HomeMy WebLinkAbout1363 FiorelloIn Re: Steven Fiorello
File Docket:
X -ref:
Date Decided:
Date Mailed:
Before: Louis W. Fryman, Chair
John J. Bolger, Vice Chair
Daneen E. Reese
Donald M. McCurdy
Paul M. Henry
Raquel K. Bergen
03 -025
Order No. 1363
2/28/05
3/14/05
This is a final adjudication of the State Ethics Commission.
Procedurally, the Investigative Division of the State Ethics Commission conducted
an investigation regarding a possible violation of the Public Official and Employee Ethics
Act, Act 9 of 1989, P.L. 26, 65 P.S. § 401 et seq., as codified by Act 93 of 1998, Chapter
11, 65 Pa.C.S. § 1101 et seq., by the above -named Respondent. At the commencement of
its investigation, the Investigative Division served upon Respondent written notice of the
specific allegations. Upon completion of its investigation, the Investigative Division issued
and served upon Respondent a Findings Report identified as an "Investigative Complaint."
An Answer was filed and a hearing was held. The record is complete.
Effective December 15, 1998, Act 9 of 1989 was repealed and replaced by Chapter
11 of Act 93 of 1998, 65 Pa.C.S. § 1101 et seq., which essentially repeats Act 9 of 1989
and provides for the completion of pending matters under Act 93 of 1998.
This adjudication of the State Ethics Commission is issued under Act 93 of 1998
and will be made available as a public document thirty days after the mailing date noted
above. However, reconsideration may be requested. Any reconsideration request must be
received at this Commission within thirty days of the mailing date and must include a
detailed explanation of the reasons as to why reconsideration should be granted in
conformity with 51 Pa. Code § 21.29(b). A request for reconsideration will not affect the
finality of this adjudication but will defer its public release pending action on the request by
the Commission.
The files in this case will remain confidential in accordance with Chapter 11 of Act
93 of 1998. Any person who violates confidentiality of the Ethics Act is guilty of a
misdemeanor subject to a fine of not more than $1,000 or imprisonment for not more than
one year. Confidentiality does not preclude discussing this case with an attorney at law.
Fiorello, 03 -025
Page 2
I. ALLEGATIONS:
That Steven Fiorello, public official /public employee in his capacity as Chief
Pharmacist /Director of Pharmacy for the Department of Public Welfare, Office of Mental
Health, Substance and Abuse Services (OMHSAS), violated the following provisions of the
State Ethics Act (Act 93 of 1998) when he used the authority of his office for a private
pecuniary gain, including but not limited to participating in actions of the DPW Pharmacy
and Therapeutics Committee related to the selection of drugs manufactured by Pfizer
Pharmaceuticals and Janssen Pharmaceuticals at a time when Fiorello served as a
compensated member on a Pfizer Advisory Board and was receiving honoraria from
Janssen; when he used his position to obtain honoraria from Janssen through
Comprehensive Neurosciences, Riverside Associates, and Pfizer through Innovative
Medical Education; and when he received honoraria for appearances, speeches and
presentations; and when he failed to disclose on Statements of Financial Interests filed for
the 1998 and 2000 calendar years all sources of income in excess of $1,300; when he
failed to disclose on a Statement of Financial Interests filed for the 2002 calendar year
income received from Pfizer through Comprehensive NeuroSciences, Inc., when he failed
to disclose on Statements of Financial Interests for the 2003 calendar year interest income
in excess of $1,300; when he failed to disclose on Statements of Financial Interests filed
for the 1998, 2000 and 2001 calendar years transportation, lodging and /or hospitality paid
on his behalf by Janssen and Pfizer; and when he failed to utilize leave from his
Commonwealth position when participating as a paid speaker for Riverside Associates and
Janssen /CNS; and when he used his public position to obtain payments from Duquesne
University for supervising pharmacy interns assigned to the Department of Public Welfare
during his regular hours as Pharmacy Director.
§ 1103. Restricted activities
(a) Conflict of interest. - -No public official or public
employee shall engage in conduct that constitutes a conflict of
interest.
65 Pa.C.S. § 1103(a).
§ 1102. Definitions
"Conflict" or "conflict of interest." Use by a public
official or public employee of the authority of his office or
employment or any confidential information received through
his holding public office or employment for the private
pecuniary benefit of himself, a member of his immediate family
or a business with which he or a member of his immediate
family is associated. The term does not include an action
having a de minimis economic impact or which affects to the
same degree a class consisting of the general public or a
subclass consisting of an industry, occupation or other group
which includes the public official or public employee, a
member of his immediate family or a business with which he or
a member of his immediate family is associated.
65 Pa.C.S. § 1102.
§ 1103. Restricted activities
(d) Honorarium. - -No public official or public employee
shall accept an honorarium.
Fiorello, 03 -025
Page 3
65 Pa.C.S. §1103(d).
§ 1105. Statement of financial interests
(b) Required information. - -The statement shall
include the following information for the prior calendar year
with regard to the person required to file the statement:
(5) The name and address of any direct or
indirect source of income totaling in the aggregate
$1,300 or more. However, this provision shall not be
construed to require the divulgence of confidential
information protected by statute or existing professional
codes of ethics or common law privileges.
(6) The name and address of the source and
the amount of any gift or gifts valued in the aggregate at
$250 or more and the circumstances of each gift. This
paragraph shall not apply to a gift or gifts received from
a spouse, parent, parent by marriage, sibling, child,
grandchild, other family member or friend when the
circumstances make it clear that the motivation for the
action was a personal or family relationship. However,
for the purposes of this paragraph, the term "friend"
shall not include a registered lobbyist or an employee of
a registered lobbyist.
(7) The name and address of the source and
the amount of any payment for or reimbursement of
actual expenses for transportation and lodging or
hospitality received in connection with public office or
employment where such actual expenses for
transportation and lodging or hospitality exceed $650 in
the course of a single occurrence. This paragraph shall
not apply to expenses reimbursed by a governmental
body or to expenses reimbursed by an organization or
association of public officials or employees of political
subdivisions which the public official or employee
serves in an official capacity.
65 Pa.C.S. §§ 1105(b)(5), (6), (7).
II. FINDINGS:
A. Admitted Pleadings
1 The Investigative Division of the State Ethics Commission received information
alleging that Steven Fiorello violated provisions of the State Ethics Act (Act 93 of
1998).
2. Upon review of the information the Investigative Division initiated an own - motion
preliminary inquiry on March 28, 2003.
3. The preliminary inquiry was completed within sixty days.
4. On May 22, 2003, a letter was forwarded to Steven Fiorello, by the Investigative
Division of the State Ethics Commission informing him that a complaint against him
Fiorello, 03 -025
Page 4
was received by the Investigative Division and that a full investigation was being
commenced.
a. Said letter was forwarded by certified mail, no. 7000 1670 0005 2766 5002.
b. The domestic return receipt bore the signature of Steven Fiorello, with a
delivery date of May 24, 2003.
5. On July 29, 2003, the Investigative Division of the State Ethics Commission filed an
application for a ninety day extension of time to complete the Investigation.
6. The Commission issued an order on September 15, 2003, granting the ninety day
extension.
7 On October 30, 2003, the Investigative Division of the State Ethics Commission
filed an application for a ninety day extension of time to complete the investigation.
8. The Commission issued an order on December 1, 2003, granting the ninety day
extension.
9. On May 11, 2004, the Investigative Division issued an Amended Notice of
Investigation to Fiorello advising him that the allegations contained in the May 22,
2003, letter were being amended.
a. Said letter was forwarded by certified mail no. 7002 3150 0000 6075 3160.
10. Periodic notice letters were forwarded to Steven Fiorello in accordance with the
provisions of the Ethics Law advising him of the general status of the investigation.
11. The Investigative Complaint was mailed to the Respondent on May 14, 2004.
12. Fiorello has been employed by the Commonwealth of Pennsylvania, Department of
Public Welfare (DPW) since April 3, 1989.
a. Fiorello has over 15 years of service with the Commonwealth of PA.
13. Fiorello's job description outlines the following duties and responsibilities:
a. Overview /job summary: Provides input to senior managers and
policymakers in DPW, as a member of the OMHSAS Clinical Leadership
Team, regarding the use of pharmaceuticals throughout the scope of the
department's programs. Coordinates the state hospital pharmacy operations
and supervises the hospital pharmacy directors. Duties include pharmacy,
drug, cost benefit related areas such as: formulary development, drug
utilization - perspective and retrospective drug utilization reviews, outcomes
based drug management, and outpatient and managed care pharmacy
benefits issues. Specific goals include streamlining and standardizing the
drug utilization and procurement for all pharmacy operations to insure
maximum efficiency of drug usage for patients within the system. This
includes providing direction in the development of clinical programs for drug
regimen review, formulary development, drug usage, pathways of medication
usage, and the purchase of pharmaceuticals in the OMH hospital delivery
system.
b. Responsibilities include:
1. Responsible for the supervision of state mental health hospital pharmacy
Fiorello, 03 -025
Page 5
directors and the coordination of hospital pharmacy operations.
2. Responsible as the OMHSAS consultant to health choices managed
care organizations on pharmacy and formulary issues.
3. Leads redesign and maintenance of the Drug Utilization Reporting
System (DURS) that provides monthly drug usage reports from the
SMH Pharmacies for use with OMHSAS pharmacy, therapeutics and
formulary in the development of drug studies.
4. Disseminates /communicates policy for the state pharmaceutical
contracting, procurement, and utilization management and
coordination with other agencies such as the Department of General
Services for cost effective drug pricing.
14. The PA Department of Public Welfare (DPW) OMHSAS has a committee known as
the DPW OMHSAS Pharmacy, Therapeutics and Formulary Committee (PT &F
Committee).
15. The role of the DPW OMHSAS PT &F Committee is to evaluate the clinical use of
drugs, to evaluate and develop policies for drug use, and manage the DPW
OMHSAS Formulary. Composition of the Committee is physicians, pharmacists,
and other health -care professionals selected by the facilities or appointed by the
DPW Medical Director, Office of Mental Health and Substance Abuse Services
(OMHSAS). The membership includes representation from the different regional
and health -care facilities within the OMHSAS.
16. The function of the DPW OMHSAS PT &F Committee is:
a. To serve in an evaluative, educational, and advisory capacity to the
Department of Public Welfare and its State Hospitals in all matters pertaining
to the use of drugs.
b. The [sic] develop and maintain a state formulary of drugs for use in the DPW
state hospitals and provide for its constant revision. The selection of drugs
in the state formulary should be based on objective therapeutic evaluation,
safety and cost. Duplication of the same basic drug type or drug product will
be minimized.
c. To establish programs and procedures to ensure safe and effective drug
therapy.
d. To plan and provide suitable educational programs for the Department's
professional staff on drug use related matters.
e. To initiate and direct drug use evaluation programs and studies to ensure
that drugs are used appropriately, safely, and effectively. Drug use
evaluations should measure and compare the outcomes of drug treatments
which did, or did not, comply with approved criteria or guidelines. Education
of professional staff should be based on this comparative information. THE
[sic] Committee will review drug utilization activities and continuous quality
improvement initiatives within the state hospital system in order to be in
compliance with the JCAHO's ORYX Program.
f. To advise the OMHSAS /Department and its facilities in the implementation of
effective drug distribution, inventory and control procedures.
To disseminate information on its actions and approved recommendations to
g.
Fiorello, 03 -025
Page 6
all Department health -care staff.
h. To be the final decision making entity with regards to policy and procedure
questions that arise in centers [state mental hospitals] involving pharmacy
and therapeutic issues.
17. The purpose of the DPW OMHSAS PT &F Committee is:
a. Formulary development: DPW OMHASS formulary system defines a method
for evaluating and selecting suitable drug products for inclusion in the
formulary. Formulary system management is the application of various
techniques to ensure high quality and cost - effective drug therapy. And [sic]
additional goal is to optimize individual care through rational selection and
use of drugs and drug products within the health -care system.
b. Policy Development: The committee formulates and recommends policies
regarding evaluation, selection and therapeutic use of drugs and drug
products.
c. Education: The committee formulates programs designed to meet the needs
of the professional staff (physicians, pharmacists, nurses and other health-
care practitioners) for the current and comprehensive knowledge on matters
related to drug and drug use. This includes programs to evaluate drug
usage for the purpose of comparison between professional staff and facilities
with the intent of educating professionals regarding the standards and
criteria of drug use developed by the organization.
18. DPW OMHSAS PT &F Committee leadership consists of a physician elected as vice
chairperson by the Committee and a pharmacist designated as secretary by the
OMHSAS Medical Director.
a. The vice chairperson will rotate as chairperson every two years.
b. The committee membership shall consist of a minimum of two members from
each OMHSAS facility, one of which [sic] is a physician.
c. Each OMHSAS facility is responsible for the selection of committee members
whose membership will be a minimum term of two years.
d. Assistant Superintendent for Nursing Co- Chairperson(s) shall be automatic
members of PT &F.
e. The committee should meet quarterly and more often when necessary.
f. The committee may invite consultants to its meetings who can contribute
specialized or unique knowledge and skills.
All members serve on their local facility P &T Committee and each member is
a liaison between this committee and the local state center [mental hospital].
Actions of this committee should be routinely communicated to the various
facilities.
g.
h. To the extent warranted, the formulary will be reviewed on an ongoing basis
and revised or updated accordingly. Additions and deletions to the
formulary, changes in drug products, removal of products from the market
and changes in policies and procedures all will necessitate periodic revision
of the formulary.
Fiorello, 03 -025
Page 7
The committee will be responsible for distributing addendums to the
formulary.
19. Fiorello has served as a member of the DPW OMHSAS PT &F Committee - - -.
a. Fiorello has served as secretary of the DPW OMHSAS PT &F Committee
during this time.
20. The PennMAP System is modeled after the Texas Medication Algorithm Project
System (T -MAP System).
a. The PennMAP System is a clinical guideline for physicians in the PA Mental
Health System.
b. The system deals with the use of the second generation a- typical anti -
psychotic drugs.
c. The idea of the use of algorithms was first discussed by the PT &F committee
during a meeting of September 16, 1999.
21. Dr. Steven Karp serves as the Director of OMHSAS.
22. The PennMAP system was discussed during PT &F Committee meetings of June 29,
2000; September 19, 2000; March 26, 2001; and June 19, 2001.
a. Fiorello was present during the meetings and provided information regarding
PennMAP implementation.
b. Fiorello was present at meetings as a member of the committee and
secretary when discussions and approvals of the PennMAP system
occurred.
23. The PennMAP System was used on a trial basis at the Allentown State Hospital
(HSH) [sic] - - - .
24. The PennMAP System has only been in use, statewide, in the PA Mental Health
Hospital System, since 2003.
25. The a- typical anti - psychotic drugs included in the PennMAP system are as follows:
Drug Name Manufacturer
Abilify( Aripiprazole) Bristol Myers Squibb
Clozaril (Clozapine) Novartis
Zyprexa (Olanzapine) Eli Lilly
Seroquel (Quetiapine) Astra Zeneca
Risperdal (Risperdael) Janssen Pharmaceuticals
Geodon (Ziprasidone) Pfizer
26. A- typical anti - psychotic drug usage for DPW mental health hospitals and estimated
expenditures for 2004 are as follows:
A- Typical Anti - Psychotic
Patient Numbers and Cost
Number of Patients on each A- Typical
Drug Ave Oct Fe Fe Jan Jan Apr Nov Est.
Fiorello, 03 -025
Page 8
Olanzapine
Risperidone
Quetiapine
Clozapine
Aripiprazole
Ziprasidone
Number of Patients on each A- Typical
Cost /pt /yr 99 b b 02 03 30 03
00 01
$5,860 964 925 979 961 722 710
$3,402 892 858 879 800 615 606
$4,330 259 283 428 446 468 483
$1,.235 279 299 303 259 230 220
$4,978 122 178
$2,137 63 71 67
27. Janssen Pharmaceuticals "Janssen" was a prime supporter of OMHSAS's
implementation of the PennMAP system.
28. Funding [from Janssen] included grants for speakers and travel expenses for
Fiorello and Dr. Robert Davis, a psychiatrist employee of OMHSAS.
a. The funding provided was identified as unrestricted educational grants.
29. Janssen has provided unrestricted educational grants (UEG) to OMHSAS since at
least March 2001.
30. Unrestricted educational grants (UEG) are funds provided to groups, both public
and private sector, to support educational activities and research.
31. Janssen, Novartis and Pfizer supply anti - psychotic medications to the
Commonwealth which are included on the PennMAP algorithm.
32. Actual use of monies received in the form of a UEG, are not monitored and /or
regulated by pharmaceutical companies.
33. The UEG's received by OMHSAS were deposited into an account known as The
Medical Director's Educational Fund" (Fund).
a. The Fund existed from November 1999 through October 2003.
b. The account was opened at the direction of Stephen Karp.
34. The Fund maintained a checking account (Account No. 09902 - 2898 -6) at the
AIIFirst Bank (now M &T Bank), Harrisburg, PA.
35. The checking account for the Fund was maintained /managed through the
accounting office of the Harrisburg State Hospital.
a. Susan Kaveney, an employee of DPW, performed all the accounting
functions for this account.
1. Kaveney made all the deposits to the account and issued checks from
the account.
36. The following chart identifies deposits into /expenditures from the Fund during the
period November 1999 until October 2003.
OMHSAS EDUCATIONAL FUND
ACCOUNT ANALYSIS
661
473
530
244
182
64
Tota
Expenditure /2004
$3,873,460
$1,609,146
$2,294,900
$301,340
$905, 996
$136,768
$9,121,610
Fiorello, 03 -025
Page 9
No. Date
1 11/23/99
2 12/28/99
3 11/07/00
4 03/07/01
5 04/01/01
6 04/09/01
7 05/25/01
8 05/29/01
9 06/01/01
10 06/01/01
11 09/25/01
12 10/16/01
13 10/22/01
14 11/18/01
15 11/20/01
16 11/28/01
17 01/09/02
18 11/26/02
19 10/21/03
20 10/21/03
Janssen:
Pfizer:
Novartis:
Amount
$2,500.00
$1,000.00
$45.00
$1,765.75
$249.99
$1,765.75
$300.00
$4,000.00
$2,028.15
$52.00
$240.00
$3,000.00
$502.00
$1,200.00
$570.00
$40.50
$15.00
$1,994.00
$6,263.36
$5,765.75
$4,500.00
$2,500.00
Detail
Deposit From Novartis Pharmaceutical
Deposit From University of Pittsburgh Medical Center
Payment to Rubinic's Catering
Speaker Expenses (Dr. Shon)
Palm Pilot
Deposit from Janssen Pharmaceutical
Deposit from Pfizer
Deposit from Janssen Pharmaceuticals
Payment for out - service training for Fiorello & Davis
Bank Fees
Payment to Rubinic's Catering
Deposit from Pfizer
Payment to First USA Bank — Airline Tickets
Deposit from Pfizer
Payment to First USA Bank — Airline Tickets
Payment for picture frames
Account placed on hold
Bank Fees
Holiday Inn — Conference Meals
[Fiorello has no recollection of the expenditure listed at No.191
Account closed & balance transferred to Harrisburg
State Hospital Patient Benefit Account
Total Deposits: $13,765.75
Total Expenditures: $ 7,446.89
37. The central office staff of OMHSAS consists of the following:
a. Dr. Steven Karp, Medical Director, OMHSAS.
b. Dr. Robert Davis, Associate Medical Director, OMHSAS.
c. Steven Fiorello, Pharmacy Director, OMHSAS.
38. There were seven (7) deposits made to the account between November 23, 1999,
and November 18, 2001.
a. Six (6) of the deposits were from pharmaceutical companies in the form of
UEG's totaling $12,765.75.
39. Pharmaceutical companies providing UEG's to OMHSAS which were deposited into
the fund are as follows:
40. All pharmaceutical companies that supplied a UEG to the OMHSAS Medical
Director's Education Fund are manufacturers of drugs on the OMHSAS Formulary
list.
a. This includes varying medications in addition to the highly specific a- typical
anti - psychotic drugs that are unique to the algorithm of the PennMAP
System.
41. In or around February 2001 Fiorello discussed with Laurie Snyder a grant request
Fiorello, 03 -025
Page 10
for OMHSAS.
a. At that time OMHSAS was considering the implementation of the PennMAP
system.
b. Janssen was interested in the development of such an algorithm and
supportive of the T -MAP system.
42. Funding for Shon's travel expenses became an issue which was discussed by
Fiorello and - - - [other(s)] - - - in or about February 2001.
a. Janssen had paid such expenses in the past but Shon wanted reimbursed by
the State and wanted immediate payment.
43. Snyder directed an e-mail to Steve Fiorello and Steve Karp on February 12, 2001,
at 12:30 p.m. labeled high importance regarding expenses of Steven Shon which
noted the following:
"I spoke with Steve Shon last Friday. He is requesting that just the travel
arrangements be reimbursed via the state. The reasoning is he wants immediate
payment so he will not have to carry this large expense, in the past, pharmaceutical
companies have taken too much time to pay. When he worked via CME, they buy
him the ticket and hotel room. This will not be the case for the March programs. He
is asking that the PA OMH send a grant for the total travel expenses. Janssen
would send a grant to the OMH for that same total travel expense. I would still send
the honorarium to the state of Texas, he does not receive this amount, therefore, it
doesn't matter to him how long the paperwork takes. Please let me know if this is
possible."
44. Fiorello e- mailed Karp on February 12, 2001, at 1:35 p.m. suggesting using the
educational account in Karp's name to pay Shon and replace it with the educational
grant money from Laurie Snyder.
a. Karp's e-mail response on February 13, 2001, authorized the use of the
AllFirst account to fund Shon's expenses.
45. On March 1, 2001, Fiorello and Snyder signed a Janssen Educational Grant Letter
of Agreement which provided as follows:
a. Title of Program: Promoting Best Practice for Schizophrenia Treatment
b. Date, Location, Time: March 13, 14, 15, 2001, at Mayview, Norristown and
Harrisburg State Hospitals
c. Amount Requested: $1,765.65
d. Payee: Harrisburg State Hospital c/o Steve Fiorello, RPH
46. Standard language contained in Janssen Educational Grant Letters of Agreement
includes the following:
It is the intent of this Agreement to ensure that the Program is conducted in a
manner consistent with the Food and Drug Administration's Policy Statement on
Industry Supported Scientific and Educational Activities, AMA Guidelines on Gifts to
Physicians, and the Accreditation Counsel for Continuing Medical Education
(ACCME).
Fiorello, 03 -025
Page 11
Statement of Purpose: The program is for scientific and educational purposes
only and is not intended to promote a JANSSEN product directly or indirectly.
Control of Content & Selection of Presenters & Moderators: Institution is
responsible for control of content and selection of presenters and moderators.
JANSSEN agrees not to direct the content of the program. JANSSEN, or its agents,
may provide suggestions of presenters or sources of possible presenters.
JANSSEN may suggest more than one name (if possible) and provide speaker
qualifications.
Disclosure of Financial Relationships: Institution will ensure meaningful
disclosure to the audience, at the time of the Program of (a) JANSSEN funding and
(b) any significant relationship between the Institution and JANSSEN (e.g. grant
recipient) or between individual speakers or moderators and JANSSEN.
Involvement in Content: There will be no "scripting," emphasis, or direction of
content by JANSSEN or its agents.
Ancillary Promotional Activities: No promotion activities will be permitted in the
same room or obligate path as the Program. No product advertisement will be
permitted in the Program room.
Objectivity & Balance: Institution will make every effort to ensure that data
regarding JANSSEN's products (or competing products) are objectively selected
and presented, with favorable and unfavorable information and balance discussion
of prevailing information on the product(s) and /or alternative treatments.
Limitation on Data: Institution will ensure, to the extent possible, meaningful
disclosure of limitations of data, e.g. ongoing research, interim analyses,
preliminary data, or unsupported opinion.
Discussion of Unapproved Uses: Institution will require that presenters disclose
when a product is not approved in the United States for the use under discussion.
Opportunities for Debate: Institution will ensure meaningful opportunities for
questioning or scientific debate.
47. The grant /funding request form submitted by Laurie Snyder to Janssen officials on
March 8, 2001, included the following:
a. Reason for Support:
b. Deliverable:
c.
d.
e.
Amount Requested:
Event Date:
Check Payable To:
OMH T -MAP initiative to expand a- typical usage and
drive Steve Shon's expenses
Successful program with solid attendance and quality
attendees. CNS follow -up with attendees.
$1,765.75
March 13 -15, 2001
Harrisburg State Hospital
48. Janssen issued check no. 3375041 dated March 22, 2001, payable to Harrisburg
State Hospital in the amount of $1,765.75.
a. The check was sent to the attention of Steve Fiorello.
Fiorello, 03 -025
Page 12
49. Fiorello received the check and submitted it to Susan Kaveney for deposit.
a. The check was deposited in the AIIFirst account on April 9, 2001.
50. Actual payment of Shon's expenses was made on or about March 7, 2001, prior to
the receipt of the grant from Janssen.
a. Other funds from the account were used to pay Shon's expenses.
a.[sic] Fiorello signed the form STD -181, dated 03/05/01, requesting a payment to
be made to Dr. Steven Shon, Texas Department of Mental Health /Mental
Retardation in the amount of $1,765.75.
b.[sic] The amount covered Shon's airfare, hotel and meal expenses.
c.[sic] A check was issued from the AIIFirst account to Shon on March 7, 2001, in
the amount of $1,765.75.
51. Shon made three presentations at Pennsylvania State mental hospitals between
March 13, 2001, and March 15, 2001.
52. During Shon's travel (March 13, 2001, to March 15, 2001) Snyder incurred
expenses on behalf of Fiorello, Karp, Davis and Shon which were enumerated on
expense reports she filed with Janssen.
53. Fiorello requested a second grant from Janssen through Laurie Snyder on or about
April 19, 2001.
a. The letter of agreement signed by Fiorello and Snyder on April 19, 2001,
lists the title of the program as Implementation Strategies for T -MAP.
b. Dates of Location of Program: May 6 -8, 2001, New Orleans
c. Amount Requested: $4,000.00.
54. Grant /Funding request [was] submitted by Snyder on April 18, 2001, - - - .
55. Janssen issued check no. 3430202 dated May 14, 2001, payable to Harrisburg
State Hospital in the amount of $4,000.
a. Fiorello received the check and directed Kaveney to deposit in the AIIFirst
account.
b. The check was deposited in the AIIFirst account on May 29, 2001.
56. The purpose of the second grant request submitted by Fiorello was to cover the
travel expenses of Fiorello and Robert Davis to attend the American Psychiatric
Association (APA) annual convention held in New Orleans from May 6, 2001, to
May 8, 2001.
a. Fiorello and Davis were to meet with Dr. Daniel Trevidi, a psychiatrist
employed by the University of Texas, who developed the T -MAP program.
b. Janssen (Snyder) recommended to Karp and Fiorello that they confer with
Trevidi who had a computer program for the algorithm.
1. Trevidi was to attend the APA convention in New Orleans.
Fiorello, 03 -025
Page 13
2. Snyder thought this would be a convenient time for the parties to
meet.
3. Snyder arranged for a meeting at the conference.
c. Fiorello made the request of Snyder that Janssen provide funding for him
[and other(s)] to meet with Trevidi.
d. Snyder then completed the funding request in the amount of $4,000.
e. The $4,000 amount of the grant was determined by the support staff of
OMHSAS who re- mailed the information to Snyder on April 9, 2001.
57. Fiorello received verbal authorization from Karp to attend the APA conference in
May 2001.
a. Karp was aware that Fiorello was using funds provided by Janssen to pay for
the trip.
58. A DPW Out - Service Training Request Form was prepared - - - requesting travel to
New Orleans, LA, to attend the American Psychiatric Association Seminar from May
5, 2001, through May 9, 2001.
a. The form is not signed by Fiorello.
b. The form bears no signatures of any approving authorities.
59. A request for approval of out of state travel was prepared - - - in conjunction with
this trip.
a. It bears no signatures of Fiorello and /or any approving authorities.
60. While in New Orleans between May 6, 2001, and May 8, 2001, Fiorello participated
in dinners with Janssen representatives and Dr. Trevidi, paid for by Janssen, as
disclosed on expense reports filed by Laurie Snyder.
61. While in New Orleans, Fiorello charged room expenses and meal charges to the
Commonwealth of Pennsylvania, Corporate American Express Card, Account No.
3787 - 444661 -4106.
Date Charge Amount
05/09/01 Courtyard, New Orleans (5/5/01 to 5/9/01) $860.21
05/09/01 Ralph & Cacoos $ 37.22
Total $897.43
62. Fiorello submitted the American Express Statement to Susan Kaveney for payment
on or about June 1, 2001.
a. Kaveney issued a payment from the Fund to American Express Corporate
Services on June 1, 2001.
b. The payment was in the amount of $2,028.15.
63. Fiorello also submitted a Travel Expense Voucher (TEV) - - - seeking additional
subsistence and taxi reimbursement for the New Orleans trip.
64. The purpose of travel reported on TEV 459690 is as follows:
Fiorello, 03 -025
Page 14
"Attended American Psychiatric Association (APA) convention in order to meet with
the T -MAPs group (Texas Medication Algorithm Project for Schizophrenia) to
discuss implementation of the T -MAPs project in PA. Travel, hotel and registration
was paid by an educational grant. Requesting reimbursement for non - covered
items: taxi cab, 2 lunches, and airport parking."
