Louisiana Governmental Ethics with a Healthcare Twist
We all know that Louisiana’s Code of Governmental Ethics (Ethics Code) prevents all sorts of things. However, did you know that there are numerous hidden exceptions available in the healthcare arena allowing health care providers to do things that are otherwise prohibited by the Ethics Code?
Physicians and other medical professionals who are public employees can, in certain circumstances, accept payment from a third party for their admission, transportation, and reasonable lodging to an educational or professional development seminar
All public employees know the Ethics Code prohibits them from accepting anything of economic value from someone other than their public entity employer in connection with the performance of their job.
But, did you know that a special exception to the Ethics Code exists permitting a physician or other medical professionals employed by a public hospital (e.g., a hospital service district) to accept from a third party their admission, transportation, and reasonable lodging – things ordinarily expressly prohibited by the Ethics Code – to an educational or professional development seminar or conference that is designed to enhance the performance of their job duties? The requirements for taking advantage of this exception are: (1) the physician or other medical professional is invited to attend the seminar/conference by the sponsoring civic, nonprofit, educational, or political group or organization sponsoring the event, (2) the seminar/conference is held in the US or Canada, (3) the sponsoring entity cannot be lobbying the agency of the physician or other medical professionals to influence the passage or defeat of legislation, and (4) the head of the public employee’s agency approves the acceptance. If all of these requirements are met and the physician (or other person) accepts the payment from the third party for these expenses, he must file an affidavit with the Board of Ethics within 60 days disclosing the sponsor and the amount expended on his behalf.
Physicians and other medical professionals who are public employees can accept pharmaceutical samples and medical supplies from salespersons
Another exception to the Ethics Code’s prohibition against the acceptance of anything of economic value is applicable to healthcare professionals. A physician, health care professional, or appropriate public employee can accept pharmaceutical samples, medical devices, medical foods, and infant formulas – as long as they are for the administration or dispensation to a patient at no cost to the patient.
Physicians and other medical professionals can enter certain contracts with agencies, despite those contracts being under their own supervision or control in the agency
Governmental employees are usually aware that the Ethics Code generally prohibits public servants, legislators, and their family members from entering in to transactions that fall under the supervision or jurisdiction of their agency.
But, did you know an exception to the Ethics Code exists permitting physicians and other licensed health care professionals to enter employment contracts with the State, Charity Hospitals, and Department of Health and Hospitals that would otherwise be prohibited by the Ethics Code? A similar exception permits health care provider contracts by a physician or other licensed health care provider with the Office of Group Benefits to provide medical, surgical, and hospital services or medical equipment or pharmaceuticals at a reduced rate for members of the Office of Group Benefits Program as the sole reimbursement for such medical services, treatment, or health care.
Physicians and other medical professionals can avoid the prohibition against nepotism in certain circumstances
Public servants understand that the Ethics Code contains a general prohibition against nepotism, which is giving a preference of any sort to a relative. So generally, a physician or other healthcare professional is prohibited from being employed by an agency where its head, member of its governing authority, or its chief executive, is an immediate family member.
But, did you know that a limited exception exists to this general prohibition? A hospital service district or hospital public trust authority with a population of 100,000 persons or less may employ a licensed physician, registered nurse, or allied health professional as a health care provider, who is a member of the immediate family of any board or authority member or of the chief executive of the district or authority. If the entity does so, the chief executive or any board or authority member who has an immediate family member employee, must recuse himself from any decision involving the employee. Further, a district board or trust authority member and/or the chief executive who has an immediate family member so employed, must file a disclosure statement with the Board of Ethics by January 30 of each year; with the penalty for failing to timely file being $50 per day the statement is late, for a maximum of $1,500.
A number of unique exemptions from the prohibitions provided by the Ethics Code are applicable to an extremely limited number of physicians and other healthcare professionals
A licensed physician who is a member of the psychiatric faculty of and compensated by Tulane University can also be employed by the office of behavioral health of the Department of Health and Hospitals without violating the Ethics Code.
A retired public health physician can enter a professional services contract for employment by the office of public health of the Department of Health and Hospitals for part-time clinician services in parish health units if (a) there are no public health physicians available to perform the services and (b) the yearly contract does not exceed twenty percent of the retired employee's former salary.
A retired registered nurse can be employed by the Department of Health and Hospitals to perform health care services if the nurse was retired on April 1, 1990, and there are no registered nurses available to perform the services. However, the contract becomes null and void if a registered nurse becomes available to perform the services.
A licensed physician in parishes with a population of 125,000 or less, who are members of a board of commissioners for any hospital service district, may (a) contract with the hospital over which the board exercises jurisdiction, (b) subcontract with another provider who contracts with the hospital, and (c) own an interest in an entity that contracts with the hospital. However, a licensed physician involved in any of these contractual arrangements must recuse himself from participating in any transaction before the board relating to it.
Any physician member of a hospital service district board or commission that is legally required to have one or more physician members on its board/commission may lease space for the provision of health care services from a hospital under the jurisdiction of the board or commission for fair market value. However, any such licensed physician shall recuse himself from participating in any transaction before the board/commission involving that lease agreement.
Any licensed physician who is the child of a member of a board of commissioners of any hospital service district, in parishes having a population of 50,000 or less or for a hospital that is defined as a rural hospital pursuant to the Rural Hospital Preservation Act, may (a) contract for professional health care services with the hospital over which the board exercises jurisdiction, (b) subcontract with another professional health care provider who contracts for professional health care services with the hospital, and (c) own an interest in any entity that contracts for professional health care services with the hospital.
A licensed physician who is also a mayor of a municipality with a population that is not in excess of 5,000 persons may contract for the provision of health care services with the health insurer for the employees of his municipality.
Physicians can, in certain circumstances, avoid the post-employment restrictions provided by the Ethics Code
When leaving their status as a public servant is when persons usually learn that there is generally a two year waiting period before they can render services relating to their former state agency to or for another.
But, did you know that there is a special exception to this prohibition available to licensed physicians who served on the governing board or commission of a hospital service district? A licensed physician who is a former member of the governing authority of a hospital service district (or any legal entity in which the licensed physician is an officer, director, trustee, partner, or employee) can (1) be employed by or contract with the hospital service district or any entity over which the governing authority of the hospital service district exercises supervision or jurisdiction to perform professional health care services directly related to his expertise as a licensed physician, (2) contract with the hospital service district or any entity over which the governing authority of the hospital service district exercises supervision or jurisdiction for the purchase or lease of property related to the licensed physician's health care practice, and (3) can contract with the hospital service district or any entity over which the governing authority of the hospital service district exercises supervision or jurisdiction for the sale of the physician's practice.
These are some of the numerous hidden exceptions available to physicians and other healthcare providers allowing them to do things that are ordinarily proscribed by Louisiana’s Ethics Code. So always be sure to consult governmental ethics legal counsel – not just for a possible exception, but to make sure that you do not violate the Ethics Code.