CHARLESTON, W.Va. — Dr. Rahul Gupta now has two hats to wear.
The first role is a paid government position as state government’s top health officer.
The second is an elected, volunteer role as president of the West Virginia State Medical Association, the organization that represents doctors.
Gupta’s challenge will be striking a balance.
“This is an opportunity that allows for closer integration, or at least the aligning, of the services on the ground with people and with policy,” he said. “Of course, if there were to be any conflict, I would recuse myself.”
The state Medical Association does have a lobbying arm, WESPAC, that lobbies state government about medical issues and makes endorsements in political races. WESPAC has its own paid director and board.
Last spring, for example, WESPAC endorsed conservative Beth Walker for state Supreme Court, as well as Republicans such as Patrick Morrisey for attorney general, House Speaker Tim Armstead in his primary re-election campaign and Senate majority leader Mitch Carmichael in his.
WESPAC makes note of candidates who are “friends of medicine,” sometimes specifically making note of state physicians who have friendly relationships with the candidates.
During the last legislative session, the advocacy arm lobbied for an increase in the tobacco tax. It also opposed efforts by advance practice nurses, such as nurse practitioners, to expand the kinds of medicine they’re allowed to prescribe.
Before accepting his position as president of the West Virginia State Medical Association, which also has its own paid director and board, Gupta says he sought informal advice from the state Ethics Commission.
The answer, Gupta said, is to recuse himself if he sees a conflict arise between his two roles. He says that’s what he intends to do.
Gupta, who was hired as State Health Officer at the beginning of 2015 and paid $182,574 that year, says the structure of the West Virginia State Medical Association already provides buffers protecting his position from conflicts.
“There is an executive committee and a council. The council is in the bylines as the central governing authority,” he said. “As far as the legislative, there are committees governing each of those. There’s a number of committees. They are relatively independent of the presidency. There’s quite a volume of arms of separation.”
Congressman Evan Jenkins, who represents the counties in southern West Virginia, has been in a similar situation. While Jenkins served in the state Legislature, he also was director of the West Virginia State Medical Association, a paid job.
“My first stop was, of course, to the Ethics Commission, making sure I can serve as a state legislator and run the association.”
Jenkins paid particularly close attention to a 2012 Ethics Commission ruling that Rick Thompson, who then was House Speaker, should not take a concurrent job as top lawyer for the West Virginia Education Association.
Commission members concluded that Thompson would have an “inescapable conflict of interest.” In his attempt to receive approval, Thompson cited legislators, like Jenkins, who were working for organizations that lobby the Legislature.
“So when that decision came out, I called the Ethics Commission again: ‘Do I have a problem?’” Jenkins recalled. “As you can tell, this has always been an issue I have been aware of in my capacity working for a non-profit.”
Jenkins noted, as Gupta did, that the voluntary nature of Gupta’s Medical Association role makes it different.
“He is a state employee. So he is also now the volunteer leader of a not-for-profit organization that advocates. So the question is, what if his government work as a state employee runs afoul of the advocacy his organization is working on?” Jenkins said.
“I know in advance of him assuming the presidency, he gave it great thought. The other leaders gave it great thought, and they all went in with their eyes open. There is a very clear understanding he would have to recuse himself of any positions at State Medical that would be in conflict from his state function. The state job takes the priority.”
The president of the West Virginia State Medical Association is elected annually by the physicians who are its members. Gupta noted that he has in the past led smaller regional medical organizations like the Kanawha Medical Society.
Gupta says his two roles should complement each other.
“Most of the work that physicians provide in general practice has directly to do with the furthering of not just clinical medicine but also public health issues such as addiction, diabetes, strokes, cancer,” he said. “One of the things that has happened is we’re having to work together to integrate the works of public health and clinical medicine.
“We can no longer afford to be in silos. That is not in the best interest of public health.”
He says he’ll be traveling, on his own time, to meet with county medical societies across West Virginia.
“We often are overlooked in the state level as bureaucrats who don’t know what’s happening on the ground and may lose touch,” he said. “This is an opportunity to work closely with physicians across the state in a way that most state health officers don’t have a chance to do.”