‘Double Bill’ Cassidy’s Double Talk

Yesterday, Rep. Bill Cassidy, an Illinois native who is now the front-runner in the run-off election for U.S. Senate in Louisiana, responded to a series of recently disclosed public records calling into question the nature of his ongoing work relationship with Louisiana State University Health Science Center while also serving in the United States Congress. In separate interviews with The HillThe Times-Picayune, and The Advocate, Cassidy directly contradicted what his campaign spokeswoman, Jillian Rogers, told E&E Daily, an energy industry news publication, in July of this year, months before these records were released. Then, Cassidy and his campaign claimed that LSU-HSC was merely covering his out-of-pocket expenses for medical malpractice insurance. We now know that in addition to paying for his insurance, licensing fees, and continuing medical education classes, LSU also provided the Congressman with a base salary of $20,000.

Per the House Committee on Standards of Official Conduct, Cassidy was supposed to have been teaching part-time, 16 hours a month. Instead, his arrangement with LSU called on him to continue his clinical work for 30 hours a month.

Apparently, as his time sheets indicate, he wasn’t just being paid a salary for work he didn’t do, which has serious legal implications; he was being paid for work he couldn’t do, which has ethical implications.

The records, which were first reported here on CenLamar and by Jason Berry of The American Zombie, include 16 time sheets submitted by Cassidy to LSU-HSC, e-mail correspondence between Cassidy and LSU-HSC administrators, and Cassidy’s personnel status forms. Taken together, along with the House Committee on Standards of Official Conduct’s advisory opinion regarding Cassidy’s employment, the documents raise serious legal and ethical questions about the Congressman’s compensation and benefits package from LSU, as well as his actual work-related responsibilities as a tenured Associate Professor of Medicine, Teaching, and Research. According to time sheets, on at least 21 separate occasions, Cassidy billed LSU-HSC for work done on the same days as he attended committee meetings and cast roll call votes in Washington, D.C.

Cassidy downplayed those questions and refuted criticism of his work with LSU-HSC, arguing that his time sheets accounted for only a portion of the time he spent on the job and claiming that he frequently worked from Baton Rouge during the morning and flew to Washington, D.C. in time for the roll call votes in the evening. He also claimed that he occasionally checked in with LSU resident physicians working in area D.C. hospitals as a part of his job with LSU-HSC. Even if his baffling work schedule is true, it appears that he directly violated the guidelines established by the House Committee, and it raises further and perhaps even more important questions about how seriously Cassidy treated his full-time job in Congress. His same-day jaunts down to LSU-HSC’s clinics and back up to Washington, D.C., all on the taxpayer’s dime, are also troubling and profoundly hypocritical, particularly considering his relentless attacks against Mary Landrieu, his opponent in the race, for inappropriately charging $33,000 in travel expenses to her Senate office and not her campaign, an error for which she apologized and quickly rectified.

“(Cassidy) said he would log about three hours in the clinic, supervising residents who were treating patients, on Monday and three more hours on Tuesday morning,” reports The Advocate. “Then he would board a noon flight back to Washington, which would put him on Capitol Hill by late afternoon, in time to make votes.”

Cassidy, if he is to be believed, has spent his years in Congress working two different jobs, collecting checks and benefits from both the state and the federal government. As admirable as the practice of medicine may be, Bill Cassidy was supposed to hang up his stethoscope the day he took the oath of office as a Congressman. Physicians are prohibited from earning outside compensation for the practice of medicine, though they can be reimbursed for the actual expenses- not a salary- necessary to conduct charitable medical services. As previously reported, Cassidy was approved by the House Committee to teach classes for credit, on a part-time basis, at LSU-HSC. His correspondence with LSU-HSC administrators reveals that almost immediately after he was elected, he hoped to either be exempted from the “teaching” requirement or, alternately, to interpret the definition of “teaching” so broadly as to actually include his own practice of medicine.

In his campaign for the U.S. Senate, Cassidy has touted his experience as a medical doctor, often appearing in campaign commercials and direct mail pieces dressed in scrubs and a lab coat. He’s attempted to use his work as a doctor to deflect criticism over his voting record, and much to his credit, he has been effective, even if, at times, his deflections have been disingenuous. Yesterday, in his interviews with the media, Cassidy acted as if he was somehow being victimized for earning more than $100,000 from LSU-HSC since he was elected. “Cassidy said he regrets that his work at LSU — which he contends has helped many patients, some of whom ‘travel from Lake Charles and other communities to get treatment from me’ — is being made into a campaign issue,” The Times-Picayune reported. Given the hours he submitted in his time sheets to LSU-HSC, it is highly unlikely that Cassidy, while a member of Congress, actually “helped many patients” who traveled from all over the state to “get treatment” from him. But that’s not even the real issue: He was specifically and explicitly prohibited by the House Committee from earning a salary in the practice of medicine.

While attempting to justify the time sheets indicating that he worked for LSU-HSC on the same days he cast votes and attended committee meetings in Washington, D.C., Cassidy retreaded a story with The Times-Picayune he’s been fond of telling on the campaign trail. “He repeated a story he has told often about ‘doing a liver biopsy’ in Baton Rouge, and then rushing to the airport to catch the flight to Washington where he quickly changed into a tuxedo to attend a White House Christmas party hosted by President Barack Obama and First Lady Michelle Obama.” It makes for a great story, and it’s refreshing to know that Cassidy, unlike his former Republican colleague Jeff Landry, is willing to be seen with the President. But if he was attempting to illustrate that he abided by the legal and ethical prohibitions against earning a salary for the practice of medicine, this probably wasn’t the best example he could have used.

