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Preserving physician clout in politics

Candidate John Bulger, D.O.

By Christopher Guadagnino, Ph.D.

This election season, perhaps few would expect to see active and enthusiastic campaigning activity by the physician community. Given the legislative outcome this summer in Harrisburg, one might instead expect disappointment, politics fatigue and even outright abandonment by physicians of the political process as an effective means to obtain sorely needed reform.

Physicians watched the Republican Senate and House Judiciary Committee Chairs – Sen. Stewart Greenleaf (R-Montgomery) and Rep. Dennis O’Brien (R-Philadelphia) – both prevent floor votes and successfully scuttle the will of the majority of legislators in both chambers to pass a bill that would have allowed the public to decide on whether to authorize legislators to lift a state constitutional ban on jury award limits for noneconomic damages in medical malpractice cases. Physicians had lobbied hard for this piece of medical liability reform, which many still see as essential to arresting the spiraling cost of malpractice insurance, only to have their efforts stomped, not by a conclusive vote, but by two individuals using the authority granted to them by the committee chair structure of the General Assembly.

Over the past three years, the Pa. physician community has demonstrated unprecedented participation in political activity, betraying conventional wisdom that, as a constituency base, they are an unorganized and inept political force. Physician rallies, fundraisers for candidates, political literature in waiting rooms, and PAC contributions have apparently produced results – in the form of a favorable change to the makeup of the Pa. Supreme Court, keeping medical liability reform front and center on the agenda of state legislators, and succeeding in having several key reforms passed.

The failure this summer to achieve an anticipated victory on the caps bill may have indeed invoked sullen disengagement from politics by many physicians, while igniting anger and renewed resolve in others. It is unclear whether more physicians were lost from disillusionment than were gained through fresh resolve. Because there is no open state Supreme Court seat this election, there is no candidate for physicians to rally behind, making comparisons to past physician campaigning difficult. On the other hand, many physicians have devoted their political energies to the presidential election.

Two physicians are devoting themselves even more heavily to political causes as candidates themselves – one for a Pa. House seat and one for U.S. Congress.

Some maintain that physicians’ political agenda is being promoted by the activism of a small minority of the physician population, which does not not carry sufficient clout to influence elections and secure further reform. While physician PAC activity is on par with previous elections, one physician group has interpreted the caps end game in Harrisburg this summer as evidence that existing physician PACs and grassroots physician advocacy for candidates are far outclassed by political opponents, and that only an exponentially more powerful statewide physician PAC will produce desired results.

Dramatic Past Activity

Three years ago, when a seat was up for grabs in the Pa. Supreme Court, physicians recognized the opportunity to achieve a Republican majority that would look favorably upon medical liability reform, instead of striking down hard-fought reform measures passed by the legislature – as the Court did in 1996. Physicians supported the candidacy of Judge J. Michael Eakin, who appeared sympathetic to physicians’ concerns. Physicians for Eakin, a group of about 150 doctors, sent statewide mailings, organized fundraisers and encouraged colleagues to post notices in their waiting rooms about the importance of liability reform to health care quality and access, and the candidacy of Eakin.

That election also marked the first time that the Pennsylvania Medical Society Political Action Committee (PAMPAC) got involved judicial elections, rallying grassroots physician support across the state in support of Eakin and making a financial contribution to Eakin’s campaign. Physicians tasted victory when Eakin won the election.

A year later, in late summer and early fall of 2002, physicians similarly campaigned for another Pa. Supreme Court Republican candidate, Judge Joan Orie Melvin, as well as candidates for the state legislature. PAMPAC had mobilized a statewide grassroots campaign for physicians to work the polls, while physicians held fundraisers and formed organized communication networks with colleagues. Although Orie Melvin did not win, hurt by the concurrent Philadelphia mayoral race that helped secure a wave of votes for her opponent Judge Max Baer, the PMS declared that the medical community’s campaign carried traditionally Democratic regions of the state and offered fresh motivation for physicians to get involved in the political process.