65. During the time period from January 2001 through May 2001 when OMHSAS was
considering implementation of the PennMAP system, which includes the drug
Risperdal, manufactured by Janssen, Fiorello solicited grants and accepted meals
from Janssen representatives.
a. Janssen paid for travel and meals for Fiorello in excess of $650.00 during
2001 - - -.
66. During calendar year 2001, when OMHSAS was in the process of implementing the
PennMAP algorithm, Fiorello also solicited grants from Pfizer.
a. Pfizer drugs are also on the formulary for DPW state hospitals which require
the approval of the formulary committee and which Fiorello serves.
b. The grants applied for were unrestricted educational grants.
c. The grants applied for by Fiorello were during the same time period as his
solicitation of grants from Janssen.
67. The solicitation was made of Pfizer Senior Specialty Representative John Quinn.
a. Quinn is a Pfizer Central Nervous System Specialty Representative
whose territory includes OMHSAS.
b. The application requested payment be made payable to PA OMHSAS and
mailed to Fiorello.
c. The request is signed by Fiorello.
d. Quinn submitted the grant approval form on April 14, 2001, to Pfizer District
Manager Paul Hoop.
1. Hoop approved the $300.00 grant.
68. Pfizer issued check no. 002256223 in the amount of $300.00 on May 9, 2001.
a. The check was made payable to OMHSAS and directed to the attention of
Fiorello.
b. The check was deposited into the AIIFirst account on May 25, 2001.
69. The $300 grant solicited from Pfizer in March 2001 was used to purchase a Palm
Pilot for use by Fiorello.
a. Fiorello made the purchase from Office Max for a Handspring Visor Deluxe
Graphic Palm Pilot on March 30, 2001.
b. Check No. 0044 was issued on March 30, 2001, to Office Max in the amount
of $249.99 to pay for the Palm Pilot.
c. The Palm Pilot was ordered by Fiorello.
Fiorello, 03 -025
Page 15
1. The purchase was approved by Karp.
70. A subsequent grant from Pfizer was solicited by Fiorello on or about May 24, 2001.
a. The request form dated May 24, 2001, and signed by Fiorello sought a grant
amount of $5,400.
b. Fiorello made the request of James Smith, a Pfizer employee.
71. Pfizer issued a check no. 002385146 on September 24, 2001, in the amount of
$3,000 payable to OMHSAS to the attention of Fiorello.
a. The check was deposited to the AIIFirst Account on October 16, 2001.
72. Pfizer issued a second check, no. 002462737 on October 9, 2001, in the amount of
$1,200 to OMHSAS to the attention of Fiorello.
a. The check was deposited into the AIIFirst account on November 18, 2001.
73. The AIIFirst account was placed on hold by DPW officials on or about January 9,
2002, prior to the Pfizer grants being used by OMHSAS.
a. The grant funds received from Pfizer from Fiorello's second grant request
were frozen and not utilized for any research.
b. The account was eventually closed by DPW officials and transferred to
patient accounts.
74. Both Janssen and Pfizer fund private companies who [sic] provide continuing
medical education.
a. Janssen contracts with Comprehensive Neurosciences, Inc.
b. Pfizer contracts with Innovative Medical Education.
75. Between 1998 and 2001 Fiorello served as a consultant on the Pfizer Behavioral
Healthcare Pharmacy Advisory Council (Council).
76. The council consists of 21 behavioral healthcare pharmacists from across the
country.
77. The role of the council is to assist Pfizer with research and development efforts, the
development of marketing strategies and educational programs, pharmaeconomic
analyses and other initiatives.
a. Participation on the council required the attendance at three day meetings
held in New York City.
1. Members participate in general sessions and workshop sessions
regarding general depression and anxiety disorder market issues.
78. The council has held meetings on the following dates at the below listed locations:
a. November 13 -15, 1998 Millennium Broadway Hotel
145 W. 44 Street
New York, NY
b. January 27 -29, 2000 Essex House
Fiorello, 03 -025
Page 16
160 Central Park South
New York, NY
c. March 22 -24, 2001 Hudson Hotel_
356 West 58 Street
New York, NY
79. Pfizer contracts with Innovative Medical Education (IME), a private firm specializing
in providing continuing medical education, for the development of council activities.
a. Payments made to consultants are made through IME, not Pfizer.
b. Funding for IME comes directly from Pfizer.
80. Members of the council are required by Pfizer to sign a Confidential Disclosure
Agreement and a Consultant Agreement for each year of service on the council.
81. Pfizer provides the following - - - for attendance at each event.
a. - - - $1,000.00
b. Expenses: One round -trip coach class airline ticket to New York
from a local airport or reimbursement for driving, ground
transportation to and from the airport in New York, hotel
room for the duration of the meeting (2 nights); meals.
c. Entertainment: Pfizer also provided entertainment in the form of tickets
to Broadway plays.
82. Fiorello attended all three council meetings held between 1998 and 2001.
a. Fiorello received - - - $1,000 each year, as well as a $500 speaker fee in
2000.
b. All hotel and meal expenses were paid by Pfizer /IME.
c. All travel expenses claimed by Fiorello were paid by Pfizer /IME.
83. Hotel expenses [were] paid on Fiorello's behalf by Pfizer - - - .
84. Fiorello submitted expense reimbursement forms to IME for the 1998 and 2001
meetings.
a. 1998:
11/13/98 Mileage, tolls, parking $ 97.72
11/14/98 Parking $ 39.00
11/15/98 Mileage, tolls $ 55.92
Total $192.64
b. 2001:
03/22/01 Mileage, train, tax $ 63.60
03/23/01 N/A $ 0.00
03/24/01 Mileage, taxi $ 56.60
Total $120.20
c. No expenses were reported by Fiorello in 2000.
Fiorello, 03 -025
Page 17
85. Fiorello received payments from IME for expenses as follows:
Date Check No. Amount
11/24/98 000151 $192.64
04/05/01 008634 $120.20
86. Meals provided by Pfizer for each meeting included the following:
Welcome Buffet Dinner
Continental Breakfast (2)
Lunches (2)
Dinner
87. Fiorello was compensated - - - by Pfizer through IME as follows:
Date Check No. Amount
11/18/98 000118 $1,000.00
02/02/00 005209 $1,000.00
02/02/00 005210 $ 500.00
03/21/01 008455 $1,000.00
a. The IME check no. 008455 dated March 21, 2001, was deposited into a
Lebanon Valley Farmers Bank account for which Fiorello has signature
authority.
88. In addition to the payments received from Pfizer /IME Fiorello received other
payments from IME in calendar year 2000.
a. Date Check No. Amount
05/10/00 004706 $ 1,000.00
05/17/00 004193 $ 32.40
1. Both checks were deposited into Fiorello's personal Lebanon Valley
Farmers Bank account on 05/20/00 and 05/27/00.
b. Date Check No. Amount
November 2000 Unknown $ 1,000.00
1. This payment was the result of Fiorello's participation in the 2000
Advisory Council meeting resulting in the production of a CD program
"Impacting Behavioral Healthcare: The Role of Pharmacy."
89. Fiorello served as a consultant and presenter at the American Society of Health
System Pharmacists (ASHP) meeting in Orlando Florida in December 1999.
a. Fiorello presented a paper, "Anti- Depressant Drug Utilization in a Multi -
Hospital Medical System."
1. Fiorello produced data of drug utilization in Pennsylvania State
Mental Health Hospitals.
b. Fiorello received a $1,000 - - - for his efforts.
c. Payment - - - occurred on or about May 10, 2000. - - -
90. Prior to December 2001, Fiorello did not submit a supplementary employment
request (SER) to participate in Pfizer's Behavioral Healthcare Pharmacy Advisory
Fiorello, 03 -025
Page 18
Council.
a. Karp verbally approved Fiorello's participation.
b. Karp was unaware that Fiorello would be compensated.
91. On or about December 21, 2001, Fiorello submitted a SER requesting
supplementary with the council.
a. Fiorello described his duties as "advise and consult in developing programs
and materials to be used in the practice of behavioral healthcare pharmacy."
b. Fiorello acknowledged a possible conflict with his departmental duties and
provided a written statement which provided, in part:
"Innovative Medical Education, a private educational firm, is responsible for
the development of the council's activities. Compensation is provided by
Innovative Medical Education for council member participation such as in the
development of educational CD -ROMs including Impacting Behavioral
Healthcare: The Role of Pharmacy. However, there may be a perception of
conflict of interest because the educational activities and programs are
funded by a grant from Pfizer Pharmaceuticals, hence the name of the
group."
92. Between 1998 and 2001 Fiorello received - - - [payments] - - - from Pfizer totaling
$5,500, as well as having expenses paid to him or on his behalf.
a. Expenses included rooms, meals and travel for council meetings in 1998,
2000 and 2001.
93. Sales of Geodon to the Commonwealth are projected to be in excess of $136,000 in
2004.
94. In or about March 2002 the Pennsylvania Department of Corrections (DOC) was
sponsoring a symposium at the Hershey Lodge & Convention Center, titled
"Exploring the Process of Quality Treatment for Offenders with Mental Illness."
a. The program was scheduled for April 17, 2002.
b. The program was intended mainly for the staff of the DOC.
95. On April 11, 2002, at 7:08 a.m. Fiorello e- mailed Boughtin advising her that he was
changing his request for donating the honorarium of April 17, 2002, to the First
United Methodist Church, Palmyra, PA.
a. Fiorello is a member of the church.
96. CNS issued check no. 007678 to Fiorello in the amount of $2,000 on June 14, 2002.
a. The check was deposited to Fiorello's personal account of LVFB on August
16, 2002.
b. On August 16, 2002, Fiorello issued two checks from the account totaling
$2,000 as follows:
Check No.
0170 International Planned Parenthood $1,000.00
0171 First United Methodist Church $1,000.00
Fiorello, 03 -025
Page 19
97. Fiorello did not use leave on April 17, 2002, when participating as a paid presenter.
a. Fiorello, at that time, was a Pay Range 10, Step 17, earning as follows:
1. Annual: $76,362.00
Bi- Weekly: $ 2,928.00
Hourly: $ 39.04
98. Fiorello did not report the receipt of the $2,000 payment from CNS on either his
Statement of Financial Interests filed for the 2002 calendar year or his 2002 Code
of Conduct Form.
a. Fiorello did not report the income on his federal income tax forms filed for
the 2002 calendar year.
b. Fiorello filed an amended federal tax return on August 30, 2003, following
the initiation of the Ethics Commission investigation.
1. Fiorello reported the $2,000 payment from CNS.
2. Fiorello also claimed two (2) $1,000 charitable deductions for the
payments issued to IPPF and First United Methodist Church.
99. In or about June 2000 Fiorello was asked by Riverside Associates to provide
training - - - .
a. Riverside Associates, located in Harrisburg, provides counseling services
and professional development programs for practicing clinicians.
b. In 2000 Dr. David Smith, CEO of Riverside, was looking for a pharmacist
with background in a mental health hospital setting to provide training.
1. Smith was referred to Fiorello by the former director of the Harrisburg
State Hospital.
c. Smith and Fiorello entered into an agreement for Fiorello to make two
presentations.
100. Fiorello agreed to accept the $300.00 per day - - - [from Riverside Associates].
a. Fiorello attempted to negotiate a greater - - - [payment(s)] - - - advising Dr.
Smith that programs he puts on for pharmaceutical companies pay
considerably more.
b. Dr. Smith did not agree to increase the amount of the - - - [payment(s)] - - -.
101. Fiorello presented two programs at the Riverside Center titled Psychopharmacology
of Mental Disorders.
a. The programs were held on June 2, 2000, and November 10, 2000.
b. The programs lasted from 9:30 a.m. to 3:30 p.m.
102. Payments were issued by Riverside Associates to Fiorello as follows:
Date Check No. Amount
06/08/00 007636 $300.00
Fiorello, 03 -025
Page 20
11/16/00 007943 $300.00
a. Check no. 007636 was deposited into Fiorello's personal account at LVFB.
103. Fiorello did not use annual leave or personal leave when making the presentation
on June 2, 2000.
a. Fiorello's hourly rate of pay was $35.80 on June 2, 2000.
b. Fiorello used the entire work day (7.5 hours) to make the presentation.
c. Fiorello's gross wages for June 2, 2000, were $268.50.
104. Fiorello, in his capacity as Pharmacy Director for OMHSAS filed Statements of
Financial Interests with the Department of Public Welfare for 1998 through 2003
calendar years.
Calendar Year Date Filed
1998 04/22/99
1999 04/11/00
2000 04/23/01
2001 04/12/02
2002 04/15/03
2003 04/23/04
[a. Fiorello avers his recollection is that he became Pharmacy Director of
OMHSAS in 1999.]
105. During calendar years 1998, 2000 and 2001, when traveling to New York City to
attend Pfizer Advisory Council meetings, all of Fiorello's travel related expenses
including, lodging, transportation and meal costs were paid for by Pfizer.
a. Travel related expenses for - - - [at least 1998] - - - were in excess of
$650.00.
106. Fiorello did not disclose on Statements of Financial Interests he filed for the 1998,
2000 and 2001 calendar years that Pfizer had paid for his travel related expenses
to attend the Advisory Council meetings.
107. Fiorello did not disclose income in excess of $1,300 received from Innovative
Medical Education in 2000 on the Statement of Financial Interests filed on April 23,
2001, for the 2000 calendar year.
a. IME issued payments to Fiorello in 2000 - - - for attending advisory council
meetings - - -.
108. Fiorello received interest income from the Pennsylvania State Employees Credit
Union (PSECU) in excess of $1,300 during the 2003 calendar year.
a. Fiorello received interest income totaling $3,482.10 from four (4) certificates
of deposit.
b. Fiorello did not disclose the receipt of the interest income as a direct or
indirect source of income in excess of $1,300 on the Statement of Financial
Interest filed on April 22, 2004, for the 2003 calendar year.
109. Fiorello failed to disclose his position as a consultant to Pfizer on Statements of
Financial Interests filed for the 1998, 2000 and 2001 calendar years.
Fiorello, 03 -025
Page 21
110. Duquesne University maintains an internship program for pharmacy students.
a. All pharmacy students are required to perform 1,240 hours of practical
experience.
b. The internships are done in five, five week rotations of 40 hours each week.
c. Each student is assigned or picks a preceptor from a pool maintained by the
university.
d. Locations for internships include a community setting, hospital setting and
an acute care institution.
e. State hospitals typically are used as an elective rotation in a student's sixth
year of training.
111. A preceptor is considered a sub - contractor appointed by the university to serve as
an adjunct clinical instructor.
a. A preceptor supervises the student in a work environment (internship).
112. Preceptors are paid $400.00 per student, per semester, to supervise that student.
113. Fiorello has served as a preceptor for students in the Duquesne University, School
of Pharmacy, Pittsburgh, PA, since at least 1998.
114. Duquesne University has had students complete internships at Harrisburg State
Hospital since at least 1998.
a. Those students have been supervised by Steven Fiorello.
115. Fiorello received confirmation of his appointment for academic year 2000 -2001 by
letter dated July 27, 2000.
a. The confirmation letter notes he will receive a stipend of $400 per student
per rotation.
1. A check made payable to the designated party, would be forwarded to
his attention at the conclusion of each semester.
b. Fiorello signed the confirmation and dated it August 1, 2000.
c. Fiorello completed the designated payee section as follows:
Steven J. Fiorello
1113 Darlene Drive
Palmyra, PA
1. This is Fiorello's home address.
d. The confirmation letter includes a section permitting an alternate payee
identified as institution.
1. Fiorello did not complete that section.
e. Fiorello completed similar confirmations for school years 2000 and 2002.
Fiorello, 03 -025
Page 22
116. Fiorello received stipends during academic years 2000 -2001; 2001 -2002; and
2002 -2003 from Duquesne are as follows:
a. Date Check No. Amount
05/26/00 609783 $800.00
05/11/01 Unknown $800.00
05/16/03 710979 $800.00
b. Check No. 609783 was deposited to Fiorello's LVFD personal account on
June 3, 2000.
c. Check no. 710979 was deposited to the LVFB account on May 24, 2003.
117. Fiorello received verbal permission from Dr. Karp, his immediate supervisor, to
continue as a preceptor after starting service as Pharmacy Director.
a. Fiorello had been serving as a preceptor prior to being supervised by Karp.
b. Fiorello never informed Karp he was being compensated as a preceptor.
c. All preceptor duties performed by Fiorello occurred during his regular
working hours as a state employee.
118. Fiorello received a private pecuniary gain of $2,400 when as Pharmacy Director of
OMHSAS he received income for supervising pharmacy interns as part of his
regular duties as a Commonwealth employee.
a. Fiorello made the decision to have payments specifically directed to him at
his home address.
b. Fiorello gave specific directions to Duquesne when signing the confirmation
to issue payments to him even though the option existed to issue payments
to the Commonwealth.
119. Fiorello did not submit a supplementary employment request to serve as a
preceptor.
120. Fiorello completed Form STD -323 for each year covering the reporting years of
1999 through 2004 as follows:
Year Date Filed
1998 01/31/98
1999 04/22/99
2000 04/11/00
2001 04/23/01
2002 04/12/02
2003 04/15/03
121. Fiorello signed and dated each form certifying that the presented information was
true and correct.
122. Fiorello failed, on any of the aforementioned forms, to report the following:
a. Consultant fees received.
b. Advisory board memberships.
Fiorello, 03 -025
Page 23
123. Fiorello was compensated as a Commonwealth employee at the same time as
receiving - - - a private pecuniary gain as follows:
a. June 2, 2000: $268.50
124. Fiorello received a private pecuniary gain of $2,400 when he supervised interns
from Duquesne University who were assigned to DPW.
B. Admissions
125. Fiorello through counsel made the following admissions at hearing:
"I sent a letter to Mr. Contino on September 7 just past, and acknowledged
five violations by Mr. Fiorello. In order to save us time here, first of all, Mr. Fiorello
has acknowledged receiving expenses exceeding $650 from Pfizer in 1998.
Second of all, he has - - - and not reporting that, I should say. These are failure to
report on his Statement of Financial Interest, those expenses. Secondly, failure to
report compensation from Pfizer in excess of $1,300 in the year 2000. Third, failure
to report interest income from Mr. Fiorello's bank, PSNCU [sic], in excess of $1,300
in 2003. Those three are all failure to report violations. Fourth, I've already
mentioned, there were actually three years involved, 2000, 2001 and 2003, in which
Mr. Fiorello received $800 in each of those years from Duquesne University, thus
totaling the $2,400 that Mr. Contino mentioned. Fifth, and finally, Mr. Fiorello did
fail to take personal leave, as he should have, on June 2 , 2000, which was one of
the dates involved in the Riverside Associates presentation. It's our position that
the $300 was not an honoraria but was compensation. On the other hand,
someone in the Investigative Division calculated the prorated share of Mr. Fiorello's
salary for his absence without leave on June 2 , 2000, which was $268.50. This is
admitted." (NT 55, 56)
126. The Investigative Division through counsel made the following statement as to a
DPW expenditure fora palm pilot that Fiorello obtained: "- - - I'll stipulate that there
was an expenditure for the personal purpose of Mr. Fiorello. Whether that was
alleged or whatever, we're not pursing that. If you want to go with your testimony,
that's fine, but we're not alleging that." (NT 817, 818)
C. Testimon
127. Laurie Snyder is a former employee of Janssen Pharmaceuticals (Janssen).
a. Snyder was a sales representative inter alia for Janssen during her
employment between October 1994 and March 2003.
(1) One of her assignments was to maintain and increase access to
Risperdal, a Janssen drug in her assigned geographical area.
b. When Snyder was a sales representative, her job was to work with
psychiatrists and pharmacists.
(1) Snyder knew Fiorello as a pharmacist at a Pennsylvania State
Hospital.
(2) Fiorello subsequently became Pharmacy Director for the
Pennsylvania Office of Mental Health (OMH).
c. One of Snyder's responsibilities was to work with requestors who wanted
unrestricted educational grants (UEG's).
Fiorello, 03 -025
Page 24
(1) Harrisburg State Hospital (HSH) in 2001 wanted a UEG to educate
state officials /employees on the Texas Medication Algorithm Project
(TMAP).
(a) Fiorello on behalf of OMH signed for and received a grant from
Janssen.
(b) Janssen gave $4,000 to HSH for the implementation of TMAP
in Pennsylvania.
(c) The grant was used to pay the expenses of Pennsylvania
employees to meet the leaders of TMAP at the American
Psychiatric Association (APA) Conference which was held in
New Orleans in May of 2001.
1. Snyder, as a representative of Janssen, met with
Fiorello and other Pennsylvania employees at
lunch /dinner meetings, paid for by Janssen, outside of
the conference setting.
(2) Janssen supported Continuing Medical Education (CME) through
grants of money.
(a) Janssen engaged Comprehensive NeuroScience (CNS), as an
outside vendor, to put on CME events.
1. The money would be given to CNS but earmarked for a
specific event.
(3) Dr. Maue in the Department of Corrections (DOC) sought to have Dr.
Karp and Fiorello speak on the algorithms used in the State Hospital
System.
(a) The DOC CME program occurred on April 17, 2002.
(b) Janssen financially supported the event.
(4) Snyder is now aware that public officials do not receive honoraria.
(a) Other than public officials, it is a common practice for Janssen
to pay honoraria to speakers for making presentations.
(b) At the time of the program, Snyder was aware that public
officials do not receive honoraria.
(c) Snyder instructed CNS about the honoraria prohibition.
1. Snyder learned subsequently that Fiorello was paid an
"honoraria" when she was interviewed by the Office of
Inspector General.
d. Although Janssen grants to UEG's are earmarked to the budget of a
particular drug, that is an internal document that Fiorello would not have
seen or heard in discussions with Snyder.
Fiorello, 03 -025
Page 25
e. The Janssen grant of $1,765.75 was to cover the travel expenses of Dr.
Shon from Texas.
(1) HSH was the payee of the check.
f. At the lunches /dinners paid by Janssen at the New Orleans APA
Conference, people from the TMAP program were present.
(1) Items discussed were medication utilization evaluation,
polypharmacy, automatic prescribing, and implementation strategies.
For TMAP, all anti - psychotic drugs approved by the FDA were in that
algorithm.
g.
h. The algorithm adopted by PA DOC was not exactly the same as OMH
because the population was different, that is, mentally ill offenders.
128. Samuel Lamonto is the Chief of Employee Relations in the Bureau of Human
Resources in DPW.
a. Lamonto performs labor relation functions in DPW.
b. Lamonto obtained and verified the job descriptions of Fiorello both in his
position of Pharmacy Director of the Office of Mental Health, Substance
Abuse Services (OMHSAS) and Chief Pharmacist at HSH.
c. Lamonto verified the Statements of Financial Interests (SFI's) filed by
Fiorello.
d. When Fiorello was hired by DPW, he received an orientation as to policies
and procedures.
(1) A checklist was used and signed by Fiorello to document the topics
that were covered for him as a new employee.
(2) This procedure ensures that new employees comply with department
policies and procedures.
e. Lamonto verified the documents in Fiorello's file including but not limited to
the above, Travel Expense Vouchers (TEV's), Fiorello's salary history, and
record of absence for the year 2000.
f. The Commonwealth has rules for supplemental employment as to its
employees to prevent conflicts of interest.
(1) Employees must secure approval before securing outside work.
(2) Outside employment must not conflict with the employee's primary
duties in DPW.
(3) Fiorello submitted two separate supplemental employment requests,
one in 1991 and another in 2001.
(4) Rules for supplemental employment are contained in the DPW
manual and Management Directives by the Governor's Office, Office
of Administration.
Fiorello, 03 -025
Page 26
129. George Kopchick is a retired state employee, formerly employed as the Director of
the Bureau of Hospital Operations in OMHSAS.
a. Kopchick supervised the superintendents of the state mental hospitals and
oversaw the operations of the ten hospitals.
b. Fiorello, under Dr. Karp's supervision, had the responsibility to ensure that
the work at state hospitals met the professional standards for medical
treatment.
c. Thomas Orr worked under Kopchick and had the responsibility for budgeting
in the state hospitals.
(1) Orr advised Kopchick that a DPW account was funded by
pharmaceutical company grants and was not properly administered.
(a) Orr was informed that a few DPW employees were using the
funds in the account for trips and other purposes without going
through proper procedures.
(b) Kopchick told the employees that they could not use the fund
unless they dealt with him or Orr.
1. Kopchick began an investigation.
(c) A meeting occurred with Kopchick, Orr and Fiorello in January
of 2002.
1. Fiorello acknowledged soliciting grants from pharma-
ceutical companies for the fund.
2. Fiorello admitted using fund monies for out -of -state
travel.
3. Fiorello in a supplemental employment request did not
explain why he bypassed the required approval of his
supervisor, Dr. Karp, and submitted the form directly to
the Personnel Office.
4. When Orr asked Fiorello if he was getting money from
drug companies or subsidiaries, Fiorello answered that
he was not.
5. Fiorello denied having supplemental employment with a
pharmaceutical company.
6. The meeting ended when Fiorello stated that he wanted
a third party to conduct the interview.
d. The Medical Directors' Education Fund (fund) that received grants from
pharmaceutical companies was to be used for teaching and educational
purposes.
e. Although a Deputy Secretary in DPW directed the discontinuance of the
practice of pharmaceutical companies paying for luncheons, the prohibition
did not extend to the Harrisburg Teaching Conference fund.
Fiorello, 03 -025
Page 27
f. Orr had concerns about the money in the fund that was dispersed to Fiorello
and Dr. Davis without proper authority and signatures.
Orr had concerns about the utilization of the fund as to the process, that is,
the propriety of the expenditures and the solicitation of grants for the fund by
the Commonwealth employees themselves.
g.
130. Susan Kaveney is a current employee of the Pennsylvania Insurance Department
and former employee of DPW.
a. Kaveney was an Accountant 11 in DPW overseeing the accounting
department in HSH.
(1) Kaveney had responsibility over the maintenance of bank accounts
from non - appropriated funds.
(a) There were three patient benefit accounts and one non - patient
benefit account.
(b) Kaveney listed receipts and issued payments from the
accounts.
(c) The non - patient account was opened by CEO Bruce Damey
and COO Dale Myer.
1. ID10, p. 95 is a summary of the account from its
inception to closing.
2. There was a disbursement for a Palm Pilot in the
amount of $249.99 for Fiorello.
3. There was a $4,000 deposit from Janssen on May 29,
2001, followed by a payment of $2,078.15 for Fiorello
and Dr. Davis to travel to New Orleans concerning
TMAP.
4. On October 16, 2001, there is a $3,000 deposit from
Pfizer into the account, a payment from the account of
$502 for airline tickets for Fiorello, another Pfizer
deposit of $1,200, a $570 expenditure for registration
for Fiorello and Dr. Karp and a payment of $1,994 to
the Holiday Inn for a two day medical /legal training
course for September 24 -25, 2003.
5. For DPW personnel, the account was only used for
travel /expenses for Fiorello and Dr. Davis.
a. No other DPW personnel used the money in the
account.
6. The account was closed on October 21, 2003.
a. The remaining balance in the fund was transferred
to a patient benefit fund.
131. Robert Davis, MD, is employed by DPW as the Associate Medical Director of
OMHSAS.
Fiorello, 03 -025
Page 28
a. A formulary is the list of medications that are approved for use within a
facility or system.
b. The Formulary Committee in OMHSAS, DPW is to develop and maintain a
safe formulary for drugs in state hospitals.
c. Drug Utilization Reporting System (DURS) looks at medications in a system
for appropriate usage.
d. Fiorello is a member and secretary to the Formulary Committee.
e. Committee minutes reflect that an educational consultant from Pfizer offered
to do a data study from DURS on Selective Serotonin Reuptake Inhibitors
(SSRI's) with Fiorello also working on the project.
(1) Fiorello would be involved in DURS in his official position.
f. The minutes of the Formulary Committee include a proposal for an SSRI
Utilization Review and Disease Therapy Evaluation for the state hospital
system with Fiorello as the central committee person and Timothy Henning
of Pfizer as a consultant.
(1) The report completion date was March 22, 1999, and presentation to
the committee was on March 25, 1999.
(a) In the report, the analysis reflects that Prozac and new
products are most costly while Paxil and Zoloft (a Pfizer drug)
are the least costly.
1. The report recommendation is a preferred first -line
SSRI of Zoloft and Paxil.
g. When Davis traveled to New Orleans on DPW business, his expenses were
paid from a UEG fund to which Janssen contributed.
h. The Formulary Committee has approximately 20 members comprised from
each of the state hospitals, consisting of psychiatrists, nurses and
pharmacists.
All drugs on the State Formulary are first approved by the FDA.
j. Doctors need to request the use of a non - formulary drug.
k. TMAP has become a Best Practice Guideline in Pennsylvania and in the
U.S.
While attending a conference in New Orleans with Fiorello, doctors from
Texas made presentations on TMAP.
(1) Fiorello, Davis and Karp could educate Pennsylvania State Hospital
staff about the Texas algorithm.
m. Since any attempt to restrict drugs would be problematic, the committee puts
all (anti - psychotic) drugs on the Formulary.
(1) The formulary committee may ban or not permit the use of a drug at
state hospitals if it determines the drug is harmful.
