria.

This is truly an amazing document.

Locally and nationally, people in EMS believe this represents "conflict of interest". Firefighters stated that they “tap their toes nervously” and wait for AMT to arrive when they have a patient with severe breathing problems and are unable to help the patient other than give basic life support, even though the PFD had firefighters with advanced skills (Intermediate and Paramedics). Many firefighters in the Peoria area, told me that Hevesy “obstructed” their departments when they attempted to upgrade their services for their citizens. The municipal fire departments are not paying Hevesy; AMT is. AMT is the only paramedic and transport service in the city of Peoria.

Three are two fundamental ethical premises that guide prehospital medical care. The principle of justice implies that the system be fair and equitable. The principle of beneficence requires that actions and intentions are in the best interest of the patient.

In the April 5, 2005 Annals of Internal Medicine a Position Paper regarding medical ethics stated the following: “The physician must seek to ensure that the medically appropriate level of care takes primacy over financial considerations imposed by the physician’s own practice, investments, or financial arrangements. Trust in the profession is undermined when there is even the appearance of impropriety.“…Physicians must be conscious of all potential influences and their actions should be guided by patient best interests and appropriate utilization, not by other factors.”

Do you think this constitutes conflict of interest?

In December 2002, my brother and I met with Monsignor Rohlfs and the Canon Law Lawyer for the Diocese of Peoria, Patricia Gibson. We met with them in Monsignor Rohlfs office. We expressed our concern with the conflict of interest regarding our EMS system as described above. They helped us draft a letter of petition to the OSF Sisters regarding a tribunal court against OSF because of OSF’s association with AMT and Hevesy. However, in February of 2003, when I met with Monsignor Rohlfs and Patricia Gibson, they told me that if I pursued a tribunal regarding OSF’s role in this matter, the diocese would withdraw its support from Haitian Hearts. They also stated that they would blame me in the media for the failure of the program. I was stunned to hear Monsignor Rohlfs say this. The Diocese effectively held the Haitian kids, who needed heart surgery, hostage to protect OSF from a Church tribunal. This was very hard to accept.

I filed the petition with Bishop Jenky, who refused to consider it.