Anna Chacko, MD, claims that administrators at the VA Pittsburgh Healthcare System (VAPHS) harassed and ultimately fired her after she criticized the way the hospital's radiology department was run. In addition to her termination, Chacko claims that someone in the system retaliated against her by leaking confidential details of her employment and personal life to a blogger for a self-styled government watchdog website -- impugning her character and jeopardizing her chances to find a new job.
The case could put the spotlight once again on a VA healthcare system that has suffered a series of black eyes in recent years. Chacko claims that patients at the Pittsburgh VA suffered from substandard care, while government resources were misused through the purchase of imaging equipment that either wasn't necessary or wasn't used properly.
Chacko was hired to run the VA Pittsburgh's radiology department in September 2008. Born in India, she entered radiology after joining the U.S. Army in 1977, and her military service made her eligible for U.S. citizenship, which she received in 1978. Her final military appointment was as special assistant to the deputy U.S. Army Surgeon General. She left the military in 2001.
After leaving the Army, Chacko worked at several radiology departments in the private sector, with her most recent position being chief of radiology at St. James Healthcare in Butte, MT. She was recruited for the VA job starting in November 2007 by Mona Melhem, MD, at the time the associate chief of clinical services for the VAPHS, who Chacko says told her that the department had a number of problems that needed fixing. Chacko accepted the offer and starting working at the VA in September 2008.
Chacko claims that shortly after she was hired she identified multiple issues that she believed needed to be addressed within the department, including hiring policies, staff attendance issues, quality control, equipment purchasing and acquisition, and treatment of veterans at the Pittsburgh VA.
For example, some nuclear medicine specialists at the hospital were allegedly showing up late for work or not showing up at all, and as a result the PET/CT scanner at the facility was only performing studies on one to two patients per day rather than the seven patients that would be expected under normal circumstances, she claimed.
In another case, Chacko said that the Pittsburgh VA bought a new gamma camera, but the facility purchased a conventional SPECT-only system rather than a model with a more advanced SPECT/CT capability. Chacko said without the more advanced technology, the new system was redundant, as the VA already had four conventional SPECT cameras in operation and the department's throughput was too low to justify an additional SPECT-only camera.
Chacko and Melhem also butted heads over clinical issues, such as the hospital's use of technetium-99m, the radiopharmaceutical that's been in short supply due to repairs at the Canadian nuclear reactor that produces most of North America's supplies.
Chacko said that due to its lower radiation dose compared to an alternative radioisotope, thallium, she preferred that VA physicians work around technetium supply shortages to ensure that patients were scheduled when the radioisotope could still be used. But Chacko said she found cases in which orders made by nuclear medicine physicians for technetium studies were changed without their knowledge to use thallium instead. Substituting radiopharmaceuticals without the prescribing physician's knowledge is a serious violation of U.S. Nuclear Regulatory Commission (NRC) rules, she said.
Chacko said she discussed her plans for reforming the department with Melhem and got the latter's go-ahead to make changes. But the relationship between the two soured after Melhem allegedly gave permission to have a friend who suffered a fall at home -- but who was not a veteran -- to be imaged with department equipment, Chacko said.
Chacko said that at this point she began filing complaints with the VA regarding inadequacies that she saw within the department. But she soon discovered, however, that she was the one under investigation under the VA's administrative board of investigation (ABI) process as the VA looked into charges that radiology staff was allegedly "intimidated" by Chacko's demeanor. Chacko believes the complaints originated with staff who were causing the issues she was trying to reform.
The Legionnaire's connection
In May 2009, Chacko was told that because she was in her first year of employment, she was still a probationary employee and could be terminated at any time -- a fact that she said she had not be informed of when she was hired. In addition, she was placed on administrative leave.
By this time she had appealed the ABI investigation, and also had contacted both the offices of Sen. Daniel Inouye (D-HI) and the subcommittee on investigations and oversight subcommittee, within the Committee on Science and Technology in the House of Representatives.
Chaired by Rep. Brad Miller (D-NC), the subcommittee has responsibility for investigating issues regarding research performed at U.S. government facilities, and had already been looking into the Pittsburgh VA due to the destruction of a major collection of legionella, the bacteria that cause Legionnaires' disease, at the facility in December 2006. Some VA watchers had charged that the incident was an example of retaliation by the Pittsburgh VA administration, which was involved in a dispute with the researchers who maintained the collection and who wanted to move it to the University of Pittsburgh.
Indeed, Miller's report on the incident, published in September 2008, found that Melhem had given the order to destroy the legionella bacteria, and also found that the incident occurred "after a number of false statements about the existence of the collection were made by Dr. Melhem to the VAPHS officials just hours before final steps were to be taken to facilitate transfer to a laboratory at the University of Pittsburgh for continued use by the researchers."
"It is breathtaking that a federal health agency official would order the destruction of a human tissue specimen collection without discussing it with and receiving approval of the agency's research officials," Miller's report states.
Chacko sees parallels between her case and that of the Legionnaires' researchers. Indeed, Miller wrote a letter in support of Chacko to U.S. Veterans Affairs Secretary Eric Shinseki, shortly after she was placed on administrative leave in May 2009. In addition to working with the offices of Miller and Inouye, she filed a complaint with the Equal Employment Opportunity (EEO) Commission.
Call from a blogger
Despite her concerns, Chacko said that she eventually settled the EEO complaint under the VA's alternative dispute resolution mechanism, and returned to work in August 2009 as service line chief. Chacko said she settled after discussions with the VA administration, in which they said they would support her efforts to reform the department.
At this point, Chacko said she felt that she had resolved her differences with the Pittsburgh VA administration. "Everything seemed to be going fine," she said. On September 1, she signed a statement acknowledging that her dispute with the VA had been resolved.