Fiorello, 03 -025
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n. Dr. Davis has never accepted any payment or honoraria from
pharmaceutical companies.
(1) Davis has never served as a paid consultant to a pharmaceutical
company.
132. John Lohr is a retired state employee, having served as the Personnel Director in
DPW.
a. An orientation checklist is used for new employees.
(1) Topics have boxes which are checked when the topic is covered to
ensure that these items are in fact covered.
(2) Some of the topics are affirmative action, sexual harassment, illegal
employment, conflict of interest, and code of conduct.
(3)
Approval for supplemental employment is to be obtained before the
employee starts to work.
(4) The employee signs the checklist to signify that the topics were
covered.
133. Richard Fuechslin is an investigator for the State Ethics Commission.
a. Fuechslin was the initial investigator assigned to the Fiorello case.
b. Fuechslin requested certain documents from Fiorello.
(1) Fiorello sent documents with an attached letter (ID15).
134. David Smith is a psychologist employed by Riverside Associates (Riverside) a
professional corporation of which he is president.
a. Riverside provides services to persons with disabilities and mental health
problems.
b. Riverside offers educational /informational programs to teach skills to people
in the human services field.
c. Fiorello has been a presenter at Riverside workshops.
(1) Fiorello did a presentation on the Psychopharmacology of Mental
Disorders on November 10, 2000.
(a) The subject matter entailed an overview of the types of
medications to treat mental disorders.
(b) Fiorello's name was mentioned by a state official (state
hospital director) as a person (Fiorello) who was qualified on
the topic.
d. Payment to a presenter at a Riverside program ranges from $0 to $300.
(1) A person employed by a county mental health system is an example
of a person who would receive no payment.
Fiorello, 03 -025
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(2) Fiorello received $300 for a presentation in June 2000 on the above
topic.
(3)
Fiorello received another $300 for his presentation in November
2000.
e. The workshops for which Fiorello was a compensated presenter were funded
in part by OMHSAS, the Office of Mental Health and Mental Retardation
(MH /MR), DPW, and by Dauphin County Mental Health and Mental
Rehabilitation via the Dauphin County Board of Commissioners.
f. Smith in a conversation with Fiorello advised that the highest amount he
could pay Fiorello was $300.
(1) Fiorello told Smith that he got more than that in his presentations with
pharmaceutical companies.
g. Other Riverside programs have funding from Dauphin County MH /MR.
(1) Dauphin County MH /MR employees do not pay a registration fee.
135. Kathleen Butler is a Special Investigator II employed by the Office of Inspector
General.
a. Butler was assigned the Fiorello investigation in the Inspector General's
Office.
(1) The main focus of the investigation was whether Fiorello had
supplemental employment with pharmaceutical companies and
whether he received funds from such companies.
b. Fiorello and Dr. Davis used the funds in a DPW account, to which
pharmaceutical companies made contributions, for trips to New Orleans.
c. Fiorello described himself as the "point man" on the State Formulary
Committee.
d. The report of interview contained the following statement made by Fiorello:
"Fiorello acknowledged that he's in a position to influence drugs selected for
the formulary. He noted that he chaired the Commonwealth's
Pharmaceutical Therapeutic and Formulary Committee, which makes
decisions concerning usage of drugs in the state hospitals.
Any person wishing to present matters to the committee must go through
Fiorello, who is the committee secretary." (NT 332)
e. In his interview, Fiorello characterized his participation in the Pfizer Advisory
Council as part of an elite group of pharmacists."
f. Fiorello acknowledged receiving "payment, honorarium and /or expenses" for
attending /speaking at pharmaceutical company meetings. (NT 333)
(1) Pharmaceutical companies paid the expenses of Fiorello, like meal
tabs, associated with their event.
Fiorello, 03 -025
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g.
Fiorello stated that the reason he submitted the supplemental employment
request for the third Pfizer Advisory Council Meeting was because he
became Pharmacy Director of the entire state.
136. Frederick Maue, M.D. is a staff psychiatrist employed by PA DOC and by Holden
Street State Hospital.
a. Maue is Medical Director of DOC.
b. Laurie Snyder of Janssen suggested to Maue that a conference be held to
teach clinical guidelines for the treatment of psychosis.
(1) The subject of the conference was the use of anti - psychotic
medication to treat psychotic disorders.
(2) Janssen through CNS would arrange for the conference and food.
(a) The state would pay for the travel and housing of its
employees.
(b) Snyder suggested that Fiorello and others from DPW could
speak on their clinical guidelines.
(3) The title of the conference was "Exploring the Process of Quality
Treatment for Offenders with Mental Illness."
(4) The conference was held on April 17, 2002 in Hershey.
(5) Fiorello gave a presentation at the conference in which Drs. Davis
and Karp participated.
(6) In the conference program, under faculty, Fiorello is described as
follows:
"Responsible for the formulation of policies and procedures for drug
use for ten state hospitals and facilities including the development
and implementation of the PennMAP project, the Best Practice
Approach." (NT 376)
(7) Maue received a payment of $6,000 plus expenses for a presentation
he made at the conference.
(a) Although the check was to be made payable to the
Commonwealth of Pennsylvania, it listed Maue as the payee.
(b) When Maue asked DOC how to process the payment to the
Commonwealth, he was instructed by DOC to cash the check
and write out a check from his account to the Commonwealth.
(c) Maue considered the $6,000 payment on honorarium.
(d) DOC policy dictates that payments for speaking engagements,
regardless of whether they are called honoraria, are payable to
the Commonwealth.
137. David Echnoz is the Division Chief of Human Resources Systems and Employee
Benefits in DPW.
Fiorello, 03 -025
Page 32
a. Echnoz has interalia responsibilities as to the Governor's Code of Conduct,
Ethics Statement of Financial Interests, and supplemental employment.
(1) Code of Conduct forms are reviewed as to possible conflicts of
interests.
b. DPW has a supplemental employment policy to guard against conflicts of
interests or the appearance thereof.
(1) A requester fills out the requisite form which goes through a chain of
command.
(a) The form then goes to Human Resources which will give its
approval or refer the potential conflict to legal counsel.
(2) Existing employees must obtain approval before starting
supplemental employment.
c. A supplemental employment request in 2001 by Fiorello came to Echnoz's
attention.
(1) Echnoz noticed that Fiorello did not submit the request through OMH.
(2) There was no recommendation for approval /disapproval from anyone
in the chain of command.
(3) Echnoz sent the form to Kopchick who is the Operations Director in
OMH.
(4) Echnoz took no action on the supplemental employment request form
by Fiorello.
(5) Subsequently Kopchick told Echnoz to consider the request as
withdrawn.
d. A prior request by Fiorello for supplemental employment in 1991 had been
approved.
(1) The request related to different employment as a retail pharmacist,
namely, filling prescriptions, dispensing medications, and counseling
retail patients.
(2) Fiorello received an approval letter to engage in the supplemental
employment.
e. Fiorello submitted no other requests for supplemental employment.
f. When an employee reports employment on a financial disclosure form, a
crosscheck is made to determine whether a supplemental employment
request was filed.
(1) Failure to report supplemental employment has potential disciplinary
ramifications.
138. Thomas Orr is the Director of Administrative Operations for the State Mental Health
facilities in DPW.
Fiorello, 03 -025
Page 33
a. Orr is responsible for personnel matters and financial operations in the
psychiatric hospitals.
b. Orr became aware of non - appropriated funds in an account funded from
grants from pharmaceutical companies.
(1) In talking to other Commonwealth employees, Orr heard that the
account was set up outside of Commonwealth practices.
(2) After Orr advised his supervisor, Kopchick, of transactions in the fund,
Kopchick and Orr decided to meet with Fiorello.
c. Orr and Kopchick met with Fiorello on January 17, 2002, regarding
information received and conversations with departmental supervisors.
(1) Fiorello was advised of the purpose of the meeting.
(2) At the meeting Fiorello was informed that an investigation would be
undertaken.
(3) Fiorello was asked about the supplemental employment issue.
(a) Fiorello indicated that he withdrew his request for
supplemental employment because Dr. Karp would not
approve it.
(b) Fiorello gave no explanation as to why he bypassed his
supervisor and attempted to file the form directly with DPW
personnel.
(4) When Orr asked Fiorello if he received compensation from drug
companies, Fiorello answered that he did not.
(a) Fiorello refused to answer a question as to whether he
obtained compensation from a subsidiary of a pharmaceutical
company.
(5) Fiorello responded to a question by stating that he did not have
employment with any pharmaceutical company and refused to answer
a question about grants from pharmaceutical companies.
(6) Fiorello told Orr that he (Orr) could not be objective.
(a) Orr responded that the alternative was an outside
investigation.
(b) Fiorello stated that an outside investigation would be fine, at
which time the interview ended.
d. Although there is no DPW policy against UEG accounts, the account that
Fiorello and Davis used for travel expenses was not handled in accordance
with Commonwealth regulations and policies.
(1) The chain of command was not followed for authorizations.
Fiorello, 03 -025
Page 34
139. John Quinn is employed by Pfizer as a Central Nervous System Specialty
Salesman.
a. Quinn has the responsibility of selling Zoloft, Geodon, and Aricept in a
specified area of central Pennsylvania.
b. Quinn met with Fiorello in the capacity of a sales representative for Pfizer on
a monthly basis.
(1) Quinn would inform him of Pfizer products, indications, and dosing.
c. Quinn was involved in the request for UEG's.
(1) Grants are budgeted under specific Pfizer products.
(2) In one instance, Fiorello himself requested a $300 grant.
d. Innovative Medical Education (IME) is a third party company that runs
advisory board /consulting board meetings for Pfizer.
e. The Pfizer Behavioral Healthcare Pharmacy Advisory Council (Advisory
Council) is composed of a group of nationally recognized individuals who get
together and advise Pfizer.
(1) Quinn nominated Fiorello from the Harrisburg State Hospital System
to be on the Advisory Council.
(a) Quinn recommended Fiorello for board membership because
of his management /expertise with the state psychiatric system.
(b) Quinn only nominated Fiorello once in order for him to be on
the council.
(2) Board members are paid compensation and their expenses.
f. Pfizer in its Field Course Manual recognizes the difference as to involvement
with government and its employees as compared to the private sector.
(1) There are differences between private sector healthcare
professionals and government employees.
g.
UEG's are made payable to DPW, OMH.
140. Paul Hoop is employed as a district sales manager by Pfizer.
a. Although Hoop's area is Washington, D.C. and the surrounding area, he
previously had an area that encompassed Harrisburg.
b. Hoop oversees 10 sales representatives who promote Pfizer products.
c. Hoop receives requests for UEG's and processes the paperwork for approval
at headquarters.
(1) One particular request came from HSH through Fiorello.
(2) A grant request for $5,400 was made to Pfizer by HSH, signed by
Fiorello.
Fiorello, 03 -025
Page 35
(a) Only $4,200 was granted by Pfizer.
d. Hoop played a part in the nomination of Fiorello to the Pfizer Planning
Advisory Council.
(1) Fiorello was chosen because of his position as Pharmacy Chief at the
flagship psychiatric hospital in the Pennsylvania system.
e. UEG's are grants to specifically provide a community -wide health benefit.
(1) Assigning grants to a specific Pfizer product is an internal book-
keeping function.
f. Pfizer has three different categories involving its funding: UEG's;
"consultant agreement[s]" for medical professionals to attend meetings
whereby Pfizer might benefit from their expertise; and speaker agreements
where professionals receive training in Pfizer technical information to
become medical /educational spokespersons for Pfizer.
g.
There are consultant honoraria paid by Pfizer to people who provide
technical expertise to Pfizer.
141. Daniel Sattele is employed by the Office of Inspector General of the Commonwealth
of Pennsylvania.
a. Sattele had responsibilities as to the Fiorello investigation as the
Investigations Manager.
(1) Sattele oversaw the two investigators assigned to the Fiorello case.
(2) A focus of the Fiorello investigation was on the use of UEG funds.
(3) Sattele participated and observed Fiorello's interview.
(4) Fiorello and Dr. Davis used funds from a UEG to go to two different
conferences in New Orleans in 2001.
(5)
Fiorello responded to one question during the interview to the effect
that he was the point man for drug selection in the Commonwealth
system for the state formulary.
(a) Fiorello stated during the interview that he was in a position to
influence the drugs selected for the state formulary.
142. Julie Fisher is employed by Pfizer as the U.S. Vice President of NeuroScience
Marketing.
a. Fisher's prior position for Pfizer was as the U.S. Group Leader for the
psychiatry franchise for marketing.
b. The Advisory Council solicits input from practitioners to help define
commercial strategies for its products.
(1) Fisher was the U.S. Team Leader for one of the brands in the
psychiatry franchise that sponsored the meetings.
(2) IME helped with logistics for the meetings of the Advisory Council.
Fiorello, 03 -025
Page 36
The financing of the entire operation of the Advisory Council is from a
Pfizer marketing budget.
(4) One purpose of the Advisory Council is to receive feedback on
pharmaceutical marketing programs.
The makeup of the Advisory Council is through a collaboration
between the headquarters marketing team and the local field
management.
(a) Field managers submit two or three names in a priority order
for membership on the Council.
(6) Members of the Advisory Council are paid an "honorarium" to attend
and provide feedback.
(a) Members are also given air transportation, food, and lodging.
(7) Council meetings last one to three days.
(8) The "honorarium" paid to Council members is based upon what they
are asked to do.
(3)
(5)
(
(a) All Council members are paid the same "honorariums."
(b) Members will receive additional compensation if they do
prepping, a presentation, or additional research.
1. Individuals who attend and also speak are given an
additional amount.
(c) Members also receive hospitality such as a Broadway show.
Fiorello was selected as a member of the Advisory Council because
of his position with DPW:
"Q. His position with the Commonwealth of Pennsylvania was
either as the Chief Pharmacist of the Harrisburg State Hospital or as
the Director of Pharmacy for the Pennsylvania Office of Mental Health
and Substance Abuse Services, which covers the entire state hospital
system. Would someone like that, with that title, be of interest to
serve on the Advisory Council?
A. The value of someone with that title would be of significance
for Pfizer because we do - - - we really want to understand the issues
of the inpatient /outpatient care and treatments of mood disorders.
Q. So the reason you would be interested in him is because he is
in the hospital system and would be able to give you the type of
information regarding transfers from inpatient to outpatient care?
A. As well as how care is decided on the inpatient setting, but
absolutely." (NT 554, 555)
(10) At a 2000 Advisory Council meeting, Fiorello made a presentation at
the meeting and received additional compensation ($500).
Fiorello, 03 -025
Page 37
(11) The Advisory Council invitation to its members was sent to Fiorello at
the address of OMHSAS, HSH.
(12) A person may decline to serve on the Advisory Council Board.
(13) When members attend, they sign an engagement agreement.
(a) Fiorello signed his name followed by the designation
" OMHSAS"
(14) The agenda for the 2001 Advisory Council meeting was expanded
from just antidepressants to schizophrenia information.
(15) Pfizer gave a UEG to the University of Kentucky for the preparation of
an educational program.
143. Delores Nobles- Knight is the Director /Team Leader of the Customer Outcome
Research Group with Pfizer.
a. The Outcomes Research Division performs research studies and projects.
b. Fiorello was a presenter at a program that Nobles- Knight coordinated.
(1) The program entailed a series of workshops for European customers
of Pfizer.
(2) The program process started by trying to identify speakers for the
program.
The conference /seminar workshops were held in Dublin, Ireland.
Fiorello's topic of presentation was on cost modeling tools.
All non - Pfizer employees were offered expenses plus an "honorarium"
of $1,000.
(a) IME was not involved in the conference so that all payments
came directly from Pfizer.
(b) Payments included reimbursement by Pfizer for travel
expenses to the presenters.
(6) Since Fiorello was familiar with specific software as to economic
modeling in OHMSAS, that was a basis for hiring him as a presenter.
144. Sapana Panday is employed by IME as a Senior Program Director.
a. Panday has the responsibility of carrying out the different medical education
programs.
b. Pfizer is a client of IME.
c. IME handled the Pfizer Advisory Council events.
(3)
(4)
(5)
(a) Fiorello was recommended to Nobles- Knight by Tim Henning
of Pfizer.
Fiorello, 03 -025
Page 38
d. As to payments to participants, such as Fiorello, the hotel expenses are
arrangements that are done directly through IME.
e. The payment to Fiorello for the 1998 Advisory Council meeting was sent by
IME to Fiorello at OMHSAS, DPW.
(1) The check for Fiorello's participation at the 2001 Advisory Council
meeting was also sent to him at HSH.
f. Fiorello received extra payment at one Advisory Council meeting for being a
speaker at the program.
Fiorello received an "honorarium" for participating in a CE program by the
University of Kentucky.
(1) Fiorello received $1,000 for his participation in the development of a
CD -ROM on Practice and Impact of Behavioral Healthcare in the Role
of Pharmacy.
(a) The check was dated November 15, 2000.
(b) The check was from IME dated May 10, 2000, and sent to
Fiorello at HSH.
g.
h. Fiorello received an "honorarium" check of $1,000 plus expenses for a
Pharmco Economic Management Summit on behalf of Behavioral Healthcare
in 2000 in California.
The hotel rate for Pfizer Advisory Council members was $250 per night plus
taxes for the 1998 and 2001 meetings and $259 per night plus taxes for the
2000 meeting.
(1) The length of stay was for two nights.
145. Robert Caruso is the Deputy Executive Director and Director of Investigations for
the State Ethics Commission.
a. Caruso had various types of involvement with the Fiorello investigation, such
as reviewing bank and other documents and participating in field interviews
and witness statements.
b. Various checks payable to Fiorello from, including but not limited to, IME,
Duquesne University, Riverside, P.C. and CNS were deposited into a joint
bank account in the names of Fiorello and his spouse.
146. David Lawrence, M.D. is a Physician 11 at Wernersville State Hospital.
a. Lawrence has also been the Chairman of the Pharmacy Therapeutics and
Formulary Committee for the last four years.
(1) The committee is generally composed of a pharmacist and a
physician or nurse from each state hospital.
b. As committee secretary, Fiorello had certain duties such as doing drug
utilization studies and annually reviewing formulary drug usage.
Fiorello, 03 -025
Page 39
(1) Fiorello did the bulk of administrative work and served as a resource
person to gather data.
c. Fiorello would collate drug utilization studies, some of which would relate to
drug effectiveness.
d. Fiorello was responsible for the annual review of formulary drug usage.
e. Fiorello played a role in psychopharmacology as to the Committee.
f. It is unusual for the secretary /member of the committee to receive a check
from a pharmaceutical company the day after the committee acted on one of
its drugs.
147. Gerald Radke is the Director of the Bureau of Facility Licensure and Certification in
the Pennsylvania Department of Health.
a. Radke was formerly the Deputy Secretary of OMHSAS, DPW from August
2001 to May 2003.
(1) Issues arose as to whether a certain DPW fund had appropriate
controls.
(a) The account was handled through HSH rather than out of the
central office.
(b) A concern existed with employees being reimbursed from the
account without both a prior approval and an after the fact
review.
(c) Another issue was whether a Commonwealth employee
received personal gain vis -a -vis the account.
b. UEG's received from pharmaceutical companies needed to be managed
properly.
c. Radke never approved any honorarium going to Commonwealth employees.
d. It was problematic that Commonwealth employee(s) who solicited funds from
drug companies actually controlled the account and its expenditures.
148. Timothy Henning is the Senior Director of National Accounts Employers with Pfizer.
a. Before his current position, he had the following positions with Pfizer: from
1997, a clinical education consultant in the Harrisburg /Mechanicsburg area;
from 1999 to 2000, a trainer for Global Learning and Development; and from
2000 to 2003, a team manager for Clinical Educational Consultants in
Reston, Virginia.
b. Henning became acquainted with Fiorello due to his position with the state
hospital in pharmacology.
(1) At some point Henning and Fiorello had discussions about Henning
making proposals as to disease state analysis or projects to the
Formulary Committee.
Fiorello, 03 -025
Page 40
c. Henning made a proposal to the Formulary Committee on June 24, 1998, to
conduct an SSRI Utilization Review of Disease Therapies in the state mental
hospitals.
(1) This was a drug therapy evaluation to analyze therapeutic areas as to
how a certain disease state was treated.
(a) Since information in the state hospital system was necessary
to conduct the study, Henning utilized Fiorello.
(2) The project was completed in March of 1999.
(a) Fiorello was involved in the completion of the project.
The analysis result reported was that Prozac and Luvox were the
most costly SSRI's while Paxil and Zoloft (a Pfizer drug) were the
least costly.
d. There was a meeting of the American Society of Health System Pharmacists
(ASHP) in Orlando, Florida on December 5 -9, 1999.
(1) There was a session on Anti - Depressant Outcomes in a Multi -
Hospital Medical System.
(a) Fiorello participated in the session which was moderated by
Pamela Smith of Pfizer.
(3)
(b) This was essentially the project Henning and Fiorello worked
on for HSH.
(2) Another agenda item was entitled Anti - Depressant Drug Utilization in
a Multi- Hospital Medical System, Review of Current Utilization, a Plan
for Cost Reduction.
(a) Henning and Fiorello are identified for the agenda topic.
(b) The topic also relates to the study done at HSH.
(c) There was a poster at the conference referencing the people
who did the work.
1. This related to the study that Henning and Fiorello
completed.
e. The topic of Anti - Depressant Outcomes in a Multi- Hospital Medical System
was presented in Dublin, Ireland.
(1) This was the title of the presentation made in Orlando.
(2) This was the same subject of the study that Henning and Fiorello
worked on for the HSH.
(a) Although very similar, the context was on therapy cost.
f. Fiorello also used the study that he and Henning worked on for a
presentation before the Pfizer Advisory Council.
Fiorello, 03 -025
Page 41
g.
As clinical education consultant, Henning gave disease awareness lectures
and also performed consulting services for customers to do analysis to help
customers meet their healthcare challenge needs.
h. The study that Henning and Fiorello performed focused on the cost of
utilization of drugs.
In general, studies that Henning performs can have outcomes that are not
favorable to Pfizer.
J.
g.
The Dublin, Ireland conference was used to demonstrate to foreign
customers how some of Pfizer's tools could be used.
149. Steven Karp is the former Medical Director for OMHSAS, DPW.
a. Karp is currently employed by the Rosewood Women's Center for the
Treatment of Eating Disorders.
b. Karp was the OMHSAS Medical Director from December 1997 to June 2004.
c. Karp brought to the attention of the executive staff of OMHSAS about how
states were following a Texas program regarding the treatment of mental
illness.
(1) After Karp presented information to OMHSAS Executive Council, the
consensus was to meet with the experts in the field.
d. Dr. Shon, the head of the TMAP, was brought to Pennsylvania with his
expenses paid from the Medical Director's Education Fund in DPW,
(1) Shon had requested that he be reimbursed.
e. Karp asked Fiorello and Davis to go to the New Orleans Conference so that
they could meet with the experts on TMAP.
(1) A number of people from the TMAP program would be at the New
Orleans conference.
(2) Funding from the trip came from the Medical Director's Education
Fund.
f. PA DOC sponsored in part a conference in April 2002.
(1) OHMSAS was collaborating with DOC because it was planning to
implement a treatment algorithm and guideline within the psychiatric
department of DOC.
(2) Fiorello was a presenter.
(3) Fiorello's attendance and presentation was within the scope of his
duties as an OMHSAS employee.
As to the PT &F Committee, new generation anti - psychotics were placed on
the formulary within one or two months from the time of their availability.
(1) As to the formulary, the drug Geodon was a concern because of
possible cardiac side effects.
Fiorello, 03 -025
Page 42
(a) All members of the committee felt Geodon was safe for
unrestricted use but with cardiac rhythm checks.
(2) The committee policy is to allow free access to all psychotic drugs in
the hospital and leave it up to the prescribing physician as to product
usage.
h. Drugs are purchased for the nine state hospitals through the Minnesota
Multi -State Purchasing Group.
i. Health Choices, Health Partners, a managed care organization that
administers the Medicaid Managed Care Program in Philadelphia, requested
that the drug Zoloft be taken off the formulary for reasons of cost
effectiveness.
(1) Zoloft was allowed to be deleted after a review among Karp, Davis
and Fiorello followed by a final decision by the OMHSAS Executive
Committee.
j. Karp was not aware at the time that Fiorello was receiving $1,000 payment
from Pfizer for each of the three years he served on their Advisory Council.
k. Fiorello in his state position was primarily involved in the
psychopharmacology of mental disorders.
Fiorello did the bulk of the administrative work on the PT &F Committee.
(1) Fiorello played a role in evaluations and studies of drug usage.
(2) Fiorello would do studies on what drugs were used in state hospitals
and whether the formulary should be changed.
(3) Fiorello studied the cost effectiveness of drugs.
(4) The information Fiorello provided to the committee could be the basis
for its decision making.
m. At a June 24, 1998, meeting of the PT &F Committee, a representative of
Pfizer was at the meeting proposing to conduct an SSRI Utilization Review of
Disease Therapy.
(1) Fiorello worked with the Pfizer educational consultant (Henning) on
the project.
n. Karp's opinion is that it is not appropriate for a state employee to perform a
service for the state and then take the result of that service and receive
payment privately.
o. At a PT &F Committee meeting, Zoloft (Pfizer) and another drug, Paxil (Smith
Kline), are recommended as preferred first line SSRI's.
p. Karp knew that Janssen and Pfizer gave funds to the UEG account.
(1) Fiorello knew that the funds in the account were from Janssen and
Pfizer and were used for the expenses of his trip to New Orleans.
Fiorello, 03 -025
Page 43
q. Karp considered Fiorello as the project director for PennMAP.
r. Karp specifically advised Fiorello not to accept honoraria.
s. Karp considered Fiorello's service on the Pfizer Behavioral Healthcare
Pharmacy Council as part of his state service.
t. Karp participated in the PA DOC conference but did not accept any
honoraria.
u. Fiorello's acceptance of "honoraria" from Janssen was against Karp's advice.
v. The acceptance by Fiorello of honoraria would be a cause of concern to
Karp because state employees are not supposed to accept honoraria.
w. Karp participated with Pfizer's Advisory Board but never accepted any
honoraria.
y.
(1) Karp left the board because he considered it a conflict /appearance of
conflict.
(a) The perception was the state challenging the pharmaceutical
companies as to costs while a state employee served on the
boards of such companies.
(b) Karp would have the same concern as to Fiorello.
x. Karp was unaware that Fiorello received compensation for pharmacy
students doing internships with him.
(1) Karp gave no approval for Fiorello to receive compensation.
When Health Choices, Health Partners tried to get approval to change the
formulary to delete Zoloft, Fiorello found the proposal unacceptable.
(1) Karp's concern was that the deletion should be for new patients but
not for every patient on that drug.
z. A check was issued from Pfizer through IME for $1,000 to Fiorello dated
March 21, 2001, which was the day after the committee made the decision to
place Geodon on non - formulary status.
aa. Because the PT &F Committee is comprised of approximately 20 practicing
professionals from the state hospitals, Karp believes that decisions are by
consensus as to what is best for state hospitals operations.
(1) Even if a drug is FDA approved, it is possible that the committee
could ban the drug from the state formulary.
bb. If there are two equally effective treatments with one less expensive than the
other, cost will then become a factor.
150. Fiorello is the Chief Pharmacist /Pharmacy Director in OMHSAS, DPW.
a. Fiorello received his pharmacy degree from the University of Connecticut
and a Masters Degree from the University of Bridgeport.
Fiorello, 03 -025
Page 44
(1) Fiorello had worked privately in a number of positions before
becoming a state employee: as a retail pharmacist for White Shield
Pharmacy; as a staff pharmacist at the Hershey Medical Center in the
specialty area of chemotherapy; at Norwalk Hospital; at the Apothecary
in Connecticut; as a chemistry teacher in Baltimore County, Maryland;
as a part -time pharmacist at Mercy Hospital; and at Powell's
Apothecary.
b. As pharmacy director, Fiorello coordinates pharmacy operations for the state
hospitals.
c. Pennsylvania has a contract with the Minnesota Multi -State Contracting
Alliance with Pharmacy (MCAP) which sets drug prices through negotiations
with drug companies.
(1) Pennsylvania contracts with drug wholesalers to buy medications at
the MCAP negotiated prices.
(2) Pennsylvania state hospitals individually order medications as
determined by the physicians.
d. The Medical Directors' Educational Fund originated because it was
necessary to educate the state hospital directors about the Texas program,
TMAP, so that the best practices for medications would be used.
(1) Dr. Shon and his staff from Texas were brought into Pennsylvania to
give three seminars, one each in Harrisburg, Pittsburgh and
Norristown.
(a) The fund was used which included deposits of UEG's.
(2) Fiorello's and Davis' trip to New Orleans relative to the plan to
implement a PennMAPS program from TMAP was paid from the fund.
(a) Meetings with the TMAP people occurred at the APA Conference
in New Orleans.
e. Allentown State Hospital was chosen as the pilot for the PennMAPS
program.
(1) After the pilot project ended, all other eight state hospitals were
directed to implement PennMAPS.
f. Once the FDA approves a drug, that drug is then appropriate for use.
g. The PT &F Committee was formed in the early 1990's to create a unified
system to replace the individual formularies in each state hospital.
(1) PT &F Committee maintains the formulary, does studies on drug
usage and cost effectiveness, and develops guidelines on pharmacy
issues.