During that same election season, members of a then-newly-formed group, the Politically Active Physicians Association (PAPA), had agreed to put brochures about tort reform and favored candidates in their waiting rooms, as well as organize physicians to appear at the polls in their white coats. Organized “Physicians For” groups emerged in support of chosen candidates, e.g., Physicians for Petrosky, and Physicians for Tomlinson, holding fundraisers and disseminating letters of support for their candidate on specially-prepared letterhead to colleagues.

Perhaps the high point of political engagement by Pa. physicians was the Code Blue Emergency rallies of early May 2003, where 160 physician organizations signed a “We Are United Pledge Document” outlining needed liability reforms, and thousands of physicians attended rallies in Harrisburg and other locations – many restricting their offices to emergency-only appointments for up to a week to emphasize how spiraling malpractice costs could erode access to physicians.

Politics Fatigue?

The momentum that physicians built in pushing the caps bill hit a brick wall when the bill was buried by two Republican committee chairs. It is difficult to establish what damage the scuttling of the caps bill has done to physicians’ confidence in the political process as a means for pushing their agenda. Physicians interviewed for this story have been politically active in the past, and for the most part remain so.

One outside observer, Donna Baver Rovito, who is past legislation chair of the Pennsylvania Medical Society Alliance and currently disseminates a political newsletter, Liability Update, to some 7,000 recipients, indicates that she received a lot of e-mails from physicians around the state who have thrown up their hands in disgust and will no longer be involved, with the tone that, “I’m sick of it. We worked our tails off. We’ve got nothing. I don’t want to hear about it. I’m talking to a headhunter,” says Rovito. On the other side of the coin, she adds, are the ones who are angry enough that they’re working harder this political season actively campaigning.

There is every incentive for physicians to remain politically involved, according to state Rep. Daylin Leach (D-Montgomery), who says the more you participate, the more you are heard. “We probably spent as much time on malpractice relief as any other issue in the past two years,” he says, noting that some good legislation was passed – including the MCARE Act, venue reform and a certificate of merit requirement – and that the failure to obtain one or two agenda items should not be judged a failure. Referring to physicians’ legislative wish list, Leach says, “Some of their agenda got passed. All of their agenda got a lot of attention. You don’t just give up.”

According to state Sen. Jeffry Piccola (R-Dauphin), “Physicians are very energized since that debacle in June and July. They are becoming more aware of how the political process works, and frustration can be extremely difficult. They’re dealing with it.”Piccola says that physicians are actively supporting his campaign and are holding fundraisers for other Pa. candidates around the state. Asked to give a medical malpractice update recently at a conference of the Pennsylvania Society of Gastroenterologists, Piccola said he received encouraging questions from physicians in attendance, who he said did not lash out or show signs of discouragement.

If physician activism is less visible this election season, it is not because of physician burnout, but because there is less opportunity to unseat an anti-physician incumbent, or to elect a strongly pro-physician candidate than there has been in the past, according to Martin J. Bergman, M.D., a board member and past president of the Delaware County Medical Society. “If there were a credible candidate, there would be statewide physician activism,” he says.

Two years ago, Bergman was one of the 150 members of Physicians for Petrosky, which tried (unsuccessfully) to unseat Rep. Thomas Gannon (R-Delaware), who had vigorously opposed tort reform legislation. The two Republicans who buried caps are untouchable this election: Greenleaf is not up for reelection until 2006 and O’Brien is running unopposed, according to Rovito.

Physicians Sustain Grassroots Activity

Bergman has attended and sponsored fundraisers for Rep. William Adolph, Jr. (R-Delaware) and Sen. Connie Williams (D-Delaware/Montgomery), has made financial contributions to their campaigns, and is one of about ten physicians whose name appeared on special letterhead mailed to about 100 physicians in Delaware, Montgomery and Philadelphia counties inviting them to a meeting in early summer with Sen. Williams, which about 20 physicians attended – impressive, says Bergman, given that it was scheduled mid-week, during a workday.

