A1 A1
An interesting article in today's newspaper

Price hike: Guilford schools sports tickets will cost $1 more. The extra money will help with athletics costs districtwide, officials say. Page A6

Transcripts highlight Sondland's role in pressuring Ukraine

WASHINGTON — Transcripts released Saturday in the impeachment inquiry show Ambassador Gordon Sondland playing a central role in President Donald Trump’s effort to push Ukraine to conduct political investigations as a condition for receiving needed military aid.

The fresh details come from hundreds of pages of testimony from Tim Morrison, a former top official at the National Security Council. They contradict much of the ambassador’s own testimony behind closed doors. Both Morrison and Sondland are expected to testify publicly before the House next week.

While some, including Trump, have begun to question Sondland’s knowledge of events, Morrison told House investigators the ambassador “related to me he was acting — he was discussing these matters with the President.”

Morrison, a longtime Republican defense hawk in Washington, largely confirmed testimony from current and former officials testifying in the impeachment inquiry. But his account also provided new insight on what others have called a shadow diplomacy being run by Trump’s personal lawyer, Rudy Giuliani, often at odds with U.S. national security interests.

As Sondland, Giuliani and others tried to persuade new Ukraine President Volodymyr Zelensky to launch the investigations Trump wanted of his Democratic rivals, Morrison said he “tried to stay away.”

Morrison called this the Burisma “bucket” — investigations into the family of Joe Biden and the role of Democrats in the 2016 election. It’s a reference to the gas company in Ukraine where Biden’s son Hunter was invited to join and served on the board at the same time his father was leading the Obama administration’s diplomatic dealings with Ukraine.

In particular, Morrison described a Sept. 1 meeting Sondland held with a top Zelensky aide, Andriy Yermak, on the sidelines of a summit in Warsaw.

Morrison said he witnessed the exchange and that afterward Sondland bounded across the room to tell him what was said.

Sondland told him that “what could help them move the aid was if the prosecutor general would go to the mike and announce that he was opening the Burisma investigation,” Morrison testified. The prosecutor general is Ukraine’s top legal official.

“My concern was what Gordon was proposing about getting the Ukrainians pulled into our politics,” Morrison said. He added: “It was the first time something like this had been injected as a condition on the release of the assistance.”

Morrison, who announced Oct. 30 he would step down from the NSC, was brought to the White House by then-national security adviser John Bolton.

Within hours of the conversation in Warsaw, Morrison called Bolton and the top U.S. official in Ukraine, William Taylor. He told them both about the conversation and his concerns about it.

Bolton told him: “Stay out of it, brief the lawyers.”

For weeks, top administration aides had been struggling to understand why the $391 million in security aid for Ukraine was being delayed. There’s longstanding bipartisan support for backing up the young democracy bordering an aggressive Russia.

Others have testified they were being told by officials at the Office and Management and Budget it was being stalled at the direction of the president’s acting chief of staff, Mick Mulvaney.

A few days later, on Sept. 7, Sondland was on the phone telling Morrison he had just gotten off a call with the president.

“I remember this because he actually made the comment that it was easier for him to get a hold of the President than to get a hold of me,” Morrison said.

Morrison said Sondland related that Trump assured him there were no strings being attached to the military aid for Ukraine.

“The president told him there was no quid pro quo, but President Zelensky must announce the opening of the investigations and he should want to do it,” Morrison recalled Sondland saying.

Morrison had what he called a “sinking feeling” — that the aid would may not be released.

“I also did not think it was a good idea for the Ukrainian President to — at this point I had a better understanding — involve himself in our politics,” he said.

Only days later, after three congressional committees said they were launching inquiries into efforts by Trump and Giuliani to investigate the Bidens, was the money released.

Morrison said that at a Sept. 11 meeting at the White House that Trump was persuaded to release the money. Vice President Mike Pence and Sen. Rob Portman of Ohio “convinced the president that the aid should be disbursed immediately,” said Morrison, who was briefed about the meeting but did not attend. “The case was made to the president that it was the appropriate and prudent thing to do.”

