Frist’s Possible Conflicts Seen as No Problem Under Senate Rules

Sen. Bill Frist, his wife and children own millions of dollars worth of stock in HCA Inc., the country’s largest for-profit hospital chain. Frist, poised to become Senate majority leader, is also promoting legislation to reshape the nation’s health-care system.

In some circles, including the executive branch of the federal government, this would be considered a conflict of interest. But not in the U.S. Senate, whose mostly wealthy members have embraced ethics rules that enable them to hold on to their fortunes while they promote bills that affect their personal financial interests.

“The public should not expect any ethics committee proceedings regarding the new majority leader’s role in health legislation because that’s not the Senate’s way,” said Charles Tiefer, a University of Baltimore law professor and nationally recognized authority on congressional ethics practices.

Since his election in 1994, Frist -- the Senate’s sole physician -- has been applying his experience as a heart surgeon to champion a long list of health-care issues. Those include prescription drug coverage for the elderly, coverage for the uninsured, bioterrorism and medical research.

Frist has rejected suggestions that because of his investments in HCA and some smaller medical providers, he should recuse himself from health-care legislation. He has argued, instead, that the Senate benefits from his expertise.

Frist spokesman Nick Smith pointed to a Senate ethics committee ruling that allowed Frist to keep his HCA stock and still vote on health-care issues. But, he said, “the senator went the extra mile” by putting his holdings in a blind trust.

Smith said that because the holdings are being managed by others, it is impossible to know what they consist of. But Frist’s Senate financial disclosure forms indicate that he, his wife and children hold millions of dollars in HCA stock.

For all of his medical knowledge, Frist -- who keeps a white lab coat and an emergency doctor’s bag in his office -- rarely strays from the party line. Critics say he frequently simply repackages the GOP’s health-care issues with his more extensive medical knowledge about the issues.

“There are numerous concerns about whether his allegiances are with health-care companies or with actual consumers who are sick and ill and need treatment,” said Gene Kimmelman, co-director of the Washington office of Consumers Union. “We’ve never found him to be very sympathetic to universal [health insurance] coverage or affordable health care for low- and moderate-income Americans.

“It’s fine that he delivers care and offers his own services to others on a voluntary basis,” he said. “But his positions are a different story.”

Ethics rules that apply to the executive branch require top federal officials to sell financial holdings that might potentially conflict with their official duties under certain circumstances. In the House, members are barred from voting on any issues in which they have a direct pecuniary interest -- a guideline that some senators voluntarily observe.

In the Senate, members can vote on legislation that benefits them personally as long as it also benefits the public. Said Tiefer: “The Senate’s rules technically allow senators a lot of wiggle room.”

Frist became a multimillionaire through his acquisition of HCA stock and smaller investments in other medical concerns. But unlike his brother, Thomas F. Frist Jr., and his father, HCA founder Thomas Frist Sr., the senator never worked for HCA, which owns and operates 180 hospitals and other health-care facilities in 23 states, Britain and Switzerland.

Supporters say that by eschewing the hospital executive ranks for patient care and public service, Frist has demonstrated that he is more interested in the public interest than financial self-interest.

He won praise, for instance, for his frequent public briefings in the aftermath of the anthrax attacks on the Capitol in 2001.

Frist also has had occasion to put his emergency doctor’s bag to use on Capitol Hill. In one instance, he helped save the life of a man shot after killing two Capitol Police officers and wounding two others. First also resuscitated Sen. Strom Thurmond (R-S.C.) when the aging senator collapsed on the Senate floor in October 2001.

The list of Frist political contributors is dominated by health-care companies, unlike most politicians whose financial support comes mainly from lawyers and financial institutions.

For the 1997-2002 Senate election cycle, the health-care industry gave Frist $1,072,157 in contributions, more than he received from any other sector, according to the Center for Responsive Politics, a Washington research organization.

In his two years as chairman of the GOP’s Senate campaign committee, Frist is also credited with luring health-care industry donors to the Republican Party -- a move that helped bolster the GOP in recent elections.

Many colleagues praise Frist as a smart and well-intentioned public servant. But with his profile rising, critics say the self-assured surgeon needs to be more attuned to how his actions are seen by others.

“It is useful to have someone who is a physician and was a surgeon before he left to enter politics because medical care is going to be a huge and important issue,” said Arnold S. Relman, a professor emeritus at the Harvard University medical school and former editor of the New England Journal of Medicine.

“But I think he’s made a mistake if he thinks that as long as he puts his HCA holdings in a blind trust he is off the hook,” Relman added. “No way can a human being be indifferent. I think the public ought to be reassured that a man in such a key position as Bill Frist should be free of such financial influence.”

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Times staff writer Doyle McManus contributed to this report.