Cleveland Clinic Board Revises Conflict-of-Interest Policies

The Cleveland Clinic's board of trustees on Monday approved a "broad revision" of the clinic's conflict-of-interest policy that will bar doctors and administrators from making investment decisions, the Wall Street Journal reports. The revisions follow news articles in the past year documenting potential conflicts of interest among some clinic physicians and executives, including CEO Delos Cosgrove. The Cleveland Clinic is regarded as "one of the most entrepreneurial hospitals in the country and has long teamed up with industry to develop devices and drugs," the Journal reports. While partnerships with industry are expected to continue, the hospital "now acknowledges that it needs to do a better job of keeping tabs on those relationships and making sure patients are aware of them as well," the Journal reports. Under the changes, investment decisions will be made by trustees, who will have additional oversight of conflict-of-interest issues. Previously, most conflict-of-interest matters were handled by committees made up of doctors (Armstrong, Wall Street Journal, 5/10). All clinic employees and trustees will be subject to conflict-of-interest monitoring. The trustees have created a permanent board committee, which will receive regular reports about how potential conflicts of interest are handled and determine how to address such concerns. Under the changes, doctors with financial relationships with specific pharmaceutical or device companies will not be allowed to participate in purchasing decisions about those companies' products. In addition, the clinic plans to review patient consent forms to determine if patients are adequately informed about potential conflicts (Abelson, New York Times, 5/10). A database "will flag companies with financial connections to both trustees and staff so hospital purchasing agents can review those transactions to make sure they are appropriate." The hospital's Institutional Review Board, which oversees clinical-trial work, will receive additional information about financial interests among research staff, and patients enrolled in trials will be informed about those relationships (Wall Street Journal, 5/10).

Reaction
William MacDonald, a clinic trustee and vice chair of the National City Corporation, said, "We're taking all the excuses away" for conflicts of interest. Joseph Scaminace, chair of the board's conflict-of-interest committee and CEO of the OM Group, said the changes "reaffir[m] some of the actions we were already taking" (New York Times, 5/10). Scaminace said trustees will monitor conflicts of interest among potential board members, but he added that some trustees may have financial ties to the clinic because "we live in a community where it is difficult to not have some kind of minor activity" with the clinic. David Rothman, director of the Center on Medicine as a Profession at Columbia University, said, "The active engagement of boards of trustees at health care institutions is new. The bottom line is this is encouraging" (Wall Street Journal, 5/10).