VA suspends Barbara Temeck over improper prescriptions

VA officials have indefinitely suspended the deputy chief of staff at the Cincinnati VA Medical Center for writing three prescriptions for a private patient, an action that her lawyer said served as a “publicity stunt” to cover up the VA’s relationship with UC Health.

Dr. Barbara Temeck, a Veterans Affairs surgeon and administrator of more than three decades, stands at the center of a years-long struggle over the troubled Cincinnati VA, which cares for 43,000 veterans in the region

Her lawyer, Ken Hawley of Cincinnati, said the suspension began Wednesday and will most likely be followed by a firing. Hawley said he would appeal the job action. The notice said the suspension does not involve Temeck’s professional conduct or competence.

In addition to the suspension, Temeck is facing the prospect of criminal charges as the U.S. attorney for the Southern District of Ohio is reviewing a federal investigative report about her.

Temeck told The Enquirer she believes Dr. David Shulkin, now the VA secretary, is the prime force behind her punishment. Temeck said removing her papers over the VA’s problems with UC Health and the University of Cincinnati College of Medicine, which she tried to correct.

Shulkin is scheduled to be the featured speaker at the May 20 commencement for the University of Cincinnati College of Medicine.

Hawley said his review of VA records shows Temeck is getting discipline not imposed on even extreme cases of VA prescription misuse.

In an April 5 statement to regional VA director Robert McDivitt, Temeck said the proposed suspension is aimed less at dealing with the prescriptions and more at “the goal of getting rid of me so that the fraud, waste and mismanagement at the Cincinnati VA can continue.”

“I know, Mr. McDivitt, that you have been instructed by Dr. Shulkin to do what you are doing,” Temeck’s statement said. “I implore you, though, to do what is best for the veterans and stop covering up the serious issues that I have exposed.”

Hawley said he believes a decision about the suspension will likely come before the end of April.

Threads to larger problem

Officials at the VA and the U.S. Attorney’s Office declined requests to comment on the Temeck case. Cincinnati VA Medical Center Director Vivian Hutson, a U.S. Army veteran who came aboard in October, had no comment. McDivitt’s spokesman, Carl Higginbotham, said, “The matter is still ongoing, and he didn’t want to comment further on it.”

Jennifer Thornton, a spokeswoman for the U.S. attorney, said the office “is aware of this matter. We can neither confirm nor deny the existence of any grand jury investigation.”

Requests for comment from Shulkin, the VA secretary, have not been answered.

Temeck’s circumstances speak to a larger problem in the VA: For more than 70 years, the nation's medical schools have been sending its graduates to residencies at VAs from coast to coast. But that shared relationship has over time turned sour in places primarily because the VA does not conduct much accountability with medical schools and the nonprofits that run teaching hospitals, government reports indicate.

Last year, a Government Accountability Office report found the VA exercised little oversight when contracting with teaching hospitals and the affiliated medical practices. A 2015 VA inspector general's study found that contracting between the VA and University of Pittsburgh Physicians was so lax that doctors billed the VA for every hour in a single month.

In June, a hearing of a House Veterans Affairs subcommittee heard that affiliates sometimes dictate contract terms, take possession of VA property and steer money away from VA research nonprofits – all with little or no oversight.

Temeck, a Georgetown University-trained cardiothoracic surgeon who has spent her 35-year career at the VA, arrived in Cincinnati in July 2013 as the hospital’s deputy chief of staff and acting chief of staff. She told The Enquirer she immediately noticed irregularities: Full-time VA doctors were working at UC Health while on federal time. The hospital was incorrectly staffed so that caregivers made as much as $50,000 a year just in overtime. She reassigned nurses and other providers but got pushback from employees whose pay would have been cut.

Temeck also found the VA often was needlessly sending veterans to UC Medical Center for care that the VA could provide. The VA pays UC Health about $40 million a year for that care.

Temeck's management so upset doctors and nurses that they called at least two meetings with Jack Hetrick, the regional VA director at the time, to complain. Officials of the UC College of Medicine twice stopped the VA from promoting Temeck to the chief of staff job permanently.

A newly released investigation did not back up many of Temeck's key allegations. Dr. Eugene Goldman, of the Coatesville VA Medical Center in eastern Pennsylvania, led the inquiry from October until last month. Temeck was required to speak to the inquiry under oath, while interviews with UC officials "under an agreement" with the inquiry "were conducted unsworn, and the format was conversational."

