The Chacko Memo

UPDATE: Please also check out my new book, The Definitive Dossier on PTSD in Whistleblowers, for only $3.95, in which I dedicate chapter four entirely to the exploits of Dr. Anna Chacko. 


Here's a copy of Dr. Chacko's entire memo in which she lays out what happened during her time at the Pittsburgh VA. Let's just say she didn't like things much at Shangri La.


The following memorandum will illustrate the many problems with the VAPHS and the VISN 4. There is no doubt that their practices currently adversely affect patient care. Their corruption and malfeasance have flourished unfettered, and have become institutionalized.
I am outlining this document with the VA, VAPHS and VISN – 4 and have organized it into three separate parts:
I. Systemic Issues with the VA
A. Equipment Issues
B. Personnel Issues
C. Patient Care Issues
How I have been retaliated and reprised against.
II. My Issues with the VAPHS
A. Fraud, Waste and Abuse, Misuse of Authority and ensuing Reprisal
B. Non-Merit Based Discrimination
III. Synopsis - Timeline
I would recommend that you peruse Part I - Pages 2 through 6. These will delineate the issues that need to be investigated thoroughly and corrected. Parts II and III deal with these issues as they apply to me and chronicle my arduous process of discovery and disillusionment. I have disclosed no HIPAA information – but would be willing to do so if I can be assured that this is allowed, is prudent and of value.
It will become abundantly clear from perusal of my memoranda, the news and other sources that write about the VHA, that there is little if any motivation or incentive to improve their operations and align them with their purported mission.
The Honorable Secretary is isolated from bad news and surrounded with millions of dollars of window-dressing so that he can “leave behind a legacy”. The careerists, (such as Ms. Wolf, Drs Jain and Melhem and Mr. Michael Moreland, Mr. Schoenhard), who may be corrupt and/or inept continue to work to shore up their jobs. Ultimately, the individuals who suffer are the veteran and the taxpayer.
Certain favored individuals are allowed to run roughshod over areas of concern such as patient care, hiring practices, credentialing, and equipment acquisition. There is no accountability or adult supervision of these individuals or their favored subordinates. While the VA has several handbooks which outline how the agency should be run, little attention is paid to these. As you will see after reading my memorandum, the inner circle makes the VA’s rules.
The VA has apparently developed a well-honed and scripted method of dealing with whistleblowers – humiliation, isolation, character and professional assassination etc. Their goal is clearly one, which is designed to stabilize their jobs, to demoralize and destroy the whistleblower and to silence anyone who would like to see the VA keep its covenant with the veteran. They are supported by yet other agencies, which are infirm, inert or apathetic.
This is to request you to help me expedite any oversight or investigation of the corrupt practices of the VA, specifically of this VA and this VISN that you may have initiated. Given the public interest in healthcare reform, it would be important to use a reformed VA to be the template for healthcare reform rather than the example of a government agency gone to perdition. Please help direct the necessary energies to changing the future for our veterans who are among the nation’s most disenfranchised and those who would minister to them – individuals such as you and I .
Sincerely

Anna K. Chacko MD
COL (ret) USA2359 Railroad St #3101, Pittsburgh, PA 15222

Here is a message from another concerned physician. While it may be hard to decipher who is right between two quarreling parties one thing we can agree on is that inapt organization is wasting tax payer dollars. If all of us who are witnessing fraud and abuse the powers have no option but to fix the system. ~Vijay Mehta

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Systemic Issues at Pittsburgh VA
Post by Vijay Mehta on Today at 11:45am

