Opening a Can of Worms

The Wall Street Journal reported this morning that a doctor was fired for a financial conflict of interest at the Cleveland Clinic, and now that doctor has countersued (subscription required):

Dr. Yadav was dismissed for allegedly not complying with the clinic's conflict of interest policies. His lawsuit, filed yesterday in Ohio state court, says he was being scapegoated.

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His suit alleges the clinic has been "indifferent" to financial conflicts of interest and that such situations are "widespread and pervasive." Those conflicts start at the top with clinic chief executive Delos "Toby" Cosgrove, according to the complaint.

The lawsuit says the clinic heavily promotes and uses an invention of Dr. Cosgrove's in patients undergoing heart-valve surgery. Dr. Cosgrove and the clinic both receive royalties from sales of the product, known as the Cosgrove-Edwards ring and marketed by Edwards Lifesciences Corp. The lawsuit says patients aren't given the choice of using competing rings or told that the hospital and its chief executive profit from sales of the Cosgrove-Edwards ring.

The clinic confirmed Dr. Cosgrove and the hospital share royalties, but declined to answer questions about what patients are told and how much the institution and Dr. Cosgrove earn from sales of the ring. The clinic said the royalty payments were proper.

Many major medical centers have such arrangements, I'm sure. Senior physicians at top institutions got there because they were either incredibly busy and productive clinically, or they had remarkable revenue streams from research - a la, intellectual property rights.

Now, research can be performed overtly, or it can be performed covertly. Overtly is okay in the eyes of the law, provided it is appropriately vetted by an institutional review board and patients sign informed consent. Covertly performed research without the patient's knowledge is illegal, obviously. But if the use of certain clincally-approved devices occurs that directly compensates physicians without the patient's knowledge to the exclusion of all other similar technologies or without the patient's knowledge, does that mean that there's a significant financial conflict of interest? Perhaps. Especially if exclusive hospital purchasing contracts exist with a particular medical device vendor.

This suit has just opened a can of worms - for doctors and hospitals - and stands to change the terrain of hospital-based purchasing agreements and royalty payment disclosures.

Maybe that's a good thing.

-Wes