Wednesday, February 21, 2007

The Plight of the Whistleblower Illustrated: the Stratton VAMC Story Revisited

Two years ago, we discussed the troubling case of Paul Kornak and the Stratton Veterans Affairs Medical Center (SVAMC) in Albany, New York. Kornak was apparently hired despite having lost medical licenses in several states due to forged credentials, and a felony fraud conviction in Pennsylvania. Although Kornak apparently never completed medical training, the Stratton VAMC allowed him to perform physical examinations and identify himself as "doctor." The FDA found that Kornak had falsified patients' medical records in several drug studies, allowing patients to enroll in studies even though they should have been excluded. Kornak plead guilty to fraud and negligent homicide for the death of one patient in a chemotherapy study.

Our post in 2005 was based on a New York Times article that suggested that Kornak's actions were part of a much larger problem, and that whistle-blowers who tried to alert the government to Kornak and these other problems were discredited and punished.

I just found another article, published last year in a health care journal, [Fudin J. Blowing the whistle: a pharmacist's vexing experience unraveled. Am J Health-Syst Pharm 2006; 63: 2262-2265.] and now available on Medscape, which reveals more troubling details about the case. Its author was a key whistle-blower in this case.

Fudin first noticed in 1994 what he felt were important problems with cancer research studies, such as enrollment of patients without informed consent, enrollment of patients who did not fit study criteria, and coercion of patients to enroll.

As I climbed the chain of command to report my observations, it became painfully obvious that institution officials were angered by my 'protected' disclosures. I felt obligated to bring my concerns to an outside agency, the VA Office of Inspector General (VAOIG).

After putting these concerns in writing, I was threatened. The exact words still ring clearly in my ears, 'Fudin, I will bury you.'

After Fudin noticed more research problems in 1995,

I wrote a report of my findings and sent copies to several administrative medical personnel in March 1996. It included my refusal to participate or comply with any physician orders to dispense these medications, at unstudied dosages in unstudied combinations, to patients. Within two days, I received a memorandum charging me with 'patient abuse for failure to dispense medication as required by the oncologist.'

After another report by Fudin,

I was investigated for 'practicing outside [my] scope by requiring certain blood work prior to dispensing chemotherapy.'


SVAMC was, however, obligated to convene an internal investigation to determine the legitimacy of my allegations. The investigation was assigned to a pulmonologist named Thomas Ferro. Many of his findings were consistent with my disclosures. But the chief of staff changed the report and ordered Dr. Ferro to sign off on certain edits and to destroy any original documents and computer files. Dr. Ferro admitted this to investigative reporters for a local newspaper and the New York Times.

By July 1995, the chiefs of staff and the department of medicine had approached Anthony Mariano, SVAMC's pharmacy manager at that time. Mariano was ordered to counsel and place me on probation regarding certain alleged 'undesirable professional activities.' A man of high integrity, Mariano refused to succumb to administrative pressures even though this made him vulnerable to retaliation. For supporting me and for making his own 'protected disclosures,' his desk was moved to an empty psychiatric ward where he had no computer, no phone, and no job assignments. He was eventually terminated for allegedly allowing a clinical pharmacist to practice outside an approved clinical scope, a charge that, upon subsequent investigation by several agencies, was dismissed. This cluster of retaliations came from a newly assigned regional pharmacy manager, a pharmacist, who Mariano and I believe was sent to our region by Washington, D.C., officials to remove us from government service. Mariano was forced to resign with no opportunity for a hearing. Just two weeks after my own termination, the regional pharmacy manager was whisked off to a Washington-based job with a promotion, but in December 2001, I prevailed in court and was reinstated to SVAMC by a federal judge.

Fudin alleged that Kornak took the fall to protect worse misdeeds made by more highly placed people.

As a cautious returning SVAMC employee, I watched the 2002 Kornak story unfold in my local newspaper. I knew in my heart that although he deserved punishment for his crimes, he had been used by the government as a convenient scapegoat to avoid accountability for more than a decade of criminality predating his employment.

This experience lead Fudin to help set up an organization to protect US Veterans Affairs whistle-blowers, the Veterans Affairs Whistleblower Coalition. Fudin has posted more details of his story on his own web-site.

Given the anechoic effect, it is remarkable that this story has come out in a health care journal, even so many years later.

This story illustrates the barriers facing anyone who seeks to complain about perceived misdeeds and malfeasance in health care, whether they affect patient care, academics, or institutional finance and governance. The unfortunately usual pattern is that the original whistle-blower is made to pay dearly, as are those who come to his or her support.

This clearly suggests the need for clear and enforced codes of conduct for everyone, including top management, who works in health care; indepedent watch-dog organizations to publicize mission-hostile management, conflicts of interest, and corrupt and criminal behavior in health care not handled by these internal resources; and finally recourse to independent, unconflicted, impartial regulatory agencies when all else fails.

Right now, as illustrated by Fudin's article, most whistle-blowers in the US must survive on their own wits while paying their own legal bills. In a health care sector increasingly dominated by "increasingly aggressive business models," in which even ethicists call for managers to " test the boundaries of legal permissibility" to beat out their competitors, failure to protect whistle-blowers will just put us all deeper into the moral swamp.


Anonymous said...

I'm a whistle-blower who, as a director, had no whistle-blower protection and was discharged without cause (my boss and an HR director were two of the people who committed some of the illegal and unethical practices I discovered). I have been blacklisted and have been unemployed for a year. No hopes of employment in my future.
I share the author's concerns, because I do know what practices are not only tolerated, but are rewarded at the senior administrative level in hospitals and inpatient institutions. The degree of filtering and distortion of information which reaches the board level bears no similarity to facts and actual events.

unbekannte said...

I worked at the Stratton VAMC about the same time as Dr. Fudin and I had my own run ins with the Hospital Administration.

Based on my experience, I say that senior leadership people at the Stratton VAMC made errors in patient care management, sometimes very serious errors. Standard procedure for dealing with these errors often was to try to intimidate some subordinate into taking the fall for the error.

Personally, I became persona non grata at the Stratton VA because I refused to take the fall for a very egregious error of patient care which was the responsibility of the Hospital Director. I was forced to report the error to VA Central Office and demand an external investigation to get the Director off my back. He backed off but 6 months later the Stratton VA was asking VA Central Office for permission to eliminate my job.