Transcripts were also released from the testimony of Jennifer Williams, a special adviser to Pence, that raised new questions about how much Pence knew about the alleged trade-off that’s central to the impeachment inquiry.

Impeachment investigators met for a rare Saturday session with a White House official directly connected to Trump’s block on military aid to Ukraine, the first budget office witness to testify in the historic inquiry.

Mark Sandy, a little-known career official at the Office of Management and Budget, was involved in key meetings about the nearly $400 million aid package.

Sandy’s name had barely come up in previous testimony. But it did on one particular date: July 25, the day of Trump’s call with Zelensky. That day, a legal document with Sandy’s signature directed a freeze of the security funds, according to testimony from Defense Department official Laura Cooper. Investigators had shown her a document as evidence.

Trump on the call had asked Zelensky for a “favor,” to conduct an investigation into Biden and his son. The link between Trump’s call and the White House’s holding back of security aid is the central question in the impeachment inquiry. Democratic House Speaker Nancy Pelosi has called it “bribery.”

Trump, who says he only wanted to root out corruption in Ukraine, says he did nothing wrong.

Sharpening the arguments, both sides are preparing for an intense lineup of public hearings in the coming week. Americans are deeply split over impeachment, much as they are over the president himself.

Twenty-eight doctors in North Carolina received more than $1 million from drug companies

This article was revised on Nov. 18, 2019, to correct the amounts received by two Greensboro doctors.

Twenty-eight doctors in North Carolina, including one from Greensboro, received more than $1 million each in speaking fees and other payments from pharmaceutical and medical device companies from 2014 through last year, according to data by ProPublica's Dollars for Doctors project.

Twelve of those doctors practice in the Charlotte area. Eight are from the Triangle area.

For years, the relationship between doctors and drug and medical device companies has raised conflict-of-interest concerns and may make some patients nervous that those payments could influence the doctor's treatment plan.

But some experts say those ties are necessary.

The two Greensboro physicians who received the most are affiliated with Cone Health. Dr. Daniel R Bensimhon, who works in the Advanced Heart Failure Clinic at Moses Cone Hospital, collected about $2 million between 2014 and 2018. Dr. Mohamed K. Mohamed, who specializes in medical oncology at the Cone Health Cancer Center at Wesley Long, got $875,142 during that same time period.

Cone Health declined to make the doctors available for an interview, but said in a statement that it had adopted policies to ensure ethical interactions between their physicians and the health care industry:

“Relationships between physicians and the health care industry, such as pharmaceutical and medical device companies, help foster innovations that improve the quality and safety of patient-centered care. While Cone Health supports and encourages genuine scientific and educational collaboration, Cone Health and Cone Health Medical Group expect exemplary conduct on the part of their employed and affiliated physicians in the workplace and the community.”

Jona Hattangadi-Gluth is an associate professor at the University of California San Diego School of Medicine who has studied industry payments to physicians. She said those payments aren’t necessarily a bad thing.

“Medicine as a field wouldn’t evolve and treatments and therapies and devices wouldn’t evolve without a close collaboration between industry and physicians,” Hattangadi-Gluth said.

However, there’s still evidence that industry payments may influence doctor behavior, she said.

A 2016 ProPublica analysis of federal data showed doctors who accepted money from pharmaceutical companies prescribed a higher percentage of brand name drugs than doctors who didn’t.

ProPublica is a nonprofit newsroom that focuses on investigative journalism.

Data on which doctors are receiving money from drug and medical device companies is available through the Centers for Medicare and Medicaid Services’ Open Payments program.

The program was created as part of the Affordable Care Act, and collects and publicizes information on the financial relationships between physicians and the health care industry.

The ProPublica Dollars for Doctors program uses that information to make an easily searchable database. Patients can look up their physicians by name on the website to see how much money the doctor takes from drug and device companies — and from which companies.

“I think we’d like to believe that all physicians are going to be completely objective and only use the drug or device that has the most data, that is the most evidence-based,” Hattangadi-Gluth said. “But I think there’s evidence, certainly, that higher payments or certain payments from certain companies are affecting behavior. We know it affects behavior.”

