by James A. Bacon

An anonymous group of Charlottesville residents has organized to bring attention to issues troubling the $3.3 billion UVA Health division of the University of Virginia.

Calling itself Parrhesia — Greek for speaking candidly and freely — the group of “concerned citizens of Charlottesville and patients of UVA Health” portrays the healthcare division as an oppressive workplace where doctors and nurses are disciplined for violating UVA Health “values,” are afraid to speak openly, and are subject to punishment if they do.

The Parrhesia website makes no outright allegations of wrongdoing. Rather than speaking “openly and freely,” however, it has adopted the rhetorical device of making a statement or publishing an email and then asking, “is it true?” The issues raised are potentially serious. They include:

• The unexplained departure of Doug Lischke, CFO of UVA Health;
• Weaponization of ASPIRE, the health system’s Diversity, Equity & Inclusion program, through the filing of anonymous complaints against doctors and nurses;
• A culture of fear and retaliation;
• Pressuring doctors to make false/misleading statements in patient medical records.

Parrhesia did not respond to questions that Bacon’s Rebellion submitted in a form through its website. UVA Health has not responded to questions submitted by email.

The Parrhesia authors (or Parrhesiastes, as they refer to themselves) claim to speak for “many” medical professionals, some of whom have sought legal counsel. Their back-handed framing of incendiary issues appears to be motivated by legal concerns. “We have been advised by counsel that merely asking these questions” could result in “threatening cease and desist letters” or retaliation, they say on the website. Presenting information and asking questions is less likely to expose individuals to libel litigation than making allegations outright.

However, the Parrhesia authors are willing to place the implied abuses in the context of UVA Health’s fiscal practices. The doctors whom the authors speak to “expressed concern about the swelling of the UVA Health Leadership C-suite ranks and the corresponding increase of spending on leadership’s salaries while nursing and essential hospital support staff remains understaffed and underfunded.”

Doctors are said to have expressed consternation at an increasing reliance on outside consultants, the spending of millions of dollars on controversial plans, and the investment of millions more on hospital acquisitions that divert resources from patients in Charlottesville.

The UVA Medical Center, the teaching hospital in Charlottesville, is the nucleus of UVA Health. The health system has expanded through acquisitions of community hospitals, outpatient centers and physician practices as the hospital industry continues to consolidate in the hope of gaining scale and negotiating better rates with health insurers. Most significant was the acquisition of Novant Health in Northern Virginia, a venture in which UVA had held a minority ownership position.

Another growth imperative, according to UVA Health officials, is the need to expand the population served to bolster the clinical trials conducted by UVA doctors and scientists. To generate statistically valid results, clinical trials need to enroll a sufficient number of patients. If the medical condition being studied is uncommon, researchers need to draw from a large population. The Charlottesville-area market served by the Medical Center is small compared to that of UVA’s peers. Through acquisitions and partnerships, UVA Health is seeking to expand its footprint.

The CFO’s Mysterious Departure. The most concrete questions raised by the blog arise from the departure of UVA Health’s chief financial officer, Doug Lischke, in February 2024. Parrhesia approached the topic in a backhanded way, replicating a series of emails and asking if they were true.

“Is it true that on February 27, 2024, the CEO of UVA Health sent the following email?” the website asked, followed by the text of a dear-colleague letter from CEO Craig Kent. The email announced that Lischke had “decided to step down from his role as Chief Financial Officer (CFO) of UVA Health” but would stay on as “Special Advisor to the CEO for Financial Strategy.”

Parrhesia then asked if it is true that eight days later, Kent sent another email announcing “the bittersweet news that Doug has accepted the Chief Financial Officer role at the Medical University of South Carolina.” The move, Kent added, “represents an extraordinary career opportunity for Doug.”

Finally, the group asked “if it is true” that an April 9, 2024, communication from the Medical University of South Carolina office of communications and marketing announced the appointment of its new CFO — but it was “Susie Edwards, CPA,” not Lischke.

“Can you help us understand if any of this is true and if so… What is going on at UVA Health?”

Lischke’s change in status followed revelations of “material weaknesses” in the health system’s books identified by state auditors and reported to the UVA Board of Visitors in December. The problems arose from a change in the way government accounting standards treated the numbers for the Novant acquisition. The Board met in closed session to discuss personnel matters relating to the auditor’s findings but did not report its actions, if any, to the public. Personnel decisions are exempt from Virginia’s public-meeting requirements.

