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Physicians and Fundraising

The following question was posted to one of the many discussion lists to which we subscribe:

We are in the process of developing a policy that clarifies who outside of the paid development staff is allowed access to the names and the dollar amounts of donor gifts. Do you share certain information with you CEO, members of your foundation board/ development committee or others who you feel are part of the extended development team? What about physicians who inspire gifts from their patients?

We have been generally very restrictive with this information, although details had been shared with a physician whose patients regularly make gifts to support her research. She previously was given a printed report listing donor names and their specific gift amounts (patients often send gifts directly to her so she knows these amounts already). We have resorted to only providing names of the donors but the physician is pushing back to have the list include the gift amount as well.

Your advice on best practices would be most appreciated, as would any policies that you can share regarding this issue.

Thinking I would dash off a quick response was a mistake!  I ended up looking around online for a couple of hours to address the many issues related to this question. Sample policies, codes of ethical conduct, Federal law (HIPAA), the IRS Code, and physician responsibility all need to be considered when creating a policy. 

My response was as follows:

BoardSource (formerly NCNB - the National Center for Nonprofit Boards) has a book/CD set called "The Nonprofit Policy Sampler."  It includes a sample confidentiality policy that specifically addresses donor lists, anonymous gifts, etc., as well as a more general and restrictive policy concerning organization proprietary information, including donor and prospect information.

Generally, the Association of Fundraising Professionals' Code of Ethics limits members' confidentiality to adherence to the law.  In other words, if sharing information is not considered illegal in a jurisdiction, then it is within ethical boundaries for an AFP member to share that information.  AFP's Code of Ethics does assert that donor information must be handled "professionally," and that donors have the right to have their information removed from any list that an organization plans to share.

Since you are fundraising in the health care field, you should be sure to take HIPAA into account.  The Association for Healthcare Philanthropy (AHP) has a resource on this issue:

When thinking about a policy, remember that the IRS has its own rules on when and what donor information must be disclosed to the IRS and to the public. From the instructions for the Form 990 Schedule B:
[, Page 9]

Schedule B is:

*  Open to public inspection for an organization that files Form 990-PF,
*  Open to public inspection for a section 527 political organization that files Form 990 or Form 990-EZ, or
*  For the other organizations that file Form 990 or Form 990-EZ, the names and addresses of contributors are not open to public inspection.  All other information, including the amount of *contributions*, the description of *non-cash contributions*, and any other information provided will be open to public inspection unless it clearly identifies the contributor. 

Finally, it sounds like the doctor in question is assisting in raising funds which benefit their own practice area and/or research.  This raises its own set of conflict-of-interest questions which I must believe that AHP has addressed for health care and CASE has addressed for higher education.  The American Medical Association (AMA) has addressed this topic, for example with the following PDF document:

This document was summarized in December, 2009 by the AMA in Opinion 10.018

as follows (emphasis added):

Donations play an important role in supporting and improving a community’s health care. Physicians are encouraged to participate in fundraising and other solicitation activities while protecting the integrity of the patient-physician relationship, including patient privacy and confidentiality, and ensuring that all donations are fully voluntary. In particular:

(1) Appropriate means of soliciting contributions include making information available in a reception area and speaking at fundraising events. Physicians should avoid directly soliciting their own patients, especially at the time of a clinical encounter. They should reinforce the trust that is the foundation of the patient-physician relationship by being clear that patients’ welfare is the primary priority and that patients need not contribute in order to continue receiving the same quality of care.

(2) The greater the separation between the request and the clinical encounter, the more acceptable the solicitation is likely to be.

(3) When physicians participate in solicitation efforts as members of the general community, they should seek to minimize perceptions of overlap with their professional roles.

(4) Physicians in institutions that rely on fundraising personnel for donation requests should work to protect privacy and confidentiality of patient information. In particular physicians should ensure that any patient information used for solicitation activities reveals only basic demographic data, not personal health information. When the medical service delivered or the diagnosis is identifiable by the nature of the physician’s practice or the physician’s specialty, permission from the patient should be obtained prior to divulging any information to third parties.

(5) When patients initiate requests to contribute, physicians should refer them to appropriate sources of information or fundraising personnel. (IV, VII, VIII)

I have contacted the American Medical Association to inquire whether they have other ethical guidance more specifically addressing a physician's involvement with fundraising from their patients for their (the physician's) own work.

The issues raised by the search for a sample policy go far beyond the single physician involved in the initial question and a need for a "boilerplate" policy statement.