December 03, 2010

 

Drug Firms Say They’ll Take Closer Look at the Docs They Pay
by Charles Ornstein, Tracy Weber and Nicholas Kusnetz, | ProPublica

(Nov. 17, 2010) Several of the nation's largest pharmaceutical companies said they plan to tighten screening of physicians who promote their drugs after ProPublica reported last month that more than 250 of them had been sanctioned for misconduct.

Eli Lilly and Co. said that next year, for the first time, it would hire an outside firm to search for state disciplinary actions against its hired speakers and advisers. Lilly, the seventh-largest company by U.S. prescription sales did not previously conduct such screening and was unaware of the dozens of actions ProPublica found against its speakers.

(image courtesy www.inLoughborough.com)

"Your reporting has raised valid and important questions, which we have taken steps to address," spokesman J. Scott MacGregor said in a statement.

AstraZeneca, the third-largest firm, is "evaluating new ways to retrieve state disciplinary actions that would allow us to act on that information in a timely manner," spokesman Tony Jewell said in an interview.

Pfizer, the largest U.S. company, said in a statement that it is doing the same.

Last month, ProPublica published an online database, Dollars for Docs that includes payments from seven pharmaceutical companies to health providers in 2009 and 2010. A review then of medical board sites in 18 states turned up more than 250 doctors who had been subject to various regulatory sanctions.

Based on checks with medical boards in the 30 most populous states and warning letters issued by the U.S. Food and Drug Administration, we have found dozens more. Today, we are publishing a list of 292 physicians who have had government actions taken against them, as well as the companies that paid them.

(kcactive Editor’s Note: The ProPublica list only included physicians from 30 states of which seven practiced in Missouri including in St. Louis, Kansas City, Independence and Joplin.)

Physicians with minor, nonmedical infractions — such as failing to update addresses or take continuing medical education courses — were not included.

We also have updated our database to include recently reported drug company payments, adding another $24 million and bringing the amount paid to physicians in 2009 and 2010 to nearly $282 million. The physicians with government actions received $7.1 million of this amount.

(Our database includes payments from only seven of more than 70 drug companies; the others have yet to disclose. Details are here.)

The sanctions against physicians were for misconduct such as prescribing unjustified or excessive medications, having inappropriate sexual relations with patients and making serious medical errors. Seventy physicians have been sanctioned multiple times or by more than one state. Twenty-one of these physicians had three or more strikes against their records.

On Probation, but Still Speaking

Dr. Kenneth Fisher has been disciplined five times between 1996 and 2009, the most of any physician on the list. The Arizona Medical Board has put him on probation twice, required him to have a chaperone when seeing patients and issued him three letters of reprimand for medical and recordkeeping lapses.

In the most serious case, in 1999, numerous male patients accused Fisher, a Phoenix family practitioner who specializes in HIV, of sexually victimizing or violating them, according to the medical board records. Fisher's license was on probation for more than nine years.

In an interview, Fisher disputed his culpability in each of the cases and said the 1999 action involved a few disgruntled patients coached by a physician who didn't like him.

Fisher said his disciplinary record has never kept him from working as a drug company speaker because of his renown as an expert in HIV treatment. He currently speaks for three companies, including GlaxoSmithKline, which paid him $11,000 in 2009.

"I think my local Glaxo [sales] reps understand the nuances of the complaints," he said. Still, Fisher said drug companies should check the backgrounds of their speakers. "I think it should be a consideration but it should not be a litmus test," he said.

Another physician, cardiologist Ali Sherzoy, had his license suspended in New York and New Jersey this year after he pleaded guilty to one count of criminal sexual contact in 2008.

Sherzoy said the matter involved his family's nanny and not his practice. He said he pleaded guilty on his lawyer's advice to put the matter behind him.

"I am the best physician around," Sherzoy said. "Ask any of my patients, ask anyone, ask my staff." He added: "I pleaded to something that I shouldn't have. I didn't even know all the ramifications of this. To bring it back up, it is just not fair."

Sherzoy's wife, Roshana, said she stands by her husband: "It had nothing to do with his patients."

Lilly used Sherzoy as a speaker in the first and second quarters of this year, the company's website shows, even though New Jersey suspended his license on Jan. 15. Lilly paid him $4,334 in the first two quarters of this year.

"They asked me because I'm one of the best and I think people trusted me," Sherzoy said. "When I spoke for the drugs, it's because I believed they work."

Pledges to Review Records

ProPublica provided each of the seven drug companies with a list of its sanctioned physicians. All said they plan to review the names and take appropriate action if warranted.