(a) Fiorello testified that Karp appointed him as secretary to PT &F
Committee in 1998 or 1999.
(b) PT &F Committee has a membership of about 20 people.
Fiorello, 03 -025
Page 45
J.
h. Geodon was not added to the formulary right away because of side effects
relating to cardiac concerns.
(1) Geodon was given a non - formulary status.
(a) About six months later the Committee added Geodon to the
formulary with guidelines for its use.
(b) Geodon is manufactured by Pfizer.
PT &F Committee has no role as to the procurement process at the individual
state hospitals.
Since Dr. Maue of PA DOC sought to institute an algorithm like PennMAPS
for DOC patients, he planned a conference to train DOC physicians.
(1) Following the conference, CNS sent a $2,000 "honorarium" to
Fiorello.
(3)
(3)
(a) Fiorello subsequently donated $1,000 each to his church and
International Planned Parenthood.
k. The proposal by Henning of Pfizer to the PT &F Committee for the study was
to be able to query data in the way people in the state hospitals directed.
(1) There was the initial study and final results that were reported to the
Committee.
(2) Fiorello participated in each stage of the study.
This was the same study that Fiorello presented in Orlando, Florida
for which he received $1,000.
(4) Fiorello presented the same study in Dublin, Ireland for which he
received $1,000 from Pfizer.
David Smith of Riverside contacted Fiorello to give a presentation on
psychopharmacology at a seminar attended by, in at least part by, paying
professionals.
(1) Riverside is a business that charges fees for attending its programs.
m. Fiorello participated in the Pfizer Advisory Council in 1998, 1999 and 2001.
(1) Fiorello states that Pfizer invited him to attend for his input to help
Pfizer develop marketing strategies.
(2) Fiorello asserts that the $1,000 payments be received were
compensation for services rendered.
In one year Fiorello received an additional $500 because he spoke at
the conference.
n. At one of the Pfizer Advisory Council meetings, it was proposed to develop
program for pharmacists on the use of psychotropic medications and disease
states involving specified mental disorders.
Fiorello, 03 -025
Page 46
(1) An arrangement was made with the University of Kentucky to develop
the program.
(a) Fiorello worked on one of the disease states for the program
and received $1,000.
1. Fiorello asserts that the payment was compensation for
services.
o. Fiorello failed to put in a state leave slip for one of the presentations he
made for Riverside.
p. Retail pharmacy is completely different from hospital pharmacy.
q. Prior to the state service, Fiorello's involvement in pharmacy involved
dispensing at drug stores and working at hospitals.
r. Part of Fiorello's job description involves DURS which is the same type of
process as the Henning study for the PT &F Committee.
s. Fiorello received $1,000 by check of May 10, 2000, for participating in the
Pharmo- Economic Summit in La Jolla, California.
(1) Fiorello received payment of $1,000 each from IME for the Pfizer
Advisory Council and Behavioral Healthcare Pharmacy CD from the
University of Kentucky.
(2) Fiorello only questions whether he received a payment for his
presentation in Orlando, Florida.
t. Fiorello failed to report the $1,000 he received from Pfizer for the Dublin,
Ireland conference in his income tax return.
u. In response to a question about discrepancies in his SFI's, Fiorello stated:
"A. Inattention to detail, I guess."
[Continued questioning by Investigative Division counsel.]
* **
A. Well, that's inattention to detail, is the only answer I can give."
(NT 970, 972)
v. Fiorello responded to a series of questions as follows:
"Q. And you never reported that on your Statements of Financial Interest;
correct, for 1998?
A. Right.
Q. And that Statement of Financial Interest you also signed under the
penalties for unsworn falsification; is that not correct?
Fiorello, 03 -025
Page 47
A. Yes, but it was a lack of ignorance (sic). I was ignorant. I wasn't
aware. I'm sorry.
Q. So you were ignorant of the Code of Conduct form requirements that
are in play at your own agency; is that correct?
A. Uh -huh. (yes).
A. Yes.
A. Yes.
Q. Is that correct?
Q. The question was, you're ignorant of the Code of Conduct
requirements that are in play at your own department; is that correct?
Q. You're ignorant of the Statement of Financial Interest filing
requirements that are required by law; is that correct?
A. At the time, yes.
Q. Are you also ignorant of the Internal Revenue Service tax reporting
requirements?
A. No.
Q. Then why didn't you report Dublin on your 1999 tax return?
A. I assume because I did not get a W2 form from them.
Q. You know you went to Dublin, didn't you?
A. Yes.
Q. That's hard to forget." (NT 976 -978)
w. Fiorello denied that the basis for submitting the request for supplemental
employment was:
"- - - because Gerald Radke began to ask questions - - -.
A. That's incorrect. That's incorrect." (NT 989)
(1) Fiorello in denying an averment in the Investigative Complaint stated
to the contrary:
"A. Further denied, since Mr. Fiorello filed supplementary employment
requests in December of 2001, after questions had been raised by
Gerald Radke the beginning of September 2001 concerning
pharmaceutical company grants.
Q. Thank you. And you verified this? You signed this under penalties
and perjury of law, did you not?
Fiorello, 03 -025
Page 48
A. Yes." (NT 991)
x. Fiorello acknowledged "a potential perception for a conflict of interest to
continue as a member of the Pfizer Behavioral Advisory Council" after he
became OHMSAS Pharmacy Director but Fiorello held that position since
1998. (NT 987, 988)
(1) Fiorello asserted that he did not submit a report for supplemental
employment until December 2001 because the atmosphere changed
with the state system ..." (NT 989). "I didn't file it before because
didn't think it was necessary." (NT 992)
(a) Fiorello had filed a supplemental employment request in 1991
to work as a retail pharmacist in a drug store.
(b) Fiorello asserted that the financial reporting threshold was
determinative of whether one had to request approval for
supplemental employment:
"Q. Oh, I see. So it's the income level that requires the
supplemental employment request; is that what it is?
A. Well, according to the financial disclosure statements,
yes.
Q. The supplemental employment request form has
nothing to do with the financial disclosure forms, does it not?
A. I thought it does.
Q. So you're telling us you're ignorant of your own
department's supplemental employment request
requirements?
A. Apparently so, if the two aren't - - - financial disclosure
and supplemental employment. The other point was, I think I
mentioned before, that the Behavioral Healthcare Council was
not employment in the sense that I was employed on a regular
basis. It was a one -time thing. (NT 994, 995)
Q. So conflict of interest doesn't play any role in it, whether
or not there's a conflict of interest?
A. Perception of conflict of interest? No.
Q. But that's not what you said in your letter, is it not? In
your letter, Exhibit 15, you tell Mr. Fuechslin that the reason
you submitted it is because of the perception of a conflict of
interest. You never mention employment. You never mention
the threshold limit. It's something totally different.
A. Yes. The atmosphere had changed and I wanted
approval before I went to this fourth conference." (NT 996,
997)
Fiorello, 03 -025
Page 49
y. As to his participation on the Pfizer Advisory Council, Fiorello in a letter to
the SEC Investigator wrote that there was no conflict as to state activities but
then conceded involvement with state activities in response to questioning:
"- - - I considered it to be an honor to work with this national group of
pharmacists and never considered it to be a conflict of interest since no
Pennsylvania state activities were ever part of the meetings; do you see
that?
A. Yes.
Q. And you wrote that; is that not correct?
A. Yes.
Q. If you would, would you please turn to Exhibit 21? And I'd specifically
ask you to turn to page 6 of Exhibit 21.
A. Okay.
Q. Isn't it a fact that the presentation you made, which is listed under
11:20 a.m. to 12:00 p.m. time frame, Anti - Depressant Outcomes of a Multi -
Hospital Medical System, is the study that you and Mr. Henning did for the
formulary committee back in 1999?
A. Yes.
Q. And that was a Pennsylvania activity; is that not correct?
A. Yes. Yes, it was." (NT 997, 998)
z. The $2,000 Fiorello received from Janssen through CNS for the PA DOC
conference was deposited into Fiorello's personal bank account.
(1) Fiorello subsequently donated $1,000 to his church and International
Planned Parenthood.
aa. Although Fiorello on direct examination stated that he did not know how he
became nominated for the Pfizer Advisory Council, he admitted to State
Ethics Commission Investigators that he knew it was Pfizer sales
representatives who made nominations.
bb. Although the Pfizer Advisory Council dealt with psychosis issues and
pharmacological treatment, Fiorello's expertise in the area was through his
Pennsylvania state service rather than his prior pharmacist positions.
(1) Fiorello was listed as an Advisory Board member as the Pharmacy
Director of OMHSAS.
cc. When Fiorello signed the paperwork for the Dublin, Ireland conference, he
signed as OMHSAS Pharmacy Director.
(1) Fiorello used his title in communications with the Advisory Council of
Pfizer.
(2) For the University of Kentucky CD -ROM project, he corrected his title
from Pharmacy Director to Director of Pharmacy Services.
Fiorello, 03 -025
Page 50
gg.
(3)
Fiorello was referenced as with the Pennsylvania State Hospital
System for his participation in the Orlando, Florida conference.
(a) The topic was "Anti- Depressant Outcomes in a Multi- Hospital
Medical System."
dd. For the DURS system, the report was written on March 22, 1999.
(1) Henning presented the results at a PT &F Committee meeting on
March 25, 1999.
ee. At the March 25, 1999, PT &F Committee meeting, there were recom-
mendations to utilize the drugs Sertraline and Paroxetine.
(1) Fiorello relayed that information to all of the state hospitals.
(2) This could limit the use of the costly drugs, Prozac and Luvox.
ff. In the OMHSAS newsletter, of which Fiorello is the editor, there is a
reference to the cost savings of Paxil and Zoloft (a Pfizer drug) over Luvox
and Prozac.
When Fiorello was working with Henning of Pfizer on the study for the PT &F
Committee, he (Fiorello) had been interviewed by Pfizer in the prior month
for a position of employment as Clinical Education Consultant.
hh. In response to a question of whether Fiorello considered it to be a conflict in
attempting to obtain a position on Pfizer's Advisory Counsel while he
(Fiorello) was working with that company in his public position. Fiorello
responded "No." (NT 1026)
ii. At the Orlando, Florida conference, the subject matter was the study Fiorello
did with Henning.
(1) There was a poster at the exhibitors stand.
(a) Fiorello was identified in his public position as the Director of
Pharmacy at HSH.
(2) This related to work that Fiorello did in his position with HSH for
which he was paid as a Commonwealth employee.
Fiorello received $1,000 from Pfizer for his participation at the Dublin,
Ireland conference.
(1) It involved the study with Henning that Fiorello performed as a state
employee for which he received compensation as part of his public
position.
(2) Fiorello provided responses to the following questions:
"Q. My question to you is, this is the study that resulted from the
work that you did for the Commonwealth, you and Mr. Henning.
A. Right.
Fiorello, 03 -025
Page 51
(3)
Q. But Henning doesn't work for the Commonwealth, so he wasn't
paid by the Commonwealth. But you were for the time that you spent
on this; is that correct?
A. Yes.
Q. And then you subsequently received payment of $1,000 to go
make a presentation of this study in Dublin; is that correct?
A. Yes.
Q. And you also were paid $500 to make a presentation of this
study in New York, were you not?
A. Yes.
Q. During the Behavioral Advisory Council meeting, were you
not?
A. Yes.
Q. So you were paid privately to make presentations of work that
you had performed in part as a Commonwealth employee; is that not
correct?
A. Yes, that's correct." (NT 1030, 1031)
Fiorello acknowledged that he was not required to take such payment
from Pfizer:
"Q. So you didn't have to take the $1,000 - - -
A. Correct.
Q. - - - for the Dublin trip? And you didn't have to take the $500
for the New York speaking, the presentation?
A. That's correct.
Q. That's correct?
A. Yes.
Q. Thank you. You made the conscious decision to keep that
money, did you not?
A. Yes." (NT 1031, 1032)
kk. Fiorello used the study that he did with Henning from the PT &F Committee
as the basis for his speech /presentation at the Pfizer Advisory Council
meeting in New York City
II. Sertraline is Zoloft which is manufactured by Pfizer.
mm. The PT &F Committee did not approve a request by Abbott Pharmaceuticals
to do a drug study in Norristown State Hospital.
Fiorello, 03 -025
Page 52
(1) The minutes reflect the following:
The committee does not approve of any cooperative study with a
drug company at the state hospital and level. PT &F can develop drug
DUEs on a central level that will avoid potential drug company bias."
(NT 1035, 1036)
nn. Although Fiorello now references the payments he received from Riverside,
Pfizer, University of Kentucky as "compensation for services," he
consistently referenced the payments as honoraria in prior correspondence.
00. At the New Orleans APA Conference and the Pfizer Advisory Council
Meeting in New York City, Fiorello was treated to various forms of hospitality.
pp.
After Fiorello and his brother sold their mother's home and divided the
proceeds between them so that their mother's assets would not exceed the
eligibility cutoff for medical assistance, Fiorello admitted to placing half of the
proceeds into his personal bank account.
(1) Fiorello stated that he considers the money to be his mother's.
(2) On the question of whether there was a filing of false information as
to his mother's assets, Fiorello stated:
"A. I assume everything that we did was legal since we went
through a lawyer. If it's not, then I'II have to go re -look at that and
correct it." (NT 1054, 1055)
151. Fiorello is not a credible witness. (Fact Finding 150.)
a. Fiorello was evasive and non - responsive to certain questioning.
b. Fiorello provided inconsistent /contradictory statements /reasons for some
questions relating to his actions.
c. Several responses to questions by Fiorello were non - plausible.
d. Fiorello, a pharmacist, on several occasions gave answers for his actions or
inaction as due to his inattention to detail or his ignorance.
e. Fiorello gave testimony which is contradictory/inconsistent with the testimony
of other disinterested witnesses.
D. Documents
152. ID3 consists of photocopies of SFI's filed by Fiorello for the calendar years 1998-
2003.
a. The 1998 calendar year SFI was signed and dated by Fiorello on April 22,
1999.
(1) Fiorello incorrectly listed the calendar year as 1999 instead of 1998.
(2) Fiorello checked "None" for Real Estate Interests; Creditors; Direct or
Indirect Sources of Income; Gifts; Transportation, Lodging,
Hospitality; Office, Directorship or Employment in Any Business;
Fiorello, 03 -025
Page 53
(3)
(1)
Financial Interest in Any Legal Entity in Business for Profit; and
Business Interests Transferred to Immediate Family Member.
(a) Fiorello failed at the least to list DPW, Commonwealth of
Pennsylvania, as a Source of Income.
(b) Fiorello failed to list transportation and lodging or hospitality
he received from Pfizer that was in excess of $650.
Fiorello did not receive income in excess of $1,300 from Pfizer or
Janssen in 1998.
b. The 1999 calendar year SFI was signed and dated by Fiorello on April 11,
2000.
(1) Fiorello listed the "Harrisburg State Hospital" as a Source of Income.
(2) Fiorello checked "None" for all other categories of financial interests.
c. The 2000 calendar year SFI was signed and dated by Fiorello on April 23,
2001.
(1) Fiorello incorrectly listed the calendar year as 2001 instead of 2000.
(2) Fiorello checked "None" for all other categories of financial interests.
(a) Fiorello failed at the least to list DPW, Commonwealth of
Pennsylvania, as a Source of Income.
(b) Fiorello failed to disclose payments in excess of $1,300 from
Pfizer in 2000.
d. The 2001 calendar year SFI was signed and dated by Fiorello on April 12,
2002.
(1) Fiorello listed "Department of Public Welfare" as a Source of Income.
(2) Fiorello checked "None" for all other categories of financial interests.
(3) Fiorello failed to list transportation and lodging or hospitality he
received from Pfizer that was in excess of $650.
(4) Fiorello did not list transportation and lodging or hospitality vis -a -vis
Janssen.
e The 2002 calendar year SFI was signed and dated by Fiorello on April 15,
2003.
Fiorello listed "Department of Public Welfare" as a Source of Income
with an address of "502 Health & Welfare Building, Harrisburg, PA
17120.
(2) Fiorello checked "None" for all other categories of financial interests.
(3) Fiorello received income in excess of $1,300 from Janssen.
(4) Fiorello did not receive income in excess of $1,300 from Pfizer.
Fiorello, 03 -025
Page 54
f The 2003 calendar year SFI was signed and dated by Fiorello on April 22,
2003.
(1) Fiorello listed "Department of Public Welfare" as a Source of Income
with no address listed.
(2) Fiorello checked "None" for all other categories of financial interests.
(a) Fiorello failed to disclose interest income in excess of $1,300
from PSECU.
153. 1D5 is a photocopy of a DPW orientation checklist for a new employee.
a. Fiorello signed the document on April 14, 1989, as Chief Pharmacist.
b. During the process, policies discussed included inter alia "Illegal
Employment/ Conflict of Interest" and "Code of Conduct /Ethics Act."
154. 1D6 is a photocopy of a Travel Expense Voucher (TEV) submitted by Fiorello for two
trips: APA Convention in New Orleans; and PA Coalition on Aging in Mifflintown,
PA.
a. The TEV is numbered 459690.
b. For the APA convention, Fiorello submitted expenses of $35.00 for a taxi
and $15.00 for airport parking.
(1) The $50.00 claim was adjusted down to $25.00.
155. 1D7 consists of photocopies of Commonwealth documents relating to Fiorello as to
personal data, employment history as to salary scale, and partial attendance usage
history.
156. 1D8 consists of photocopies inter alia and in part of documents relating to a bank
account in the names of Fiorello and Susan A. Fiorello.
a. Fiorello deposited a check of Innovative Medical Education, No. 004076
dated May 10, 2000, payable to Fiorello, RPH, MS, Harrisburg State
Hospital, in the amount of $1,000.00. (p. 2)
b. Fiorello deposited a check of Duquesne University of The Holy Ghost, No.
609783, dated May 26, 2000, payable to Steven J. Fiorello in the amount of
$800.00. (p. 4)
c. Fiorello deposited a check of Riverside Associates, P.C., No. 0007636 dated
June 8, 2000, payable to Steven J. Fiorello in the amount of $300.00. (p. 5)
d. Fiorello deposited a check of Innovative Medical Education, No. 008455
dated March 21, 2001, payable to Steven J. Fiorello, RPH, MS, Harrisburg
State Hospital, in the amount of $1,000.00. (p. 6)
e. Fiorello deposited a check of Comprehensive NeuroScience, Inc., No. 7678
dated June 14, 2002, payable to Stephen Fiorello in the amount of
$2,000.00. (p. 8)
Fiorello, 03 -025
Page 55
f. Fiorello deposited a check of Duquesne University of The Holy Spirit, No.
710979, dated May 16, 2003, payable to Steven J. Fiorello in the amount of
$800.00. (p. 10)
157. 1D9 consists of photocopies of a program entitled "Exploring the Process of Quality
Treatment for Offenders with Mental Illness."
a. The agenda provides in part for a "Review of Harrisburg State Study on
Physician Prescribing Practice Patterns." (p. 1)
b. The program faculty consists of Steven J. Fiorello, RPh, MS, Director of
Pharmacy Service, OMHSAS, DPW; Frederick R. Maue, MD, Director of
Clinical Services at PA DOC; and a physician from the Albert Einstein
College of Medicine. (p. 2)
c. The program is made through a type of PowerPoint presentation. (pp. 7 -74)
158. ID10 consists of photocopies inter alia and in part of documents relating to a bank
account at Allfirst Bank in the name of Harrisburg State Hospital.
a. The account number is 09902 - 2898 -6. (p. 1)
b. The balance as of December 31, 1999, was $3,500.00. (p. 1)
(1) The initial funding came from a check from Novartis dated September
13, 1999, in the amount of $2,500.00 and a check from the University
of Pittsburgh Medical Center in the amount of $1,000.00 dated
December 17, 1999. (pp. 2, 3)
c. A disbursement by check no. 0091 dated November 17, 2000, in the amount
of $45.00 to Rubinic's Catering Service was made for expenses at an event
for OMHSAS. (pp. 7, 9)
d. A disbursement by check no. 0092 dated March 7, 2001, in the amount of
$1,765.75 to Dr. Steven P. Shon of the Texas Department of Mental Health/
Mental Retardation was made for travel expenses to speak at an OMHSAS
seminar held March 13 -15, 2001, on TMAP. (pp.14, 17, 19)
e. Fiorello completed an Agency Purchase Request on March 30, 2001, for
$249.99 to purchase a PDA Handspring Visor Deluxe Graphite for which
check no. 0094 dated March 30, 2001, to Work Advancement Center in the
amount of $249.99 was issued from the account. (pp. 25, 26, 30)
f. On May 25, 2001, US Pharmaceuticals Group (Pfizer, Inc.) made a payment
of $300 to the account as an "unrestricted educational grant." (p. 36)
On May 29, 2001, Janssen Pharmaceutica Products made a payment of
$4,000.00 to the account for the "educational fund." (p. 36)
g.
h. A disbursement of $2,028.15 from the account was made on June 1, 2001,
for "Out- Service Training for Steven Fiorello and Robert Davis." (p. 42)
(1) This payment related to Fiorello's trip to New Orleans from May 5 -9,
2001, for the annual meeting of the APA.
(a) Fiorello submitted an Out - Service Training (OST) Request
form with estimated expenses of $1,803.00. (p. 47)
Fiorello, 03 -025
Page 56
J.
(b) Fiorello's request for approval of out -of -state travel totaled
$1,016.00. (p. 49)
i. A disbursement of $240.00 on September 25, 2001, from the account was
made to Rubinic's Catering Service for a DPW event. (pp. 56, 58)
A disbursement of $502.00 was made from the account on October 22, 2001,
for airline tickets. (pp. 62, 67)
(1) The two tickets were for Fiorello and Dr. Davis to attend the American
Society of Health Systems Pharmacists Midyear Clinical Meeting.
k. A deposit of $3,000.00 from Pfizer was made into the account on October
19, 2001. (p. 63)
A disbursement from the account in the total amount of $1,994.00 was made
to cover the expense of a two -day medical /legal training course on a
number of topics, including PennMAPS to be held at the Grantville Holiday
Inn on September 24 and 25, 2003." (p. 73)
m. Pfizer made a payment in the amount of $1,200.00 to the account on
November 8, 2001. (p. 83)
n. Disbursements of $570.00 for registration fees for Fiorello and Dr. Davis on
November 20, 2001, for attendance at a ASHP Convention were made from
the account. (pp. 84, 90, 91, 92)
o. A disbursement of $40.50 to the Work Advancement Center on November
28, 2001, for frames of ten prints was made from the account. (pp. 84, 88,
89)
The account was closed via a transfer of the balance to the "Patient Benefit
Fund" on October 1, 2003, following a request by S. Reeves Power, CEO of
the Harrisburg State Hospital, in a memo dated September 11, 2003:
We are requesting the balance of the OMHSAS Medical Director's
fund be transferred to the Patient Benefit fund at Harrisburg State. This fund
is used to provide goods or services for the best interest of our patients,
especially those who have little or no outside support or income.
This transfer can be made immediately after all outstanding invoices
are processed." (p. 76)
159. ID11 consists of photocopies interalia and in part of requests for expenditures for
three specific events: (1) funding from Janssen for the travel expenses for Dr.
Steven Sohn, the Medical Director of the Texas Department of Mental Health to
speak at three programs sponsored by the Commonwealth of Pennsylvania; (2)
funding from Janssen for travel costs for Fiorello and Dr. Davis to go to New
Orleans to meet with individuals to discuss implementation of the TMAP to the
Pennsylvania Mental Health System; and (3) payment from Comprehensive
NeuroScience, Inc. (Janssen) for a symposium held in Hershey, Pennsylvania on
April 17, 2002, on the topic of "Exploring the Process of Quality Treatment for
Offenders with Mental Illness."
p.
Fiorello, 03 -025
Page 57
a. The funding for Shon's travel expenses was $1,765.75 as per an
Educational Grant Letter of Agreement between Janssen and the Harrisburg
State Hospital. (p. 4)
(1) The agreement was effectuated on March 1, 2001. (p. 6)
(2) Laurie P. Snyder signed for Janssen. (p. 6)
(3) Fiorello signed for Harrisburg State Hospital as OMHSAS Pharmacy
Director. (p. 6)
(4) Fiorello was a participant in the program.
b. The funding for the Fiorello /Davis travel to New Orleans was $4,000.00 as
per an Educational Grant Letter of Agreement between Janssen and the
Harrisburg State Hospital. (p. 26)
(1) The agreement was effectuated on April 19, 2001. (p. 28)
(2) Laurie P. Snyder signed for Janssen. (p. 28)
(3) Fiorello signed for Harrisburg State Hospital as OMHSAS Pharmacy
Director. (p. 28)
(4) Fiorello went to New Orleans.
c. Funding for the symposium in the amount of $2,000.00 was paid by Janssen.
(1) The request form identified Fiorello as the vendor. (p. 33)
(2) The Purpose of Expenditure states: "Janssen 02 Schizophrenia Faculty
Honoraria $2,000.00 per meeting, Hershey, PA + $2,000." (p. 33)
(3) Fiorello was a participant in the symposium.
(4) Payment was made by Janssen on April 4, 2002. (p. 34)
(5) Fiorello received a check from Comprehensive NeuroScience, Inc.
(Janssen) payable to himself in the amount of $2,000.00.
(a) Fiorello endorsed the check with his signature plus For
deposit only."
(b) Fiorello deposited the check into his private account. (p. 42)
(6) Fiorello was identified under the Program Faculty as follows:
Steven J. Fiorello R.Ph., M.S.
Director Of Pharmacy Services,
Office of Mental Health And Substance Abuse Services,
Pennsylvania Department of Public Welfare,
Harrisburg State Hospital (p. 37)
The symposium has the following program characterization:
"Acknowledgement
(7)
Fiorello, 03 -025
Page 58
This program is supported by an unrestricted educational grant from
Janssen Pharmaceutica.
Educational Statements
Intended Audience: This activity was developed for physicians,
psychiatrists, psychologists, nurses, social workers and marriage and
family therapists /professional counselors.
Statement of Need
The purpose of this activity is to bring you new information about best
practices in the treatment of schizophrenia. The contribution of new
atypical antipsychotics in encouraging optimism for the rehabilitation
and recovery of persons with schizophrenia which represents the
most important breakthrough of the last twenty years. You will have
the opportunity to learn about new medication and disease management
tools aimed at optimizing clinical outcomes. Concerns about using
these tools will also be discussed. Audience participation will be
actively encouraged.
Learning Objectives:
Upon completion of this activity participants should be able to:
* Recognize clinical algorithms that support best practices
* Discuss new literature regarding drugs interactions
* Better recognize treatment that is culturally and racially sensitive
* Report on the economics of drug treatments in mental illness" (p.
40)
160. 1D12 consists of photocopies inter alia and in part of documents relating to
unrestricted educational grants from Pfizer to OMHSAS, DPW.
a. $300.00 grant.
(1) Pfizer gave a grant by check no. NY01002256223 dated May 9, 2001,
to the Pennsylvania Office of Mental Health. (p. 2)
(2) The request for the grant was made by Fiorello in a letter dated
March 23, 2001. (pp. 5, 6)
b. $1,200.00 grant.
(1) Pfizer gave a grant by check no. NY01002402737 dated October 9,
2001, to the Pennsylvania Office of Mental Health. (p. 7)
(2) The request for the grant was made by Fiorello in a letter dated May
24, 2001. (p. 10)
c. $3,000.00 grant.
(1) Pfizer gave a grant by check no. NY01002385146 dated September
24, 2001, to the Pennsylvania Office of Mental Health. (p. 11)
(2) The request for the grant was made by Fiorello in a letter dated May
24, 2001. (p. 12)
161. 1D13 consists of photocopies inter alia and in part of documents and payments
Fiorello received from Pfizer.
Fiorello, 03 -025
Page 59
a. Pages 1, 10 -12 are forms, Confidential Disclosure Agreement and form letter
from Pfizer for a "consultant" as to activities that would be performed.
b. Fiorello received payments and expenses for participating in meetings in
New York City by Pfizer relating to its pharmaceutical and marketing
programs.
c. Pfizer, via Innovative Medical Education (IME), paid Fiorello $1,000.00 by
check no. 000118 dated November 18, 1998. (p. 2)
(1) This related to Fiorello's participation at the Pfizer Behavioral
Healthcare Pharmacy Advisory Council. (p. 2)
d. IME by check no. 000151 dated November 24, 1998, paid Fiorello $192.64
for expenses relating to a Pfizer conference. (p. 4)
e. Fiorello received a check in the amount of $1,138.00, no NY01001756909,
dated June 1, 1999, for payment plus expenses as to a Dublin, Ireland from
Pfizer for an "Outcomes Research Workshop." (pp. 6 -8)
(1) Fiorello's acknowledgment letter dated May 11, 1999, sought
expense reimbursement of $138.00.
(a) Fiorello hand wrote on the letter: "Also, $1000 Speaker's
honorarium." (p. 8)
f. IME made payment to Fiorello by check no. 005209 dated February 2, 2000,
in the amount of $1,000.00 payable to "Steven J. Fiorello, RPH, MS,
Pennsylvania Office of Mental Health & Sciences."
