For years, Republican Tom Coburn juggled his duties as a House member and a family physician back in Oklahoma, where he delivered dozens of babies annually.
But since winning a Senate seat last fall, Coburn has clashed with Senate ethics committee members over whether he could continue to do double duty as a lawmaker and an obstetrician. Now, Coburn says, the ethics committee has ruled that his private practice constitutes a potential conflict of interest with his work in Washington, and it has given him until Sept. 30 to close his office in Muskogee, Okla. An outraged Coburn is vowing to fight the ruling, arguing that the panel's decision contradicts the Founding Fathers' desire for lawmakers to retain ties to their communities.
In an interview yesterday, he vowed to seek the backing of sympathetic grass-roots groups to try to persuade the panel to alter Senate rules and open the way for doctors in the Senate to see patients for pay.
"My hope," he said, "is to get a rules change that will allow me to continue to practice medicine."
Coburn and Senate Majority Leader Bill Frist (R-Tenn.) are the only senators who are physicians. For nearly two decades, Senate rules have barred members from holding outside professional jobs, such as those as lawyers, real estate agents and physicians, for fear that such services -- and compensation for those services -- might conflict with their role as policymakers. The Senate panel refused Coburn's request to grant him a special exception once he closes his business.
The decision is a blow to the freshman who pledged at almost every campaign stop last year to serve as a citizen legislator -- a senator in Washington and an obstetrician-gynecologist at home.
The maverick conservative won election to the Senate last November after a bitter battle with Democrat Brad Carson. Coburn's medical practice became an issue when he was accused of sterilizing an underage women without her consent. Coburn denied the charge and called it a smear tactic by his opponent.
Last December, the chairman and vice chairman of the Senate ethics panel warned Coburn in writing that long-standing rules prohibit senators from receiving compensation for various professions, including a medical practice. The committee asked Coburn to shut down his practice by the time he was sworn in.
In response, Coburn, 57, stopped accepting new patients "to comply with the spirit" of the request and began negotiating with the committee to waive the rules in his case. Meanwhile, he has continued to see patients and deliver babies in technical violation of those rules.
Coburn argued that the nation's founders envisioned that legislators would continue to function as citizens in their communities, including as doctors. He said that he wanted to make only enough money as a doctor to cover his expenses, and that working as a physician does not pose the same kind of potential conflicts of interest that being a lawyer might.
He said that he has a duty to his patients, many of whom are indigent, and that he needs to continue his practice to maintain his skills and his medical license.
"I am currently caring for many high-risk patients including some who have multiple sclerosis and other debilitating conditions," Coburn wrote the committee. "I simply cannot abandon those patients. I trust that the committee can imagine how abruptly terminating my practice would violate my medical ethics."
While Coburn served in the House from 1995 to 2001, that chamber's ethics committee allowed him to practice medicine provided he did not receive net income beyond his expenses.
But Senate ethics rules do not differentiate between net and gross income, and the Senate panel concluded on March 18 that physician-lawmakers are barred from taking any money from patients regardless of expenses.
Sen. George V. Voinovich (R-Ohio), the ethics panel's chairman, and Sen. Tim Johnson (D-S.D.), its vice chairman, informed Coburn by letter that "it would not be possible, prudent or fair" for the panel to reconsider or reinterpret the rules, which have been in place since 1977.
The original rules were written during the reform-minded period after the Watergate and South Korea influence peddling scandals when lawmakers were cracking down on their own conflicts of interest and other possible ethical lapses.
The Senate committee did agree to Coburn's request, conveyed by J. Steven Hart, his attorney, to allow the senator to take nine months to close shop, enough time to see his pregnant patients to term.
Coburn said that he will continue to treat patients until the end of the year, but, in line with the ethics panel's decision, will not take any payment from them after Sept. 30.
In the meantime, he said, he intends to "live by the rules" but added that "I would love to enlist anybody's help that I can to put a balanced perspective on the issue."