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Doctor Exposes Veterans Administration

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    Shoot the Messenger! VA tries to fire whistle-blower doctor BY LAUREL CHESKY OCTOBER 31, 2008: NEWS
    Message 1 of 1 , Nov 4, 2008
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      Shoot the Messenger!
      VA tries to fire whistle-blower doctor
      OCTOBER 31, 2008: NEWS

      It all began with such promise.

      The Brain Imaging and Recovery Laboratory, launched in January, would
      hunt for treatments for what has become the Iraq war's signature
      ailment: traumatic brain injury. A program of the Central Texas
      Veterans Health Care System, part of the U.S. Department of Veterans
      Affairs, BIRL was housed at the University of Texas' J.J. Pickle
      Research Campus, where VA researchers had access to UT's $2.7 million
      brain scanner to help diagnose invisible head injuries.

      But now, BIRL's research has ceased, and the program's director,
      neurologist Dr. Robert Van Boven, has been suspended from duty with
      pay since September, while the VA decides what to do with him. On
      Oct. 15, the VA held a closed hearing to determine whether or not to
      terminate Van Boven's employment. A board presiding over the hearing
      is expected to make a recommendation to Thomas Smith, the director of
      the Central Texas system, within a few weeks.

      Van Boven is a compact, tightly wound man. Fast-talking and brimming
      with energy, he could serve as poster boy for the type A personality.
      His educational and professional feats match his tireless demeanor.

      Van Boven earned a doctorate in dental surgery from the University of
      Illinois and an M.D. from the University of Missouri. He completed
      two neurology residencies, at Harvard's Beth Israel Deaconess Medical
      Center and at Northwestern University. He has worked as a clinician
      at the National Institutes of Health and as an associate professor at
      Chicago Medical School and Louisiana State University.

      The Central Texas VA system, based in Temple, hired Van Boven in July
      2007 to start up the BIRL program. At the time, VA officials may have
      considered themselves lucky to find Van Boven and woo him into
      running their modest $4.2 million brain research program. Van Boven,
      in turn, was excited to work on potentially groundbreaking research
      that could help thousands of soldiers returning from active duty with
      head injuries.

      "I had a chance to help 40,000 veterans with brain injury," Van Boven
      said. "I felt this was a gift and a blessing to help those who have
      served and suffered, and I am well trained to do it. ... I don't want
      these soldiers to become the next generation of homeless veterans."


      Uncovering Waste at the VA

      But within a few months, the relationship between Van Boven and his
      bosses was turning sour. Maybe they weren't expecting a take-charge
      go-getter like Van Boven. And perhaps the doctor wasn't ready for the
      stodgy, insular environment of one of the country's most notoriously
      inexpedient bureaucracies.

      The VA in general and the Central Texas Veterans Health Care System
      in particular are not models of efficiency. The Central Texas system –
      which runs two hospitals in Temple and Waco, five outpatient
      clinics, two nursing homes, and two rehabilitation centers – ranks
      118th in patient satisfaction out of 139 veteran health-care systems
      in the country. The local system made national news when the press
      was leaked an e-mail from Norma Perez, a post-traumatic stress
      disorder coordinator in Temple, advising mental-health professionals
      not to diagnose patients with PTSD "straight out," because "we
      really ... don't have time to do the extensive testing that should be
      done to determine PTSD" – a serious mental illness that can, among
      other things, lead to suicide and homicide.

      Almost immediately, Van Boven observed what he calls fraud, waste,
      and research mismanagement totaling $1.2 million in misused funds. He
      was concerned about research being conducted at BIRL by a VA
      physician – an inexperienced researcher, Van Boven says, whose work
      was flawed and of "highly questionable scientific merit." To be
      certain, he sought the opinion of five experts, including researchers
      at the Wilmer Eye Institute, Johns Hopkins University, and Harvard,
      to review documents related to the research. "All five uniformly
      panned the research," Van Boven says.

      Moreover, the research was costly. Exper­i­ments took more time on the
      MRI brain scanner (240 hours at $487 per hour over nine months) than
      they should have, Van Boven thought. And the research didn't have
      anything to do with traumatic brain injury incurred in combat. The
      research was related to diabetic retinopathy, or blindness triggered
      by diabetes.

      According to Van Boven, he also discovered that a consultant helping
      with the research was billing the VA for hours that he had not worked
      and that a grant proposal the consultant had written was plagiarized,
      lifted almost word for word from an Oxford University document posted
      on the Web. The consultant was paid $107,000 in fiscal year 2007,
      with, according to Van Boven, little to show for it. "There is no
      grant proposal, no publication, nothing has come out of this research
      that the VA spent over $1 million of taxpayer money on," he says.

      In September of last year, Van Boven voiced his concerns to Dr. Paul
      Hicks, associate chief of staff for research with the Central Texas
      Veterans Health Care System. According to Van Boven, Hicks took no
      action. In the following months, Van Boven repeatedly asked VA
      leadership for an investigation into the research he alleged was
      fraudulent. Those requests were not only ignored, but Hicks stripped
      Van Boven of his oversight duties concerning the diabetic retinopathy
      research and threatened him with reassignment. When contacted, Hicks
      referred all questions to Nelia Schrum, the Central Texas system's
      public affairs officer, who replied in an e-mail, "It is the VA
      policy not to comment on ongoing administrative reviews."