(1) This related to Fiorello's participation at the Pfizer Behavioral
Healthcare Pharmacy Advisory Council. (p. 13)
Pages 14 -15 is a letter from Pfizer dated February 16, 2001, addressed to
"Steven J. Fiorello, RPh, MS, Pennsylvania Office of Mental Health &
Substance Abuse" seeking to "engage - - - [Fiorello] as a consultant to assist
Pfizer" as to its efforts, marketing strategy, programs, analyses and
initiatives.
g.
(1) Fiorello would be reimbursed for travel, hotel and meals.
(2) The letter provided that "- - - [ Fiorello's] compensation will be
$1,000.00 for the activities - - -."
Fiorello signed the document as "Pharmacy Director, OMHSAS, on
February 21, 2001.
(4) Fiorello signed a Confidential Disclosure Agreement on February 21,
2001.
(3)
h. IME by check no. 008455 dated March 21, 2001, payable to "Steven Fiorello,
RPH, MS, Harrisburg State Hospital" in the amount of $1,000.00 was
provided to Fiorello.
(1) This related to Fiorello's participation at the Pfizer Behavioral
Healthcare Pharmacy Advisory Council. (p. 17)
Fiorello, 03 -025
Page 60
(2) Fiorello also received a check for expenses, No. 008634 dated April
5, 2001, in the amount of $120.20.
Fiorello received $500.00 for a speech /presentation at a Pfizer event in New
York City via a check of IME no. 005210 dated February 2, 2000, payable to
"Steven J. Fiorello, RPH, MS, Pennsylvania Office of Mental Health &
Sciences. (p. 20)
J.
IME issued check no. 006727 dated November 15, 2000, in the amount of
$1,000.00 payable to "Steven Fiorello, RPH, MS, Harrisburg State Hospital."
(1) The check stub states: "Impacting Behavioral Healthcare CD -ROM
Honorarium." (p. 21)
162. 1D14 consists of photocopies of documents relating to Fiorello's "supplementary
employment" and (Pfizer) Advisor List for its Advisory Counsel.
a. By letter dated December 21, 2001, Fiorello submitted a "Supplementary
Employment Request" to DPW for his membership on the Pfizer Behavioral
Healthcare Advisory Council.
(1) No review or approval was obtained by Fiorello. (p. 1)
(2) An attachment to the request lists the Advisory Council members.
(a) Fiorello was listed as follows:
Steven J. Fiorello, RPh, MS
Director of Pharmacy Services
Pennsylvania Office of Mental Health
and Substance Abuse
Harrisburg State Hospital
Harrisburg, PA (p. 3)
Fiorello wrote in part in his accompanying letter: "However there may
be a perception of conflict of interest because the educational
activities and programs are funded by a grant from Pfizer
Pharmaceuticals, hence the name of the group." (p. 2)
(3)
b. On July 3, 1991, a request for supplementary employment was filed by
Fiorello with DPW to work at White Shield Pharmacy. (pp. 9, 10)
(1) By letter dated July 17, 1991, Fiorello was advised by DPW that any
departmental approval would also require approval from the Office of
Administration (OA) and that no employment could be accepted until
approval is rendered. A DPW approval was given on July 17, 1991.
(pp. 7, 8)
(2) OA, by letter of November 19, 1991, approved the supplementary
employment subject to the following conditions:
"1. that your supplementary employment does not interfere with
your regular work hours or job performance or violate the
provisions of the Governor's Code of Conduct or the State
Adverse Interest Act;
Fiorello, 03 -025
Page 61
2. that you cannot utilize Commonwealth equipment, supplies or
properties or information, ideas or data derived from your
Commonwealth employment in the course of your
supplementary employment;
3. you may not participate through your supplementary
employment in any matter which presents a conflict with your
responsibilities as an employee of the Department;
4. you may not participate through your supplementary
employment in any transaction in which the Commonwealth
has a direct and substantial interest;
5. you may not use your position as an employee of the
Department or any confidential information gained through that
position in the course of your supplementary employment; and
6. you must comply with Management Directives 205.8 and
205.14 and are prohibited from conducting any private
business in Commonwealth offices at any time before, during
or after normal business hours. See your local Personnel
Office for a copy of these Directives." (p. 5)
163. ID15 is a photocopy of a letter from Fiorello to Richard Fuechslin of the State Ethics
Commission dated September 3, 2003, proffering certain documentation and
offering his explanations as to certain documents.
a. Fiorello wrote:
It was only after becoming OMHSAS Pharmacy Director, in a
statewide position, that I considered there might be a potential perception for
a conflict of interest to continue as a member of the Pfizer Behavioral
Healthcare Advisory Council. This is why I have submitted the attached
copy of a Supplemental Employment Request to obtain permission to remain
a member of the Behavioral Healthcare Advisory Council and let my
employers be the judge. I have not participated in the Advisory Council
since even though I still believe there is no conflict of interest as also stated
by Doctors Karp and Davis." (p. 1)
b. Fiorello admits to the following:
"Attached is specific information regarding my participation in the
Behavioral Healthcare Advisory Council meetings in 1998, 2000 and 2001
for which I received honoraria of $1000.
I have attached a copy of the CD Program "Impacting Behavioral
Healthcare: The Role of Pharmacy" which was a result of the Advisory
Council activity. This was funded by a grant for the University of Kentucky
for which I received an honorarium of $1000 through Innovative Medical
Education .. .
Included is copy of a study and additional information on a publication
"Antidepressant Drug Utilization in a Multi- hospital medical [sic]
System" that I presented at the American Society of Health- System
Fiorello, 03 -025
Page 62
Pharmacists (ASHP) Clinical meeting in Orlando, Florida in December 1999.
I received the $1,000 honorarium for the presentation from Innovative
Medical Education in the year 2000... Thus the total of $3500 reported in
my 2000 Tax return was a result of $1500 from Advisory Council
participation, $1,000 from University of Kentucky for the education CD
"Impacting Behavioral Healthcare: The Role of Pharmacy ", and $1,000
for my presentation at the ASHP Clinical meeting.
In 2002 I received an honorarium from Janssen Pharmaceuticals for a
lecture on our PennMAPS program. I requested that Janssen donate the
honorarium to my church and did not expect the $2,000 honorarium in my
name." (p. 2)
164. ID 17 consists of photocopies of documents relating to Fiorello's involvement with
the development of a CD -ROM program entitled, "Impacting Behavioral Healthcare:
The Role of Pharmacy."
a. By letter dated November 17, 2000, IME sent a letter to Fiorello on behalf of
the University of Kentucky providing him with an "honorarium payment." (p.
1)
(1) Fiorello was directed in the letter to make any changes or corrections
as to his listing:
"Steven J. Fiorello, RPh, MS
Pharmacy Director
Pennsylvania Office of Mental Health & Substance Abuse
Harrisburg State Hospital
Harrisburg, Pennsylvania
Director of Pharmacy
Harrisburg State Hospital
Pennsylvania Office of Mental Health
Harrisburg, Pennsylvania"
(a) Fiorello changed the second line from "Pharmacy Director" to
"Director of Pharmacy Services."
(b) Fiorello directed a deletion of the second paragraph which
referenced his position as "Director of Pharmacy." (p. 1)
b. The program was supported by a grant from Pfizer.
c. In a "Disclosure of Financial Interest Statement," Fiorello checked a box to
the effect that he had no "financial arrangements or affiliations with any
manufacturer(s) of commercial products that - - - [he] will discuss during - - -
[his] presentations - - -." (p. 2)
165. ID18 consists of photocopies of documents relating to the annual meeting of
American Society of Health System Pharmacists (ASHP) in Orlando, Florida. (p. 1)
a. Fiorello is listed as one of the moderators for a Wednesday, Exhibitors'
Theater II on "Antidepressant Outcomes in a Multihospital Medical System."
(1) Fiorello is identified with Harrisburg State Hospital.
Fiorello, 03 -025
Page 63
(2) Pfizer is identified as a sponsor. (p. 2)
b. International Pharmaceutical Abstracts, Volume 36, Number 21, provides
under no. 3612761:
"ANTIDEPRESSANT DRUG UTILIZATION IN A MULTI - HOSPITAL MEDICAL
SYSTEM: REVIEW OF CURRENT UTILIZATION AND A PLAN FOR COST
REDUCTION
Fiorello, S. J. (Pennsylvania State Hospital System, Office of Mental Health,
Harrisburg State Hospital, Harrisburg, PA 17105, USA) and Henning, T. A.
(Abstract of Meeting Presentation) ASHP Midyear Clinical Meeting 34:P-
219E (Dec) 1999" (p. 5)
166. ID19 consists of photocopies of documents relating to a presentation made by
Fiorello for The Riverside Center.
a. The subject of the presentation was "Psychopharmacology of Mental
Disorders." (p. 1)
b. Fiorello as the presenter was described as follows:
"Steven is a registered pharmacist in Pennsylvania and Connecticut.
He brings over twenty years experience as a pharmacist and public speaker.
For the past ten years he has worked at the Harrisburg State Hospital as the
Director of Pharmacy. He has been responsible for the formulation of
policies and procedures for drug use in 21 state hospitals and centers." (p.
1)
c. The presentation occurred on November 10, 2000. (p. 1)
167. ID20 consists of photocopies of documents relating to a presentation made by
Fiorello for The Riverside Center.
a. The subject of the presentation was "Psychopharmacology of Mental
Disorders." (p. 1)
b. Fiorello as the presenter was described as follows:
"Steven is a registered pharmacist in Pennsylvania and Connecticut.
He brings over twenty years experience as a pharmacist and public speaker.
For the past ten years he has worked at the Harrisburg State Hospital as the
Director of Pharmacy. He has been responsible for the formulation of
policies and procedures for drug use in 21 [sic] state hospitals and centers."
(p1)
c. The presentation occurred on June 2, 2000. (p. 1)
168. ID21 consists of photocopies inter alia in part of Fiorello's participation at the 1998
Pfizer Behavioral Healthcare Pharmacy Advisory Council in New York City for 1998,
2000 and 2001.
a. The 1998 meeting was from November 13 -15, 1998.
(1) The first day was for registration and a welcome buffet dinner. (p. 1)
Fiorello, 03 -025
Page 64
(2) The second day involved sessions, typically 45 minutes in duration
with break, luncheon, off -site dinner and Broadway show, ART. (pp.
1, 2)
The third day entailed breakfast, three workshops, luncheon and
departure. (p. 3)
(4) The "General Information" flyer inter alia listed the schedule of events,
all of the covered expenses, general information and a section
entitled "Honorarium" which stated:
(3)
b. The 2000 Advisory Council met on January 27 -29, 2000, in New York City.
(1) The first day was for registration and a welcome buffet dinner.
(2) The second day involved sessions, typically 45 minutes in duration
with break, luncheon, off -site dinner and Broadway show, Annie Get
Your Gun. (pp. 5, 6)
The third day entailed breakfast, three workshops, luncheon and
departure. (p. 7)
(4) The "General Information" flyer inter alia listed the schedule of events,
all of the covered expenses, general information and a section
entitled "Honorarium" which stated:
(3)
c. The 2001 Advisory Council met on March 23 -24, 2001, in New York City.
(1) The first day was for registration and a welcome buffet dinner. (p. 9)
(2) The second day involved sessions, typically 45 minutes in duration
with break, luncheon, off -site dinner and Broadway show, The Music
Man. (pp. 9, 10)
The third day entailed breakfast, three workshops, luncheon and
departure. (p. 10)
(4) The "General Information" flyer inter alia listed the schedule of events,
all of the covered expenses, general information and a section
entitled "Honorarium" which stated:
(3)
In appreciation of your participation in the 1998 Pfizer Behavioral
Healthcare Pharmacy Advisory Council, you will receive a $1000
honorarium as well as reimbursement of any necessary expenses for
attending the meeting." (p. 4)
In appreciation of your participation in the Behavioral Healthcare
Pharmacy Advisory Council, you will receive a $1000 honorarium as
well as reimbursement of any necessary expenses for attending the
meeting." (p. 8)
In consideration of your participation in the Behavioral Healthcare
Pharmacy Advisory Council, you will receive a $1000 honorarium as
well as reimbursement of any necessary expenses for attending the
meeting." (p. 11)
Fiorello, 03 -025
Page 65
169. ID22 consists of photocopies of a handwritten letter by Fiorello dated October 22,
2002, to Mr. Jones wherein Fiorello states that he includes a copy of his request for
Supplemental Employment , Advisor List, the CD "Impacting Behavioral Healthcare:
the Role of the Pharmacy," and statement of his recollection of the Pfizer Behavioral
Healthcare Advisory Council meetings.
a. Fiorello references the Advisory Council meeting and the honorarium" that
he received. (p. 2)
b. In a letter dated December 21, 2001, by Fiorello, he references his
membership in the Advisory Council and notes:
"However there may be a perception of conflict of interest because the
educational activities and programs are funded by a grant from Pfizer
Pharmaceuticals, hence the name of the group.
I will defer to your judgment regarding the perception of a conflict of interest
and will continue my membership in this group pending on your judgment."
(p. 5 )
170. ID23 consists of photocopies of minutes of the Statewide Formulary Management
Committee of OMHSAS DPW from April 29, 1998, to December 17, 2002.
a. The minutes from April 29, 1998, reflect that Dr. Karp will be Chair of the
committee and "Steven J. Fiorello, as Secretary, will be doing the bulk of the
administration work." (p. 1)
b. The minutes of June 19, 2001, September 25, 2001, and December 18,
1001, reflect agenda items as to the status of the PennMAPS project for
implementation in Pennsylvania. (pp. 68, 71, 74)
c. The minutes for March 19, 2002, June 18, 2002, September 17, 2002, and
December 17, 2002, include agenda items for the implementation of
PennMAPS in Pennsylvania. (pp. 78, 81, 84)
d. Fiorello took the following actions in part as to the committee;
(1) April 29, 1998, minutes: Fiorello as committee secretary will be
doing the bulk of the administration [sic] work." (p. 1)
(2) Fiorello makes the following suggestions to the committee: "Steve
Fiorello asked if presentations could be given for certain drugs, i.e.
asthmatic medications, by someone with expertise." (p. 6)
(3) In updating the State Formulary Booklet, "[t]he Introduction and
Formulary Management Criteria Sections will be rewritten by Steven
Fiorello, RPh, and Dennis J. Mike, MD. - - -" (p. 10)
(4) The minutes reflect an offer by Pfizer to provide consulting services to
the committee:
An educational consultant from Pfizer Pharmaceuticals has been
offering his service to our facilities. He can do a study using data
from the DURS system on SSRIs and cost analysis (see attached
proposal). (p. 13)
Fiorello, 03 -025
Page 66
(a) Fiorello was the point of contact for the study.
(5) Fiorello would compile quarterly reports for the Committee to review
for possible additions to the state formulary. (p. 24)
(6) The minutes reflect the following activity by Fiorello:
"Mr Fiorello presented a spreadsheet of the non formulary drug
requests by facility from November 1998 through February 1999.
This information is useful in determining NF usage and will be used in
evaluating requests to add drugs to the formulary." (p. 31)
(7)
Steven Fiorello will work with the consultant on this project. The
Committee will make a decision after review of the initial details of the
project."
The minutes provide:
"Dr. Burkins and Steve Fiorello RPh, were assigned the task of
developing a standardized approach for handling drug dosages
above the recommended maximum. Such a standard approach for
the system may include a statement on what is appropriate
justification and when a chart review is needed to insure proper
documentation." (p. 36)
(8) Fiorello and two other pharmacists are responsible ". . . to develop
mission, vision, and goal statements for the drug regimen review
process." (p. 39)
(9) Fiorello has responsibility for guideline review as to handling drug
dosages above the PDR recommended drugs. (p. 40)
(10) Fiorello has the responsibility for annual review of formulary drug
usage. (p. 54)
(11) "Fiorello shared the top 25 drugs by dollar volume" in each state
hospital for a specified period of time. (p. 55)
(12) Fiorello was engaged in the following activity:
"D.Geodon (ziprasidone):
The Committee decided to maintain ziprasidone on non -
formulary status for 6 months and to establish guidelines for
use as a restricted drug. Mr. Fiorello and Mr. Fire will develop
guidelines for review at the next meeting and a speaker will
[sic] obtained to discuss QTc evaluation. (OPEN)." (p. 69)
(13) The minutes indicate the following intent of Fiorello:
F. Criteria for Formulary Consideration:
Mr. Fiorello sent members a draft of a Criteria Sheet for
Evaluation of Drugs for OMHSAS Formulary Addition using
evidence -based criteria. Dr. Lawrence presented a simplified
version of the criteria to the Committee. Valerie Minnich, RPh,
will chair an Ad -Hoc Committee to combine the two versions
Fiorello, 03 -025
Page 67
e. Fiorello had involvement on the PT &F Committee as to the drug Risperdal
which is manufactured by Janssen Pharmaceuticals.
(1) April 1998 - Discussion in context of statewide formulary vis -a -vis
state programs to generate savings, as with drugs with no exclusivities.
(p. 7 )
(2) September 1998 — Discussion of cost savings and conflict of interest
as to guaranty program for established drugs. (p. 21)
December 1998 — Report by Fiorello as to use of atypical drugs and
related costs. (p. 25)
f Fiorello had involvement on the PT &F Committee as to the drug Geodon
which is manufactured by Pfizer.
(1) March 2001 - Geodon (Ziprasidone) and other drugs listed as non -
formulary. (p.66)
(2) March 2001 - Pharmacy newsletter on Geodon approved; Committee
votes to give Geodon non - formulary status for 6 -12 months with
guidelines for usage; article on Geodon with recommended guidelines
and other drugs will be placed in the next issue of the newsletter. (p.
66. b.)
(3) Geodon listed on summary of drugs reviewed. (p. 66.d.)
(4) June 2001 — Committee is to develop guidelines for use of Geodon at
its next meeting. Summary of drugs reviewed includes Geodon. (p.
70)
September 2001 - The Committee voted to add Geodon to the state
formulary; prior guidelines are withdrawn; article to be placed in
newsletter recommending baseline EKG and dosing guidelines. (p.
72)
(6) Geodon is listed under the Summary of Drugs Reviewed. (p. 73)
Fiorello had involvement on the PT &F Committee as to the drug Zoloft which
is manufactured by Pfizer.
(1) March 1999 — Presentation to Committee by Tim Henning of Pfizer
that Prozac and Luvox are most costly SSRI's while Paxil and Zoloft
are least costly. The recommendation from the model was in part to
consider Zoloft or Paxil as preferred first line SSRI. (pp. 32, 33)
g.
(3)
(5)
into a working document for approval at the next meeting,
(OPEN) (p. 88)
171. ID24 consists of photocopies of Healthcare Law Compliance Field Guide, v1.0,
prepared by Pfizer for operational purposes.
a. In the "Consultants /Investigators" section, under Procedures, the following
appears as to Speaker Programs:
All speakers are considered consultants, and therefore subject to all
applicable rules regarding consulting arrangements." (p. 30)
Fiorello, 03 -025
Page 68
172. ID26 is a photocopy of check no. 0007636 from Riverside Associates, Inc., dated
June 8, 2000, payable to Fiorello in the amount of $300.00.
173. ID27 is a photocopy of a Record of Absence 2000 for Fiorello.
a. The date June 2, 2000, reflects that Fiorello took no leave.
174. ID28 is a photocopy of a letter dated February 16, 2001, jointly from Drs. Gillespie
and Romano of Pfizer to Fiorello inviting him to participate in the 2001 Pfizer
Behavioral Healthcare Pharmacy Advisory Council.
a. The letter is addressed as follows:
Steven J. Fiorello, RPh, MS
Pennsylvania Office of Mental Health & Substance Abuse
Harrisburg State Hospital
Pouch A, Cameron and Maclay Streets
Harrisburg, PA 17105 (p. 1)
b. The letter states in part:
As a member of this Advisory Council, you will be asked to attend one
meeting this year. This meeting will be held Thursday, March 22, through
Saturday, March 24, at the Hudson Hotel in New York City. In consideration
of your participation, you will receive an honorarium as well as
reimbursement of expenses for attending this meeting." (p. 1)
175. ID29 is a photocopy of an email of January 18, 2002, from Thomas Orr to Gerald
Radke and George Kopchick concerning an interview with Fiorello that occurred on
or about June 17, 2002.
a. The memo states in part:
"Fiorello acknowledged that he solicited funds from drug company
representatives to establish an account outside of the Commonwealth
system for the sole purpose of "educational" grants. The size of the account
totaled approximately $14,000 over a 1 year period until he was advised to
stop soliciting and /or receiving any further funds. (p. 1)
Mr. Fiorello also acknowledged that he traveled to other states using these
funds. He also acknowledged that he did not receive permission according
to Commonwealth policy. Mr. Fiorello also acknowledged that either he or
Dr. Karp's former secretary made contact with drug company
representative(s) in at least 1 case to specifically seek reimbursement of
travel expenses for himself and another Commonwealth employee in the
amount of $1,765.75. Mr. Fiorello vacillated when questioned about whether
he or the former secretary of Dr. Karp made the contact with the drug
company. (The drug company representative indicated it was his
recollection that Mr. Fiorello made the contact with him.)" (p. 1)
b. On the topic of whether Fiorello had filled out and filed a Supplemental
Employment request and whether he had employment with a pharmaceutical
company /subsidiary, the memo reflects the following response of Fiorello:
"During the interview the issue of his Supplement Employment request arose.
Mr. Kopchick asked Mr. Fiorello if he had filled out this form. Mr. Fiorello
Fiorello, 03 -025
Page 69
indicated that he withdrew the form because Dr. Karp would not sign it. He
also did not explain why he bypassed his supervisor and attempted to file the
form directly with DPW Personnel. At that point I asked Mr. Fiorello if the
supplemental employment was with a drug company. He indicated it was
not. I asked if the employment was with a subsidiary of a drug company. He
said it was not, but that it was a grant. When I asked if the grant was
provided by a drug company, he refused to answer." (p. 2)
176. ID32 is a photocopy of an email sent on April 9, 2001, from Fiorello's
Commonwealth computer.
a. The subject matter is a solicitation to Janssen for $4,000 to cover expenses
of Fiorello and Dr. Davis to attend an APA meeting relative to PennMAP.
b. The email directs the grant be sent to the Harrisburg State Hospital.
177. ID33 consists of photocopies of the Governor's Code of Conduct forms completed
and filed by Fiorello for the calendar years 1998 -2003.
a. The form defines "Employment" as follows:
"List all payments, compensation, or consideration of any nature (including
but not limited to salaried employment, consultant fees, offices,
directorships, honoraria, travel /related expenses and other fees, etc.) earned
during the preceding calendar year. Exclude Commonwealth employment
listed on Page 2."
b. The form defines "Gifts" as follows:
"List all gifts of value in excess of $100, including the forgiveness of a debt
received during the preceding calendar year. For the purpose of this
section, gifts received from family members need not be disclosed."
c. For the calendar years 1998 -2003, Fiorello listed "none" for "Employment"
and "Gifts."
d. The form is signed subject to the following certification:
"I hereby certify that the information presented herein is true and correct to
the best of my knowledge, and is provided in compliance with the Governor's
Code of Conduct promulgated by Executive Order 1980 -18 dated May 16,
1984, as amended September 28, 1987.
(1) Fiorello signed and dated all six forms.
178. ID34 is a photocopy of DPW's 7170 Standards of Conduct, 7170.8 Supplementary
Employment.
a. The "Policy" section provides in part:
All full -time Department employees who anticipate, accept, or engage in
employment or render service for which any payment, compensation, or
consideration is received outside of their Departmental employment, must
obtain approval for supplementary employment using Form STD 355,
Supplementary Employment Request. Supplementary employment shall
include but not be limited to per diem employment, salaried employment,
Fiorello, 03 -025
Page 70
self - employment, consultant fees, educational service, and any honoraria
(travel and related expenses).
Employees who engage in an activity for which they are not compensated,
such as voluntary service, must consider whether such activity may
constitute a conflict of interest or an appearance of a conflict of interest with
their Departmental responsibilities."
b. The "General" section states in part:
"Current and prospective employees are required to have approval prior to
their acceptance of supplementary employment.
* **
Department employment is considered primary employment over any
supplemental employment. Conflict between an employee's Departmental
and supplemental employment will be resolved in favor of the Department.
Conflicts of interest include, but are not limited to, apparent direct conflict
with supplementary employment policy, a conflict in working hours /work shift/
working conditions, interference between an employee's supplementary
employment and Departmental duties, job acquired Departmental skills used
to benefit an employee's supplementary employment, and the total amount
of combined supplementary and Commonwealth employment interferes with
the employee's ability to perform Departmental duties."
179. 1D35 is a photocopy of Management Directive 515.18 Amended of the Governor's
Office dated July 7, 1998, concerning supplementary employment.
a. Under the "Policy" section, it is provided in part:
"a. All full -time employees who work for compensation or remuneration in
any capacity outside of their Commonwealth employment, except for military
duty, are required to file Supplementary Employment Requests with their
agency head or designated official who will either approve or disapprove the
requests. Such supplementary employment shall include self - employment.
Employees are required to resubmit requests when changing supplementary
employment or whenever the duties of either their Commonwealth or
supplementary employment position change substantially.
b. Approval for supplementary employment must be obtained prior to
accepting such employment for current employes and prior to employment
with the Commonwealth for prospective employes."
180. 1D36 consists of photocopies of Fiorello's Federal Income Tax Returns for 1998-
2002 calendar years with W- 2's/1099's attached.
a. For 1998, Fiorello included as income, $1,000 from Innovative Medical
Education. (pp. 1, 9)
b. For 2000, Firoello included (gross) business income of $4,900 as a
"Pharmaceutical Consultant." (p. 20)
(1) $3,500 was received from Innovative Medical Education.
(2) $600 was received from Riverside Associates.
Fiorello, 03 -025
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(3) $800 was received from Duquesne University. (p. 24)
c. For 2001, Fiorello received gross income and (gross) business income, the
following:
(1) $800 from Duquesne University. (p. 32)
(2) $216 from PRS Consultants, Inc. (p. 31)
(3) $1,135.75 from "(unintelligible) Centers, Inc.
(4) Fiorello reported $1,000 from Innovative Medical Education in an
amended return he later filed. (p. 33)
d. For 2002, Fiorello failed to list $2,000 received from Janssen. (p. 42)
(1) Fiorello filed an amended return on August 30, 2003, listing the
$2,000. (p. 40)
(a) Fiorello claimed deductions of $2,000 with the following listing:
"$2000 honoraria from CNS was donated and not reported on
original return
$1000 Donated to Palmyra 1 United Methodist Church
$1000 Donated to International Planned Parenthood
Donations not reported on original Itemized Deduction Tax
Return." (p. 41)
(2) The $2,000 payment was received from CNS.
(a) Check no. 007678 was issued to Fiorello on June 14, 2002.
(p. 42)
(b) The invoice comment stated: "Jans Honoraria meeting." (p.
42)
181. 1D38 is demonstrative evidence as to "Financial Gain Realized by Steven Fiorello."
182. 1D39 is demonstrative evidence as to "Steve Fiorello Statement of Financial
Interests Filing Deficiencies" for 1998 -2003.
183. 1D41 is demonstrative evidence as to "Timeline Selected Events."
184. R1 consists of photocopies of a Harrisburg State Hospital Special Funds Annual
Status Report.
a. For the fiscal year ending June 30, 2001, the OMHSAS Medical Director's
Education account had a balance of $5,476.89.
b. For the fiscal year ending June 30, 2000, the OMHSAS Medical Director's
Education account had a balance of $2,500.00.
185. R7 is a photocopy of the minutes of the PT &F Committee of September 25, 2001,
which include inter alia an update as to the PennMAPS program.
186. R8 is a photocopy of an OMHSAS State Pharmacy Newsletter of October 2001.
Fiorello, 03 -025
Page 72
a. The newsletter provided an update on the PennMAPS program:
"Allentown State Hospital is progressing well in its pilot of the Pennsylvania
Medication Algorithm Project for Schizophrenia (PennMAPS), a best
practices model for the treatment of schizophrenia.
Mayview State Hospital will begin the second PennMAPS pilot in November/
December 2001 and the program will be rolled out to the rest of the State
Hospitals early in 2002."
187. R21 is a photocopy of a letter dated July 21, 2003, by David A. Lawrence, M.D.,
Chairman of the OMHSAS PT &F Committee.
a. Lawrence expresses his personal view of Fiorello's involvement on the PT &F
Committee:
"Steven J. Fiorello, MS, R.Ph. serves at [sic] the secretary of our committee
but has not influenced any of our proceedings for either this drug or any
others.
* **
been very helpful in securing information requested by the committee to
encourage the liberal addition of drugs requested by various psychiatrists
and pharmacists.
* **
Mr. Fiorello has not commented on the presentation but left that to the
interpretation of the committee, which is usually critical of various assertions
made by speakers."
188. R26 is a duplicate as to ID9.
189. R27 -29 are photocopies of three documents by Commonwealth personnel
concerning the use of unrestricted educational grant funds from pharmaceutical
companies for certain purposes by DPW /employees.
190. Fiorello's actions at the annual Pfizer Advisory Council Meeting in New York City in
1998, 2000, and 2001 were taken in his Commonwealth position and resulted in his
receipt of honoraria consisting of payments from Pfizer totaling $3,500 for such
appearances and one speech.
191. Fiorello's actions at the Pfizer Conferences in Orlando, Florida and Dublin, Ireland
were taken in his Commonwealth position and resulted in his receipt of honoraria
consisting of payments of $1,000 for each event for such appearances.