PART I - SYSTEMIC ISSUES WITH THE VA
A. Equipment – Acquisition, Composition and Maintenance
1. Fraud and negligence in acquisition and procurement of high dollar value equipment.
At the VAPHS and VISN 4, during my tenure as Program Leader in Radiology, the composition of the High Dollar and High tech Committee was chaired by an Internist (Dr. Glenn Snyder COS at Clarksburg VA), who had neither knowledge of the need for nor the elements that defined the purchases in Radiology in the VISN. This accounts for the unnecessary purchases of a third linear accelerator, the fifth Gamma Camera or the low field strength Orthopedic Scanner.
2. Oversight by the VACO.
This was not evident in any judgment exercised in the equipment purchased.
For instance, a) when the 1.0 T Orthopedic Unit was acquired and upgrade to the 1.5 T unit was available and could have been purchased. Currently with the 1.0T scanner, few if any scans are performed. Patients who have been scanned in the 1.0T unit are then rescanned in the higher strength units. This translates to a wasted sum of ≈ $600,000 for the purchase of the unit and an expenditure of 10% of the purchase price for maintenance.
b) A second example is the acquisition of a fifth SPECT scanner when the need is for a SPECT-CT unit was clearly obvious. This has resulted in a number of cases being “fee-based” to UPMC or elsewhere for SPECT-CT scanning.
3. No input from Subject Matter experts –
Neither Dr. Melhem who was the Service Line VP nor the Committee accepted any input from radiologists who worked with the equipment and had the requisite training. Instead input was solicited from non-radiologists such as the Administrator of the Radiology Department and the Business Manager of the Service Line who are trained Dieticians and the Service Line VP who is a pathologist. For e.g. a) The Storage device purchased for the Nuclear medicine and PET scans are a system, which does not provide the features, which are fundamentally needed for retrieval for comparison purposes.
b) The Nuclear medicine physician had provided input regarding the purchase of a SPECT-CT unit. His input was ignored. I provided input and was fobbed off.
4. Inadequate optimization for purchased equipment.
The necessary firm/hard and software for equipment is not addressed in a consistent fashion.
The most notable omission in the acquisition of new equipment was the additional purchase of Uninterruptible Power Supply (UPS) for the scanners. With the frequency of thunderstorms and power outages in the city, equipment is frequently affected. Without adequate maintenance contracts, the institution has to spend substantial sums of money to have the repair contractors arrive to restart the equipment causing not just expenditure of unnecessary sums of money but also waste of time.
MRI Scanners were purchased to address the issues of cardiac disease, breast cancer, degenerative joint problems etc. Omitting the purchase of the necessary software and coils for imaging the body parts in question is a serious error.
5. Acceptance testing
The acceptance testing on the equipment purchased at the VAPHS in Radiology is sporadically applied. In the case of the PET-CT scanner, I am told that no acceptance testing was done. The same is allegedly true of the CT scanners. The vendor was asked for their input in the acceptability of the equipment and their word was taken in lieu of acceptance testing.
6. Faulty equipment
When there have been persistent quality problems with equipment, there is no advocate for the physician who will make the company provided the necessary repairs/upgrades in order to make the equipment functional.
For e.g. a) the Fat Suppression sequences on the Siemens 1.5 T scanners have been unacceptable. I was not allowed to demand that the company make the necessary changes in order to render the image interpretation safe.
b) The calibration of the CT scanners and the reporting of the Housnsefield units on the CT scanners were consistently faulty. This precludes the accurate tissue characterization of various pathologies and organs. I was prevented from insisting on that the vendor affect necessary repairs and changes.

B. Personnel Issues – Hiring, Workload, Board Certification, Credentialing, Peer review, Disparate incomes etc.

1. Hiring of Radiologists and Nuclear Medicine Physicians.
This has been extremely arbitrary and based on nothing other than the whim of the Assistant chief of Staff.
For e.g.: a) Dr. P, a Nuclear Medicine physician was purportedly based on the fact that he walked in through the door and asked for the job
b) When I was hired, there should have been interviews with members of the Executive Leadership Board or the Medical executive Board.
c) Inadequate documentation and follow-through on checking on credentials. When I insisted on checking on the training and the certification of the training of one the doctors in the department, I was told to “lay off”. She had completed only 1.5 years of training in an ACGME certified fellowship. The required additional training of 0.5 years was not completed at an ACGME certified program. She also claimed that she had completed one year of PET-CT fellowship, which was inaccurate.

2. Enticement with inaccurate representation of the position and remuneration.
No mention has been made to some of the physicians that there would be a probationary period of TWO years.
Although a relocation bonus was promised, it was not given. The plea has been that this was not allowed – one should question as to why this was even raised and promised.
One of the physicians was told that she would be making more than the chairman of Radiology at the University – which was a gross misrepresentation of fact.

3. “Sweetheart” deals made for some of the physicians:
The Assistant chief of Staff who has been given free reign in making promises to hires allowed them to set their pick of what they would do. For instance, when a Nuclear Medicine Physician is hired, it is expected that they would do all aspects of the specialty particularly when there was a need in the department.
The Assistant Chief of Staff has also claimed that she makes it a point to hire women even if they were not the best candidates so that she could help with removing the glass ceiling for women.
IV. Unfair implementation of standards of payment
One of the female physicians (of Asian extraction) has habitually and deliberately never completed her work within the specified time of 24 hours. Despite this Dr. Melhem made no issue of her lack of performance. By contrast, a male Caucasian physician was docked a significant amount of pay for minor tardiness.

Physicians with less experience and in some instances, an inferior work ethic have been compensated at a higher rate merely because the ACOS decided it was so.

