The Doctor vs. the Hospital
Whistleblower fights legal war of attrition with Lakeway Medical Center
In July 2009, the Chronicle reported the closure of the U.S. Department of Veterans Affairs Brain Imaging and Recovery Lab at the J.J. Pickle Research Center in North Austin ("$4 Million Later: Austin Loses Lab to Waco," July 3, 2009). The lab's record was less than stellar, reporter Laurel Chesky wrote: "After spending more than $4 million, the Austin lab is closing without one veteran having been studied or treated."
At the center of that lamentable tale was former BIRL Director Dr. Robert Van Boven, a neurologist who had arrived in July 2007, planning to study combat-related traumatic brain injuries. But Van Boven was soon embroiled in a whistleblower controversy with his superiors over prior mismanagement of BIRL research and funding. Before his research even officially began, in 2008 Van Boven was suspended from the directorship and assigned to clinical services. He was eventually placed on paid leave, and in January 2009 he was fired.
In the meantime, he had sued the V.A., claiming retaliation. A consequent investigation by the Office of Inspector General substantiated many of Van Boven's claims of mismanagement, and the lawsuit was resolved in a 2010 settlement. The terms were undisclosed, but Van Boven and media reports describe the settlement as "vindicating" the doctor.
That wasn't the first such episode in Van Boven's career. In 2007, he parted ways with the Virginia Regional Medical Center (of Virginia, Minnesota), via a reported $150,000 settlement of a lawsuit he filed after an earlier settlement agreement with the VRMC went sideways. According to the Virginia-based Mesabi Daily News, "Van Boven alleged that the defendants violated the terms of the May 18, 2005 settlement agreement, defamed him, and interfered with his potential employment opportunities."
Following his embattled departure from the BIRL and a brief stint in Kansas, Van Boven returned to Lakeway, working at Fort Hood on a Defense Department grant project, a clinical treatment trial of traumatic brain injuries in combat veterans. In 2012, he was hired by the newly opened Lakeway Regional Medical Center (now the Baylor Scott & White Medical Center at Lakeway) as the hospital's sole neurologist. But Van Boven says he was immediately concerned by the for-profit hospital's business model. (In 2014, the hospital defaulted on its $164 million mortgage, which in an unusual arrangement had been guaranteed by the U.S. Department of Housing and Urban Development.) More directly, within a month of his arrival he became alarmed at LRMC's medical practices (aggravated, he says, by administrative cost-cutting), and began filing complaints with management about patient care – complaints, he says, that were ignored. "There were persistent systemic errors," he told me. "It included everything from medical errors, lack of resources, and lack of knowledge, training, and competency of hospital staff."
Van Boven recalls at least 10 such cases in his first six months at LRMC, and several more over the next two years, critical episodes that he describes as resulting in "deaths or risks of death." He says that despite his repeated attempts to elicit action from management, nothing was done. "I only went public after two and a half years of making internal reports," he explained.
Van Boven says he did so – filing complaints first with the Joint Commission (a hospital accrediting agency), and then the Texas Department of State Health Services – only after he discovered that LRMC management had complained about him to the Texas Medical Board, filing what Van Boven calls "retaliatory complaints" that the TMB eventually concluded either had no or "trivial" merit.
On the other hand, a few of the most egregious cases reported by Van Boven to the DSHS included:
• Failure to properly treat a cardiac staph infection, resulting in a patient's death.
• Inappropriate, unsafe discharge of a patient, contributing to a patient's death.
• Failure to diagnose and treat a severe stroke, "a clear breach in the standard of care."
• Improper treatment of a cardiac arrest and consequent coma, resulting in a patient's death. Subsequent investigations by the DSHS confirmed many of the problems Van Boven reported.
In response to the management actions against him, Van Boven demanded to be released from his staff position, and by September 2014 he had opened his own neurology practice nearby, while retaining admitting privileges at LRMC. By 2015, he and hospital managers had settled into a mutual war of attrition (including lawsuits and countersuits) with a repetitive pattern: 1) Van Boven files complaints over patient care; management fails to respond to his satisfaction. 2) Van Boven files complaints with state and federal regulators; management responds with counter-complaints. 3) The Department of State Health Services (acting also on behalf of federal agencies) investigates LRMC practices, substantiates several critical problems, and imposes corrections. With variations, the cycle repeats.
Meanwhile, Van Boven either sues or threatens to sue LRMC ... and the hospital settles, thrice paying Van Boven undisclosed sums (although correspondence reflects at least $500,000 in all), but without getting him to agree to end his complaints. Asked if he ever considered just throwing up his hands and leaving the hospital to its own devices, Van Boven said: "I was here first. This was a hospital where my family and friends deserved quality care .... I was determined to not walk away." He attributes the notoriously high U.S. hospital-related illness and fatality rates to what he calls "the ubiquitous culture of silence" among medical professionals and managers. "I was motivated to take a stand," he insists, "and to shed public light on the problem."
Van Boven is not without supporters, even among hospital administrators. In 2015, when some board members were asking the TMB to take action against Van Boven, former LRMC CEO David Kreye wrote the agency: "I can state that [Dr. Van Boven] is fully committed to advocating for his patients, being available for patient care and to assist his fellow medical staff members 100%. I can attest to the fact that the medical staff at Lakeway Regional Medical Center had great faith in Dr. Van Boven's clinical competence."
Most recently, Van Boven's battle with LRMC management descended into farce. In early 2015, the hospital began issuing "no trespass" orders against him – the first two of which were eventually rescinded when Van Boven threatened another lawsuit. Meanwhile, hospital ownership flipped twice, first to MedEquities (which now owns the land and buildings), and then to Baylor Scott & White (which manages the hospital) – although some original administrators remained in place. In September 2016, in the middle of a visit to the hospital to look in on a friend and patient, Van Boven was accosted by two Lakeway police officers, who informed him that yet another no trespass order had been issued (without notice to Van Boven). When the doctor attempted to leave the premises as requested, he was instead arrested.
That arrest became the subject of yet another lawsuit, this time against the two police officers, for false arrest. The suit went to mediation on June 30 – and was resolved when the city of Lakeway agreed to pay Van Boven $55,000 in reparations.
If all this isn't enough, two female patients treated by Van Boven in early 2015 ("in the middle of all this bullshit with the hospital," he recalls) later filed TMB complaints against him of "boundary violations" – essentially of sexual harassment during their appointments. Van Boven insists the complaints were "bad-faith" retaliations by patients who were disappointed in his diagnoses. But the TMB has found them sufficiently credible to forbid Van Boven from treating women until the complaints are adjudicated. That's happening right now (two years later), under the State Office of Administrative Hearings, with a ruling expected in a few months. Says Van Boven: "Based on the hearing [earlier this year], I expect to be fully vindicated by the administrative hearing officer."
If he's right, that may not be sufficient to restore his reputation or his career. "All of these are pyrrhic victories," he said. "I don't think that my practice or reputation will ever be completely restored. I believe that this experience has instilled a modified purpose in me – of trying to be a spokesperson for larger changes, to improve transparency and reform in medicine."
Despite several attempts to reach out to LRMC administrators, spokespeople, and attorneys regarding the hospital's perspective on the disputes with Van Boven, those inquiries have not yet received a response.
Van Boven remains defiant. He told me recently: "This has killed me in terms of my career, and finances, and reputation. It has ruined me and run me dry, financially. ... Until and unless I'm vindicated, I can't work. ... But it's worth it if I can bring change and make things better."