192. Fiorello's actions at the Conference in La Jolla, California were taken in his
Commonwealth position and resulted in his receipt of honoraria consisting of a
payment of $1,000 for such appearance.
193. Fiorello's actions in the production of the CD -ROM at the University of Kentucky
were taken in his Commonwealth position and resulted in his receipt of honoraria
consisting of a payment of $1,000 from Pfizer for such published work.
194. Fiorello's actions at the Pennsylvania Department of Corrections Conference in
Hershey were taken in his Commonwealth position and resulted in his receipt of
Fiorello, 03 -025
Page 73
honoraria consisting of a payment of $2,000 from Janssen for such presentation.
195. Fiorello's actions at the Riverside Associates, Inc. were taken in his Commonwealth
position and resulted in his receipt of honoraria consisting of a payment of $600
from Riverside.
III. DISCUSSION:
At all times relevant to this matter, the Respondent, Steven Fiorello, hereinafter
Fiorello, has been a public employee subject to the provisions of the Public Official and
Employee Ethics Law, Act 9 of 1989, Pamphlet Law 26, 65 P.S. § 401, et seq., as codified
by the Public Official and Employee Ethics Act, Act 93 of 1998, Chapter 11, 65 Pa.C.S. §
1101 et seq., which Acts are referred to herein as the "Ethics Act."
The allegations are that Fiorello, as Chief Pharmacist /Director of Pharmacy for the
Department of Public Welfare (DPW), Office of Mental Health, Substance and Abuse
Services (OMHSAS), violated Sections 3(a)/1103(a), 3(d)/1103(d) and 5(b)(5), (6), and
(7)/ 1105(b)(5), (6), and (7) of the Ethics Act when he participated in actions of the DPW
Pharmacy and Therapeutics Formulary Committee (PT &F) related to the selection of drugs
manufactured by Pfizer Pharmaceuticals (Pfizer) and Janssen Pharmaceuticals (Janssen)
while serving as a compensated member on a Pfizer Advisory Board and receiving
honoraria from Janssen; when he used his position to obtain honoraria from Janssen
through Comprehensive NeuroScience (CNS), Riverside Associates, and Pfizer through
Innovative Medical Education (IME); when he received honoraria for appearances,
speeches and presentations; when he failed to disclose on Statements of Financial
Interests (SFI's) filed for the 1998 and 2000 calendar years all sources of income in excess
of $1,300; when he failed to disclose on an SFI filed for the 2002 calendar year income
received from Pfizer through CNS; when he failed to disclose on SFI's for the 2003
calendar year interest income in excess of $1,300; when he failed to disclose on SFI's filed
for the 1998, 2000 and 2001 calendar years transportation, lodging and /or hospitality paid
on his behalf by Janssen and Pfizer; when he failed to utilize leave from his
Commonwealth position when he participated as a paid speaker for Riverside Associates
and Janssen/ CNS; and when he used his public position to obtain payments from
Duquesne University for supervising pharmacy interns assigned to DPW during his regular
hours as Pharmacy Director.
Pursuant to Section 3(a)/1103a) of the Ethics Act quoted above, a public official/
public employee is prohibited from using the authority of public office /employment or
confidential information received by holding such a public position for the private pecuniary
benefit of the public official /public employee himself, any member of his immediate family,
or a business with which he or a member of his immediate family is associated.
Section 3(d)/1103(d) of the Ethics Act is an absolute prohibition against accepting
honoraria. The statutory definition of "honorarium" generally includes payments which are
made in recognition of speaking engagements /presentations, appearances, and published
works, but excludes such payments if they are legitimately intended as consideration for
the value of such services undertaken in the public official's /public employee's private
professional or occupational capacity and are not related to the public position.
Section 5(b)(5)/1105(b)(5) of the Ethics Act requires that every public official /public
employee and candidate list the name and address of any direct or indirect source of
income totaling in the aggregate of $1,300 or more.
Section 5(b)(7)/1105(b)(7) of the Ethics Act requires that every public official /public
employee and candidate list the name and address of the source and the amount of any
payment for or reimbursement of actual expenses for transportation and lodging or
hospitality received in connection with public office or employment where such actual
Fiorello, 03 -025
Page 74
expenses for transportation and lodging or hospitality exceed $650 in the course of a
single occurrence.
Before we highlight the facts, we preliminarily must address a legal issue raised by
Respondent. Specifically, Fiorello argues that the allegations in this case do not
encompass two matters prosecuted by the Investigative Division at the hearing: Fiorello's
involvement with the PT &F Committee regarding the Pfizer drug Zoloft and, second,
Fiorello's participation in Pfizer conferences in Dublin, Ireland and La Jolla, California.
Fiorello questions whether the allegations conform to the evidence produced at
hearing. It is established that in administrative proceedings the record must be in
conformity with and limited to the allegations. Pennsy v. Department of State, 594 A.2d
845 (Pa. Cmwlth. 1991). However, the courts have not construed this requirement so
restrictively that any discrepancy in an allegation would violate this principle. See, Straw
v. Human Relations Commission, 10 Pa Commw. 99, 308 A.2d 619 (1973). The question
is whether a respondent through the allegations has notice of what he /she has to defend
against in the proceeding. Pennsy, supra.
Fiorello argues that he had no notice of these issues because they were not
specifically stated in the allegations. We disagree. Fiorello had notice of what he had to
defend against in these proceedings. The wording of the allegation was sufficiently broad
to encompass the two matters. First as to Zoloft, the allegation is detailed about Fiorello's
participation on the PT &F Committee while he had financial relationships with Pfizer and
Janssen. The allegation references Fiorello's involvement as to "drugs manufactured" by
Janssen and Pfizer. Zoloft is manufactured by Pfizer. Fiorello had notice of the issue.
Regarding the Dublin, Ireland and La Jolla, California conferences, the allegation
not only references use of office to obtain honoraria from Pfizer and Janssen but also the
receipt of honoraria for appearances, speech and presentations. The Dublin, Ireland and
La Jolla, California issue relates to Pfizer conferences at those locations where Fiorello
participated and received $1,000 payments. Once again, Fiorello received notice of the
allegations that encompassed this matter. Thus, Fiorello had notice as to what he had to
defend against in the hearing. Since the allegations meet the legal requirements set forth
in the above judicial precedent, we find that due process has been accorded. See,
Catone, Order 994.
Having set forth the issues, the applicable law and the resolution of the procedural
issue, we shall first provide an overview and then a summary of the relevant facts.
Fiorello is a registered pharmacist by profession. Prior to his service with the state
hospital system in DPW, Fiorello had several jobs in the pharmacy field. In addition to
being a retail dispensing pharmacist in drug stores, he worked as a pharmacist in two
hospitals: Norwalk Hospital in Connecticut and the Hershey Medical Center. Although
both of those hospitals have psychiatric wards, Fiorello did not specialize in that area. The
only prior specialty that Fiorello had was in chemotherapy pharmacology at Hershey
Medical Center. It was not until Fiorello became employed with the Commonwealth that he
became involved with psychopharmacology.
When Fiorello became a public employee, he started work at the state hospital in
Harrisburg and then transitioned into the Director of Pharmacy in OMHSAS. Fiorello
became secretary and a member of the PT &F Committee.
In his position, Fiorello's duties and responsibilities include but are not limited to
supervising the state mental hospital pharmacy directors, coordinating hospital pharmacy
operations, acting as the OMHSAS consultant to health managed care organizations on
pharmacy and formulary issues, leading the redesign and maintenance of the drug
utilization reporting system (DURS) as to monthly drug usage reports, and disseminating
Fiorello, 03 -025
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policy for state contracting procurement and utilizing management in coordination with
other agencies.
Fiorello's involvement with the PT &F Committee encompasses the development of
the formulary for the evaluation and selection of drug products in the state hospital system,
policy development for recommending evaluation, selection and therapeutic use of drugs
and drug products, and education as to the professional staff for current and
comprehensive knowledge on matters related to drugs and drug use.
During the course of Fiorello's employment as Pharmacy Director with OMHSAS in
DPW, he had various types of interactions with a number of individuals, corporations,
universities, programs, committees, conferences and pharmaceutical companies. Such
involvement included: a new type of psychiatric treatment program that was developed in
the state of Texas, a relationship with Pfizer and Janssen during his work on the PT &F
Committee; participation by presentations, speechmaking, published work and involvement
with Pfizer, Janssen, PA DOC, the University of Kentucky, Duquesne University and
Riverside Associates.
The above activities and the SFI reporting by Fiorello have given rise to the
following charges: (1) use of a DPW account funded by pharmaceutical companies for
travel by Fiorello; (2) actions taken by Fiorello as to the PT &F Committee on Pfizer and
Janssen drugs during the time that Fiorello had financial relationships with Pfizer and
Janssen; (3) paid participation by Fiorello on Pfizer's Advisory Council; (4) Fiorello's paid
participation as to Pfizer conferences in Orlando, Florida; Dublin, Ireland; and La Jolla,
California; (5) Fiorello's paid involvement as to the development of the CD -ROM by the
University of Kentucky via Pfizer sponsorship; (6) Fiorello's paid participation at a PA DOC
conference in Hershey sponsored by Janssen; (7) Fiorello's paid presentations at
educational courses run by Riverside Associates; (8) the utilization by Fiorello of
Commonwealth paid time while making a presentation for Riverside Associates; (9)
Fiorello's receipt of compensation from Duquesne University for his participation in the
Pharmacy Intern Program during DPW working hours; and (10) various deficiencies by
Fiorello in filing SFI's.
We shall now summarize the facts as to each of the above ten areas seriatim.
DPW account funded by pharmaceutical companies
Although DPW operates from funds appropriated by the General Assembly, DPW
also has certain non - appropriated funds. The two types of non - appropriated funds that
DPW utilizes are for patients' benefits and for educational purposes. One particular fund
within OMHSAS, the Medical Director's Education Account, was used inter alia for three
DPW individuals: Fiorello, Dr. Karp who was a psychiatrist and head of OMHSAS, and Dr.
Davis, a physician. Aside from a few routine expenditures, the fund was primarily used for
expenses relating to the development and implementation of a PennMAPS program for
utilization in the Pennsylvania State Hospital system. PennMAPS became an outgrowth of
a model that was implemented in Texas where various state health system personnel
developed a TMAP program that gained national recognition for its algorithmic approach to
pharmacological treatment in a state hospital system.
When individuals in OMHSAS learned about TMAP, they became interested in
obtaining information about the program to determine whether a comparable program
could be implemented in the Pennsylvania State Hospital System. To that end, an
invitation was extended to the creator of TMAP, Dr. Shon from Texas, to come to
Pennsylvania to speak to healthcare professionals about the TMAP system. In addition,
since a number of individuals from Texas who were involved in the TMAP system planned
to attend the annual APA Convention in New Orleans, it was proposed that Fiorello and Dr.
Fiorello, 03 -025
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Davis would go to the convention so that they could meet and have discussions with the
key TMAP individuals.
Since there would be expenses incurred in bringing Dr. Shon from Texas to
Pennsylvania and expenses for Fiorello and Davis to attend the New Orleans APA
Convention, it was proposed that funds would be taken from the Medical Director's
Education Account, which was funded by unrestricted educational grants (UEG's) from
pharmaceutical companies. Fiorello himself solicited funds for the account. Deposits from
pharmaceutical companies were offset by expenditures to pay for Dr. Shon's travel
expenses as well as the expenses of Fiorello and Davis to go to the APA Convention in
New Orleans.
At some point, George Kopchick, the Bureau Director of Hospital Operations in
OMHSAS and Thomas Orr, the Director of Administrative Operations for State Mental
Health in DPW became concerned about this particular fund for the reason that it was not
set up according to Commonwealth guidelines and policies, was not subject to pre -
approval and after - the -fact review, and appeared to be available in DPW for only three
employees: Karp, Davis and Fiorello. Following a review within DPW, the account was
closed due to the above concerns. The balance was then transferred to a patient care
account.
OHMSAS Pharmacy Therapeutic and Formulary Committee
The OMHSAS PT &F Committee was established within the Office of Mental Health
for the purpose of streamlining and unifying a singular drug formulary that could be used in
all of the state hospitals. Prior to that time, each state hospital had its own formulary. One
of the functions of the PT &F Committee is to conduct reviews and studies and make
determinations as to what FDA approved drugs will be on a single state formulary for use
in the entire state mental system. Dr. Karp, the head of PT &F Committee, designated
Fiorello as the secretary to the committee. Fiorello is also a member of the PT &F
Committee.
Fiorello's duties and responsibilities on the PT &F Committee may be summarized
as follows: perform the bulk of the administrative work on the PT &F Committee; play a role
in evaluations and studies of drug usage; conduct studies on what drugs are used in state
hospitals and whether the formulary should be changed; study the cost effectiveness of
drugs; and provide information to the committee as the basis for its decision making.
Around the time when Fiorello became secretary and a board member, he was
being considered for placement on Pfizer's Advisory Council. One of Pfizer's employees,
John Quinn, who knew Fiorello by virtue of his position with OMHSAS, made the
nomination. Fiorello was invited to be a member of the Pfizer Advisory Council which
generally meets annually in New York City. Fiorello served on Pfizer's Advisory Council in
1998, 2000, and 2001. In addition, Fiorello interviewed for a position of employment with
Pfizer while serving on the PT &F Committee.
As to the PT &F Committee, Tim Henning from Pfizer had discussions with Fiorello
about Henning doing a study for the Committee. Henning proposed that Fiorello would
work with him since Fiorello had access to the state data which was needed to prepare
the study. After the proposal was submitted and approved by the PT &F Committee, the
study was completed by Henning with Fiorello's assistance and subsequently submitted to
the PT &F Committee. One of the reported results from the Henning /Fiorello study was that
Paxil and Zoloft (a Pfizer drug) were least costly while Prozac and Luvox were the most
costly.
During the relevant time period, Fiorello's financial relationship with Pfizer extended
to various conferences that were held in Orlando, Florida; La Jolla, California; and Dublin,
Fiorello, 03 -025
Page 77
Ireland. In addition, Fiorello did work on a CD -ROM project for the University of Kentucky
through Pfizer sponsorship. Fiorello received payments in all of those instances involving
his participation at the conferences and his involvement with the CD -ROM project.
Since the PT &F Committee was made up of approximately 20 healthcare
professionals consisting of physicians, psychiatrists, nurses, and pharmacists from the
state mental hospitals, Fiorello as an individual member only had one vote. However,
Fiorello by virtue of his position as secretary was in the position to conduct studies,
perform analyses and make information presentations to the committee that could be the
basis for its decision - making. See, Fact Finding 149(1).
With Fiorello having a financial relationship with Pfizer while serving as a board
member and secretary to the PT &F Committee, Fiorello, in those positions, had
involvement with issues concerning Pfizer drugs as well as other drugs as to formulary
status by the PT &F Committee. See, Fact Finding 170. However, as to Janssen, Fiorello
did not develop a financial relationship until he received a $2,000 payment for his
participation in a PA DOC conference that was held in Hershey in April of 2002. As to the
PT &F Committee minutes of record, actions taken on Janssen's drug Risperdal occurred
prior to April of 2002. Thus, from the record, Fiorello did not participate as to any Janssen
drug while he had the financial relationship with Janssen.
As to the following subgroupings of facts (except for SFI's), these relate to
compensation Fiorello received from sources other than the Commonwealth. As a DPW
employee, Fiorello was required to submit a request for supplemental employment and
receive approval before engaging in outside employment. Although Fiorello obtained such
approval for working part -time as a retail pharmacist in a drug store in the early 1990s,
Fiorello did not seek approval for all of the following activities for which he received
compensation. It was not until well after Fiorello had received compensation from various
companies /institutions that he attempted to obtain supplemental employment. Fiorello
bypassed the required signature of his supervisor whom he knew would not approve the
request and submitted the request to the personnel office which did not consider the
request due to the lack of Fiorello's supervisor's approval. Fiorello at that point did not
pursue the request for supplemental employment any further.
Pfizer Advisory Council
As noted above, Fiorello, while he was Chief Pharmacist /Director of Pharmacy in
DPW as well as and secretary and board member of the PT &F Committee, had a financial
relationship with Pfizer which included his participation in Pfizer Advisory Council meetings
in New York City in 1998, 2000 and 2001. Fiorello was nominated to the Advisory Council
by John Quinn who was employed by Pfizer as a salesman. Quinn met with Fiorello in his
capacity as a sales representative for Pfizer. Quinn recommended Fiorello for the board
membership because of his management and expertise within the state psychiatric system.
Quinn only nominated Fiorello once in order for Fiorello to become a board member. Paul
Hoop, a district sales manager of Pfizer who oversees ten sales representatives, was
instrumental in placing Fiorello on the Pfizer Advisory Council. Hoop testified that Fiorello
was chosen because of his position as Pharmacy Chief /Director of Pharmacy in the
Pennsylvania state hospital system. Fiorello, as an Advisory Council member, became
entitled to receive compensation and expenses for his service.
Pfizer typically holds an annual meeting of the Advisory Council in New York City
that lasts three days. Generally the first day of the conference involves checking in and
various social and hospitality functions. The second day entails various presentations and
hospitality, including meals as well as a Broadway show. The third day usually involves
the concluding of the conference and departure. For the three conferences that Fiorello
attended, he was a participant. For the year 2000, Fiorello also gave a speech for which
he received additional compensation. The topic of Fiorello's speech concerned the study
Fiorello, 03 -025
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he and Henning conducted for the PT &F Committee. For his participation in each year
Fiorello received $1,000, except for 2000 when he received an additional $500 payment
for making the speech. For the details of the specific Advisory Council schedules, see
Fact Finding 168.
The ostensible purpose for having the annual meetings of the Pfizer Advisory
Council was to solicit input from healthcare professionals to help Pfizer define its
commercial strategies for its products. The $1,000 payments and $500 for the speech in
2000 were denominated by Pfizer as "honorarium" for Fiorello.
Pfizer Conferences
Fiorello was invited by Pfizer to participate in three different conferences that it held
in Orlando, Florida (Fact Finding 148.d.), La Jolla, California (Fact Finding 144.h.), and
Dublin, Ireland (Fact Finding 143, 148.e.). Fiorello was invited because of his position with
the Commonwealth of Pennsylvania. See, Fact Finding 143.b.(6). But for the fact the
Fiorello was Director of the Pharmacy, he would not have been invited and could not have
participated in making these presentations. See, Fact Finding 148.d.,e. As to at least the
Orlando, Florida, Dublin, Ireland conferences and a presentation at a Pfizer Advisory
Council meeting in New York City, Fiorello's participation related to work that he and
Timothy Henning, a Pfizer employee, conducted for the PT &F Committee. See, Fact
Finding 148. As noted above, Henning offered to do a study with Fiorello's participation
for the PT &F Committee. After the study was done, a presentation was made to the PT &F
Committee. The work that was presented to the PT &F Committee was the basis for
Fiorello's participation in at least two of these conferences: Orlando, Florida and Dublin,
Ireland. The topic for these conferences was listed as follows: Anti - Depressant Outcomes
in a Multi- Hospital Medical System. See, Fact Finding 148.d.,e.
Following Fiorello's participation, he received from Pfizer, through IME which
coordinated the events, a check in each instance in the amount of $1,000 which was
designated as an "honorarium." Just like the invitations that were sent to Fiorello
referencing his state position and addressed to the state hospital, the payments for the
most part were sent to Fiorello with reference to his state title or his state hospital address.
See, Fact Finding 156.a.,d.; 161.f.,h.,i.,j.
University of Kentucky CD -ROM
Pfizer approached the University of Kentucky with a proposal whereby Pfizer would
fund the development of an educational CD -ROM relating to psychopharmacology. The
topic of the CD -ROM was the Practice and Impact of Behavioral Healthcare in the Role of
Pharmacy. See, Fact Finding 144.g. After the University of Kentucky agreed to undertake
the project, Fiorello was offered the opportunity to participate as to one particular area.
Fiorello participated in the project, completed his part of the project and received $1,000
payment which was designated as an "honorarium." The check in payment to Fiorello
issued by IME was sent to Fiorello at the Harrisburg State Hospital. Fact Finding
144.g.(1)(b).
Janssen PA DOC Conference
Dr. Maue, who is the staff psychiatrist at PA DOC, was approached by Laurie
Snyder of Janssen for a conference to teach clinical guidelines for the treatment of
psychosis. After Maue agreed, Janssen arranged for the conference and food through
CNS. The conference was held in Hershey in April 2002 under the title of "Exploring the
Process of Quality of Treatment of Offenders with Mental Illness." Fiorello, along with Drs.
Davis and Karp, participated. Fiorello gave a presentation at the conference. The
program under "faculty" listed Fiorello in his state position noting that he was responsible
Fiorello, 03 -025
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for the formulary policies and procedures for drug use in the ten state hospitals as well as
the development and implementation of the PennMAP project.
The presentation by Fiorello related to the work that he had done for OMHSAS,
DPW. There was a slight variation in terms of focus at the PA DOC conference based
upon the added element that the target group was not merely people with mental disorders
in state hospitals, but criminal offenders in the state correctional system.
Maue received a $6,000 payment for his participation at the conference. Since
Maue considered the payment as an honorarium to which he would not be entitled, he
consulted DOC. Maue was instructed to cash the check and then immediately write out his
personal check in the same amount to the Commonwealth. Dr. Maue did so. Fiorello also
received a payment of $2,000 which was designated as an "honorarium." Fiorello
accepted the honorarium and negotiated the check for deposit into his personal account.
Subsequently, Fiorello made donations to his church and International Planned
Parenthood, each by check in the amount of $1,000.
Riverside Associates Programs
Riverside Associates is a business of which David Smith, a psychologist, is the
president. Riverside provides services to people with disabilities and mental problems and
also provides educational and informational programs to teach skills to people in the
health services field. When Riverside decided to put on presentations involving the
psycho - pharmacology of mental disorders, Fiorello's name was mentioned, by a state
official in a state hospital, as an individual who would be qualified on the topic. After
Fiorello and Smith had some negotiations about the amount of payment Fiorello would
receive, Fiorello agreed and gave two presentations for which he was paid $300 each or
$600 in total.
The two programs for which Fiorello made presentations and received
compensation were funded in part by OMHSAS DPW as well as the Dauphin County
Mental Health and Mental Rehabilitation through the Dauphin County Board of
Commissioners. See, Fact Finding 134.e. Since some of Riverside programs are funded
by Dauphin County Mental Health /Mental Retardation, the county employees who attend
the programs do not pay any registration fee. Lastly, as to one of the presentations which
occurred on June 2, 2000, Fiorello failed to take leave from his state position for that day.
Fiorello's Leave Usage
As noted above, on June 2, 2000, Fiorello made one of his two presentations to
Riverside Associates in the area of psychopharmacology of mental disorders for which he
received a payment of $300. On that day, Fiorello failed to submit a leave request to
OMHSAS, DPW. Thus, Fiorello, in addition to receiving the $300 for his presentation at
Riverside, was also paid $268.50 for 7.5 hours of listed service with the Commonwealth on
that date.
Duquesne University Pharmacy Intern Program
For a period of time, Fiorello was a preceptor for the pharmacy student internship
program at Duquesne University. Although Fiorello's supervisor, Dr. Karp, was aware that
Fiorello was participating in the program, Karp was unaware that Fiorello was
compensated. Dr. Karp gave no approval to Fiorello to receive compensation for
mentoring pharmacy students during Commonwealth working hours. Nevertheless, Fiorello
received compensation of $400 per student for mentoring the pharmacy students in the
internship program. Fiorello engaged in this activity and received the compensation during
his normal work hours in OMHSAS, DPW. Fiorello received a total of $2,400 for the
interns that he mentored during regular Commonwealth business hours.
Fiorello, 03 -025
Page 80
SFI's filed by Fiorello
The SFI's that Fiorello filed as a Commonwealth employee for the years 1998
through 2003 are included as part of the record. Fiorello has admitted to receiving
hospitality, travel and lodging in excess of $650 from Pfizer in 1998 and failing to list that
on his SFI for that calendar year. Further, Fiorello admits failing to list income in excess of
$1,300 from Pfizer on his 2000 calendar year SFI. Likewise, Fiorello admits failing to list
income in excess of $1,300 from PSECU on his SFI for the calendar year 2003.
As to income received by Fiorello, for calendar years 1998 and 2000 Fiorello failed
to list on his SFI sources of income in excess of $1,300 he received from DPW. For
calendar year 2002 Fiorello failed to list income in excess of $1,300 received from
Janssen /CNS. For calendar year 2003 Fiorello failed to disclose interest income in excess
of $1,300 from PSECU on his SFI.
For calendar years 1998 and 2001 Fiorello failed to disclose on his SFI's
transportation, lodging and /or hospitality paid on his behalf by Pfizer /IME. In 2000,
Fiorello did not receive $650 or more in hospitality, lodging and /or hospitality.
Having summarized the above relevant facts, we must now determine whether the
actions of Fiorello violated Sections 3(a/1103(a), 3(d)/1103(d), and 5(b)/1105(b) of Act 9 of
1989.
Positions of the parties
The parties have filed briefs wherein they advocate for their respective positions.
The Investigative Division in its brief raises the following arguments:
- Fiorello violated the Ethics Act in obtaining a pecuniary benefit /honoraria for three
separate presentations (Dublin, Orlando and New York City) for a study he co- prepared
for the PT &F Committee during Commonwealth working hours;
- Fiorello used his title, office and status of his public position to make speeches,
appearances, presentations and a published work on matters relating to his public
employment;
- Fiorello engaged in intentional conduct in failing to disclose the receipt of funds and
acted to evade disclosure;
- The Investigative Division by clear and convincing proof established all the prerequisite
elements for violations of the Ethics Act;
- Fiorello jointly worked with Tim Henning of Pfizer on a study for the PT &F Committee
which recommended Zoloft; a Pfizer drug, as a preferred first line SSRI when Fiorello
had a business relationship with Pfizer;
- Fiorello made presentations and received compensation from IME /Pfizer on the topic
that was the study that Fiorello and Henning of Pfizer conducted for the PT &F
Committee;
- Fiorello used his office to obtain payments from Pfizer of $3,000 for Advisory Council
meetings and $500 for a speech, $1,000 for a CD -ROM produced through the
University of Kentucky with Pfizer sponsorship, $2,000 from Janssen for a PA DOC
Conference, and $600 from Riverside Associates, yielding a total of $10,100 in
honoraria through the use of public office;
Fiorello, 03 -025
Page 81
- The payments Fiorello received, as Director of Pharmacy at his state address on
subject matter relating to his public position constitute honoraria;
- The same actions by Fiorello implicate Section 3(d)/1103(d) as well as 3(a)/1103(a) of
the Ethics Act;
- Honorarium encompasses a published work, appearance, presentation or speech
unless the payment is intended as consideration for services that are non - public
occupational /professional in nature;
- The Legislative History as to the honorarium prohibition in the Ethics Act establishes
that the exclusion does not apply if the payment for such presentations, speeches,
appearances or published works related to the individual's public position;
- Fiorello received honoraria for presentations, speeches, appearances and a published
work that involved services that were public in nature;
- Fiorello's honoraria for the presentations in Dublin, Orlando, and New York City
specifically related to a study he conducted in a state position for which he received
compensation from the Commonwealth;
- Fiorello's participation in the CD -ROM program and La Jolla presentation related to his
position with the Commonwealth;
- Fiorello's presentation at the PA DOC conference as Pharmacy Director on the topic of
PennMAPS resulted in a $2,000 honorarium paid to him by Janssen;
- A donation by Fiorello of the $2,000 he received from Janssen after the fact does not
nullify his receipt of the prohibited honorarium;
- The Legislative History on honoraria establishes that an after the fact donation does
not void the violation;
- Fiorello received honoraria from Riverside Associates for two presentations on
medications for mental disorders which relate to his public position in OHMSAS;
- An application of the criteria in Baker, Opinion 91 -004 establishes that Fiorello
received honoraria in all such instances;
- Fiorello overtly attempted to conceal his efforts to receive honoraria which he knew
were prohibited as a result of discussions with colleges and the orientation process he
had as a new employee in DPW;
- Fiorello did not report the honoraria on his SFI's and Governor's Code of Conduct to
avoid detection;
- Fiorello did not file a request for supplemental employment as to the honoraria to avoid
being detected;
- Fiorello violated Section 3(a)/1103(a) of the Ethics Act when he, as PT &F Committee
member /secretary, participated in matters involving pharmaceutical companies which
were making payments to him;
- Fiorello participated in a study with Henning from Pfizer which had a favorable
recommendation for the Pfizer drug Zoloft;
Fiorello, 03 -025
Page 82
- Fiorello participated in PT &F Committee matters involving Pfizer drugs when Fiorello
interviewed for a position of employment with Pfizer and received honoraria;
- The allegations against Fiorello include his participation as to Pfizer drugs in general,
one of which is Zoloft;
- Fiorello intentionally violated the Ethics Act when he failed to list transportation, lodging
and hospitality received from pharmaceutical companies;
- Fiorello failed to report income from IME /Pfizer in excess of $1,300 for calendar year
2000, even though Fiorello included the income on his tax return filed approximately
one week earlier;
- Fiorello failed to report income in excess of $1,300 from Janssen on his 2002 calendar
year SFI;
- Fiorello failed to report transportation, lodging and hospitality that he received from
Pfizer which was in excess of $650 for the calendar years 1998 and 2001 vis -a -vis
Pfizer Advisory Council meetings that Fiorello attended;
- Fiorello failed to list transportation, lodging and hospitality received from Janssen in the
calendar year 2001 as to fees reimbursed to Fiorello for travel from a DPW account
funded in part by Unrestricted Educational Grants from Janssen;
- Fiorello violated Section 3(a)/1103(a) of the Ethics Act when he mentored pharmacy
interns from Duquesne University in his Commonwealth office for compensation during
Commonwealth working hours;
- This Commission should impose restitution, treble penalty and referral for criminal
prosecution and disciplinary action by DPW and the State Pharmacy Board for
Fiorello's violations of the Ethics Act;
- Of the total financial gain of $12,768.50 Fiorello received, the $2,000 he subsequently
donated to charity does not offset the financial gain;
- A treble penalty of $7,500 should be imposed based upon a trebling of the $2,500
Fiorello received for three presentations as to the study he conducted with Henning of
Pfizer for the PT &F Committee;
- A referral to the Office of Attorney General should be made due to the substantial and
serious violations; and
- A referral to DPW for disciplinary action and to the Pennsylvania Bureau of
Professional and Occupational Affairs, State Pharmacy Board should be made.