When the job title has changed to a higher one, the institution does not make any restitution to pay the employee at the higher rate – merely because the employee is a whistleblower.
V. Workload and compensation
A female physician (VAG) with very little experience is compensated at a higher rate than those with more experience and qualifications.
In order to reward her for aiding in harassing physicians who were not in favor with Dr. Melhem and Dr. Jain, she has been rewarded with a promotion to the Section Chief.
VI. Tours of duty memoranda and comp time
Some of the favored physicians are allowed to arrive at work and leave at their convenience – frequently working a mere fraction of the time that they were supposed to work.
Some of the physicians are allowed to arrive late to work while the VAPHS pays for the ancillary staff who have to wait around not doing any work due to the tardiness of the physician in question.
Comp time is allowed for physicians who do minimal work on call despite the fact that allowing for comp time is apparently not allowed according to HR regulations.
VII. Credentialing and Privileging
Certain of the physicians had been allowed privileges in practicing in areas which they clearly had neither expertise nor experience, while this was denied to a male Caucasian physician who had the necessary boards and certification – merely needed supervised or mentored work.
VIII. Peer Review
Certain physicians have been allowed to practice without regard to the number of complications that have accompanied their practice.
These physicians have been allowed to make specious accusations regarding the competency of others who may not have been in favor with Drs. Melhem and Jain.

Continued

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Systemic Issues at Pittsburgh VA Page 2
Post by Vijay Mehta on Today at 11:45am

C. Patient Care Issues: Abandonment, Practising on patients without privileges/credentials, Excessive and indiscriminate radiation

1. Work not completed on time
There have been some radiologists/Nuclear Physicians who have not completed their work in time and not had to face any consequences. As a matter of fact, they have actually been rewarded (for testifying and complaining against physicians in disfavor) despite their problematic work ethic.

2. Abandonment of patients
One of the female physicians left her post while on call telling the clinicians that she would not be available for the rest of the day – leaving the hospital without coverage. When I attempted to hold her accountable, I was severely chastised for getting the physician to be accountable.
Referring clinicians have complained bitterly about her non-availability, refusal to perform studies that were necessary, unacceptable and unprofessional interactions. These were transmitted to the COS and ACOS to no avail.

3. Administration of excessive and unnecessary radiation to patients
When there was a temporary shortage of radioactive Technetium 99m, two of the subject matter experts advised that the material be acquired from other sources. These orders were countermanded by individuals (Dr. Melhem, Ms Weihrauch and Ken DiSibio) who were neither subject matter experts nor authorized users. This resulted in subjecting eight veterans to 2.5+ times the body radiation dose. Additionally the images obtained were suboptimal and did not provide the information needed.

4. Allowing technologists to prescribe the procedure in Nuclear Medicine and CT scanning
For the administration of radioactive material or prescribing procedures, which deliver a significant radiation dose to the patient, it is imperative that the physician (radiologist/Nuclear Medicine) be involved in the prescription. Assigning this task to a technologist is a dangerous process.

5. Presence of a physician at the time of injection of radioactive material
The appointed Nuclear medicine physician was rarely ever present at the time of the injection of the patients in PET Scanning. This task was generally unmanned. There was no accountability exercised or enforced by the leadership.

6. Unhygienic and unsafe facilities
Despite the fact that there was a leakage from pipes in the ceiling, the only changes made to repair this was in the physician reading area. There was a continuing leakage in the patient scanning area – with contaminated water leaking over the biopsy table and equipment. Any changes I asked for ignored and the Engineering Department was instructed not to follow through.
I asked for certification of the area as being safe. The COS and the ACOS deliberately misrepresented the issue and claimed that the Engineering facility had “deemed it clean”. I discovered that this was a deliberate falsehood and the the COS and ACOS had full knowledge of the lack of certification on the issue.

7. NRC Violations
The hot lab door in the PET Scanning area was unsecured for several months – despite the fact that I made several appeals to the ACOS to instruct that this be repaired – my please were ignored and I was severely penalized for raising an issue of patient concern and possible violation of NRC regulations.

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Dr. Chacko's Issues with Pittsburgh VA
Post by Vijay Mehta on Today at 11:47am

PART II - MY ISSUES WITH THE VAPHS;
Anna Chacko Vs. Dr. Rajiv Jain, Dr. Mona Melhem, Ms. Terry Gerigk Wolf of The Veterans Administration Pittsburgh Healthcare System (VAPHS) and Mr. Michael Moreland of VISN – 4.

