Regarding the article in AAOS Now (November 2007) describing the settlement between the orthopaedic implant manufacturers and the U.S. Attorney of New Jersey (Department of Justice or DOJ): You should also mention the enormous amount that the DOJ has required the companies to pay the monitors. For example, John Ashcroft’s firm was chosen to monitor Zimmer because the attorney general (Christopher Christie) worked under him previously (an obvious conflict of interest) and has required Zimmer to pay his firm $52 million for 18 months of monitoring (and an hourly fee of $895). There are also payments to the firm’s “lead partners” that total $750,000 per month.

If they can cap physician consulting [payments] to $500 per hour, how can they pick and choose friends as monitors and essentially cost-shift payments from doctors who are trying to improve the implants, etc., to “monitors” at such an exorbitant cost? The public should be aware that the government feels attorneys are worth $52 million over 18 months but doctors who help to improve the quality of medicine or implants are capped at $500 per hour, and only if the government feels their services are even worth paying for at all.

I think that the doctors who are getting paid for not doing any work should be punished, but the majority of consultants provide a value-added service that directly translates into better implants and procedures for our patients. With caps placed on these services, it can become cost-prohibitive for the busier, more innovative surgeons to participate in research and development of new products. Even more importantly, it may preclude them from teaching other doctors at courses because [teaching] takes them away from their practices.

The public needs to know the true story, especially with regard to huge payments to law firms. The AAOS should provide public service announcements so the information is disseminated.

David S. Bailie, MD
Scottsdale, Ariz.

Editor’s note: The information about payments to monitors did not become public knowledge until after the November issue of AAOS Now went to press. The $52 million figure cited by Dr. Bailie is the maximum Ashcroft’s firm could earn during the 18-month monitoring period.