The heavily blacked-out report, released this week to The Enquirer under the U.S. Freedom of Information Act, blamed Temeck herself for the problems that she uncovered: "If Dr. Temeck had any actual evidence of wrongdoing on the part of . . . any staff under her organizational division, she was empowered as the (word removed) chief of staff to take corrective actions, including disciplinary actions."

Complaints to headquarters

In September 2015, more than 30 doctors, nurses and other staffers – including third-generation Cincinnati orthopedic surgeon Richard Freiberg – complained about Temeck to Robert McDonald of Indian Hill, former chairman of Procter & Gamble and then the VA secretary. When that complaint did not remove Temeck, the letter writers went public, which led to stories in February 2016 by WCPO.com accusing Temeck of creating a culture of intimidation.

The stories also revealed that Temeck had written prescriptions for painkillers for Kathleen Hetrick, a former VA nurse who is the wife of Jack Hetrick, the former VA regional director.

The VA is not immune to problems with prescription misuse. In one instance, VA nurse practitioners in Jackson, Mississippi, were prescribing medications to patients without adequate licensing or oversight. At least one doctor said superiors pressured doctors to write prescriptions for patients they hadn't seen.

In a statement this month defending herself, Temeck told the VA that she and the Hetricks had been friends for years and VA co-workers. She had overseen Kathleen Hetrick’s medical care since 2002 when Hetrick was injured on the job in a VA hospital, but Temeck had never prescribed drugs. But when Hetrick was between doctors, Temeck wrote three prescriptions in December 2012, November 2013 and May 2013, under her federal drug license issued through the VA, which is to be used only for VA patients.

Temeck wrote two prescriptions for 30-day supplies of diazepam (brand name Valium) and one for hydrocodone (brand name Vicodin).

Hawley, Temeck's lawyer, said that when the prescriptions became public, agents from the Drug Enforcement Administration questioned Temeck. She acknowledged writing the prescriptions and surrendered her DEA license.

"We thought the matter had ended there," Hawley said, since the VA has not punished other doctors for prescription problems with the kind of career-ending consequences facing Temeck. "They want to silence Dr. Temeck to maintain the relationship with UC,” he said. “They are retaliating against her in a way they have never treated another VA doctor.”

In the suspension proposal given to Temeck earlier this month, the VA accused Temeck of writing the prescriptions to curry favor with the regional director. But Temeck said she had no reason to do so since at the time the prescriptions were written, she was at another VA hospital and not under Jack Hetrick’s supervision.

Temeck said that in the fall of 2013, shortly after she arrived in Cincinnati, she connected Kathleen Hetrick with a VA pain doctor, and that was the last time she was involved in Kathleen Hetrick's care. Temeck said she did not know how the information about the three prescriptions became public. The Hetricks didn't authorize the release.

Potential HIPAA violation?

Hawley said the public release of Kathleen Hetrick's medical records to WCPO.com violates the federal medical privacy law known as HIPAA since the Hetricks never authorized the release.

In February 2016, the VA’s office of inspector general determined Temeck “inappropriately” prescribed medication under her DEA license. Though she kept her title as deputy chief of staff, Temeck was reassigned to a data-entry job in the basement of the Cincinnati VA, where she has been ever since.

Hawley said he has learned from Cincinnati VA insiders that during a visit to the facility last fall, David Shulkin, then the VA undersecretary in charge of VA hospitals, explicitly directed hospital leaders to remove Temeck. A few weeks later, hospital managers tried to persuade an oversight board of hospital doctors to remove Temeck’s clinical privileges to pave the way for her removal. The board did not do so.

Shulkin was the VA's undersecretary of health under President Baral Obama, and President Donald Trump nominated Shulkin to the top job this year. Shulkin, the first non-veteran to head the department, was a hospital executive before joining the VA in 2015, and he has made management accountability one of his goals at the VA.

The office of inspector general finished its report on Temeck in August and turned it over to the U.S. attorney for the Southern District of Ohio, said OIG spokesman Michael Nacincik in Washington. The federal prosecutor could ask a grand jury to indict Temeck on felony charges of writing a prescription outside the scope of her DEA license.