These fall into two categories:
A. Retaliation and reprisal for blowing the whistle on fraud and abuse
B. Retaliation and reprisal for having exercised my EEO rights.
I am listing the pertinent issues with the VAPHS and its leadership. I had brought these to their attention with disastrous consequences to my career and me.
A. Retaliation For Blowing The Whistle: Fraud, Waste And Abuse And misuse of authority
I exposed the following issues and was reprised and retaliated against:
1. Fraudulent use of Government Resources - Doctors not adhering to their tour of duty memoranda. Doctors abandoning patients to attend to their personal affairs (Gupta, Kanderi). This has cost the VA large sums of money. When VA doctors are not available – patients get sent to University of Pittsburgh Medical Center at prohibitively high costs to the taxpayer.
2. Improper use of Radiopharmaceuticals: - Unauthorized users overturning the prescriptions of authorized users. Violation of Nuclear Regulatory Commission guidelines. Violation of ALARA (As Low as Reasonably Achievable) principles
3. Flawed healthcare provided to veterans – Multiple complications by practitioners. I was not allowed to put measures in place, which would have made healthcare safe for the patients. Multiple complications by one practitioner (Dr. Vidhi Gupta) who has a protected status per orders of Dr. Jain.
4. Inadequate documentation and implementation of patient safety issues – I was prevented from documenting or remedying safety issues – re practitioners in the department. I was ordered not to set up a Magnetic Resonance safety Committee by Dr. Jain.
5. Disparate compensation – There is unchecked discrimination against Caucasians in the department. Favoritism is rampant and is perpetrated by the leadership. One of the neuroradiologists is compensated far less than the other Neuroradiologist despite having the additional qualification of being a neurointerventionalist.
One of the Nuclear Medicine doctors is allowed to appear for work at any time it suits her. She is also allowed to pick and choose what she will do despite the fact that she has been recruited into a specific subspecialty – Nuclear Medicine.
6. Intimidation and Harassment – Use of ABIs, SRBs for intimidation and harassment for blowing the whistle and for exercising EEO rights. This appears to be modus operandi for the VA pursuant to media articles. It is well known that the ABIs, SRBs and other investigative tools fall into one of three groups: witch hunts, whitewashes, and fair and balanced. My personal experience indicates that the two ABIs and the SRB were virtual witch-hunts. I believe that the Boards had been given verbal marching orders to find a basis for terminating my employment. Consequently, they exceeded their scope.
7. Retaliation and Reprisal for approaching the congress and the senate for further scrutiny. I went though the chain of command and got no response and was therefore left with no recourse.
8. RICO – Using slander and libel to threaten and intimidate whistleblowers - in my case to besmirch my professional reputation. A blogger (Michael Volpe – a stranger to me) has been solicited to publish derogatory information, half-truths, and innuendoes and outright lies, which were fed to him. Every one of his allegations can be proved to be wrong. He has identified some one in the leadership of the VA being his source of information. He disclosed this fact to a third party and to that individual he indicated that his source was Dr. Melhem.
9. Perjury –Director Terry Gerigk Wolf has informed me that she canceled the first Administrative Board of Investigation because it was improperly conducted. It has become clear to me that it was done expressly for the purposes of
a. Concealing the erroneous and possibly perjured statements made by Dr. Jain, Dr. Melhem, Dr. Gupta, Dr. Bandi, Dr. Kanderi, and Ms. Weihrauch.
b. Concealing the fact that the ABI exceeded the scope of their charge letter.
c. Concealing the fact that Dr. Melhem had engaged in fraud which had been condoned by the leadership - Dr. Jain (the chief of Staff) and Ms. Terry Wolf, (the Director of the VISN).
10. Disparate implementation of peer review standards –Dr. Jain has deliberately applied different professional standards for different physicians, anonymized complainants’ identities in order to protect doctors who made spurious complaints to harass colleagues who happen to be veterans. I had provided him with information regarding the multiple errors made by Dr. Gupta and the complaints made about her by referring clinicians. He acknowledged receipt of these yet did nothing about it.
11. Flawed hiring process: The VA provides VISA-waivers and work permits for doctors. These individuals are required to obtain their board certification. There are individuals in this department who have yet to be board certified (Dr. Mourad). I understand that the VA has to re-advertise the position in the trade journals every two years. While the VAPHS may have done this – there is no indication that they actively considered any Americans for the positions. We accuse private companies of out-sourcing – the VA is guilty of handing over jobs to non-Americans while better-qualified Americans are looking for jobs. This has been a deliberate action instituted by Drs. Melhem and Jain.
12. Rewarding fraud: - Dr. Vidhi Gupta has been protected by Dr. Jain et al despite complaints from multiple sections of the hospital that she was a subpar physician, and often abandoned her post to the detriment of veteran care. Her record of adverse outcomes has been unmatched in the department – yet she is retained despite my protests as the department Chief.
Dr Kanderi – There is ample evidence that she has NEVER been to work on time or been available in the hospital to supervise when patients were being injected with radioactive material. There is also ample evidence that while working at the VA she performs only a small fraction of the work she performs while at her other job at the University of Pittsburgh Medical Center – Hillman Cancer Center
Furthermore, when the VAPHS decided to make the position a full-time one – no economic analysis was performed. The position was not advertised which, according to HR personnel, was against regulations. It was done as a ploy to compensate Dr. Kanderi for testifying against me. . She has now been given a full time position at the VAPHS. I understand that she continues to be tardy as usual. I also understand that there has been no commensurate increase in the number of patients seen after the increase in her status.
Continued

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Dr. Chacko's Issues with Pittsburgh VA Page 2
Post by Vijay Mehta on Today at 11:48am

