State officials checking into fees cardiologists got from manufacturer

Four cardiologists at the Nevada Heart and Vascular Center, which contracts with UMC, are paid consultants for Biotronik, a German company that sells pacemakers and defibrillators to the hospital.

The relationship between the doctors and Biotronik raises ethical and legal questions about the potential for the doctors’ financial interest to conflict with the patients’ medical care.

A New York Times story reported Biotronik paying the doctors as much as $5,000 a month and becoming UMC’s preferred heart-implant vendor. Last year, 250 of the 263 patients, or 95 percent, who had a heart device implanted at UMC got one made by Biotronik, the Times reported.

The Times article prompted Gov. Brian Sandoval to request a teleconference Monday between the state Health and Human Services and the Board of Medical Examiners to discuss possible wrongdoing.

A medical board official wasn’t certain whether the doctors would be investigated. It’s legal for doctors to take consulting fees from a vendor, as long as they disclose that relationship to their patients and it doesn’t override what’s best for the patient, said Douglas Cooper, the medical board’s executive director.

"Did it affect their objective evaluation of the patient and treatment?" Cooper said, calling that the ethical question.

If so, the doctor would be in breach of the Nevada Medical Practices Act, he said. And if a doctor recommended a Biotronik product without disclosing his business relationship with the company, he would have violated the law.

The Justice Department is doing a civil investigation into Biotronik’s marketing practices, according to the Times story. A local FBI agent declined to comment.

County Commissioner Lawrence Weekly, who heads UMC’s board of trustees, said he thinks doctors who work for the hospital should not be on a vendor’s payroll.

"It gives the appearance of being unethical," Weekly said.

UMC officials and the cardiologists’ group defended their ties to Biotronik and the company’s products.

"Unlike with other cardiac devices, UMC has never had a product recall of the Biotronik device and results to date show significantly improved outcomes for our cardiac patients who receive them," UMC chief executive Kathy Silver said in a written statement.

Biotronik’s devices have helped the hospital to win awards for cardiac care and to save $1 million a year for heart implants, Silver said.

She noted that stricter disclosure rules went into effect in 2010, requiring doctors to reveal any financial relationship with a vendor. That was after the four doctors began consulting for Biotronik, so they were never compelled to disclose their relationship, she said.

In a written statement, Dr. William Resh, one of the doctors, said they never received incentives to sell Biotronik’s devices to patients. He insists the reason most patients ended up with these implants was because he and his colleagues trusted the devices.

"Neither I, nor any other doctors in our group, receive compensation based on the selection/use of a particular device," Resh said. "All of our work as consultants is documented and logged, and is based on the number of hours worked."

Weekly said the stricter disclosure laws should prevent such dealings from happening at UMC in the future.

Contact reporter Scott Wyland at swyland@review journal.com or 702-455-4519.