Other physicians remain involved in state-level political campaigns on an individual level. Charles Cutler, M.D., chair of the Montgomery County Medical Society, has met with, and made financial contributions to the campaign of Melissa Murphy Weber (R-Montgomery), whom he says plans to reintroduce a caps constitutional amendment bill once the legislative session begins in January. Cutler, an internist affiliated with Montgomery Hospital, plans take a day off of work to be at the polls on Weber’s behalf, even though he can no longer vote for her because of reapportionment of his voting district, and he plans to contact physicians in her district by either phone or letter endorsing her. Cutler has campaign literature for Weber and other candidates in his medical office, and has contributed to the campaigns of other candidates, including Williams’.

In the wake of disappointment at losing caps on the state level many physicians are turning their attention to the national agenda. In the Allentown region, physicians are supporting Charles Dent for U.S. Congress (15th District) to succeed Rep. Pat Toomey, whose seat is vacant for this election, according to Robert Murphy, M.D., legislative chair and past president of the Lehigh County Medical Society. A private plastic surgeon, Murphy plans to send a letter co-signed by colleagues to about 500 physicians in the Allentown area, recommending Dent as a friend of tort reform and patient safety. As a self-described “politically active physician,” Murphy also sends out emails to colleagues in the Lehigh Valley area announcing opportunities to attend fundraisers for candidates in an election season, and expects to do the same this season.

George Isajiw, M.D., a solo internist in Delaware Co. who closed his office to all but emergency calls during the entire week of last year’s Code Blue Emergency protests, believes that rallies did achieve public recognition of the threat that medical liability costs pose to physician availability, but didn’t achieve much politically. Isajiw says that physicians have to stay organized and aggressive, and he is making financial contributions to PAPA, as well as turning his attention to the national presidential election by putting a “Doctors for Bush” sign in his office. “If asked,” Isajiw says, “I tell patients that Bush supports tort reform.” If he can find new literature that effectively informs patients about the erosion of access to physicians because of malpractice costs, Isajiw says he will put it in his office.

According to the Bush campaign, there is a Doctors for Bush coalition chair for each county in Pa., with five regional chairs, and over 1,000 physicians who have signed on, agreeing to staff phone banks, participate in Bush rallies and attend press conferences. Marilyn Heine, M.D., an emergency physician at Mercy Suburban Hospital in Norristown and hematologist/oncologist in Langhorne, is the group’s coalition chair for Bucks County and has participated in four rallies so far, including one attended by 300 physicians in Fort Washington on August 9, at which she introduced First Lady Laura Bush.

Two years ago Heine was chair of Physicians for Tomlinson, a group of 140 doctors campaigning for Sen. Robert Tomlinson (R-Bucks). This year, she says about 100 Bucks County physicians have signed up to support the reelection of President Bush by making presentations to professional groups at hospitals, writing letters to newspaper editors and having the option of distributing campaign literature in their waiting rooms. Heine says the group is campaigning for Bush based on his support of MICRA-style reforms (modeled after California’s tort reform) which include caps on noneconomic awards, a sliding scale on attorney contingency fees and a greater proportion of the award going to patients if injured; as well as Bush’s approach to extend health care coverage to the uninsured by encouraging responsible consumerism; and his signing of the Medicare Modernization Act, which reversed scheduled cuts in reimbursement to physicians.

Not all physicians support Bush. Some 1,000 physicians statewide have signed on to “Pennsylvania Physicians for Kerry,” and plan to organize fundraisers and roundtable discussions on health care issues, according to the Kerry campaign. Gene Bishop, M.D., a general internist in Philadelphia whose practice is owned by the University of Pennsylvania Health System, says she is one of about 100 physicians in the Philadelphia area who are part of the coalition and are exchanging emails with colleagues to raise money and support for the Kerry campaign.

Bishop says she felt strongly about becoming involved in the presidential election and notes that Kerry addresses the reasons why physicians went into practice, including helping people who can’t afford some aspect of their care and supporting investments in health care technology, such as prescription tracking and order entry systems. “It’s hard to take care of people who can’t pay for what we prescribe, or can’t afford to see us,” says Bishop. She notes that Kerry addresses a key cause of the malpractice cost problem by attacking frivolous lawsuits instead of lawyers, i.e., by proposing that all malpractice claims be screened by an expert panel and by sanctioning lawyers who file multiple frivolous claims by barring them from practice for several years.

