St. Jude spokeswoman Amy Jo Meyer, responding to an initial Herald inquiry about the Sabbota-Lodowski relationship, said: “We have only recently become aware of this information and are in the process of reviewing it.”

She referred a reporter to the code of ethics of the Advantaged Medical Technology Association, which represents device makers. The code limits sales reps in giving doctors trips, sports tickets, fancy meals and lucrative consulting contracts — all methods that have been used in the past for device makers to reward friendly doctors.

The AdvaMed code says, “Company interactions with Health Care Professionals should be professional in nature and should facilitate the exchange of medical or scientific information that will benefit patient care.” It says nothing about business partnerships, and a spokeswoman for the trade group refused to say whether partnerships were or should be forbidden under the code.

St. Jude did not respond to six follow-up calls and emails.

For most hospitals, the business relationships of non-staff doctors tend to fall outside the scope of their ethics rules. Like Memorial, Baptist Health South Florida, the largest Miami-Dade hospital group, doesn’t require outside doctors to sign codes of conduct.

Though Sabbota almost exclusively used St. Jude devices, Baldwin said doctors who work at Memorial are also free to use pacemakers made by Biotronik, Medtronic and Boston Scientific devices.

Does that mean Memorial doesn’t care what side deals its non-staff doctors does with vendors? “I don’t want to say Memorial doesn’t care — it’s not about that,’’ Baldwin said.

Biomedical experts say that for hospitals there is a conflict between pushing physicians to provide more transparency for patients and real-world economic considerations.

Hospitals are always seeking qualified outside or “community” doctors to use their facilities and generate revenue , said Sal Barbera, a former Broward hospital administrator who won a 2004 whistleblower judgment exposing illicit relationships between doctors and hospitals.

Barbera, who now teaches at Florida International University, believes Sabbota’s and Lodowski’s business relationship “is clearly a conflict of interest’’ but acknowledged that it’s hard to know specifics because outsiders don’t have access to financial dealings within the corporation .

Michael Carome, a physician with the Washington watchdog group Public Citizen, said the underlying problem is the cost of healthcare. “Companies spend hundreds of millions of dollars on sales and marketing, and they wouldn’t be doing that unless they had an effect on their bottom line,” Carome said. Those marketing costs are ultimately paid by the government, through Medicare and Medicaid, or by employers and consumers, through private insurers.

Not commenting directly on the Memorial case, he said the healthcare industry should be concerned any time there is an unusually close relationship between doctor and device rep. “It certainly raises concerns that the decision to use that device may be influenced by their relationship, and that influence could be very subtle.”

Goodman, the UM bioethicist, said that because of all its legal troubles, the medical device industry has strengthened its code of ethics, and a growing number of institutions, like the University of Miami, have online sites that are intended to reveal all relationships between its doctors and outside companies. Relationships like the UM cardiologist and his girlfriend/sales rep would no longer be tolerated.

“There’s been a sea change,” Goodman said. “The trips and dinners for the most part are nearly over.... But maybe some people are finding new ways.” A situation like Sabbota’s, he said, raises “questions about whether somebody’s judgment” is shaped by non-medical considerations.

Still, Barbera, the former hospital executive, said it’s not coincidental that the device makers have the toughest code.

“They’ve got caught doing all this devious behavior,’’ he said. “So on paper at least they’re looking good.”