B. Non-Merit Based Discrimination
1. Hiring
When the VAPHS hired me – the process was flawed from the start. I, however, not having been a GS employee, had no idea of the flawed nature of the recruitment or the magnitude of the flaws.
I was never informed in writing that this was a two-year probationary period. I learned of this probationary issue in May 09 - 8 months after the hiring when Dr. Jain handed me a copy of my SF-50. I had never heard of an SF-50 until then.
I was told that I would be making more in compensation than the Chairman of Radiology at UPMC. I have this in writing on email from Dr. Melhem. I discovered later that he makes over $750.000. While I did not expect to make in excess of the VA imposed cap on salaries, I believe that it is discriminatory and fraudulent that I was deliberately lied to,.
I was promised that I would be the radiology expert for the VISN because the current chair of the Radiology committee is an internist and has "no knowledge " of radiology issues - which accounts for the profligate spending of money at VAPHS.
2. Abusive and disrespectful language and behavior:
Employees/subordinates have used abusive language against me – both directly as well as in staff meetings. When I approached Dr. Jain and asked for assistance on multiple occasions, I was denied any relief.
3. Refusal to grant supervisory privileges and access to computers. When I was detailed to Butler VAMC, Dr. Jain left instructions that I was to read 5 studies per day. However, he refused to allow me to have privileges to access the computer. This was done in a deliberate attempt so that he could accuse me later of not following orders.
Once I had returned to VAPHS in August, It took several weeks before I was granted access to supervisory menus on VISTA. This was done deliberately and not granted despite several requests. This was yet another attempt to entrap me.
4. Professional and academic oppression:
After being appointed professor at University of Pittsburgh, in March 09, I was invited to lecture to the BioMed engineering students at UPitt. Dr. Melhem who has used this venue for giving lectures several times in her own career, refused to give me permission to lecture. She put several roadblocks in the way including demanding that I get an official letter on letterhead from the University. This was an acute embarrassment to me.
Dr. Gupta who is one of the staff radiologists received permission to take off for two weeks in August 09 to “study” MRI at University of Pittsburgh Medical Center. Although I was the Chief of Radiology and was back at the VA at the time, I was not notified of her absence. She purportedly went for a course. When I inquired, I found that this was not a formal course, no continuing education credits were attached to it.
By contrast, I had secured permission to attend the Radiological Society of North America annual course in November 09. Dr. Jain had given me permission and I registered for the course and paid for the hotel reservations ahead of time. At the last minute, he withdrew his permission and Ms. Wolf refused to let me go. I had to take leave and pay for the entire course personally.
By placing me on administrative leave for more than 8 months, the VAPHS has significantly affected my professional future. I have not practiced any radiology except from the computer and from textbooks.