The Respondent in his brief argues as follows:
- The Investigative Complaint did not provide notice of a private pecuniary benefit/
honoraria from Pfizer as to presentations in Dublin, Ireland and La Jolla, California as
well as a use of office for private pecuniary benefit in financing /promoting the Pfizer
drug Zoloft;
- The specificity of the Investigative Complaint on all other allegations creates omissions
as to the Dublin /La Jolla presentations and Pfizer drug Zoloft;
- The Investigative Complaint does not encompass a charge about the use by Fiorello of
the Medical Director's Education Fund (Fund);
Fiorello, 03 -025
Page 83
- The Fund received UEGs to support processes in OHMSAS;
- DPW staff administered the money in the Fund;
- Fiorello's and Davis' attendance at the APA Conference in New Orleans related to the
TMAP program;
- The Investigative Division did not establish any quid pro quo between the UEG's going
into the fund and Fiorello's actions;
- The Fund had no connection with Janssen's drug Risperdal and its use in
Pennsylvania;
- The UEG's that were deposited into the Fund had no strings attached;
- The Investigative Division failed to establish any direct connection between Fiorello's
actions as a member and secretary of the PT &F Committee involving Janssen or Pfizer
drugs vis -a -vis financial gains received by Fiorello;
- The Investigative Division shifted the focus of its charge against Fiorello relative to his
actions on the PT &F Committee from the drugs Risperdal and Geodon to Zoloft;
- The PT &F Committee approved all second - generation, atypical antipsychotic drugs
with no preference given to any one drug;
- The Investigative Division failed to establish any quid pro quo between Fiorello's
actions as to the PT &F Committee and the approval of drugs for the state formulary;
- All members of the PT &F Committee voted to restrict Geodon to a non - formulary
status;
- The subsequent approval by the PT &F Committee of Geodon had no connection to a
UEG by Pfizer around that time;
- The Investigative Division produced no evidence to show improper action by Fiorello to
favor or promote a pharmaceutical drug before the PT &F Committee;
- The Investigative Division never challenged the validity of the study done by Henning
of Pfizer and Fiorello vis -a -vis Zoloft as a least costly drug and Zoloft as a preferred
first line SSRI;
- The use of Zoloft could result in savings to the Commonwealth based upon Henning's
analysis;
- Fiorello took action which had the effect of reducing the use of Zoloft as to the Health
Partners Medical Assistance Managed Care program regulated by DPW;
- Fiorello does not order drugs for the state system which is done through the Minnesota
Multi -State Contracting Alliance for Pharmacies (MMCAP);
- Fiorello's actions as to the PT &F Committee do not fall within the Ethics Act prohibition
as to conflict;
- The money Fiorello received for presentations at La Jolla and Dublin and for the CD-
ROM were not honoraria but payments for consulting services;
Fiorello, 03 -025
Page 84
- Fiorello received no payment for his presentation in Orlando;
- Fiorello's participation at the PA DOC conference was within the scope of his official
duties relating to PennMAPS and an equivalent transition by DOC;
- Fiorello instructed Janssen not to pay him an honorarium and when he received the
payment, he subsequently made donations to two charities in an equivalent amount of
money;
- The Governor's Code of Conduct allows for the donation of honoraria to charity;
- Fiorello's activities on Pfizer's Advisory Council did not involve the promotion of any
Pfizer product;
- Pfizer selected Fiorello for membership on its Advisory Council due to his experience,
qualifications and standing in the area of behavioral healthcare pharmacy;
- Fiorello received compensation as per consulting agreements with Pfizer vis -a -vis his
participation on Pfizer's Advisory Council;
- The consulting agreement with Pfizer characterized Fiorello as a consultant retained to
perform services;
- Fiorello did not use his position to obtain the membership on Pfizer's Advisory Council;
- The term "honorarium" has no relevance to the proceeding because the term was used
according to its common meaning;
- The Ethics Act does not prohibit a public official /public employee from engaging in
outside business activity and receiving payments for such services;
- Pfizer did not make a payment to Fiorello for his participation at the Orlando, Florida
conference by Pfizer;
- For the 2001 Advisory Council, the Investigative Division alleged hospitality, transportation
and lodging of less than the reportable $650 for the SFI but presented evidence which
purported but still did not exceed $650;
- Pfizer events were irregular so that Fiorello never knew when he would be invited to
Pfizer events vis -a -vis a supplemental employment request or income filing
requirements for SFI's;
- The testimony of Tom Orr does not assail Fiorello's credibility;
- Fiorello's participation at the two seminars of Riverside Associates for a total of $600
was compensation for services that were under the income reporting threshold for SFI
purposes; and
- Fiorello acknowledges his failure to list "expenses" from Pfizer exceeding $650 in 1998,
compensation from Pfizer in 2000 exceeding $1,300, PSECU interest issued in 2003
exceeding $1,300, and private pecuniary gain from Duquesne, $800 per year in 2000,
2001, and 2003 along with the failure to take a leave day representing $268.60 in
salary.
above.
We shall now address the allegations in the order and grouping as they appear
Fiorello, 03 -025
Page 85
Fiorello's credibility
Preliminarily, we note that we have found that Fiorello is not a credible witness.
See, Fact Finding 151. During Fiorello's cross - examination, we found instances where
Fiorello gave responses that did not answer the questions asked. At times, he was also
evasive. We found it particularly telling when, for a given line of questioning, Fiorello
would proffer different reasons for his action and then, when confronted with
inconsistencies or contradictory statements, would fall back on a general type excuse that
he is a person who is not attentive to detail or was ignorant of the matter.
Consider the following specific instances which in part lead us to the above result:
Fiorello's December of 2001 supplemental employment request, the Pfizer Advisory
Council nomination process, and conflict as to his state activities vis -a -vis Pfizer.
As to Fiorello's request for supplemental employment, DPW has a requirement that
any supplemental employment must have a multiple level approval before the employee
actually begins outside employment. In 1991, Fiorello requested and obtained approval to
work part -time as a retail pharmacist. However, in the late 1990s when Fiorello began a
financial relationship with Pfizer and others, he did not initially seek supplemental
employment. It was only much later in December of 2001 that he submitted a request for
supplemental employment as to the Pfizer Advisory Council. Fiorello bypassed submitting
the request to his supervisor, Dr. Karp, because as Fiorello himself stated, Karp would not
approve it. DPW Personnel Office would not process the request because it did not have
Karp's approval. At that point Fiorello did not attempt to pursue the request any further.
When Fiorello was asked why he attempted to obtain supplemental employment at
that late time, he told the investigator that he did so because it was only then that he
became the state -wide Director of Pharmacy. Fact Finding 135.g. However, Fiorello in a
letter to the SEC investigator indicated that he submitted the request at that time because
of a concern of a perception of a conflict. Fact Finding 163.a. On cross - examination,
Fiorello indicated that he submitted supplemental employment because the atmosphere
had changed in DPW in terms of the perception of pharmaceutical companies. Fact
Finding 150.x. At another point in cross - examination Fiorello responded that the need to
report on the SFI was the determining factor for filing a supplemental employment request.
Fact Finding 150.x.(1)(b). When Fiorello was asked whether the motivation for his
supplemental employment was because DPW was beginning to look at his actions,
Fiorello twice responded "That's incorrect." Fact Finding 150.w. When it was then pointed
out to Fiorello that in his pleadings he specifically denied an averment and stated that the
reason he sought supplemental employment was because DPW was beginning to look at
his actions, Fiorello then admitted that, thereby contradicting himself. See, Fact finding
150.w.
As to the nomination process for Fiorello for the Pfizer Advisory Council, we have
Fiorello telling investigators that he knew nothing about the process for nomination on the
Advisory Council but subsequently at the hearing readily admitting that he was aware of
the process as to the how he attained membership on the Council. See, Fact Finding
150.aa.
In a letter authored by Fiorello he stated that there was no conflict as to the
Advisory Council because there was no connection to any state activities in which he was
engaged. However, on cross - examination he conceded that there was a connection with
state activities. See, Fact Finding 150.y.
There were instances in Fiorello's cross - examination when he realized that he was
providing contradictory, inconsistent answers and then stated that he was a person who
did not give attention to detail or just had a general ignorance of the area. Fact Finding
150.u.,v. We find these responses incredible, given that Fiorello is a pharmacist, who
Fiorello, 03 -025
Page 86
absolutely must pay attention to detail to ensure that a physician's prescription is
accurately filled in terms of the right medication and the correct dosage. Further, Fiorello's
excuse as to ignorance is remarkable considering his degrees in pharmacy and (Masters)
in education. Once again, given Fiorello's educational background, his experience, and
his profession, we just do not accept his claim that he was inattentive to detail and ignorant
as plausible excuses. In this regard, Fiorello, when he became employed by DPW, went
through a detailed orientation /information process wherein he was specifically advised
interalia about conflicts, supplemental employment, the Governor's Code of Conduct and
SFI filing requirements.
Many of the allegations in this case concern the honoraria that Fiorello received.
Although Fiorello had no concerns about taking the honoraria and routinely referred to
them as honoraria, he now indicates that the honoraria are not honoraria but
compensation for services. Fiorello makes these statements even though he received the
invitations for participation because he is OMHSAS Director of Pharmacy. Several
conferences in Orlando, Florida, Hershey, Pennsylvania, Dublin, Ireland and New York
City involved work product Fiorello performed for the Commonwealth. In some cases,
Fiorello made the presentations to audiences that were comprised in part of government
personnel, as at Riverside Associates and the PA DOC Conference in Hershey,
Pennsylvania. Nevertheless, he now steadfastly asserts that the payments he originally
called honoraria are now compensation for consulting services.
Fiorello was not only contradictory and inconsistent as to his own statements but as
to statements that he made to other witnesses. Thus, when he was asked during an
interview by Orr and Kopchick in DPW whether he had any relationship or received
compensation from pharmaceutical companies, Fiorello responded with a denial. Fact
Findings 129.c.(1)(c); 138.c.(4),(5). On cross - examination, Fiorello admitted that he
received such compensation.
Even Fiorello's testimony on non - allegation issues raises credibility issues. For
example, Fiorello explained his failure to report income he received from a pharmaceutical
company on his federal income tax return because he did not receive a 1099. Fiorello
rationalized the deposit of half of the proceeds from the sale of his mother's home into his
bank account so that she would not lose her eligibility for assistance. These areas go to
credibility, given Fiorello's signing subject to the applicable legal penalties. See, Fact
Findings 150(v), (pp)
DPW account funded by pharmaceutical companies
We shall now apply the Ethics Act to the above fact findings. We perceive an
allegation /hearing issue as to this first matter. However, given the efforts of the parties at
hearing and in their briefs, we will discuss the issue in that the result will nevertheless be
the same regardless of whether we address either the procedural issue or substantive
issue. This issue concerns the use of the DPW account funded by UEG's from
pharmaceutical companies. There were uses of authority of office by Fiorello both in terms
of his solicitation of pharmaceutical companies for UEG's as well as his usage of the funds
for travel expenses as to the APA Conference in New Orleans. The monetary value of
these travel expenses constituted a pecuniary benefit. However, there was no private
pecuniary benefit to Fiorello because these expenses related to official DPW business. If
the expenses were not paid from the fund, there would be appropriated DPW funds to pay
for such expenses. Hence, Fiorello did not violate Section 3(a)/1103(a) of the Ethics Act as
to his use of a DPW account funded with unrestricted education grants from
pharmaceutical companies for travel expenses in that such expenses related to
Commonwealth business.
Our finding of no violation under Section 3(a)/1103(a) of the Ethics Act does not
extend to issues that are beyond the scope of the Ethics Act as to the fund. Indeed, it
Fiorello, 03 -025
Page 87
appears that there are non - Ethics Act issues. However, DPW has dealt at least in part
with these issues by closing out the account and transferring the balance to a patient
benefit fund.
OMHSAS PT &F Committee
As to the actions of Fiorello on the PT &F Committee, the fact findings reflect a
pattern of action by Fiorello in Committee actions involving drugs, including those of Pfizer,
on the state formulary. This occurred when Fiorello had a financial relationship with Pfizer.
At one point, Fiorello even interviewed for a position of employment with Pfizer. Thus,
Fiorello participated as secretary and board member of the Committee while Pfizer drugs
were considered vis -a -vis the state formulary. Such actions were uses of authority of
office. Fiorello realized private pecuniary benefits consisting of his appointment to the
Pfizer Advisory Council and his participation in the Pfizer conferences for which he
received compensation. We have held that a public official /public employee has a conflict
when he has a financial relationship with persons who have matters before his
governmental body. See, Miller, Opinion 89 -024; Kannebecker, Opinion 92 -010.
Accordingly, Fiorello violated Section 3(a)/1103(a) of the Ethics Act when he participated
in actions of the OMHSAS PT &F Committee in DPW relating to Pfizer drugs as to the state
formulary when he had financial relationships with Pfizer that manufactured those drugs.
We are aware that Fiorello had but one vote on the Committee. However, Fiorello's
position of secretary allowed him to play a role in evaluations and drug studies whereby
the information he provided could form the basis for Committee decisions. The fact that
Fiorello may not have been a deciding vote in Committee decisions does not negate an
Ethics Act violation. A public official need not cast the deciding vote in order for a violation
of Section 3(a)/1103(a) to be found. In Snyder v. State Ethics Commission, 686 A.2d 843
(Pa. Commw. Ct. 1996), Commonwealth Court affirmed an Order of this Commission which
had found that a township supervisor who had participated and voted on development
issues when he had actual or anticipated business relationships as to such developments
had violated Section 3(a)/1103(a) of the Ethics Law. Commonwealth Court rejected the
township supervisor's arguments that in order for a conflict to exist, he would have had to
have cast the deciding vote. The Court stated:
We are likewise unconvinced by the fact that Snyder's vote was never
controlling or necessary for a quorum. Snyder violated the Ethics Law by
discussing and voting on issues in which he had a private pecuniary interest,
not by affecting the outcome of those votes. Similarly, it is irrelevant whether
Snyder improperly used his influence as a Supervisor to gain the Colonial
Commons and Blue Meadow contracts; Snyder may have been able to
obtain the jobs even if he were not a Supervisor, but as a Supervisor, he
should not have considered and voted on issues involving his personal
business dealings.
Snyder v. State Ethics Commission, 686 A.2d. at 849. (Emphasis added.)
However, as to Janssen and its drug Risperdal, the minutes of the PT &F Committee
reflect various commentary in 1998 as to Risperdal. During that time Fiorello did not have
a financial relationship with Janssen. In this regard, it was not until 2002 that Fiorello
participated in the PA DOC conference and received the $2,000 payment from Janssen.
From the minutes that are part of the record, no action was taken by Fiorello as to a
Janssen drug after he received the payment from Janssen. Accordingly, Fiorello did not
violate Section 3(a)/1103(a) of the Ethics Act as to his participation in PT &F Committee
actions vis -a -vis Janssen and its drug, based upon an insufficiency of evidence.
Uses of authority of office and honoraria
Fiorello, 03 -025
Page 88
The most serious allegation in our view concerns payments Fiorello received from
Pfizer, Janssen and Riverside Associates. Fiorello was offered these various opportunities
to participate, make presentations, speeches, or work on the CD -ROM because of his
position with the Commonwealth. But for the fact that Fiorello was Chief Pharmacist/
Director of Pharmacy, he would not have received the offers and made the decisions to
participate. Such actions by Fiorello were uses of authority of office. See, Juliante, Order
809. Through such uses of authority of office, Fiorello received private pecuniary benefits.
The benefits were not authorized because Fiorello did not receive approval for such
supplemental employment. Parenthetically, Fiorello submitted a request for supplemental
employment only after he realized that DPW was looking into his conduct. The
administrative officer of DPW would not process the request because Fiorello's supervisor
did not sign the request. Fiorello did not submit the request to his supervisor because
Fiorello knew that his supervisor would not approve it. Lastly, DPW does not allow
employees to start supplemental employment until after approval is given. Fiorello started
his business relationships without any such approval. Hence, all of the financial gain
Fiorello received was not authorized and consequently private pecuniary benefits to
Fiorello in violation of Section 3(a)/1103(a) of the Ethics Act. H &W v. SEC, 673 A.2d 1004
(Pa. Commw. 1996).
Accordingly, Fiorello violated Section 3(a)/1103(a) of the Ethics Act when he used
the authority of his office to obtain private pecuniary benefits for himself from Pfizer as to
its Advisory Council, and its conferences in Orlando, Florida, Dublin, Ireland, La Jolla,
California, and its CD -ROM program through the University of Kentucky. Likewise, Fiorello
violated Section 3(a)/1103(a) of the Ethics Act when he used the authority of office to
obtain private pecuniary benefits from Janssen for the Hershey, Pennsylvania PA DOC
Conference and from Riverside Associates for the two presentations he made in June and
November of 2000.
As to at least the presentation made at one Pfizer Advisory Council meeting and the
presentations in Orlando and Dublin, all of these involved Commonwealth work product
done by Fiorello for which he received compensation from the Commonwealth. See,
Brocious, Order 1151. See also, Reist, Advice of Counsel Nos. 01 -524, 01- 524 -S.
Act.
We will now consider this same conduct under Section 3(d)/1103(d) of the Ethics
As stated, Section 3/1103(d) is an absolute prohibition against accepting honoraria.
The question of whether a given payment is an honorarium is determined as a matter of
law by an application of the statutory definition set forth in the Ethics Act, not by the mere
label which may have been attached to the payment. Under Pennsylvania law, form is not
elevated over substance (Baehr Brothers v. Commonwealth of Pennsylvania, 487 Pa. 233,
409 A.2d 326 (1979)), nor is an arbitrary label elevated over the applicable statutory
definition.
The statutory definition of "honorarium" generally includes payments which are
made in recognition of speaking engagements /presentations, appearances, and published
works, but excludes such payments if they are legitimately intended as consideration for
the value of such services undertaken in the public official's /public employee's private
professional or occupational capacity and are not related to the public position. 65 P.S. §
402/65 Pa. C. S. §1102.
In Baker, Opinion 91 -004, this Commission set forth criteria for determining whether
the exclusion applies in a given instance. The criteria include: the private occupation of
the public official /public employee; the expertise of the public official /public employee in
the area; the history of activity in the occupation prior to public service; the purpose for the
invitation; the capacity in which the public official /public employee is invited; the subject of
the speech, work or presentation; the group spoken to and the composition as to members
Fiorello, 03 -025
Page 89
or non - members of the group; the purpose for gathering the group; the amount of the fee
relative to the services performed; the source of the invitation; the event at which the
speech is given; the subject matter of the speech or published work as compared to the
normal subject matter dealt with by the occupational/ professional group; and any other
relevant factors.
In applying these criteria in Baker, we held that a Senator with a Bachelor's degree
in Political Science as well as a Masters degree and Ph.D. in Government, who was an
assistant professor and faculty associate, taught political science at Temple University, co-
authored numerous publications involving political science and government, and had
previously served as a panelist or speaker at several professional and civic meetings and
conferences, would not be prohibited from accepting a $500 fee for speaking at a seminar
on the subject of legislative priorities for local government. We determined that under the
factual circumstances, the payment would be nonpublic occupational or professional in
nature and not an honorarium. Baker, supra.
In Confidential Opinion, 01 -001, we determined Section 1103(d) of the Ethics Act
would not prohibit a member of a licensing board from accepting payments legitimately
intended as consideration for the Member's services relative to speeches, appearances,
presentations, published works, or participation on a test development committee where
such activities would be undertaken in the Member's professional capacity and would be
unrelated to the Member's public position. We held that under the factual circumstances,
such payments would not constitute "honoraria" under the definition of the Ethics Act and
could be accepted subject to the restrictions of Section 1103(a) of the Ethics Act.
In the instant matter, we conclude that the exclusion to the definition of "honoraria"
would not apply to the payments received by Fiorello. As detailed in the Findings and
factual recitation set forth above, the payments to Fiorello were made specifically because
of his public position. But for being the Chief Pharmacist /Director of Pharmacy, he would
not have been asked to participate on the Pfizer Advisory Council, in the various Pfizer
conferences, in the PADOC Conference in Hershey sponsored by Janssen, the
presentations for Riverside Associates and the production of the CD -ROM by Pfizer
through the University of Kentucky. The participation by Fiorello specifically was based
upon his public position and service so that the payment he received constituted an
honorarium.
Our analysis above is consonant with an application of the criteria in Baker. Fiorello
had no private occupation in psychopharmacy other than as Chief Pharmacist /Director of
Pharmacy. There was no prior history of such activity prior to public service. Such
activities by Fiorello began after and because of public service. The purpose of the
invitations by the pharmaceutical companies and Riverside Associates was because
Fiorello was Pharmacy Director for OMHSAS. Fiorello was invited specifically because he
was the Pharmacy Director. The subject of his participations in all instances related to
public work. The amount of Fiorello's fees, with the possible exception of the payments
from Riverside, are indicative of honoraria and were so named. Hence, the exclusion does
not apply because Fiorello received payments for services which were public in nature.
Fiorello had no private /professional occupation, other than working part -time as a
dispensing pharmacist in a drug store in the early 19902. Fiorello received prohibited
honoraria, and violated Section 3(d)/1103(d) of the Ethics Act when he accepted them.
Fiorello as Chief Pharmacist /Director of Pharmacy violated Section 3(d)/1103(d) of
the Ethics Act when he received honoraria for his participation in Pfizer Advisory Board
Meetings in New York City in 1998, 2000, and 2001.
Fiorello as Chief Pharmacist /Director of Pharmacy violated Section 3(d)/1103(d) of
the Ethics Act when he received honoraria for his participation in conferences in Orlando,
Florida and Dublin, Ireland sponsored by Pfizer Pharmaceuticals.
Fiorello, 03 -025
Page 90
Fiorello as Chief Pharmacist /Director of Pharmacy violated Section 3(d)/1103(d) of
the Ethics Act when he obtained an honoraria as to his participation in the production of a
CD ROM through the University of Kentucky that was sponsored by Pfizer
Pharmaceuticals.
Fiorello as Chief Pharmacist /Director of Pharmacy violated Section 3(d)/1103(d) of
the Ethics Act when he obtained honoraria as to his participation in a conference at La
Jolla, California.
Fiorello as Chief Pharmacist /Director of Pharmacy violated Section 3(d)/1103(d)
when he made presentations and received honoraria totaling $600 from Riverside
Associates.
Fiorello as Chief Pharmacist /Director of Pharmacy violated Section 3(d)/1103(d) of
the Ethics Act when he obtained an honorarium of $2,000 for his participation in a
Pennsylvania Department of Corrections conference sponsored by Janssen
Pharmaceuticals. We are aware that Fiorello subsequently directed $1,000 each to his
church and to International Planned Parenthood. It appears that Fiorello was "motivated"
to do this because he knew at that time that his conduct was being reviewed. In any event,
this is not material since Fiorello did take the money. See, Keller v. SEC, 860 A.2d 659
(Pa. Commw. September 2004).
Although emphasis is placed upon the characterization of the payments received by
Fiorello as "honorarium" or "consulting services," we believe that such references are
relevant but not controlling as to the nature of the payments. To hold otherwise would
elevate the label of the payment over its substance. This is not the law in Pennsylvania as
noted above.
Fiorello misperceives the statutory definition of honorarium by arguing in effect that
the term "honorarium" and the phrase "compensation for services rendered" are mutually
exclusive. They are not. The definition of "honorarium" includes payments for works,
appearances, and presentations. There is an exclusion from "honorarium" as to payments
that are consideration for the services that are non - public (occupational /professional).
Fiorello provided services which were public in nature and received honoraria.
It is perhaps easier to understand honorarium from the perspective of what it is not.
If the payment is not consideration for the value of the services, the payment is an
honorarium. If the payment is not for services that are non - public occupational or
professional in nature, the payment is an honorarium. If either (or both) of the foregoing
two negatives apply, the payment is an honorarium. For Fiorello, all the payments he
received from Pfizer and Janssen, except for Riverside, were not in consideration for the
services and were not occupational /professional in nature but public so that the payments
were honoraria. As to Riverside Associates, although the payments to Fiorello appear to
be consideration for services rendered, the presentations related to his public position/
service and hence, were honoraria. A hypothetical example of a payment to Fiorello that
would not be an honorarium would be a presentation to educators in the subject area that
he taught for a period of time. If Fiorello obtained the requisite approval for the outside
employment, and then made a presentation which was consideration for services rendered
that were non - public occupational /professional in nature, that would not be an honorarium.
However, as to all incidents in this case, each and every one was an honorarium to
Fiorello.
Fiorello's leave usage
Turning to the allegation on leave usage, Fiorello failed to take a day of leave from
the Commonwealth on July 2, 2000, when he gave a presentation at Riverside Associates.
Fiorello, 03 -025
Page 91
Fiorello received $300 for his presentation. Fiorello used the authority of office to make
the presentation at Riverside on that date while he was listed as working for the
Commonwealth. Such action resulted in a private pecuniary benefit to Fiorello consisting
of the wages ($268.50) he received from the Commonwealth when he did not work on that
date. Accordingly, Fiorello violated Section 3(a)/1103(a) of the Ethics Act when he
participated in making a paid presentation without utilizing leave from the Commonwealth.
See, Holt, Order 1153; Williams, Order 734 -R. Fiorello has admitted to this infraction of
the Ethics Act. See, Fact Findings 103, 125.
Regarding the allegations that Fiorello also failed to take leave from the
Commonwealth when he did a paid presentation for Janssen, there is no evidence of
record to establish that Fiorello did so. Accordingly, Fiorello did not violate Section 3(a)/
1103(a) of the Ethics Act when he participated in making a paid presentation for Janssen
based upon an insufficiency of evidence to establish that he failed to take leave from the
Commonwealth on that day.
Duquesne University Pharmacy Intern Program
As to the Duquesne University pharmacy student intern program, Fiorello
participated in the program and mentored students during Commonwealth working hours
for which he received payments of $400 per student. Dr. Karp knew that Fiorello mentored
students but Karp did not know that Fiorello received compensation. Fiorello used the
authority of office by participating in the program during normal work hours at DPW. Such
uses of authority of office resulted in private pecuniary benefits to Fiorello of $400 per
student for a total of $2,400. The $2,400 was a private pecuniary benefit because it was
not authorized, as discussed above. In effect, Fiorello conducted a pharmacy intern
mentoring business during his Commonwealth working hours while simultaneously
receiving two sources of income from Duquesne University and the Commonwealth.
Accordingly, Fiorello violated Section 3(a)/1103(a) of the Ethics Act when he, as Chief
Pharmacist/ Director of Pharmacy on Commonwealth time, mentored pharmacy student
internees for which he received a financial gain of $400 per student. Fiorello concedes
this infraction of the Ethics Act. See, Fact Finding 125.
SFI's filed by Fiorello
For the SFI allegations, our review is simply to compare what Fiorello had to report
on his SFI forms based on the record before us with what he actually reported. A review
reflects that Fiorello failed to list Pfizer as a source of income on his 2000 calendar year
SFI and failed to list income from PSECU on his 2003 calendar year SFI. Fiorello violated
Section 5(b)/1105(b) of the Ethics Act in each instance when he failed to disclose such
income.
Fiorello concedes the violations above as well as for the calendar year 1998 as to
his failure to list hospitality, transportation and lodging from Pfizer. However, that
particular allegation also encompasses the calendar years 2000 and 2001. A review of the
record for those two years reflects the receipt of hospitality, travel and lodging from Pfizer
in 2001 but not for the year 2000. Accordingly, Fiorello violated Section 5(b)(7)/1105(b)(7)
of the Ethics Act when he failed to disclose on his SFI's for the 1998 and 2001 calendar
years transportation, lodging and /or hospitality paid on his behalf by Pfizer /IME. Fiorello
did not violate Section 5(b)(7)/1105(b)(7) of the Ethics Act regarding transportation,
lodging and /or hospitality for the calendar year 2000 in that Fiorello did not have
reportable amounts in that year. Fiorello did not violate Section 5(b)(7)/1105(b)(7) of the
Ethics Act as to Janssen in 2001 in that such payments for travel by Fiorello were from a
DPW account that was funded by UEG's from pharmaceutical companies.
