Docs Up in Arms
A letter from 128 physicians to the University of Virginia Board of Visitors has urged the Board to uphold academic freedom, free speech and patient safety by replacing UVA Health Systems CEO Craig Kent and medical school Dean Melina Kibbe.
In the letter issued last week, the physicians accused Kent and Kibbe of compromising patient safety, spending excessively on the C-Suite, and creating a culture of fear and retaliation, among other abuses. The signatories withheld their names from the public but said they were willing to reveal them to select members of the board.
The Board of Visitors is scheduled to meet Thursday morning to discuss health system business, but there is no mention in the board agenda, typically prepared by Rector Robert Hardie and President Jim Ryan, that the issues raised by the letter will be addressed. It is an open question whether other members of the board will attempt to shoehorn a discussion into what is a time-constrained and carefully scripted two-day meeting.
In a letter to the medical school faculty, Ryan expressed his skepticism about the charges but promised to look into them. Every organization has malcontents, and the letter signatories represent only 9% of the medical school faculty, he wrote. Moreover, the charges in the letter are vague, and the signatories are unwilling to reveal their names. He wrote:
They have besmirched the reputations of not just Melina and Craig. Instead, through some of their allegations, they have unfairly—and I trust unwittingly—cast a shadow over the great work of the entire health system and medical school.
William G. Crutchfield Jr., a Charlottesville businessman serving on the health system board, had nothing but praise for the health system leadership. “It is my opinion that our health system is better today than it has been at any time over that period. And it is evolving into one of the truly top health systems in the nation,” he wrote in a letter published by Virginia Business.
The physicians’ letter contains a list of alleged abuses but provides no supporting documentary evidence to support the allegations. The authors appear to be affiliated with a Substack account, Parrhesiastes, dedicated to “raising red flags about serious issues at UVA Health in the hope of motivating principled UVA stakeholders and Charlottesville citizens to address them.”
Kent and Kibbe have fostered an environment, the letter charges, that has “directly attacked the values that inspired us to study, teach and work at the University of Virginia School of Medicine and UVA Health.” That environment has led to “egregious acts” that can “no longer be tolerated.” Topics addressed in the letter include:
Compromised patient safety;
Culture of fear and retaliation;
Devaluing the academic standards of promotion and tenure;
Excessive spending on C-Suite executives and support;
Failure to be forthcoming on significant financial matters;
Consistently violating the Board of Visitors-approved code of ethics in the faculty handbook;
Subjecting residents to bullying and harassment.
Perhaps the most serious accusation is this: “disregarding valid points of fraudulent billing and requests by senior leaders to fraudulently modify patient records in order to obfuscate adverse outcomes and boost productivity metrics.”
The last few years have brought significant change to the UVA Health System. As the hospital industry has consolidated nationally, UVA Health has grown through acquisitions, the most significant of which was the 2021 merger with Novant Health, a small health system in the Northern Virginia market dominated by regional giant Inova. In the wake of the merger, state auditors identified “material misstatements” in health system finances, which have since been addressed. The health system and medical school also have aggressively expanded Diversity, Equity & Inclusion (DEI) initiatives, subsumed under the banner of ASPIRE, which advances the values of accountability, stewardship, professionalism, respect, and equity.
Under Kent, who took on the Health System CEO job in 2020, and Kibbe, who became dean in 2021, the University of Virginia has boosted the level of sponsored medical research to $287 million in 2023. UVA hopes to attract more research dollars when it opens the Manning Institute of Biotechnology, made possible by a $100 million gift from local entrepreneur Paul Manning (who now serves on the Board of Visitors).
Charges that the medical school has created a “culture of fear and retaliation” are not new. In 2021 first-year med student Kieren Bhattacharya ignited a controversy when he attended a seminar on microaggressions and publicly challenged the premises behind the theory. Other employees found his statements disturbing, and one filed a “professionalism concern card” against him. In the subsequent administrative inquiry things went downhill. Bhattacharya, who was suffering from mental health issues, fought back in an argumentative manner, and med-school authorities hospitalized him involuntarily for treatment. Later, after he broke up with his girlfriend, the University adjudged him a potential danger and issued a No Trespass Order forbidding him from entering University property. Unable to pursue his studies, he dropped out of medical school.