5. Inadequate preparation for supervisory role.
• I was given every assurance that I would be given the tools to do the job.
• The COTR training was promised in July 09 but not provided.
• When I joined the VA Pittsburgh as the chief of Radiology, I was given no preparatory courses. No training in the VA’s supervisory modules was provided. In December 08, I met with Dr. Jain and asked if he would let me go for one of the courses where the material was presented in the form of lectures. He was silent about this and waited until the time for registration was over – so that I could not go.
• When the chiefs of Radiology across the VA were gathering for their annual meeting in May 09, I was not allowed to go. A very junior radiologist was sent in stead. After much protesting, I succeeded in getting permission to attend the meeting.
• There is a two-week leadership seminar provided in Shepherdstown for new supervisors. After booking me for the two weeks, the VAPHS withdrew the booking for the first week claiming that they would rebook me for a later date. This should have been done almost immediately. They failed to do this. It is my contention that they planned to kill my career from the very outset even though they had canceled the first ABI and re-instated me.
• I brought this to the notice of VACO – to no avail.
6. No Authority to perform my job: I was NEVER given any actual authority to perform my job as the Chief of Radiology, or support from higher management.
• To evaluate any of the personnel employed in the department,
• To implement any tour of duty memoranda for the physicians in the department
• To supervise the timekeeper who was falsely documenting the time that physicians came to work
• To insist that the equipment vendors correct problematic issues with the department.
• To correct or optimize the millions of dollars of equipment that had been purchased by the VAPHS. Any suggestions that I made were canceled or disregarded by Dr. Melhem and the Radiology Hi-Tech equipment at the VISN level.
7. Inadequate office and administrative support:
• I have spoken with other Service Chiefs - specifically Dr. Wilson. He told me that he was hired to improve the department of Surgery. He was given every tool that he needed to build a world-class department. I was given no such support.
• While he and other Service chiefs were provided Business Managers, I was given a poorly trained and poorly performing Administrative officer. I had a GS-5 administrative assistant who had to be shared with the rest of the radiology staff where all other service chiefs were provided at least more than one administrative assistant.
8. Action taken before conclusions of the ABI:
• Even before the ABI was concluded, Dr. Jain announced in the Executive leadership counsel that he was looking for my replacement. This occurred in early October 09 and was reported to me in writing by one of the attendees. It has been abundantly clear that this has always been a witch-hunt. The ABIs were given direction that they were to find a basis to terminate me.
• The administration at the direction of Ms.Wolf downloaded my hard-drive to look for incriminating evidence while all the while coming to the table for an ADR.
• There was a thorough and exhaustive search was made of my phone records wherein every phone number was traced to the party I called.
9. Summary judgment before investigations (SRB) was concluded.
The VAPHS posted the job for Imaging Service Line Chief even before the SRB published their recommendations as can be seen by the job number. This again demonstrates that the VAPHS never intended to give me a chance to succeed at my job despite the ADR.
10. No VP designation after appointing me as Service Line Chief
The Clinical Service Line Chiefs are designated as Vice-Presidents. This was not provided to me.
11. No provision of supervisory access to Administrative Computer systems
After I returned to work at VAPHS, I was not given access to the supervisory menus on the Computers despite repeated requests to Dr. Jain. Nothing had improved; as a matter of fact it had gotten worse.
12. No pay increase even after changing my job title.
When I was returned to my position in June of 09 as Imaging Line Service Chief, I was not given the commensurate increase in pay of ≈ $50,000 per annum. However, when this position was advertised, the notice in USAJOBS posted the pay for a Service Line Chief as being $50,000 higher than a Program Leader,
13. No evaluation, No pay increase based on performance
I had to define the elements of my own position since Dr. Melhem had no idea of what these might be. Despite the fact that I had identified severe issues of fraud and abuse, and provided methods for correction etc, no performance pay increase was given to me. This appears to be a tactic that has been used by the VAPHS administration in the past.
Dr. Melhem wrote to the Radiology community in Feb/Mar 09 and asked if anyone had a narrative of the job for a Chief of Radiology. Of course, she excluded me from the universal email to the Radiology Chiefs. Paradoxically she gave me a glowing appraisal on March 6th, 09. Not surprisingly, when I asked for a copy of the document, nobody seemed to be able to find it. Finally in March 2010, when the VAPHS sent me my personnel and personal papers out of the Department secretary’s office, it was there with Dr. Melhem’s signature.
In summary
i. I was not given the tools to affect change,
ii. I was actively subverted in affecting the change
and then
iii. I was accused of attempting to make any changes with the limited resources I had.

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Dr. Chacko's Timeline Part 1
Post by Vijay Mehta on Today at 11:50am