Physicians as Candidates

Two Pa. physicians are taking political activism to a higher level by running in the election themselves.

John Bulger, D.O., is running as the Republican candidate for the 107th District of the Pa. General Assembly against incumbent Robert Belfanti, Jr. (D-Columbia/Montour/Northumberland). He believes that a letdown like the loss of the caps bill in Harrisburg, had it occurred four or five years ago, would have been a death knell for physician faith in the political system. “At least there are enough physicians who now ‘get it’ and understand that politics is a long process. I sense a general energy to move forward that would not have been there in past years,” he says.

Bulger believes that physicians have a critical role to play in state and national politics, and he points to physicians in leadership positions, such as U.S. Sen. Bill Frist (R-TN), as instrumental in moving health reform, such as the recent Medicare Modernization Act, which among other things reversed physician reimbursement cuts by six percent and resulted in a net increase.

Bulger – the only physician candidate in the state election this year – notes that the absence of any physician in the Pa. legislature puts the physician community at a disadvantage, and he believes that an elected physician is needed to leverage expertise in legislative caucuses as a “go-to” person on health care issues. With experience as a PAMPAC board member, Bulger says that, “It’s a natural progression for physicians to run for public office and provide the next level of community service and constituent advocacy.”

Bulger believes that increasing overhead costs and decreasing reimbursements to physicians accrue from a lack of adequate checks and balances on large organizations in Pa., especially in the medical liability and health insurance markets, and that Pa.’s “archaic” business tax structure hurts physicians as small business owners.

He says that hundreds of physicians have given financial contributions to his campaign and have encouraged their colleagues to contribute, while many will be working the polls on election day. Bulger says he is also being supported through various physician listservs, including Donna Rovito’s emailed updates.

A few physicians have agreed to put Bulger campaign literature in their offices, although Bulger says that option is limited because most physician practices in his region are owned by Geisinger Health System, a nonprofit organization that is not permitted to endorse a political candidate. Bulger himself is director of inpatient services and general internal medicine at Geisinger Medical Center in Danville.

Word-of-mouth support by physicians to friends and family could influence the election, Bulger believes, as one to two thousand additional votes in his district represents ten percent of the total number of anticipated votes.

Melissa Brown, M.D., a general ophthalmologist in Flourtown, is running as the Republican candidate for the 13th District of U.S. Congress, against Pa. Sen. Allyson Schwartz (D-Philadelphia). She acknowledges that the “shenanigans” that buried the caps bill in Harrisburg has led to discouragement in the physician community, but urges physicians not to get frustrated with the political process. “There are opportunities to work hard. Reform at the policy level is what we have to accomplish,” she says.

Brown herself has not given up, having run for U.S. Congress in the 1998 primaries and having been narrowly defeated for Pa.’s 13th Congressional District seat in 2002 by Joe Hoeffel.

Brown says her priorities are to keep physicians in practice and taming runaway costs of health care through caps and other tort reforms to stabilize the medical liability system and attract more insurers to Pa., through evidence-based medicine, and by making joint negotiation options available to physicians in their dealings with health insurers.

She says that several physician fundraisers for her campaign are being held, and that physicians from various specialty organizations in the state have either endorsed or contributed to her campaign, including members of the Pa. societies of anesthesiologists, otolaryngologists, psychiatrists, surgeons, throracic surgeons, orthopedic surgeons, emergency medicine physicians, radiologists and pathologists.

Campaign literature describing Brown’s call for tort reform and preserving access to health care has been given to physicians at Abington, Holy Redeemer and Central Montgomery hospitals, as well as parts of Philadelphia, she says. The literature includes pamphlets with titles such as, “Who better to fight for your doctor than a doctor herself?” and “Keep doctors in their offices,” she notes. Her campaign has also distributed “Melissa Brown for Congress” lab coat stickers to make it easier for physicians to stimulate discussions with patients about her candidacy, she adds.

