The Senate Rules and Administration Committee will consider legislation that would alter the definition of the word “compensation” and thereby allow Sen. Tom Coburn to continue practicing medicine on a “not-for-profit” basis.
The committee’s chairman, Sen. Trent Lott (R-Miss.), has in principle supported Coburn’s effort to continue practicing as an obstetrician but is currently reviewing the ideas put forth by the Oklahoma Republican, which would overrule the Ethics Committee’s decision requiring him to shut down his practice by Sept. 30.
“Sen. Lott, from Sen. Coburn’s election, has been very sympathetic to his wanting to continue his practice within ethical boundaries,” said Susan Irby, Lott’s spokeswoman. Citing Lott’s views on the matter, Irby added, “How can delivering babies be a conflict of interest?”
For Coburn, Lott’s support will be essential in any effort to change Senate Rule 37, which specifically forbids a Senator from practicing medicine — or law, engineering, real estate and many other professions — that would involve a “fiduciary” relationship.
Citing that very specific rule, the Ethics Committee on March 18 rejected a request from Coburn to alter the rules to say that a doctor could receive payments to cover his expenses, including, as Coburn spelled out in a Dec. 23 letter to Ethics, payments to cover his nursing staff, medical liability premiums, office rent and “limited” overhead costs at his practice in Muskogee, Okla.
But Coburn is now taking his fight to the Rules committee, which he hopes will be more receptive to his requests, particularly with Lott backing at least the concept that he be allowed to continue plying his trade. “He’s supportive of the idea of me practicing medicine,” Coburn said last week.
Coburn’s office said that no specific language had been presented to Lott, but that Coburn has spoken at length with the chairman, as well as to Majority Leader Bill Frist (R-Tenn.) and Republican Conference Chairman Rick Santorum (Pa.), both of whom sit on Rules.
“In many respects, the real battle begins now,” said John Hart, Coburn’s spokesman.
As he awaits the legislative fight, Coburn has followed through on several steps he negotiated with the Ethics Committee that put him in compliance with Senate rules, which allow for a new Senator to “wind down” a professional practice rather than shutter it immediately. He is not taking any new patients, dating back to December, and he has consolidated his entire practice — which used to be dispersed in six different medical offices and entities — into one corporation, Thomas A. Coburn, MD Inc.
In addition, Coburn has set up a separate billing account for all services he provides and expenses incurred after Jan. 1 to demonstrate that he is not making any net profit from his practice, and he will provide those to the Ethics Committee by Oct. 31 for the panel’s verification.
To be able to continue practicing, Coburn will need the committee to endorse his view that the ethical standard should not be a complete prohibition against any compensation, but rather accept his preferred version allowing payment from patients to cover “actual and necessary” costs. That was the compromise Coburn and the House ethics committee came to in early 1998 after a lengthy debate about his practice and those of several other doctors in that chamber.
Some ethics lawyers, however, questioned how the Rules committee could get around the restriction, which specifically cited practicing medicine at a clinic or any other financial partnership as a forbidden activity.
“I don’t know that there’s a way around it, because it was designed to prohibit precisely what he wants to do,” said Stan Brand, an ethics lawyer at Brand and Frulla. “It’s sort of like saying you’re going to challenge the speed limit. The speed limit is 55, you can’t waive it.”
For that reason, Ethics Chairman George Voinovich (R-Ohio) and Sen. Tim Johnson (D-S.D.), the vice chairman of the evenly divided panel, denied Coburn’s request and also said they could not support a legislative fix at the Rules Committee.
“It appears that a proposal to, in effect, equate ‘compensation’ with ‘net’ profit would not only be impracticable but, more importantly, would be inconsistent with the clear purposes” of the rule, Voinovich and Johnson wrote in their March 18 letter.
In a direct rebuke to Coburn’s political philosophy that Members of Congress should be “citizen legislators,” Voinovich and Johnson wrote that the rules are intended to ensure that Senators “undertake their official duties as, and understand them to be, a full-time responsibility.”
But Coburn believes that he won’t face any ethical quandaries as an obstetrician delivering babies, and certainly nothing akin to what a practicing lawyer would encounter.
“It’s ludicrous to say that Medicaid moms are going to choose him to influence his vote or that lobbyists are going to be lining up for physicals,” Hart, his spokesman, said.
Aides to Sen. Chris Dodd (D-Conn.), the ranking member of Rules, were not available to comment on the Coburn matter Friday.
One GOP aide, requesting anonymity, said the critical questions for Rules would be the ability to craft a bill that is narrow enough that it doesn’t open a loophole for Senators looking to earn outside income — but also not crafting it so narrowly that it appears as if Coburn is being granted a special privilege.
Coburn, who has been an outspoken voice in favor of advancing the conservative agenda since winning a House seat in 1994, has the backing of many conservative activists and interest groups in his effort to continue delivering babies in Oklahoma.
He notified many of his conservative supporters in an e-mail last week of the Ethics panel’s decision requiring him to close down his practice by September and alerted them to his pending effort to change the rules. In a brief interview last week, he said he would ask those activists for help in passing his legislative fix, but only after a bill is drafted and ready for Senate action.
“I’m not aggressively pursuing anything until I have something that we can bring to the floor,” he said.