Part III. SYNOPSIS OF EVENTS/TIMELINES:
A synopsis of the events that transpired at the VAPHS follows:
1. In and around October/November 07, Dr. Melhem, the Assistant Chief of Staff at the VAPHS actively recruited me for the position of Chief of Radiology at the VAPHS. She claimed that there was a leadership vacuum at the hospital in the department of Radiology. This had resulted (according to her) in major decisions being left to be made by her (a Pathologist) and the Administrative Officer (a Nutritionist). She said that she wanted me to come in and take a look at the inefficiencies in the department, the fraudulent use of duty hours by radiologists and waste of government resources. She said that she wanted me to provide her with “snapshot” and come up with a plan for correcting these issues.
2. In and around May 08: After much discussion and debate, I signed the contract to join the VA as their chief of Radiology. I also spoke with General Peake who was then secretary of the VA. General Peake had been the Army Surgeon General when I was serving – during my last tour of duty. I believed that there was a mission to be accomplished in “cleaning up the department and realizing its fullest potential”.
3. In July 08: I was approached by one of the radiologists (Dr. Robin Prasad) who cautioned me that Dr. Melhem, the Director – Michael Moreland, and Dr. Jain (Chief of Staff) ran a highly dysfunctional hospital. He said that there had been a Congressional investigation of Mr. Moreland Dr. Melhem and Dr. Jain in their harassment of two VA doctors (Victor Yu and Janet Stout) and findings of perjury, harassment and intimidation by the committee.
4. In August 08: I raised questions about this with Dr. Melhem only to be told that it was all false and that she was not at liberty to discuss them. Subsequently I found out that Dr. Melhem had not told me the truth and I had no means of verifying the veracity of her statements.
5. At about the same time: The entire staff of the radiology department took me to dinner and articulated all their problems with Dr. Melhem and Dr. Jain. They said that they had approached Dr. Jain several times regarding these issues only to be verbally threatened and harassed by Dr. Melhem. They also said that prior to my arriving at the VA, four separate chiefs of radiology had stepped down or relieved by dr. Melhem.
6. In September 08 to January 09: I started working for the VAPHS in September 08 as the Program leader for the Radiology program with Dr. Melhem as my supervisor. I was directed to look into all the critical issues in radiology. In my survey, I found several issues including the following;
a. Fraudulent use of leave and
b. Unauthorized use of comp time by the doctors,
c. A very poorly structured peer review program,
d. Arbitrary hiring practices,
e. Inequitable and secret compensation schemes where certain favorites were paid more than others,
f. Possible illegal hiring practices on individuals requiring visa waivers,
g. Purchase of millions of dollars worth of equipment which had not been optimized for use Despite the advice of subject matter experts unnecessary equipment purchase was planned and executed – SPECT Scanner without CT, Low field strength MRI unit which is barely ever utilized, High field Strength MR. unit without adequate safety planning, more linear accelerators than were necessary.
h. Equipment which was inadequately resourced causing problems with patient care (e.g. no UPS on major equipment, no calibration on CT scanners)
7. In the third week of January of 09, I asked Dr. Melhem for a recommendation letter since I had applied for an academic position at the University. She gave me a glowing recommendation.
8. In the first week of February 09: I found that Dr. Melhem was ordering x-rays on an individual ineligible for care at the VA. I spoke to Dr. Jain about this and he told me to “kill it – sweep it under the rug”. At no time did he tell me that this was legal and had been authorized by the VAMC, although he later claimed, as did Ms. Wolf that this was legal. I called former secretary of the VA Dr. Peake and asked him for advice – he suggested I put it in writing and hand it to Dr. Jain.
9. In mid-February 09: Dr. Jain told me that an Administrative Board of Investigation would be convened. What he neglected to tell me was that the ABI was to be convened against me. I went unprepared for the meeting.
The Board refused to accept any additional information and evidence I attempted to provide them,
10. In mid February 09: I also found that Dr. Melhem had violated Nuclear Regulatory Commission guidelines by countermanding our prescription for radioactive materials and replacing them with “2nd string” radiopharma--ceuticals which produced poor images and increased by 3 to 8 times the radiation burden to veteran patients. She had put in place radiopharmaceutical contracts with vendors with no input from the authorized users of radioactive materials. When I complained in writing about this to the VAIG no action was taken to insure that such an event would not occur again.
11. In mid- late February 09: I found that one of the doctors (Dr. Vidhi Gupta) was consistently providing poor care to our patients – with larger number of complications than her peers. I brought this to Dr. Jain’s notice – he told me he would take care of this and that I was not to interfere or investigate this.
12. In early February 09, I apprised Dr. Jain of the fact perusal of the workload and attendance data, some of the doctors notably Dr. Kanderi never fulfilled her time obligations. He told me not to interfere with this since this was Dr. Melhem’s area of concern.
13. In early May 09:
a. Dr. Jain received the recommendation of the ABI and called me for an interview to inform me that I would be terminated based on the recommendation of a Summary Review Board. I was then escorted off the premises with a police escort and told not to return except for medical care at which time I would have to notify them in advance so that they could have me under police surveillance.
b. At this time Dr. Jain gave me a copy of my SF-50 detailing the probationary nature of my employment. This was the first time I had heard of this. He informed me that I was JUST a probationary employee and could be summarily fired. I had never seen this document prior to this. Apparently this should have been in my recruitment package.
c. I also found out that some of the other doctors (for- e.g. Dr. Shah) who had been hired at the same time did not receive their SF-50. Dr.Gupta received her SFG-50 - she had been hired a few days before I was.
14. In mid May 09: Ms Wolf sent for me and said that she was canceling the board and its findings because she was convinced that it was done illegally and that I had been treated unfairly. She also told me that at no time was I to blame and that she knew that Dr. Melhem was to blame and that she would discuss this with me at a later date because it was a long story.
15. In late May 09 and June 09: I was detailed to Butler VAMC until things “had settled down”. During this time she would get an executive coach from the National Center for Organizational Development to assess the situation and help in team building. The coach and her team turned up. They managed to alienate my entire team of technologists who refused to meet with them. I secured Ms. Wolf’s permission to dispense with using the NCOD team to interface with my department while retaining their offices to help me with my issues if any. I understand from outside sources, that Ms. Wolf retained the NCOD to “dig up dirt” on me.
16. In July 09: I was sent for some of the many courses I should have taken as a new supervisor in September 08 but were denied to me by Dr. Melhem.
The radiologists at the VAPHS allegedly met with Mr. Michael Moreland and secured an understanding from him that I would be removed from my position within 90 days. Dr. Prasad reported this to me when I returned to work at the VAPHS

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Dr. Chacko's Timeline Part 2
Post by Vijay Mehta on Today at 11:50am