The next day she received a phone call from Michael Volpe, a blogger with a self-styled government watchdog website on Blogspot.com called TheProvocateur, who said he was writing an article on Chacko. Chacko spoke with him briefly, but she claims she was shocked when his article appeared, entitled "Clout: Congressman Brad Miller, General Shinseki, and the Pittsburgh VA ."
Volpe's blog posting also drew connections between the legionella case and Chacko's situation, but came to a far different conclusion: It portrayed Chacko as a politically well-connected radiologist who used Miller's intervention to save her job at the Pittsburgh VA. But what's more, it characterized her as a "psychopath" and included a laundry list of accusations that included salacious details allegedly drawn from Chacko's personal life.
Volpe said he learned about Chacko's situation while researching an unrelated story on the Georgia state attorney general's race, which led him to investigate Chacko's tenure at St. James Healthcare, then the Pittsburgh VA. He said that one of his first sources was an employee at the Pittsburgh VA who contacted him through a dummy e-mail account, he told AuntMinnie.com.
After publication of his first posting on Chacko, Volpe said his e-mail account and website "lit up" with messages from individuals who had worked with her at previous jobs. He said their comments formed the basis for future postings on what was happening at the Pittsburgh VA, as well as on Chacko's personal life.
Chacko claims that Volpe either made up or mischaracterized most of the details, the publication of which has tarnished her reputation and complicated her efforts to find new employment. Volpe also posted information such as Chacko's letters to investigators that she believes could only have come from someone within the VA administration -- indicating that sources within the VA are feeding him information in an effort to retaliate against her.
"The VA has a history of isolating and harassing people who want to do the right thing. Whistleblowers have absolutely no protection at the VA," Chacko said. "There are administrative details the blogger has posted that no one other than someone in the VA administration would know about."
As Volpe's postings began to win a wider audience, Chacko said she was told in October 2009 that the VA was investigating her again, and that she would be put on administrative leave and possibly terminated, allegedly for harassment of four staff members at the Pittsburgh VA. The investigation acknowledged that Chacko's allegations of fraud, waste, and abuse at the VA were accurate, she says, but the investigators said that it was her responsibility to attempt to rectify the problems.
Chacko was officially terminated on March 25. Chacko said the probe incorrectly characterized her attempts at reform as harassment.
In addition to Inouye's and Miller's offices, Chacko has reached out to other Congressional representatives and federal agencies to plead her case. One of them is the office of Rep. Joseph Sestak (D-PA), a retired U.S. Navy admiral who is running for the U.S. Senate seat held by Sen. Arlen Specter (D-PA). Sestak defeated Specter in the Democratic primary in May and will face Republican Pat Toomey in the general election in November.
Sestak is drafting HR 3843, the Transparency for America's Heroes Act, which according to Sestak's office would increase transparency and accountability at the VA, changing "the current VA culture of abuse, mismanagement, and waste into a productive and efficient system serving those who have served our country honorably."
In a July 1, 2010, press release promoting HR 3843, Sestak's office drew parallels between Chacko's case and two other former VA physicians who have allegedly been the victims of retaliation: Robert Van Boven, MD, DDS, a neurologist who was formerly director of the Brain Imaging and Recovery Lab at the Central Texas Veterans Health Care System, and Pamela Gray, MD, a rheumatologist at the Hampton VA Medical Center.
Van Boven claims that the VA accepted millions in funding for a center to study traumatic brain injury in veterans, but then spent the money without a single veteran being treated, while Gray claims that she was terminated after trying to stop the overprescription of schedule II narcotics. The cases of Chacko, Van Boven, and Gray were all mentioned as examples of the need for VA reform in the July 1 press release.
"I respect the fact that these physicians put their careers and reputations at risk to advance the treatment of our veterans," Sestak stated in the release.
Chacko said she has also contacted the U.S. Office of Special Counsel, an independent federal agency that investigates cases of retaliation against government employees. Chacko said that OSC officials have told her that the agency has taken up her case. Press officials with OSC did not respond for requests to comment for this story.
Looking for work
In the meantime, Chacko says she continues to look for work. In January 2010, she reached out to contacts in the U.S. Army Medical Command, volunteering to take a position running a hospital or performing radiology in Afghanistan. That initiative ended after her letter appeared on Volpe's blog site -- a development that Chacko believes proves that someone at the VA is leaking her personal communications in an effort to retaliate against her.
Chacko said Volpe's blog has effectively destroyed her chances of employment at the level she enjoyed before she joined the VA.
Volpe told AuntMinnie.com that he stands by "everything he's written" about Chacko, including his characterization of her as a "psychopath." He denies that the letter about her interest in Afghanistan came from someone within the Pittsburgh VA.
"There are lot of people who are not in the Pittsburgh VA who are following her career and are interested in what's she's doing," Volpe said. "People have known her for many years and were concerned that she was about to get a job in Afghanistan, that's why they sent [the letter] to me."
Volpe said he hasn't updated the blog on Chacko in several months, but is debating whether to write a book on her story. He's tried to interest the mainstream media in picking up his blog posts, to no avail, he said.
"I've tried to sell these pieces to newspapers, but they say the way my language is, it sounds like I'm biased," Volpe said. "But when I call her a psychopath, that's what I think."
Ironically, Chacko claims that the Pittsburgh VA has put Chacko's former job as chief of radiology out to bid for the second time after failing to find a candidate in its first search. A representative with the Pittsburgh VA declined to comment on personnel matters at the facility, citing privacy concerns.
With the political winds appearing to shift in her favor, Chacko says she's considering whether to apply for the Pittsburgh VA job again.
"I'm going to apply," Chacko said. "I know the corruption in the VA better than anyone else. I want to make the VA safe for veterans."
By Brian Casey
AuntMinnie.com staff writer
July 19, 2010
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