PACs Remain Active

Several of the medical community’s political action committees (PACs) say they are contributing to campaigns at a level similar to previous elections, while one is even breaking new ground on endorsement policy. PAMPAC, which did not endorse judicial candidates until the Eakin campaign three years ago, is now for the first time endorsing candidates for federal races, including Bush, Brown, and the incumbent Sen. Arlen Specter (R-Pa.), according to PAMPAC’s Executive Director David Thompson. The recent precedent of having endorsed judicial candidates, combined with intensified concern for liability reform at the national level, prompted PAMPAC’s board to go federal with its endorsements, says Thompson.

PAMPAC is also contributing to the campaigns of Bulger, Weber and Williams, adds Thompson.

The Pennsylvania Orthopaedic Society’s political action committee, OrthoPAC, continues its strategy of supporting Pa. General Assembly incumbents, regardless of party, who have supported the society’s positions, according to Jonathan Bigley, a lobbyist for the society and senior vice president for governmental relations of Triad Strategies. OrthoPAC’s list of supported legislators this year includes Williams, Piccola, state Sens. Jake Corman (R-Centre) and Chip Brightbill (R- Lebanon), and state Reps. Mike Turzai (R-Allegheny) and Curt Schroder (R-Chester), notes Bigley. OrthoPAC organizes about a dozen campaign fundraisers each election cycle and expects to reach or exceed that number this cycle, Bigley adds.

The Politically Active Physician’s Association (PAPA), has endorsed Bulger, Brown and Bush. A chief tool in the arsenal of the 5,000-member organization has been the “physician pyramid,” whereby physician offices function as conduits for physicians to educate patients and encourage them to contact legislators on the need for tort reform and other key health care issues, according to Anthony V. Coletta, M.D., PAPA’s statewide coordinator.

That approach has been far less effective than it could have been, says Coletta, and PAPA is now shifting its strategy in the belief that the medical profession doesn’t contribute a meaningful amount, economically, to the political process. PAPA is looking to form a “super” PAC to counter the 10-to-1 imbalance in state campaign contributions enjoyed by the state trial bar relative to the physician community. Such a project might require several hundred physicians to contribute $1,000 or so each year, Coletta believes, and PAPA is consulting with business and labor PACs to learn how to generate mechanisms to raise a significant amount of money to create a powerful PAC. Although there are far fewer physicians than labor or business members, Coletta notes that per-capita, physicians have more to contribute.

Coletta says that no statewide physician PAC has had a meaningful impact on the political process. “Sen. Greenleaf has received about $75,000 in political contributions from trial lawyers and between $3,000 to $6,000 from physicians. That says it all,” notes Coletta.

Coletta believes that a super PAC approach can succeed where advocacy may have failed. “At best, maybe five to ten percent of physicians have been engaged in the political process. The vast majority are disengaged and never were engaged,” says Coletta, who regards last year’s Code Blue Emergency rallies as “flash in the pan” activity to call attention to the medical liability problem. “A small group of doctors continue to be persistent on behalf of many doctors who are not politically engaged and never will be,” Coletta says, noting that he sees the same group of doctors writing checks, attending fundraisers, actively campaigning for political candidates, putting political literature in their offices and working the polls. PAPA believes that the Republican leadership in Harrisburg gave non-engaged physicians even less reason to participate, says Coletta. “But we hope to get a smaller number to be involved on a large scale in return for political access and influence,” says Coletta. “We want to be able to mobilize this PAC quickly to get the attention of key candidates,” he adds, noting that the project would take at least one to three years.

Coletta says that PAPA’s chief issues – malpractice reform through caps on awards and attorney fees, insurance reform to facilitate different mechanisms for malpractice insurance, reimbursement protection, and joint negotiation opportunity – remain under the aegis of a core group of legislators who control the process, with little hope of being enacted unless physicians “meaningfully get into the ‘pay to play’ mode.”

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