Three Long Island doctors selected to lead a committee that recommends the drugs two Suffolk hospitals stock for patients accepted tens of thousands of dollars from pharmaceutical companies while serving on the advisory panel.
The doctors -- affiliated with John T. Mather Memorial and St. Charles hospitals in Port Jefferson -- accepted about $125,000 from drugmakers between 2009 and 2013, company records show.
Databases posted on the websites of various drugmakers -- including pharmaceutical giants Merck, Novartis and Pfizer -- list the payments.
The Physician Payments Sunshine Act passed by Congress in 2010 requires drugmakers to start reporting such payments this year. However, some drugmakers began reporting the payments before the 2014 deadline -- either voluntarily or in settlement of lawsuits brought against them by the Justice Department.
A continuing Newsday examination of financial links between drugmakers and Long Island doctors traced the three physicians to a key committee for Mather and St. Charles, which share staffs.
Dr. Philip Nizza, Dr. Alan Kaell and Dr. Kenneth Fishberger have all served for more than 10 years on the hospitals' joint pharmacy and therapy panel, known as the formulary committee.
And all three have served as the committee's co-chairmen.
Paid for promoting
Nizza and Kaell received most of the payments for speeches promoting the companies' drugs. Some smaller payments were recorded as "noncash" transactions for meals and travel expenses related to the doctors' attendance at drugmakers' promotional events.
Last September, St. Charles and Mather announced Nizza would be replacing Kaell as co-chairman of the formulary committee. Fishberger is the other co-chairman.
Other companies that have paid Nizza, Kaell and Fishberger include Eli Lilly, Forest Laboratories and AstraZeneca.
Two of the doctors defended their acceptance of money from drugmakers -- Nizza said he only suggested drugs needed by patients to the formulary committee while Fishberger said he deserved to be paid because his presence at drugmakers' promotional events helped boost their credibility. Kaell could not be reached for comment.
Many medical ethicists frown on the practice of doctors accepting money from drugmakers -- arguing they can develop a bias toward one company's drugs and fail to recommend the best possible medications for patients.
A Georgetown University expert on pharmaceutical marketing said formulary committee members should avoid all conflicts of interest.
"Obviously, formulary committee members are like gold to pharmaceutical companies," said Dr. Adriane Fugh-Berman, director of a Georgetown project that examines drug marketing.
Josephine Johnston, a bioethicist at the Hastings Center in upstate Garrison, agreed. "It shouldn't be allowed for the head of the formulary committee [to accept money from drugmakers]," Johnston said.
Generally, formulary committees are composed of doctors and other health care professionals.
The American Society of Health-System Pharmacists, a professional group based in Bethesda, Md., cautions against financial conflicts on formulary committees.
"A conflict of interest, financial or otherwise, may interfere with professionals' ability to make evidence-based decisions, and even the appearance of a potential COI [conflict of interest] can undermine a formulary decision," ASHP guidelines state.
Hospitals have varying policies concerning payments from drugmakers -- some, like St. Charles and Mather, permit formulary committee members to receive such payments.
New transparency rules
Hospital spokesman Stuart Vincent said Mather and St. Charles did not require doctors to disclose financial links to drugmakers until 2013.
"Upon reappointment or application, physicians on or applying to the joint Mather/St. Charles medical staff must disclose all financial interests in drug or medical device companies," Vincent said.
Vincent said a hospital pharmacy director researches drugs proposed for the formulary and the committee uses various safety and efficacy guidelines to reach its decisions. If the committee approves a drug, Vincent said, the boards of the two hospitals have the final say.
One former member of the formulary committee, Dr. Michael Shanik, a Smithtown endocrinologist, accepted more than $100,000 from drugmakers between 2010 and 2013 for speaking, consulting and covering travel and other expenses, databases show.
It is unclear whether Shanik accepted pharmaceutical money in 2008, the year he was on the committee, because payments were not public at that point.
When Newsday phoned Shanik about the payments he accepted from drug companies, he acknowledged taking about $30,000 from Novartis, mostly for making promotional speeches for Novartis between 2010 and 2012. He then ended the conversation.
Vincent said the committee co-chairmen "facilitate" its business but don't propose new drugs and don't vote on them as some other committee members do.
However, Nizza, an East Setauket infectious disease specialist, said he had proposed at least two drugs for the formulary.
Nizza would not identify the drugs he proposed but said they were made by Merck & Co., of Whitehouse Station, New Jersey.