17. In August 09: I started back at VAPHS now as the Service chief. Dr Melhem was removed as the supervisor of Radiology. I was asked to look into administrative issues in Radiology and to surface them with Dr. Jain. I brought the many issues I found in radiology to Dr. Jain, who said that he would help me attend to these. Dr. Jain set up frequent meetings with me 8/3, 8/10. 8/21. 8/24. 8/28 and 9/3. At no time did Dr. Jain discuss that there was a problem with my management style. He never informed me that there were any complaints. He specifically gave me directions to start setting up the procedures for mammography
18. In September 09:
a. I had filed an EEO complaint against Dr. Jain in May. This came for ADR on September 1st 09. It was agreed upon verbally that Dr. Jain would support me in implementing solutions to problematic issues in the hospital. He would let me know if things were going wrong and suggest course-corrections.
b. On September 2nd, a blogger (Michael Volpe) called me at my office and told me that he would be writing up slanderous and very injurious articles about me on the Internet. Since I did not know Mr. Volpe personally, I asked him what his sources of information would be. He claimed and subsequently has stated on his blog that his sources of information would be the VA.
c. On September 3rd, Dr. Jain and Ms Wolf called me in to tell me that there had been several complaints about me and they would be issuing a letter informing me of forthcoming disciplinary action. She then said that she had not investigated this. She told me that her source was complaints from the blogger. She assured me not to worry and that this letter was not a serious one – it was designed to get my attention. When I asked her why I had not been told that there was an issue, she said that she was telling me now.
d. In mid September: Dr. Jain asked me to perform a focused peer review on several cases read by one of my staff – Dr. Shah. These had been turned in by an anonymous source. I discovered on logging into the system that Dr. Gupta lodged these complaints. She had made several critical errors in reading and in patient care. This was used as a red herring to cloud the issue of her problematic and subpar performance. I had brought this to Dr. Jain’s attention at the time of her evaluation and was directed to give her a good evaluation. I refused and said that at best I would give “damn her with faint praise”.
e. On the 29th of September 09, Ms. Wolf came to my office to tell me that she was on my team to give me a hug and that I should not worry about anything. She said things were proceeding very smoothly
19. On October 2nd: Dr. Jain called me in off leave to tell me that I was the subject of yet another Administrative Board of Investigation. This was convened in the 2nd week of October. It was clear from the Board chairman Mr. Goldman (VA chiropractor) was that they had spent an inordinate amount of time downloading my hard drive indicating that they had started this process prior to any rapprochement they had initiated. This clearly indicates that they had never any intention of supporting me in my initiatives to “clean up” the department – they were waiting for an opportune moment to lower the boom again!!
20. In December 09:
a. I was notified that the ABI had recommended that I be separated from the VA. When they provided me with the depositions that they had considered, it was clear that they had NOT heeded the recommendations of several of the key personnel including the Chief Technologist Hallie Montgomery.
b. I was then summoned before a Summary Review Board (SRB) , which has recently concluded that I be removed. This was to have occurred on January 25th, 2010.
c. The SRB conceded that the issues I had raised were legitimate but they I had not corrected them. There is no mention made of the fact that I was directed not to take any corrective actions. During the period that I was placed on Administrative leave May – August 09 Dr. Jain had ample opportunity to take corrective actions himself which he did not do.
d. Furthermore, the attempts I took to implement corrective solutions were deemed as harassment and I have been punished severely for this.
21. In January ’10:
a. The Detroit Office of Special Counsel transferred my files to the Detroit Office. Mr. Eric Calhoun from the Detroit Office is now handling the matter. They were successful in getting a stay for 60 days from the VA. He tells me that he is requesting records, phone logs and emails from the VA to look at this investigation.
b. I had sent an email to COL Jonathan Jaffin of the Army Medical Department asking if there was a position I could take in Afghanistan for the Army particularly since I knew the culture and was fluent in Urdu, the language spoken in Pakistan. He responded saying that he would send the letter to his executive Office, the chief of Consultants and the Radiology consultant, COL Breitwieser. Dr. Sri Kottapally of VAPHS called to tell me on Friday 29 January 2010 that a copy of my email had appeared on the blogger blogsite with the usual vicious narrative.
c. I called COL Jaffin and found out that he had no idea of who might have sent this to the blogger. He said he would be handing this to the Med COM JAG and to head of Medical Corps with a copy to LTG Schumacher for further investigation. He read the blog and was very distressed at the contents of the blog. But more importantly, he was concerned that an internal AMEDD document was sent to a blogger.
d. I called the FBI, Agent Deborah Mitchell, (412-432-4722) at the Pittsburgh Office and notified her of my concerns regarding the blogger and his use of the Internet to terrorize and intimidate. I also told her that the Chicago Office had indicated that this fell in the realm of RICO and needed to be followed up – but by the field office where I resided rather than where the blogger resided.
22. In March 09
I was informed that I would be separated from the VA on the 25th of January. The Office of Special counsel had taken over the retaliation and reprisal portion of my complaint and is currently investigating it. They secured a stay for 60 days and I was terminated on the 26th of March 2010.

Here is the full dossier of Dr. Anna Chacko.