Senate panel keeping line between medicine, lawmaking

Washington -- Tom Coburn, MD, desperately wants to keep delivering babies.

The obstacle in his way isn't the one that typically springs to mind these days -- sky-high liability insurance premiums. Instead, Dr. Coburn finds himself thwarted by the U.S. Senate.

That's because Dr. Coburn is not only a family physician specializing in obstetrics, he's also a freshman senator from Oklahoma.

The Republican lawmaker was recently informed by the Senate ethics panel that continuing the paid practice of medicine breaks the body's rules against outside compensation. The ban applies even if the money he collects is only enough to cover his liability insurance premiums and overhead.

During his Senate campaign, Dr. Coburn promised to work as a citizen legislator, noted his spokesman John Hart.

In a recent letter to the Daily Oklahoman, Dr. Coburn wrote: "I made this pledge at nearly every campaign stop, not merely because I wanted to keep practicing medicine but because I believed maintaining my connection with the real-life needs and concerns of my patients and neighbors would make me a better senator."

But with the ethics panel having so far rejected his requests to reinterpret the rules, Dr. Coburn is seeking legislation to change them. His office is already working on building grassroots support for such a move.

The issue has sparked a mixed reaction back home.

Oklahoma physicians have come out in support of Dr. Coburn.

"I really don't see why he should be prevented from working in his practice on the weekends," said Jack Beller, MD, immediate past president of the Oklahoma State Medical Assn.

Dr. Coburn will need to keep his skills sharp if he wants to return to full-time practice once his time in the Senate is over, Dr. Beller said. He should be allowed to keep his promise to be a citizen legislator, he added.

But several editorials in Oklahoma newspapers have urged the senator to drop medical practice and devote himself fully to his job in Washington.

In his Daily Oklahoman letter, Dr. Coburn said: "I have been and will continue to devote at least 60 to 70 hours per week to my Senate duties. No newspaper questioned my work ethic while I practiced medicine during my six years of service in the House."

Dr. Coburn continued to practice medicine between 1995 and 2001 while serving in the House. The House ethics panel awarded him a waiver of the rules limiting income to $20,000 a year based on the fact that he was using the compensation only to cover overhead costs. But the Senate panel has concluded that the ethics rules cannot be read to differentiate between net and gross income.

It gave him until Sept. 30 to wind down his practice after he argued that he could not immediately stop seeing patients, many of whom are mid-pregnancy. To comply with the spirit of the rules, Dr. Coburn already had stopped taking new patients but plans to continue seeing his existing patients through the end of the year, without payment after the deadline.

The policies on outside compensation were put into place in 1977, mainly as a reaction to members of Congress who continued to work as lawyers and took on clients who were lobbyists or otherwise represented a conflict of interest.

Continuing to work as a practicing physician would present at least the appearance of a "conflict between Senate duties and outside employment," the ethics panel wrote in a letter to Dr. Coburn.

"Moreover," the letter continues, "the legislative history of this provision, enacted as part of the original Senate Code of Conduct in 1977 ... specifically and explicitly includes the practice of medicine among the professional services covered by the prohibition."

Dr. Coburn has argued that physicians do not face the same types of conflict of interest, while they do face overhead costs, including expensive liability insurance premiums, that far exceed those of other professionals, such as lawyers. Physicians also have a unique responsibility to their patients, particularly those with chronic conditions and other ongoing medical needs, he told the panel.

Dr. Coburn is not the only physician in the Senate. Majority Leader Bill Frist, MD (R, Tenn.), is a heart surgeon. Dr. Frist does not maintain a practice but still volunteers his services during annual trips overseas.

Reportedly, Dr. Frist supports Dr. Coburn's efforts, although no one in Dr. Frist's office could be reached to confirm that.

Another important ally, Sen. Trent Lott (R, Miss.), has come out in support of Dr. Coburn. Lott chairs the Senate Rules and Administration Committee, which would have to approve any rule-changing legislation before it could go to the Senate floor for a vote.