Lilly and Glaxo each had more than 100, while Johnson & Johnson with 21, and Merck, 18, had the fewest.

The companies did not make officials available for interviews. Most declined to say whether or how they would alter practices to learn about sanctions or other blemishes on the records of speakers or consultants. Pfizer and Glaxo noted that some of the physicians listed no longer speak for them.

Pfizer also noted that none of its doctors had been banned from participating in federal health programs.

Merck & Co. said it had "previously initiated" plans to conduct more frequent background checks and "is exploring additional capabilities." The firm would not be more specific.

Johnson & Johnson, Glaxo and Cephalon each said that they are always looking for ways to enhance their selection of speakers.

In an e-mail, Glaxo spokesman Kevin Colgan added that disciplinary actions alone shouldn't be the basis for excluding a potential speaker or consultant.

"When looking at state disciplinary records, it is important to note such an examination would have to take into account differences between accusations and findings of wrongdoing; differences in the severity of infractions; whether infractions are isolated incidents or patterns of behavior; and how long ago an infraction occurred," he wrote in an e-mail.

That said, Glaxo does not routinely look at such records when hiring speakers.

Dr. Humayun J. Chaudhry, chief executive of the Federation of State Medical Boards, said pharmaceutical companies could easily ask his group to search for discipline in any state against any of their physicians -- and even get alerts if something changes. Simply checking to see if a doctor is excluded from participating in federal health programs -- what most companies do -- is not enough, he said.

"If I'm sitting in an audience listening to a physician tout a certain drug and I was aware of those disciplinary actions," Chaudhry said, "I would have questions about their character and their motivation for talking about that subject -- and I would imagine that the pharmaceutical companies would also have similar concerns."

Josephine Johnston, a research scholar at the Hastings Center, a nonprofit bioethics think tank in New York, said she found it difficult to believe that multibillion-dollar drug companies haven't done simple background checks.

"Let's be honest, they do a lot of very complicated things very well," she said. "These are the people who have figured out how to get prescription data for individual doctors so they can send drug reps to target particular doctors in particular ways."

For this article, ProPublica shared the disciplinary actions it gathered with several news organizations, including The Dallas Morning News, The Detroit News, Health News Florida, the San Francisco Chronicle and WNYC in New York City. Reporters examined the disciplinary records of physician speakers in their regions. Among the findings:

  • WNYC reports that Long Island psychiatrist Richard Schloss spoke on behalf of Pfizer's antipsychotic drug Geodon even though New York suspended his medical license in 2001 and placed him on probation for five years for helping supply Vicodin to six patients who were drug addicts. Schloss told WNYC that Pfizer never asked about his record. "No, it did not come up. They didn't bring it up, and I didn't volunteer it but if they asked, I would have been forthcoming, obviously."
  • The Dallas Morning News reports that psychiatrist Wayne Jones was disciplined in 2000 after accusations that he had improperly prescribed drugs to several patients, including one who died of an overdose, according to Texas Medical Board records. The board required him to have a monitor to oversee his practice and keep detailed records of his prescriptions. Another accusation is pending against him for similar failings.

Jones has given more than 1,300 presentations on stress disorders, according to his website, askdrjones.com. Jones told the Morning News he couldn't discuss treatment of specific patients, but said relatives often make allegations when struggling with loved ones who are mentally ill.

  • Health News Florida reports how Orlando-area urologists Steven Brooks and E. "Jake" Jacobo pleaded guilty in 2001 to a federal charge of defrauding Medicare and the military based on bill-padding for the prostate cancer drug Lupron. Department of Defense investigators said the doctors lied about what they spent to get the Lupron after having pretended to be wholesalers to get it cheap. The doctors were sentenced to five years' probation and 500 hours of community service, and their practice had to repay the government $1.1 million. The Florida Board of Medicine fined each doctor $10,000 and required each to take classes in medical ethics and risk management. New York, where Brooks held a license, was much stricter. Its Board for Professional Medical Conduct pressured him into giving up his medical license. Glaxo paid Brooks $178,250 from 2009 through mid-2010, while Jacobo received $14,750 over that time. Neither returned calls from Health News Florida.

Separately, Colorado Public Radio reviewed Dollars for Docs data and found that at least 84 Colorado physicians did not follow state law and disclose their contracts with drug companies. Doctors are required to disclose such relationships worth more than $5,000 so that patients can weigh whether the advice they are giving might be biased, CPR reports.

News applications developer Dan Nguyen of ProPublica and freelance researcher Steve Suo contributed to this report.

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