The medical profession is a noble one, but let’s not be deluded into thinking that a doctor who works for a charitable hospital is working for free. Before he was elected to Congress, Cassidy made more than $300,000 a year working “for charity.” He made the decision to relinquish his career as a physician in order to seek a full-time job in Washington, D.C. in the United States Congress. However, instead of giving up the perks of his former job with LSU-HSC, Cassidy remained on the payroll. LSU continued to pay him a salary, albeit reduced significantly; it continued to pay for his medical malpractice insurance, his licensing fees, and his continuing medical education classes.

Being a physician is obviously a point of pride for Rep. Cassidy, and he’s not to be faulted for that. But as both the record and his statements make clear, he never quite figured out how to justify his ongoing role with LSU-HSC. When he and his campaign spokeswoman were interviewed about the subject in July, they suggested that he was only working for his insurance coverage. Quoting from E&E Daily (bold mine):

Based on his some of his TV ads, Cassidy clearly sees his medical work as a political asset as he aims to oust Landrieu, the chairwoman of the Senate Energy and Natural Resources Committee, who has served three terms in the Senate and whose political career stretches back to 1979, when she was just 23 years old.

While the American Medical Association’s political action committee tabulates 20 physicians currently serving in Congress — with 17 of them in the House — a review of recently released financial disclosure records suggests Cassidy is among a small subset of lawmakers who continue to see patients in between pushing legislation on Capitol Hill.

Cassidy’s most recent financial disclosure report reveals he earned $20,000 for his work in 2013, the same salary he has claimed in each of his financial disclosure reports since 2009.

In his newest report, Cassidy notes that the salary — which he detailed in a previous report as payments of $1,666.70 per month — “merely covers his expenses” for working at the Baton Rouge-based facility. In his 2008 report, prior to starting his House term, Cassidy reported receiving a $305,000 salary.

“Dr. Cassidy’s expenses are for medical liability insurance. As you may know, Medical teaching is often taught bedside — through procedure demonstration, clinic supervision and advising on particular patient issues,” Cassidy spokeswoman Jillian Rogers told E&E Daily in an email.

That’s a nice spin, but none of it is true, at least if Cassidy’s time sheets and his statements to the House Committee are to be taken as factual. He wasn’t being compensated for his own out-of-pocket insurance expenses; LSU already covered those, something he later acknowledged to The Times-Picayune. The distinction here is important, because if Cassidy was merely being reimbursed for his out-of-pocket insurance costs, as his spokeswoman asserted, he would never need to account for the hours he spent teaching. At the same time, however, his spokeswoman attempts to cleverly include Cassidy’s bedside consultations, surgeries and operations on patients (which she recasts as “procedure demonstration”), “clinic supervision and advising on particular patient issues,” all under the rubric of “teaching;” indeed, everything Cassidy did would be considered teaching.

According to The Hill, Cassidy, who claimed to have been the only liver doctor in the system, had once asked to be fired if he failed to bring value. Cassidy was later granted a leave of absence in April. Quoting (bold mine): 

A source close to the Landrieu campaign argued to The Hill that the congressman knowingly maintained his tenured status even though he didn’t meet the minimum level of requirements. Cassidy said it’s LSU’s decision to terminate tenure, and that “it’s not absolute” based on whether he’s meeting minimum requirements.

Cassidy took a leave of absence from LSU in April and hasn’t received any paychecks since then, but he still goes into the clinic and performs pro-bono work for the school by working with students on residency in Washington.

Cassidy offered a somewhat different explanation to The Advocate (bold mine): 

“I emphasized (to LSU), ‘If ever you think I do not bring value please terminate me’, and they say, ‘No, you bring value.’ And demonstrably I do,” Cassidy said.

Emails acquired by The Advocate indicated that LSU officials worried the situation could get audited and cautioned medical school officials to carefully detail the work Cassidy did.

Cassidy described the terms much more casually and called the monthly $1,666.70 a “stipend,” rather than a strict set pay for set hours arrangement.

Though some of the emails mention a contract, no actual contract has been released.

In an October 2009 letter written by Dr. George Karam, who is the head of internal medicine and Cassidy’s direct boss, wrote of the congressman’s stipend: “The payment is for services on an ongoing basis, not for individual presentations or lectures.”

Karam has not responded to calls or emails seeking comment.

The work, we now know was never sufficiently detailed. Believe it or not, despite Cassidy’s tenured position, he claimed yesterday to The Times-Picayune (bold mine):

As for tenure, Cassidy said he wasn’t even aware he had been kept in a tenured position.

“It doesn’t matter to me,” Cassidy said. “Who cares? If they aren’t’ satisfied with me and want to get rid of me, that’s fine. They’ve gotten rid of lots of tenured people in recent years.”

This seems remarkable. Cassidy didn’t know his job title; he didn’t know how often he worked; he didn’t even seem to understand his approved and prohibited job responsibilities.

In situations such as these, the simplest explanation is usually the correct one. Here, it appears that Cassidy was more concerned with maintaining his medical malpractice insurance and payments for his continuing medical classes than he was in actually teaching courses as a professor, and in order to do that, he would need to intermittently submit hasty and incomplete time sheets documenting the bare modicum of work needed to pass muster.

Perhaps he hoped that would have worked for his purposes, at least until December 6th, but it doesn’t even come close to answering the real and legitimate questions raised by these reports.