We note that Fiorello failed to disclose DPW as a source of income on his 1998 and
2000 calendar year SFI's. Hence, Fiorello violated Section 5(b)(5)/1105(b)(5) of the Ethics
Fiorello, 03 -025
Page 92
Act when he failed to list on his SFI's for the 1998 and 2000 calendar year's income in
excess of $1,300 he received from DPW.
For the calendar year 2002, the allegation charges a violation based upon a failure
to report income in excess of $1,300 from Pfizer. The record reflects that although Fiorello
in that year received income in excess of $1,300 from Janssen, he did not receive income
in excess of $1,300 from Pfizer. Accordingly, Fiorello did not violate Section 5(b)(5)/
1105(b)(5) of the Ethics Act for the 2002 calendar year SFI in that he did not receive
income in excess of $1,300 from Pfizer in 2002.
Although we have already considered and dispelled many of the arguments raised
by Fiorello in his brief, we note the following.
Commentary on Fiorello's arguments
As to the many arguments concerning the Medical Director's Education Fund, we
need not address these arguments given that we have found that both the procedural and
substantive issues result in no violation. Regarding the argument that the Investigative
Division failed to show a connection between Fiorello's actions as to the PT &F Committee
and action involving Pfizer's drugs, Fiorello misperceives the criteria necessary to
establish a violation of Section 3(a)/1103(a) of the Ethics Act. Based upon Commonwealth
Court's decision in the Snyder case, supra., Fiorello should not have participated
regarding Pfizer drugs as to the state formulary and through such actions on his part, he
violated Section 3(a)/1103(a) of the Ethics Act. The argument by Fiorello that all members
of the PT &F Committee voted to approve all second generation atypical antipsychotic
drugs is addressed in the analysis of the Snyder case.
The assertion that the use of the Pfizer drug Zoloft could result in savings to the
Commonwealth is immaterial as to a violation of Section 3(a)/1103(a) of the Ethics Act.
See. Opinion of the Attorney General, 45 of 1971; Salem Township Municipal Authority v.
Township of Salem, 820 A.2d 888 (Pa. Comwlth. 2003). Regarding the argument that
Fiorello does not order drugs, the Investigative Division never made that argument and, in
any event, the ordering of drugs is not a requirement to establish a violation of Section
3(a)/1103(a) of the Ethics Act. The argument that Fiorello's actions as to the PT &F
Committee do not fall within the Ethics Act prohibition of conflict is erroneous. See,
Snyder, supra.
The argument that the payments Fiorello received for his presentations at La Jolla,
Dublin, and for his participation in the preparation of the CD -ROM are payments for
consulting services rather than honoraria is legally in error. To the contrary, based upon
the precise statutory definition of honoraria and the criteria in Baker, supra., it is clear that
Fiorello participated in making presentations and a published work and received payments
that were not consideration for the value of services which were public in nature.
As to the assertion that Fiorello instructed Janssen not to pay him an honoraria but
made donations to two charities when he received the payment, such an argument is
factually and legally unsound. First, Dr. Maue also received a check payable to himself
but he properly contacted his department and followed their instructions in dealing with the
situation. Fiorello chose to cash the check and deposit it in a personal account. As noted
above, the subsequent action of making the donations, particularly when Fiorello knew his
actions were under scrutiny, does not legally undo his violation of the Ethics Act.
As to Fiorello's argument that his activities on the Pfizer Advisory Council did not
involve a promotion of any Pfizer product, such is irrelevant; the lynchpin of the violation
was Fiorello's use of office to obtain prohibited honoraria as to Pfizer's Advisory Council.
The argument that Fiorello was selected for the Advisory Council due to his experience
and qualifications in the behavioral healthcare pharmacy is factually untrue; to the
Fiorello, 03 -025
Page 93
contrary, Fiorello was selected for membership because he was the Director of Pharmacy
for OMHSAS, DPW as per the testimony of several Pfizer witnesses.
Although Fiorello is correct that the Ethics Act does not prohibit outside business
activities, Fiorello has a convoluted argument based upon distinguishable facts. In
particular, Fiorello could have mentored pharmacy interns on his own time but instead he
did so during Commonwealth working hours for which Fiorello received his Commonwealth
salary as well as payments from Duquesne University. Similarly, Fiorello could engage in
private business activities on his own time without the use of Commonwealth equipment,
facilities, personnel or work product after he obtained the required approval for
supplemental employment. However, Fiorello did not obtain such approval and
consequently the compensation he received was not authorized in law and, hence, a
private pecuniary benefit. Fiorello's repeated assertion that he did not receive
compensation for his presentation in Orlando, Florida is contradicted by his admitted
pleading. See, Fact Finding 89.
The argument that the Investigative Division did not establish hospitality /transportation /
lodging in excess of $605 for the calendar year 2001 based upon both its Investigative
Complaint and hearing is in error. To the contrary, an admitted pleading establishes that
he received $120 from Pfizer for transportation. See, Fact Finding 84.b. In addition,
testimony of an IME employee establishes that Fiorello had two nights lodging at a cost of
$250 per night plus taxes. See, Fact Finding 144.i. The foregoing alone amounts to $620.
Taking administrative notice of the additional hotel occupancy taxes paid establishes that
Fiorello received more than $650 in transportation /lodging/ hospitality from Pfizer in the
calendar year 2001. Lunch, an off -site dinner, and a Broadway show were also provided.
Fiorello's argument that Pfizer's events were irregular so he never knew when they
would occur vis -a -vis supplemental employment or SFI filing requirements is totally
pointless. As to supplemental employment, Fiorello was required to obtain approval before
he started and he did not do that. As to SFI filing requirements, such does not have to be
filed until on or before May 1 of the following year.
Regarding Fiorello's claim that the testimony of Tom Orr could not assail his
(Fiorello's) credibility, Fiorello's lack of credibility was not only established by the testimony
of Tom Orr but several other witnesses. If there were only one person who effectively
destroyed Fiorello's credibility out of all witnesses, it would be Fiorello himself.
Lastly, as to Fiorello's argument that the $600 he received from Riverside
Associates was compensation for services that did have to be reported for SFI purposes,
there was no allegation or requirement that Fiorello had to report the $600. Second, as to
the assertion that the $600 was compensation for services, that is true in part in that the
payment appears to be in consideration for services but such was done in a public
capacity. Consequently, Fiorello used the authority of office to obtain a prohibited
honoraria in violation of Sections 3(a)/1103(a) and 3(d)/1103(d) of the Ethics Act as to
Riverside Associates.
Having applied the Ethics Act to the allegations before us, we are compelled to
comment upon the above violations by Fiorello. This is not a case where Fiorello was
unaware and passively accepted payments from Pfizer, Janssen, Duquesne University,
and Riverside Associates. To the contrary, Fiorello knew exactly what he was doing when
he used his public position as a means to obtain compensation from these entities. When
Riverside approached Fiorello about making the presentation, Fiorello had negotiations
with Smith from Riverside about his payment. Fiorello received the maximum amount
payable by Riverside which was $300 per presentation. Fiorello blatantly used his office
as a means of making as much additional money on the side as he could. This is also true
of the PA DOC conference in Hershey in which Fiorello participated and received a $2,000
honorarium. Similarly, Fiorello participated in the Duquesne Pharmacy Intern Program
Fiorello, 03 -025
Page 94
during regular common business hours and received a payment of $400 per student in
addition to his Commonwealth wages. Fiorello had no concept or even care of ethics;
Fiorello strived and obtained compensation through the use of public office. We find such
conduct by a person in a high profile, sensitive, healthcare position to be particularly
egregious conduct. A careful review of the record reflects a pattern of conduct by Fiorello
to conceal his efforts at obtaining financial gain in derogation of the Ethics Act. Such
conduct by Fiorello warrants the imposition of a payback for the financial gain he obtained
in violation of the Ethics Act.
Payback of financial gain
Before we calculate restitution, we note two issues as to the amount of financial
gain Fiorello received from Pfizer. The Investigative Division claims that Fiorello received
a total financial gain of $7,500 from Pfizer in the relevant time period. Fiorello disputes
this and further asserts that he did not receive $1,000 for his presentation at the Pfizer
Orlando, Florida conference. Both of these issues may be resolved by reviewing the
admitted pleadings. Case law dictates that any divergence between testimony /documents
and the pleadings must be resolved by adherence to the pleadings. See, Bartholomew v.
SEC, 795 A.2d 1073 (Pa. Commw. 2002). From the pleadings, Fact Finding 92 states that
the total received from Pfizer for 1998 -2001 was $5,500 and consequently, that amount
may not be exceeded. Although Fiorello asserts that he did not receive $1,000 for his
presentation at the Orlando, Florida Pfizer conference, he likewise is bound by the
admitted pleadings in this case. Fiorello did receive $1,000 for his Orlando presentation
because he admitted that in his pleadings. See, Fact Finding 89.
Parenthetically, although the Investigative Division is limited by the pleadings in
seeking payback up to $5,500 as to payments Fiorello received from Pfizer, the
Investigative Division is not precluded from seeking violations as to such actions in that the
allegation is sufficiently broad to encompass Fiorello's participation in those other Pfizer
conferences.
Section 407(13)/1107(13) of the Ethics Act empowers this Commission to impose
restitution in instances where a public official /public employee has obtained a financial
gain in violation of the Ethics Act. We will impose restitution totaling $10,768.50 for the
violations that Fiorello committed under the Ethics Act. The foregoing restitution is based
upon the payments from IME /Pfizer totaling $5,500 (as limited by Fact Finding 92), $2,000
from CNS /Janssen, $600 from Riverside Associates, $2,400 from Duquesne University for
the pharmacy intern mentoring program during Commonwealth working hours, and
$268.50 for the failure to take Commonwealth leave while making the presentation at
Riverside Associates.
In addition, Section 9(c)/1109(c) of the Ethics Law directs:
§ 1109. Penalties
(c) Treble damages. - -Any person who obtains financial gain from
violating any provision of this chapter, in addition to any other penalty
provided by law, shall pay a sum of money equal to three times the
amount of the financial gain resulting from such violation into the
State Treasury or the treasury of the political subdivision. Treble
damages shall not be assessed against a person who acted in good
faith reliance on the advice of legal counsel.
65 Pa. C. S. §1109(c)
This provision of the Ethics Act does not require mens rea in order to impose a treble
penalty; merely a violation of the Ethics Act suffices under the statute.
Fiorello, 03 -025
Page 95
The Investigative Division seeks to impose a treble penalty of $7,500 based upon
trebling three payments that Fiorello received: $1,000 for the Orlando presentation,
$1,000 for the Dublin presentation and $500 for the speech at the New York City Advisory
Council conference in 2001, all of which presentations relate to the study Henning and
Fiorello conducted for the PT &F Committee.
Although Fiorello's conduct was egregious as to all of the honoraria he received,
we will, in addition to directing restitution, exercise our discretion and impose a treble
penalty of $16,500 ($5,500 x 3) based upon the $3,500 in honoraria /private pecuniary
benefits from the Pfizer Advisory Council and the $1,000 that Fiorello received for each of
his presentations at the Dublin, Ireland and Orlando, Florida Pfizer conferences.
As to the three Pfizer Advisory Council meetings, the private pecuniary benefits/
honoraria that Fiorello received were for his participation in helping Pfizer define
commercial strategies for its drugs. Fact Finding 142.b. Such occurred while Fiorello, as
the secretary and member of the PT &F Committee, was involved in the process of
reviewing drugs (including those of Pfizer) for placement on the state formulary. Placing
drugs on the formulary results in the Commonwealth buying those drugs for use in the
state hospitals. Fiorello played both sides; he participated with Pfizer Advisory Council
Board as to drug selling strategies and participated on the PT &F Committee as to selecting
drugs for the state formulary. In marked contrast to Fiorello, Dr. Karp refused to accept
honoraria from Pfizer while on its Advisory Council Board and subsequently left the Board
because he considered it to be a conflict. See, Fact Finding 149.w.
In addition to the above $3,000 from Pfizer for Fiorello's participation on its Advisory
Council Board, Fiorello received $2,500 from Pfizer for the three presentations he made as
to the study he and Henning completed for the PT &F Committee. That study was done for
the Commonwealth. Fiorello performed the work on the study during Commonwealth time
and received his state salary. Fiorello used that Commonwealth work product as a means
of making money for himself outside of his Commonwealth employment. Such actions by
Fiorello are particularly unconscionable in our view.
Fiorello's conduct reflects a callous disregard of his public position and a violation
of the public trust in an effort to use his public position for financial gain. Accordingly,
Fiorello is directed to make a total payback of $27,268.50 (restitution of $10,768.50 plus
treble penalty of $16,500.00) to be paid within 30 days of the date of mailing of this order
to the Commonwealth of Pennsylvania through this Commission. Non - compliance will
result in the institution of an order enforcement action.
Lastly, we direct Fiorello to file amended SFI's to include the following deficiencies:
for 1998, DPW as a source of income and Pfizer as a source of transportation /lodging/
hospitality; for 2000, DPW and Pfizer as sources of income; for 2001, Pfizer as a sources
of transportation /lodging /hospitality; for 2002, Janssen as a source of income; and for
2003, PSECU as a source of income. When listing income, both the name and address of
the source must be listed. As to transportation /lodging /hospitality, the name and address
of the sources as well as the amount of payment(s) when in excess of $650 must be listed.
Fiorello is directed to file the amended SFI's with the filing office in DPW within 30
days of the date of mailing of this order with copies filed with this Commission for
compliance verification purposes. Failure to comply will result in the institution of an order
enforcement action.
Referral
We conclude that there is a reasonable expectation that a prosecution may be
instituted against Fiorello. It is our view that a jury or court as fact finder would have a
Fiorello, 03 -025
Page 96
sufficient basis to conclude that Fiorello acted intentionally with respect to the conduct we
have reviewed in this matter. See, 18 Pa.C.S. § 302(c). Accordingly, this case shall be
referred to the Office of Attorney General with the Commission's recommendation for
review as to a criminal prosecution against Fiorello as to violations of the Ethics Act.
In addition, we will refer this matter for review as to disciplinary action to Fiorello's
employer, the Department of Public Welfare, and also to the Bureau of Professional
Occupational Affairs, State Board of Pharmacy.
IV. CONCLUSIONS OF LAW:
1. Fiorello, as a Chief Pharmacist /Director of Pharmacy for the Department of Public
Welfare, Office of Mental Health, Substance and Abuse Services, is a public
employee subject to the provisions of Act 9 of 1989 as codified by Act 93 of 1998.
2. Fiorello as Chief Pharmacist /Director of Pharmacy violated Section 3(a)/1103(a) of
the Ethics Act when he participated in actions of the OMHSAS PT &F Committee in
DPW relating to Pfizer drugs on the state formulary when he had financial
relationships with Pfizer that manufactured those drugs.
3. Fiorello did not violate Section 3(a)/1103(a) of the Ethics Act as to his participation
in PT &F Committee actions vis -a -vis Janssen drugs based upon an insufficiency of
evidence.
4. Fiorello as Chief Pharmacist /Director of Pharmacy did not violate Section 3(a)/
1103(a) of the Ethics Act as to his use of unrestricted education grants from
pharmaceutical companies for travel expenses in that such expenses were related
to Commonwealth business.
5. Fiorello as Chief Pharmacist /Director of Pharmacy violated Section 3(a)/1103(a) of
the Ethics Act when he used the authority of office to obtain private pecuniary
benefits for his participation in Pfizer Advisory Board Meetings in New York City in
1998, 2000, and 2001.
6. Fiorello as Chief Pharmacist /Director of Pharmacy violated Section 3(d)/1103(d) of
the Ethics Act when he received honoraria for his participation in Pfizer Advisory
Board Meetings in New York City in 1998, 2000, and 2001.
7 Fiorello as Chief Pharmacist /Director of Pharmacy violated Section 3(a)/1103(a) of
the Ethics Act when he used the authority of office to obtain private pecuniary
benefits for his participation in conferences in Orlando, Florida and Dublin, Ireland
sponsored by Pfizer Pharmaceuticals.
8. Fiorello as Chief Pharmacist /Director of Pharmacy violated Section 3(d)/1103(d) of
the Ethics Act when he received honoraria for his participation in conferences in
Orlando, Florida and Dublin, Ireland sponsored by Pfizer Pharmaceuticals.
9. Fiorello as Chief Pharmacist /Director of Pharmacy violated Section 3(a)/1103(a) of
the Ethics Act when he used the authority of office to obtain a private pecuniary
benefit in the production of a CD ROM through the University of Kentucky that was
sponsored by Pfizer.
10. Fiorello as Chief Pharmacist /Director of Pharmacy violated Section 3(d)/1103(d) of
the Ethics Act when he obtained an honorarium as to his participation in the
production of a CD ROM through the University of Kentucky that was sponsored by
Pfizer.
Fiorello, 03 -025
Page 97
11. Fiorello as Chief Pharmacist /Director of Pharmacy violated Section 3(a)/1103(a) of
the Ethics Act when he used the authority of office to obtain a private pecuniary
benefit in the amount of $1,000 for his participation at a conference at La Jolla,
California.
12. Fiorello as Chief Pharmacist /Director of Pharmacy violated Section 3(d)/1103(d) of
the Ethics Act when he obtained honoraria as to his participation in a conference at
La Jolla, California.
13. Fiorello as Chief Pharmacist /Director of Pharmacy violated Section 3(a)/1103(a) of
the Ethics Act when he used the authority of office to obtain a private pecuniary
benefit of $600 in total from Riverside Associates for two presentations on topics
that related to public work as a DPW Commonwealth employee.
14. Fiorello as Chief Pharmacist /Director of Pharmacy violated Section 3(d)/1103(d)
when he made presentations and received total honoraria of $600 from Riverside
Associates.
15. Fiorello as Chief Pharmacist /Director of Pharmacy violated Section 3(a)/1103(a) of
the Ethics Act when he used the authority of office to obtain a pecuniary benefit of
$2,000 for his participation in a Pennsylvania Department of Corrections conference
sponsored by Janssen that was based upon work product that he developed as a
state employee.
16. Fiorello as Chief Pharmacist /Director of Pharmacy violated Section 3(d)/1103(d) of
the Ethics Act when he obtained an honorarium of $2,000 for his participation in a
Pennsylvania Department of Corrections conference sponsored by Janssen.
17. Fiorello violated Section 3(a)/1103(a) of the Ethics Act when he, as Chief
Pharmacist/ Director of Pharmacy, trained on Commonwealth time pharmacy
student internees for which he received a financial gain of $2,400 based upon a fee
of $400 per student.
18. Fiorello as Chief Pharmacist /Director of Pharmacy violated Section 3(a)/1103(a) of
the Ethics Act when he participated in making a paid presentation for Riverside
Associates without utilizing leave from the Commonwealth on June 2, 2000.
19. Fiorello as Chief Pharmacist /Director of Pharmacy did not violate Section 3(a)/
1103(a) of the Ethics Act when he participated in making a paid presentation for
Janssen based upon an insufficiency of evidence to establish that he failed to take
leave from the Commonwealth on that day.
20. Fiorello as Chief Pharmacist /Director of Pharmacy violated Section 5(b)(5)/
1105(b)(5) of the Ethics Act when he failed to list on his Statement of Financial
Interests (SFI) for the 1998 calendar year sources of income in excess of $1,300 he
received from DPW.
21. Fiorello as Chief Pharmacist /Director of Pharmacy violated Section 5(b)(5)/
1105(b)(5) of the Ethics Act when he failed to list on his SFI for the 2000 calendar
year sources of income in excess of $1,300 he received from Pfizer /Innovative
Medical Education (IME) and DPW.
22. Fiorello as Chief Pharmacist /Director of Pharmacy did not violate Section 5(b)(5)/
1105(b)(5) of the Ethics Act for the 2002 calendar year SFI in that he did not
receive income in excess of $1,300 from Pfizer in 2002.
Fiorello, 03 -025
Page 98
23. Fiorello as Chief Pharmacist /Director of Pharmacy violated Section
5(b)(5)/1105(b)(5) of the Ethics Act when he failed to disclose on his SFI for the
2003 calendar year interest income in excess of $1,300 from PSECU.
24. Fiorello as Chief Pharmacist /Director of Pharmacy violated Section
5(b)(7)/1105(b)(7) of the Ethics Act when he failed to disclose on his SFI for the
1998 calendar year transportation, lodging and /or hospitality paid on his behalf by
Pfizer /IME.
25. Fiorello as Chief Pharmacist /Director of Pharmacy violated Section
5(b)(7)/1105(b)(7) of the Ethics Act when he failed to disclose on his SFI for the
2001 calendar year transportation, lodging and /or hospitality paid on his behalf by
Pfizer /IME.
26. Fiorello as Chief Pharmacist /Director of Pharmacy did not violate Section 5(b)(7)/
1105(b)(7) of the Ethics Act for the calendar year 2000 in that Fiorello did not have
reportable transportation, lodging and /or hospitality.
27. Fiorello did not violate Section 5(b)(7)/1105(b)(7) of the Ethics Act as to Janssen in
2001 in that such payments for travel by Fiorello were from a DPW account that
was funded by UEG's from pharmaceutical companies.
In Re: Steven Fiorello
File Docket: 03 -025
Date Decided: 2/28/05
Date Mailed: 3/14/05
ORDER NO. 1363
Fiorello, as a Chief Pharmacist /Director of Pharmacy for the Department of Public
Welfare, Office of Mental Health, Substance and Abuse Services, violated Section
3(a)/1103(a) of the Ethics Act when he participated in actions of the OMHSAS
PT &F Committee in DPW relating to Pfizer drugs on the state formulary when he
had financial relationships with Pfizer that manufactured those drugs.
2. Fiorello did not violate Section 3(a)/1103(a) of the Ethics Act as to his participation
in PT &F Committee actions vis -a -vis Janssen drugs based upon an insufficiency of
evidence.
3. Fiorello as Chief Pharmacist /Director of Pharmacy did not violate Section 3(a)/
1103(a) of the Ethics Act as to his use of unrestricted education grants from
pharmaceutical companies for travel expenses in that such expenses were related
to Commonwealth business.
4. Fiorello as Chief Pharmacist /Director of Pharmacy violated Section 3(a)/1103(a) of
the Ethics Act when he used the authority of office to obtain private pecuniary
benefits for his participation in Pfizer Advisory Board Meetings in New York City in
1998, 2000, and 2001.
5. Fiorello as Chief Pharmacist /Director of Pharmacy violated Section 3(d)/1103(d) of
the Ethics Act when he received honoraria for his participation in Pfizer Advisory
Board Meetings in New York City in 1998, 2000, and 2001.
6. Fiorello as Chief Pharmacist /Director of Pharmacy violated Section 3(a)/1103(a) of
the Ethics Act when used the authority of office to obtain private pecuniary benefits
for his participation in conferences in Orlando, Florida and Dublin, Ireland
sponsored by Pfizer Pharmaceuticals.
7 Fiorello as Chief Pharmacist /Director of Pharmacy violated Section 3(d)/1103(d) of
the Ethics Act when he received honoraria for his participation in conferences in
Orlando, Florida and Dublin, Ireland sponsored by Pfizer Pharmaceuticals.
8. Fiorello as Chief Pharmacist /Director of Pharmacy violated Section 3(a)/1103(a) of
the Ethics Act when he used the authority of office to obtain a private pecuniary
benefit in the production of a CD ROM through the University of Kentucky that was
sponsored by Pfizer.
9. Fiorello as Chief Pharmacist /Director of Pharmacy violated Section 3(d)/1103(d) of
the Ethics Act when he obtained an honorarium as to his participation in the
production of a CD ROM through the University of Kentucky that was sponsored by
Pfizer.
10. Fiorello as Chief Pharmacist /Director of Pharmacy violated Section 3(a)/1103(a) of
the Ethics Act when he used the authority of office to obtain a private pecuniary
benefit in the amount of $1,000 for his participation at a conference at La Jolla,
California.
Fiorello, 03 -025
Page 100
11. Fiorello as Chief Pharmacist /Director of Pharmacy violated Section 3(d)/1103(d) of
the Ethics Act when he obtained honoraria as to his participation in a conference at
La Jolla, California.
12. Fiorello as Chief Pharmacist /Director of Pharmacy violated Section 3(a)/1103(a) of
the Ethics Act when he used the authority of office to obtain a private pecuniary
benefit of $600 in total from Riverside Associates for two presentations on topics
that related to public work as a DPW Commonwealth employee.
13. Fiorello as Chief Pharmacist /Director of Pharmacy violated Section 3(d)/1103(d)
when he made presentations and received total honoraria of $600 from Riverside
Associates.
14. Fiorello as Chief Pharmacist /Director of Pharmacy violated Section 3(a)/1103(a) of
the Ethics Act when he used the authority of office to obtain a pecuniary benefit of
$2,000 for his participation in a Pennsylvania Department of Corrections conference
sponsored by Janssen that was based upon work product that he developed as a
state employee.
15. Fiorello as Chief Pharmacist /Director of Pharmacy violated Section 3(d)/1103(d) of
the Ethics Act when he obtained an honorarium of $2,000 for his participation in a
Pennsylvania Department of Corrections conference sponsored by Janssen.
16. Fiorello violated Section 3(a)/1103(a) of the Ethics Act when he, as Chief
Pharmacist/ Director of Pharmacy, trained on Commonwealth time pharmacy
student internees for which he received a financial gain of $2,400 based upon a fee
of $400 per student.
17. Fiorello as Chief Pharmacist /Director of Pharmacy violated Section 3(a)/1103(a) of
the Ethics Act when he participated in making a paid presentation for Riverside
Associates without utilizing leave from the Commonwealth on June 2, 2000.
18. Fiorello as Chief Pharmacist /Director of Pharmacy did not violate Section 3(a)/
1103(a) of the Ethics Act when he participated in making a paid presentation for
Janssen based upon an insufficiency of evidence to establish that he failed to take
leave from the Commonwealth on that day.
19. Fiorello as Chief Pharmacist /Director of Pharmacy violated Section
5(b)(5)/1105(b)(5) of the Ethics Act when he failed to list on his Statement of
Financial Interests (SFI) for the 1998 calendar year sources of income in excess of
$1,300 he received from DPW.
20. Fiorello as Chief Pharmacist /Director of Pharmacy violated Section
5(b)(5)/1105(b)(5) of the Ethics Act when he failed to list on his SFI for the 2000
calendar year sources of income in excess of $1,300 he received from
Pfizer /Innovative Medical Education (IME) and DPW.
21. Fiorello as Chief Pharmacist /Director of Pharmacy did not violate Section 5(b)(5)/
1105(b)(5) of the Ethics Act for the 2002 calendar year SFI in that he did not
receive income in excess of $1,300 from Pfizer in 2002.
22. Fiorello as Chief Pharmacist /Director of Pharmacy violated Section 5(b)(5)/
1105(b)(5) of the Ethics Act when he failed to disclose on his SFI for the 2003
calendar year interest income in excess of $1,300 from PSECU.
Fiorello, 03 -025
Page 101
23. Fiorello as Chief Pharmacist /Director of Pharmacy violated Section
5(b)(7)/1105(b)(7) of the Ethics Act when he failed to disclose on his SFI for the
1998 calendar year transportation, lodging and /or hospitality paid on his behalf by
Pfizer /IME.
24. Fiorello as Chief Pharmacist /Director of Pharmacy violated Section
5(b)(7)/1105(b)(7) of the Ethics Act when he failed to disclose on his SFI for the
2001 calendar year transportation, lodging and /or hospitality paid on his behalf by
Pfizer /IME.
25. Fiorello as Chief Pharmacist /Director of Pharmacy did not violate Section 5(b)(7)/
1105(b)(7) of the Ethics Act for the calendar year 2000 in that Fiorello did not have
reportable transportation, lodging and /or hospitality.
26. Fiorello did not violate Section 5(b)(7)/1105(b)(7) of the Ethics Act as to Janssen in
2001 in that such payments for travel by Fiorello were from a DPW account that
was funded by UEG's from pharmaceutical companies.
27. Fiorello is directed to make payment in the amount of $27,268.50 to be paid within
30 days of the date of mailing of this order to the Commonwealth of Pennsylvania
through this Commission. Non - compliance will result in the institution of an order
enforcement action.
28. Fiorello is directed to file amended SFI's for the following calendar years, if he has
not already done so, to include the following deficiencies: for 1998, DPW as a
source of income and Pfizer as a source of transportation /lodging /hospitality; for
2000, DPW and Pfizer as sources of income; for 2001, Pfizer as sources of
transportation /lodging /hospitality; for 2002, Janssen as a source of income; and for
2003, PSECU as a source of income. The amended SFI's are to be filed with DPW
within 30 days of the date of mailing of this order with copies filed with the State
Ethics Commission for compliance verification purposes. Failure to comply will
result in the institution of an order enforcement action.
29. This case shall be referred to the Office of Attorney General with the Commission's
recommendation for the review as to a criminal prosecution against Fiorello as to
violations of the Ethics Act.
30. This case shall be referred as to disciplinary action to Fiorello's employer, the
Department of Public Welfare, and also to the Bureau of Professional Occupational
Affairs, State Board of Pharmacy.
BY THE COMMISSION,
Louis W. Fryman, Chair