State Rep. Todd Atwater, R-Lexington, giving his farewell speech to the S.C. House on Wednesday. Atwater, who is seeking the GOP nomination for attorney general, voted on several medical-related bills while he was CEO of the South Carolina Medical Association. Jamie Lovegrove/Staff

COLUMBIA — A Republican lawmaker running for South Carolina attorney general voted on several bills supported by a state physician's advocacy group while he was the organization's top executive.

While state Rep. Todd Atwater of Lexington was chief executive of the South Carolina Medical Association from 2013-16, he voted on at least seven bills that the SCMA actively supported — including bills regarding hospital liabilities, telemedicine, vaccines by pharmacists without a prescription, opioid prescriptions, medical marijuana and death certificates.

Questions about the votes come as Atwater seeks to become the state's top prosecutor, a role that includes overseeing what happens in political office. Ethics experts say the votes could raise questions about whether he improperly boosted the organization in the General Assembly.

Atwater denied that the votes represented any kind of conflict of interest because he said he did not stand to financially benefit and did not know what the SCMA's positions were on the bills.

Even though he held a leadership role at the organization, Atwater said his job was focused on overseeing the board and the association finances, not directing the group's legislative priorities. He said he did not communicate with any of the organization's lobbyists.

Ethics laws in South Carolina can be subject to interpretation and, even in the rare instances when cases are prosecuted, penalties are often light. But experts said Atwater's votes could still present potential issues.

"If his organization represents a direct beneficiary of the legislation, it's kind of squirrelly to say that he doesn't have a dog in the fight because the organization's whole reason for existence is to serve the interests of those direct beneficiaries," said John Freeman, a former ethics professor at the University of South Carolina law school.

Atwater said he checked with the S.C. Ethics Commission and the House Ethics Committee to make sure the votes were acceptable ahead of time. House ethics staffers could not confirm what they told Atwater because of attorney-client privilege. The commission did not immediately respond to a request for comment.

House Ethics Committee Chairman Mike Pitts, R-Laurens, declined to weigh in on whether Atwater's votes were improper, saying he would need to see all of the relevant details to make a call.

But in general, Pitts said, conflicts of interest are not just limited to votes in which lawmakers stand to reap a personal financial reward and can extend to other potential benefits.

Patrick Dennis, the medical association's senior vice president and general counsel, said the organization never asked Atwater to vote for or against any piece of legislation in the S.C. House. Dennis was chief of staff for House Speaker Jay Lucas until earlier this year.

The organization did not financially benefit from the seven bills where Atwater cast votes, Dennis added, and the group's policy priorities are set by a group of physicians who vet the association's legislative decisions — as well as the board of trustees.

Atwater alleges that S.C. Attorney General Alan Wilson, who Atwater is challenging in the June 12 primary, has stirred this issue to distract voters from his own record.

"The attorney general is the king of conflicts, and he is trying to deflect," Atwater said. "He has come up with health-related bills and is then claiming that therefore I have a problem. None of these come close to the conflict in law or in use that we have."

Sign up for updates!

Get the latest political news from The Post and Courier in your inbox.

In the GOP primary against Wilson, Atwater and Greenville lawyer William Herlong have criticized the incumbent for his connections to former political consultant Richard Quinn, who was embroiled in a long-running Statehouse corruption probe.

After recusing himself from the probe in 2015, Wilson tried to take back control from special prosecutor David Pascoe. The S.C. Supreme Court ruled in Pascoe's favor in 2016.

Wilson dismissed Atwater's accusation.

"Sounds like he's the king of conflicts," Wilson said, rebutting Atwater. "He has absolutely no clue what he's talking about. Bless his heart."

At a recent GOP primary debate in Greenville, Atwater claimed that he recused himself "from every single vote that had anything to do with the SCMA or myself." He clarified to The Post and Courier that he was specifically referring to any votes that represented a conflict.

Atwater did recuse himself from some medical bills, including a 2011 measure to lower Medicaid payments from the state health agency. That decision came after Atwater said then-Gov. Nikki Haley brought him into her office and told him he should not vote on the bill because of his role with the association.

Follow Jamie Lovegrove on Twitter @jslovegrove.

Jamie Lovegrove is a political reporter covering the South Carolina Statehouse, congressional delegation and campaigns. He previously covered Texas politics in Washington for The Dallas Morning News and in Austin for the Texas Tribune.

We're improving out commenting experience.

We’ve temporarily removed comments from articles while we work on a new and better commenting experience. In the meantime, subscribers are encouraged to join the conversation at our Post and Courier Subscribers group on Facebook.