      In February, Van Boven went over his bosses' heads and reported his
      concerns to the VA Office of Inspector General. In a July 29 report,
      the office partially substantiated his allegations. The report agreed
      that "BIRL funds had been misspent since approximately September 2006
      because eight hours of magnetic resonance imaging (MRI) scanner time
      [a week] ... was paid to the University of Texas Austin without BIRL
      research to support expenditures of this magnitude." The
      report "neither substantiated or refuted" Van Boven's allegation of
      waste in the payment of the consultant due to a technicality: The
      consultant didn't have a contract with the VA. In the absence of a
      contract spelling out expectations, the Office of Inspector General
      could not determine whether or not the consultant was overpaid.

      On Oct. 21, Dr. Robert Van Boven wrote an 11-page letter to the U.S.
      Senate Committee on Veterans Affairs, asking for a review of
      questionable actions and procedures at the Central Texas Veterans
      Health Care System in Temple. This excerpt from the letter offers a
      snapshot of one of Van Boven's allegations as well as the personal
      atmosphere at the Central Texas system. Download the whole
      letter.However, the report did conclude that payments to the
      consultant were against VA policy. "VA Handbooks ... do not permit
      hourly payments under a free basis contract," the report
      states. "Rather, consultants must be paid on the basis of services
      rendered and not on the basis of time taken to complete tasks."

      The report recommended that the Central Texas VA cease paying for the
      eight hours a week of MRI scanner time in the absence of a contract
      and execute a contract with the consultant for further work. The
      report also recommended that the Central Texas VA's Office of
      Research & Development and Institutional Review Board review the
      research in question and address issues identified in the report.

      "All recommendations of the VA's OIG report have been appropriately
      addressed and necessary actions taken to ensure compliance," Schrum
      wrote. "More oversight has been put in place to ensure that research
      complies with directives put in place by our Institutional Review
      Board.In addition, Central Texas Veterans Health Care System has just
      received a three-year accreditation after an extensive review by the
      Association for the Accreditation for Human Research Protection


      How Do We Get Rid of This Guy?

      You'd think Van Boven's VA bosses would have been happy that he had
      rooted out misuse of taxpayer money. If they were, they didn't show
      it. Instead, they called for an investigation into allegations of
      misconduct against Van Boven – allegations which, curiously, began to
      accumulate soon after Van Boven started needling his VA bosses about
      his concerns over waste and mismanagement.

      Now a bona fide whistle-blower, Van Boven won't be so easy to kick
      out of the VA system. Federal law protects people who allege
      misconduct within an organization from retaliation, including
      harassment, demotion, or termination of employment. Nevertheless,
      they're trying. VA officials in Temple have assembled a laundry list
      of allegations against Van Boven and are using it as grounds for
      possible termination. Among them:

      • Insubordination for defying orders to refrain from organizing a fun
      run to benefit traumatic brain injury research – even though a letter
      from the VA regional counsel opined that Van Boven was free to
      organize the event as a private citizen.
      • Hanging a personalized door tag outside of his office.
      • The use of profanity and engaging in "threatening gestures" at
      work. The employee who made the allegations occasionally socialized
      with Van Boven's family outside of work and has since moved out of
      state. Van Boven admits he occasionally used profanity at work but
      says it was never directed toward a person. He says he never made
      threatening gestures to the employee.
      • "Disrespecting" Sen. John Cornyn at a BIRL event attended by the
      senator. The VA alleges Van Boven inconvenienced the senator by
      allowing the event to run long in order to allow two veterans not on
      the agenda to speak. Cornyn's office wrote a letter denying that
      Cornyn felt disrespected.
      • Sexual harassment. A subordinate claims that he overheard Van Boven
      asking a female UT researcher about her sex life. The researcher, who
      does not work for Van Boven, wrote a letter vehemently refuting the

      In mid-September, Van Boven was suspended with pay and now awaits the
      review board's decision and his professional fate. (The review board,
      incidentally, declined to hear testimony from Van Boven's former
      supervisor, who wrote a letter in support of him.)

      All of which raises another question: Why would an obviously smart
      and qualified neurologist put up with such nonsense?

      Van Boven says he's looked for other work – but something
      called "Google" has thus far worked against him. When you search his
      name, the whistle-blowing stuff lands at the top of the heap. He had
      accepted a job at a small private practice in Illinois, but when the
      doctors there read about the brouhaha in Austin, they decided not to
      hire him. "They said they were worried about loyalty and integrity,"
      Van Boven says. "My reputation has been damaged. Some people might
      admire a whistle-blower, but nobody wants to hire one."

      So for now, Van Boven is standing his ground and fighting like a
      soldier against the VA. The doctor has now reached beyond the VA and
      has contacted a host of federal agencies with allegations of waste,
      mismanagement, and misconduct of VA officials in Temple. He has sent
      letters to Cornyn, the U.S. Senate Committee on Veterans Affairs, and
      even the FBI. And he's just beginning.

      "My reputation is at stake, so there is no slipping away into the
      night," Van Boven says. "If they succeed and I am truly a dead man,
      then they will have to deal with the stench of my corpse."

      Download and read documentation associated with the Van Boven case:
      1) The VA Office of Inspector General's July 29 report on the Central
      Texas Veterans Health Care System


      2) Van Boven's July 19 letter to the VA Office of Research Oversight


      3) Van Boven's letter to the U.S. Senate Committee on Veterans
      Affairs, asking for a review of questionable actions and procedures
      at the Central Texas system




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