Top earners

The North Carolina doctor who received the most money from drug and device companies was Kimberly Livingston of Raleigh, with a total of $3.9 million from 2014 to 2018, according to the ProPublica database. Second most was R. Williams of Durham, at nearly $3.1 million.

The top earning Charlotte-area doctor — and fourth in the state — is William Hodges Davis, a foot and ankle specialist at OrthoCarolina, who made $2 million from drug and device companies over those five years, according to the database.

The Observer asked to speak to doctors through Atrium Health and OrthoCarolina but none was made available. Other doctors could not be reached.

Payments from drug and device companies include consulting fees, honoraria, gifts or entertainment, but do not include royalty or research fees. ProPublica excluded royalties from the database reviewed by the Observer because royalties are payments that compensate doctors and inventors for intellectual property.

The ProPublica database shows that 101 North Carolina doctors received at least $500,000 in the past five years. Those doctors received a combined $94 million during that time.

Of that group, 33 are from the Charlotte area, and another 38 are from the Triangle.

What’s more, according to Dollars for Doctors, 35 doctors statewide received at least $500,000 from drug or medical device companies for services other than consulting — typically, for promotional talks about a product. But in some cases, drug companies have used this label for other types of payments.

Ties that bind

Most of the Charlotte- or Triangle-area doctors listed as top earners in the Dollars for Doctors project are affiliated with a larger hospital system or medical group.

Atrium Health had the biggest portion of doctors on the Charlotte-area list. Thirteen of the 33 Charlotte-area doctors who received at least $500,000 from drug or medical device companies, excluding royalties, are Atrium physicians, according to the hospital system’s website.

“Due to the talent of Atrium Health physicians, members of the healthcare industry often seek their expertise, whether that is to educate fellow physicians, improve patient therapies or otherwise contribute to cutting edge treatments,” Atrium said in a statement.

Physicians are required to disclose relationships with health care companies and get approval to avoid conflicts of interest, Atrium said.

Certain specialties are more likely to interact directly with the health care industry, Hattangadi-Gluth said.

In her research, she’s found that surgeons tend to receive more money from drug and medical device companies, especially in specialties like orthosurgery and neurosurgery, she said.

Six of the Charlotte-area doctors on the list are OrthoCarolina physicians, according to the OrthoCarolina website.

OrthoCarolina is proud of the cooperation between drug and device companies and its physicians, spokeswoman Logan Kureczka said in a statement.

“Innovation and development of new and improved products and techniques cannot occur without involvement of physicians,” Kureczka said. “... OrthoCarolina is proud that a number of our providers are recognized as innovators in delivery of orthopedic care.”

All payments from drug and medical device companies to OrthoCarolina physicians are reviewed by a compliance committee of OrthoCarolina’s governing board each year, Kureczka said.

“Avoidance of conflict of interest in patient care is a critical part of our compliance program,” she said.

Two of the 33 are Novant Health physicians, according to Novant’s website.

“Novant Health’s physician-led conflict of interest process requires physicians to disclose when they are paid by pharmaceutical or medical device companies,” a Novant Health spokesperson said in a statement. “This policy helps maintain the integrity of Novant Health’s decision making related to what drugs or devices are used on our patients.”

Patient benefits

In the Triangle, 16 of the 38 doctors who received $500,000 or more from drug and device companies were listed as providers with Duke Health on the hospital system’s website.

Duke Health requires physicians to report industry relationships, the health system said in a statement.

Four of the 38 were listed as providers on UNC Health’s website.

UNC Health reviews physician relationships with health care companies to make sure the financial relationships do not interfere with patient care, the system said.

“When conducted ethically and transparently, interactions with vendors can result in benefits to our patients, support our research and contribute to improved training,” UNC Health said in a statement.

Hattangadi-Gluth said it’s important to keep the field of medicine objective.

While it’s not a bad thing that doctors work with drug and medical device companies, she said, it’s important that patients are now able to see how much money their doctors make from those companies — and if they make money from drugs or devices they recommend.

“We know that pharma and the evolution of therapies rely on physicians interacting with them, and being involved in drug development and device development,” Hattangadi-Gluth said. “So it’s not necessarily something that’s bad, it’s something now that’s documented.”