(Lischke’s LinkedIn page still lists him as chief financial officer of UVA Health, and the University’s organization chart still lists him as CFO and direct report to Craig. However, neither UVA Health nor the Medical University of South Carolina (MUSC) “leadership” pages list him or anyone else for the position. The slot at both institutions appears to be vacant at the moment. UVA Health has not returned a request for clarification.

Bacon’s Rebellion could not find a copy online of the announcement cited by Parrhesia regarding “Susie” Edwards. A Susan Edwards lists her job title on LinkedIn as controller of MUSC. MUSC media relations has not yet returned a phone call.)

Update: Sheri Harmon with MUSC returned Bacon’s Rebellion’s call. She said Lischke is not CFO of the medical university and that she had never heard of him.

Weaponization of ASPIRE. ASPIRE stands for “Accountability, Stewardship, Professionalism, Integrity, Respect, and Equity,” which, according to the Health System website, reflect the organization’s core values. UVA Health defines equity this way: “fostering an environment of belonging that promotes justice, equity, diversity, inclusion, and unity throughout the organization and within the communities we serve.”

States the Parrhesia website:

We’ve been told despite our doctors having successfully navigated years of education, residency and fellowships at prestigious medical institutions followed by years and even decades of outstanding service as doctors and faculty to UVA’s patients and students, their careers have been blemished, derailed and potentially irreparably harmed by ASPIRE values policies.

Parrhesia does not specify the alleged offenses, which may or may not have stemmed from equity-related complaints. Organizers say they have been advised by counsel that merely asking questions could result in UVA Health senior leaders issuing “threatening cease and desist letters in an attempt to silence these questions” or other forms of retaliation.

The website goes on to ask:

Is it true that respected and accomplished doctors were summoned individually by UVA Health senior leaders for meetings with no stated agenda in which the doctors were outnumbered? And then informed they had allegedly committed ASPIRE values violations?

“Is it true,” Parrhesia continues, “that several doctors received letters signed by the UVA School of Medicine Dean or other UVA Health senior leaders” stating that they violated the ASPIRE Values policy, that they must adhere to those values, and that the letter ‘would be part of their Human Resources file?’”

Furthermore, the authors ask, “Is it true that these ASPIRE values violation letters have been cited as justification to block Promotion and Tenure for doctors who otherwise have strong if not exemplary academic and professional standing?”

Fear of retaliation. Parrhesia says that the UVA health professionals who have shared their stories are withholding their identities for fear of retaliation. “We have witnessed and heard additional accounts of doctors and nurses being reduced to tears because of their stress and mental anguish caused by current UVA Health senior leaders.”

“Many” doctors and nurses have followed the required reporting protocols only to be admonished and in some instances punished for doing so. Several have sought legal counsel and been informed that they have valid cases, Parrhesia alleges. But if they go public with evidence of their mistreatment, UVA Health management could “attempt to damage their reputations and career prospects inside and outside of UVA Health.”

Parrhesia goes on to ask what changed at UVA Health “in the last four years” to create this climate? (This is a possible allusion to the Board of Visitors’ adoption of the recommendations of the Racial Equity Task Force report in 2000 that accelerated efforts to achieve racial equity.) And further, is it true that in January 2024, the UVA School of Medicine Faculty Senate delivered a Resolution to the UVA Provost that included the following?

WHEREAS, it is the understanding of the SOM [School of Medicine] Faculty Senate that UVA Health senior leaders have followed up with some Department Chairs and other leaders so that they may caution faculty who have already expressed their views to stand down and discourage faculty from raising concerns at open forums on a variety of topics of late …. This, along with confidential reports from current and former faculty regarding specific responses and behavior from SOM leadership has created a Culture of Fear and Retribution amongst many faculty members….

(Note: The School of Medicine has representatives on the university-wide Faculty Senate but does not have its own faculty senate.)

According to Parrhesia, health system executives give no credence to anonymous gripes coming from disgruntled employees.

Then, citing UVA’s Compliance Hotline and Just Report It systems to facilitate anonymous complaints, Parrhesia asks, “Do the same UVA Health senior leaders believe anonymous concerns delivered via the following links on the University of Virginia website also mean nothing?”