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Shoot the Messenger!

VA tries to fire whistle-blower doctor

By Laurel Chesky, Fri., Oct. 31, 2008

Dr. Robert Van Boven
Dr. Robert Van Boven
Photo by Jana Birchum

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. <a href=/media/content/696352/3vbtosenatevetaffairs10_21_08.pdf target=blank><b>Download the whole letter</b></a>.
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 Programs."


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 accusation.

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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