What UVA Leadership Knew—and When: A FOIA-Based Account of Governance Failure at UVA
This account is based entirely on records obtained through a Freedom of Information Act (FOIA) request, including internal correspondence, contemporaneous complaints, and summaries of 36 formal interviews conducted by outside counsel with physicians, administrators, and staff at UVA Health. These materials document years of warnings to President Ryan and his administration about patient safety risks, administrative dysfunction, and retaliation against clinicians who attempted to intervene.
What emerges from these records is not simply a story about one hospital executive. It is a story about institutional failure—specifically, what senior UVA leadership knew, when they knew it, and how they responded.
From as early as April 2020, just weeks after Dr. Craig Kent’s arrival as CEO of UVA Health, serious concerns were escalated to President Jim Ryan and other senior university officials. Over the next five years, those concerns grew in number, detail, and severity. Yet Kent, along with Dean Melina Kibbe and CEO Wendy Horton, remained in their positions—while doctors who raised alarms faced retaliation, professional harm, and, in many cases, departure from the institution.
The disclosures summarized below represent only a portion of what was formally presented to the UVA Board of Visitors under Robert Hardie’s leadership in February 2025.
A Pattern Established Early
According to interview summaries and internal correspondence, concerns about Kent’s leadership surfaced almost immediately after his appointment in February 2020.
By April 2020, a highly decorated physician had written directly to President Jim Ryan expressing alarm about unsafe practices and governance failures. That physician ultimately resigned rather than continue working under Kent’s leadership.
Over the following years, clinicians repeatedly described a leadership culture marked by unilateral decision-making, disregard for established safety protocols, and intimidation. These warnings did not remain confined to internal channels—they were escalated to hospital leadership, university administrators, and the President’s office.
Decisions That Put Patients at Risk
Over his five-year tenure, Kent—alongside Dean Melina Kibbe—dismantled safety protocols, bypassed established hiring processes, and installed or promoted unqualified staff in high-risk specialties, particularly cardiothoracic surgery.
Among the most troubling examples documented in the FOIA materials:
1. Pediatric Oncology
A pediatric oncologist reported being pressured to perform high-risk bone marrow transplants for children with leukemia despite severe shortages in staff and resources. UVA had promised a specialized team for these procedures, but critical positions remained unfilled.
The physician believed proceeding under these conditions would be unsafe and potentially malpractice. At the time of his interview, he described himself as the “last safeguard” against dangerous practices—fearing that, if he were replaced, less experienced physicians might be pressured to proceed, putting children’s lives at risk.
Team members left due to moral distress and untenable working conditions.
2. Cardiothoracic Surgery
Kent and Kibbe repeatedly bypassed search committees to hire surgeons over the objections of quality officers and senior medical staff.
In 2023, they hired Dr. Ourania Preventza as chief of cardiothoracic surgery despite a unanimous recommendation against her. Within weeks, residents and surgeons raised serious concerns about her competence and patient safety risks. Rather than investigate, leadership dismissed these warnings and disciplined physicians who spoke out.
Her surgeries were later linked to multiple patient safety incidents, prompting a special review. She resigned before the investigation was completed.
Soon after, Kent and Kibbe pushed through the hiring of Dr. Kim de la Cruz despite warnings that he lacked the ability to operate independently. His short tenure was marked by alarming incidents, including refusing to perform an urgent surgery that others later completed successfully.
3. COVID: Centralization, Secrecy, and Financial Priorities
During the early stages of the COVID-19 pandemic, physicians described working around the clock to establish protocols, prevent spread, and expand testing. Several reported that Kent initially took a vacation during this critical period.
When he returned, he centralized decision-making, overriding clinical leadership. Doctors said his focus was not on infection control, but on preserving high-revenue elective surgeries.
Multiple interviewees alleged that Kent directed limited COVID tests to be reserved for himself, his family, and VIPs, while staff were left exposed due to delayed pre-operative testing.
He imposed salary cuts of 20% and furloughs of two weeks, even after UVA Health received federal funds intended to prevent those measures.
4. A System That Harmed Patients
Under Kent, Kibbe, and Horton, UVA Health became what many physicians described as a dangerous and chaotic environment.
Doctors reported:
Strokes caused by delayed care
Vision loss due to triage failures
Missed diagnoses from staffing shortages
Equipment and supply shortages
Chemical leaks in operating rooms
Mishandled pediatric heart surgeries
One ophthalmologist warned that a new “patient-friendly access system” was causing catastrophic triage errors. When a patient lost their sight due to misrouting and delays, leadership did not address the system failure. Instead, the physician who raised the alarm was disciplined.
5. Retaliation as a Governance Failure
The records describe a consistent pattern: when physicians raised safety concerns, they were punished.
Doctors were:
Denied promotions
Issued reprimands
Subjected to complaints
Demoted
Marginalized
This pattern is not incidental. It is systemic. And it matters, because retaliation silences reporting—and silenced reporting leads to patient harm.
6. Leadership Turnover and Institutional Drain
Shortly after Kent’s arrival, senior staff began leaving rather than remaining in what they described as a culture of fear and incompetence.
Departures included:
Emergency medicine leaders
Pediatric oncology staff
Senior nurses
HR professionals who refused to carry out improper directives
7. Financial Mismanagement and Supply Shortages
Internal records show that UVA Health frequently failed to pay invoices, leading to credit holds, delayed shipments, and equipment substitutions during procedures.
One vendor reported nearly $1 million in overdue balances.
In some cases, doctors were forced to use inferior tools because the correct equipment was unavailable.
8. What UVA Leadership Knew
President Jim Ryan and other senior administrators were aware of these issues. The earliest documented complaint to Ryan dates to April 2020.
By fall 2021, a draft letter of verbal no confidence from the UVA Physicians Group cited:
Patient safety failures
Low morale
Millions spent on consultants
No strategic plan
Collapsing national rankings
The draft also referenced Kent’s prior leadership controversies at Ohio State.
In 2024 alone, no fewer than eight formal escalations were made to UVA leadership before the September 5 letter of no confidence signed by 128 physicians. Despite this, Kent remained in place until February 2025—when he was permitted to resign.
Why This Matters
The UVA Board of Visitors accepted Kent’s resignation in February 2025. But the public remains in the dark.
The Williams & Connolly report has not been released. The reasons for leadership departures have not been fully disclosed. The extent of patient harm has not been publicly acknowledged.
UVA now faces a federal lawsuit.
And the most important questions remain unanswered:
Why did UVA leadership allow this to persist for nearly five years?
Why were repeated warnings ignored?
Why were whistleblowers punished?
Why was Kent allowed to resign rather than be terminated?
And why has the public still not been allowed to see the full findings?
Resignation is not accountability. Silence is not transparency.
If UVA hopes to restore trust—with patients, physicians, donors, and the broader community—it must confront not only what happened at UVA Health, but how and why its top leadership failed to intervene.