One of the prominent themes in the physicians’ letter was fear of retaliation. The letter provided several bullet points elaborating on the charge:
Using explicit and implicit threats and retaliation – often relayed to faculty via their chairs and chiefs – against those who have raised concerns about patient safety, capacity constraints, and moral distress;
Responding to concerns and questions raised by faculty in open forums with ridicule and disrespect;
Subverting the true intent of credentialing, quality review, and professional support processes to silence and intimidate faculty;
Using delays and denials of promotion and tenure as retaliation against respected faculty for speaking out about patient safety concerns, a culture of fear of retaliation, and unethical behavior by UVA Health senior leaders;
Implementing non-transparent and inconsistent standards regarding academic rank and compensation for new hires relative to existing faculty;
Failure to protect confidential reporting and internal whistleblowing;
Weaponizing ASPIRE values: senior leaders of UVA Health have and continue to use ASPIRE Values to punish and intimidate faculty – often in the form of letters placed in Human Resources and Departmental files that have been referenced as cause to withhold recommendations for promotion and tenure;
Many faculty, doctors, nurses and staff who have shared … legitimate concerns have been silenced, intimidated, and/or punished for following recommended UVA reporting protocols.
The letter offered no particulars for any of these charges.
However, some controversies have broken into public view. UVA is fighting a lawsuit filed by former employees who were fired when they refused orders to take the COVID-19 vaccine. The plaintiffs say the University denied them a religious exemption on the arbitrary grounds that they did not belong to a handful of pre-selected religious denominations. Roughly 200 employees lost their jobs for refusing the vaccine.
Crutchfield, the Health Systems board member, said in his letter that some of the physicians’ criticisms are demonstrably untrue. Regarding patient safety, he wrote, UVA Health has received A ratings in safety audits for its four hospitals. And its ratio of observed mortality compared to expected mortality is at an all-time low, “suggesting we are saving 2-3 out of 10 patients that were otherwise not expected to live.” And in contrast to assertions of a toxic work environment, he wrote, UVA Health has a 5.1% turnover rate compared to a national average of 8.1%.
“The letter itself is daunting,” said Ryan in his letter. “There are many accusations. There are few details.” Some allegations apparently address matters that the University has already addressed or is addressing now.
Regarding new allegations raised in the physicians’ letter, Ryan said, “Even though it is difficult to investigate generalized and anonymous claims of wrongdoing, without specific details or names to follow up with, we will do our best to investigate.”
Ryan went on to express his “disappointment” with the letter writers’ approach. He and Provost Ian Baucom had been meeting with “small groups of faculty” over the past couple of months to hear their concerns. Instead of working “in good faith” within the system, the signatories “decided to take a different path” and “besmirch” the reputations of Kent and Kibbe.
The 128 faculty members represent roughly 8% of the medical school faculty, Ryan noted. “It bears noting that national surveys consistently show that, across the country, 8-9 percent of medical school faculty are dissatisfied.”
In his letter, Ryan found it significant that the dissident faculty members “did not suggest that the allegations be investigated,” nor that Kent and Kibbe be afforded due process. Rather, they demanded that the two leaders be immediately removed.
One can infer from the physicians’ letter that the signatories have lost faith in working through the system and fear retaliation if they try to do so. In an introduction to the letter, they explained that they were reaching out directly to the Board of Visitors and were willing to disclose their identities to four board members, of whom two are physicians — Dr. Stephen P. Long and newly-appointed Dr. David O. Okonkwo – and two of whom serve on the Audit, Compliance and Risk Committee: Rachel W. Sheridan and Porter N. Wilkinson.
James A. Bacon is the founder of Bacon’s Rebellion and a contributing editor with The Jefferson Council.