One database shows Merck paid Nizza at least $27,000 -- mostly for promotional speeches. In total, Nizza received about $84,000 from drugmakers while he was on the committee.
When Newsday told Vincent that Nizza had said he had proposed drugs to the committee, the hospital spokesman said Nizza was an exception.
Vincent said Nizza is permitted to propose drugs because he is a "super-specialist" in infectious diseases and proposes drugs that only specialists like himself can prescribe in the hospitals.
"I have brought drugs to the committee [for consideration]," Nizza said in an interview. "I felt what I was adding addressed a specific need."
"This is a hot-button issue, I know, and it's difficult," Nizza said. "It's been associated generally as a bad thing."
"You can have ethics and speak for a pharmaceutical company." Nizza said. "I only speak for products that . . . I've had experience with."
Nizza said he once agreed to have a Merck antifungal medication removed from the formulary because the hospitals' pharmacy director had found a cheaper product and told him it worked just as well.
A 2013 government report on conflicts of interest in Medicare prescription drug decisions found doctors paid by drugmakers appeared more likely to ask hospitals to add drugs from those companies to their formularies.
Federal and state prosecutors in New York are suing Novartis Pharmaceuticals, a Swiss drugmaker with U.S. headquarters in East Hanover, New Jersey, in connection with payments it gave doctors for promoting its diabetes and blood pressure pills.
A lawsuit, filed by Manhattan U.S. Attorney Preet Bharara last year, accuses Novartis of paying illegal kickbacks to doctors across the country. Prosecutors contend the speeches provided an excuse for Novartis to pay doctors to keep prescribing its drugs in high volumes.
The lawsuit describes Long Island as a hotbed for the scheme.
A 2011 whistle-blower's lawsuit alleged that Fishberger and other Long Island doctors had financial links to Novartis.
That lawsuit, filed in Manhattan by whistle-blower Oswald Bilotta, a former Long Island Novartis sales representative, states that to keep Fishberger prescribing its cardiovascular drugs at high levels, the company arranged a Bronx job for his son as one of its sales representatives.
Novartis is seeking dismissal of the federal lawsuit. Neither lawsuit has proceeded to trial.
Fishberger, a Port Jefferson internist, denied Novartis arranged a job for his son. He said his son got the job on his own after graduating from Boston University.
Payment databases show Fishberger received payments between 2009 and 2013 from drugmakers totaling about $1,700 for meals and attendance at drugmakers' events.
'A witch hunt'
Fishberger first denied accepting any payments -- citing his position on the formulary committee. "It's a conflict of interest for me, taking money from a drug company and being in charge of a formulary," Fishberger said.
But when told about the payment databases, Fishberger said he took "three small payments" from drugmakers.
Fishberger said he deserved to be paid for his attendance at events. "Your presence gives them more credibility," he said.
Fishberger said federal investigators had contacted him as a result of the U.S. attorney's lawsuit against Novartis. He said the government had "untrue data" about him.
"I was subpoenaed and interviewed," Fishberger said, noting he brought an attorney with him. "It's kind of rude and it's kind of a witch hunt."
Dr. Carl Elliott, a physician and bioethics professor at the University of Minnesota Medical School, said drugmakers have long sought formulary committee members to help sell their products.
"Someone who holds the key to the hospital drug cabinet -- those are exactly the people they want to get on their payroll," Elliott said. "They cultivate them."
Newsday found an online LinkedIn resume posted by Jennifer Confort, a former Novartis sales representative on Long Island.
The resume noted that Confort worked to have Diovan -- a Novartis blood pressure pill -- "added to the formularies at Peconic Bay Medical Center, Eastern Long Island, Southampton, Mather and St. Charles hospitals."
Confort acknowledged in an interview that she had approached Fishberger to get Diovan placed on the St. Charles and Mather formulary. Fishberger said he spoke to her.
"Yeah, I called him as a physician," Confort said. "I just spoke with physicians and asked for their support. He was open. He had good experience with the drug."
A few days after Newsday spoke to Confort, all references to Long Island hospital formularies had been deleted from her online resume.
The third doctor who took drugmakers' money while serving on the St. Charles and Mather formulary committee was Kaell, of Port Jefferson Station, with specialties in internal medicine and rheumatology.
Employees at Kaell's old practice said he has retired. Kaell received about $39,000 from drugmakers, the databases show.