IN DEFENSE OF UVA HEALTH'S DOCTORS

We respond to Board member responding to faculty call for CEO, medical school dean to stop down.

Like so many people, we were not surprised or shocked that a board member planted a letter online 9/9/24 in support of Craig Kent and Melina Kibbe in response to the UVA Health No Confidence Letter sent to the University of Virginia Board of Visitors on 9/5/24.

And we wish we were surprised by the deafening silence from the UVA Health Physicians Group (UPG) Board of Directors but it appears to confirm what multiple UPG-employed faculty have told us — that the perception among doctors is the UPG Board appears more concerned about serving UVA Health’s senior leaders.

In the spirit of continuing the dialogue started by the board member who vigorously defended UVA Health’s leaders while attacking and discrediting our doctors — who are also our friends and neighbors in Charlottesville — we’ve reposted his letter here intercut with our questions and clarifications in bold.

In defense of UVA Health’s leaders
Board member responds to faculty call for CEO, medical dean to step down
Published September 9, 2024
By William Crutchfield, Jr.

Like so many people, I was surprised and shocked to read the U.Va. faculty letter of no confidence in Dr. Craig Kent and Dr. Melina Kibbe. This is especially disturbing since I have served on various UVA Health boards over the past 30 years.

- Surprised and shocked because this is the first time there have been issues at UVA in the past 30 years?

- Especially disturbing because if true, board members have been lied to and misled by leadership?

It is my opinion that our health system is better today than it has been at any time over that period.

- It’s our understanding that UVA Medical Center’s ranking in Virginia has gone down in U.S. News & World Report. Or is better today defined mostly by increased revenue and profit?

And it is evolving into one of the truly top health systems in the nation. Drs. Kent and Kibbe must be given an enormous amount of credit for this accomplishment.

- An enormous amount of credit should go to two administrators? Wow. How much of the remaining credit can be divided up among the faculty, doctors, nurses, staff, and employees on the front lines who do the daily work and interact with patients? 

In full disclosure, I am not writing this letter as a member of the UVA Health System Board. I am writing it as a friend of the University of Virginia who believes that there is another side to this story which needs to be understood.

- The opening line of his letter states, “This is especially disturbing since I have served on various UVA Health boards over the past 30 years.” Friend of the University that just happened to work with the communications team that crafted Craig Kent’s, Melina Kibbe’s, and Jim Ryan’s messages to assure compliance with the message template and verbatim usage of the same key concepts: “Anonymous”, “128 vs. 18,000” etc? But friend of the University it shall be!

- We are friends of the University as well. And we look forward to that other side of the story coming into full view of the public after the UVA Board of Visitors hopefully carries out its responsibilities and conducts an unbiased, thorough and transparent investigation. 

- We are curious to see how counsel weighs in on a friend of the University of Virginia who is not writing this letter as a Member of the UVA Health System Board taking such a rapid public stand like this against the doctors.

- Based on the language below on the UVA Health System Board website, we thought a Public Member’s fiduciary responsibilities included oversight for the Medical Center and School of Medicine:

The Health System Board is charged with oversight of the operations of the Medical Center and the Transitional Care Hospital for Joint Commission on Accreditation of Hospital Organization purposes, as delegated by the Board of Visitors. The Health System Board shall further provide governance and strategic oversight for the various subsidiaries and affiliates of the Medical Center, including UVA Community Health, Inc., and for the School of Medicine and the School of Nursing.

- But the writer has served on various UVA Health boards over the past 30 years so he must know better than we do. From the cheap seats, however, are we reading it correctly that this language implies if not a legal obligation perhaps a moral one to at least attempt to appear impartial in the face of serious allegations against UVA Health?

There are two aspects of this letter which need to be addressed. First, it comes from 128 people.

- “People?” They are Doctors. People Doctors who have graduated from medical school, finished residencies and fellowships and spent years — in many cases decades — serving UVA and our community. They are world class physicians and surgeons who take care of our loved ones and save lives. They are not just “128 people.”

Our health system has 18,000 employees. Therefore, the writers represent less than 1/10 of 1% of our employees.

- Huh, where else have we seen references to the total number of UVA Health system employees in recent days? The nuances of how coordinated PR campaigns use words and statistics are fun to track.

- First, the writer calls the doctors “people”. Then the writer references a large number to imply that the 128 people doctors can be ignored.

- Second, for clarification, the 128 doctors are clinical faculty who mostly work in and around the UVA Medical Center.

- Third, we wonder if the writer considered how many RVUs the 128 signers generate annually before rendering them irrelevant.

And, based on an outpouring of emails to President Ryan, the UVA Health System Board and the Board of Visitors, the allegations of these anonymous writers do not reflect the opinions of a broad cross section of our faculty and staff. Instead, they express widespread support for Drs. Kent and Kibbe.

- 30 years serving on various boards and a sampling of incoming emails is sufficient to determine the opinions of a broad cross section of our faculty and staff? We missed that master class on data analysis.

- We look forward to seeing that outpouring of letters. 

- In the meantime, please note: referring to the writers as “anonymous” is simply not true. But perhaps the writer can’t be blamed for being a good friend of the University of Virginia and following the communications template.

- For the record, the cover letter sent to the Rector and Board of Visitors of the University of Virginia on 9/5/24 clearly stated that the signatories WERE NOT ANONYMOUS:

As indicated in the letter, the signatures are being protected from public disclosure.

To protect the faculty we will arrange for the exclusive, limited audience named below to view and verify the signatures should this be requested by the Board of Visitors:

• Ms. Rachel W. Sheridan and Ms. Porter N. Wilkinson in their capacity as Chair and Vice Chair of the Audit, Compliance, and Risk Committee.

• Dr. Stephen P. Long and Dr. David O. Okonkwo because they have both worked at academic medical centers and can understand the rank and specialties of those signing.  

UVA faculty expect the Board of Visitors to take measures to ensure there is no attempt by UVA Health leaders to retaliate against those who signed (or are suspected to have signed) this letter.

- And then the Signature Page on the 9/5/24 LETTER OF NO CONFIDENCE IN CRAIG KENT AND MELINA KIBBE:

Sincerely,
(Signatures signed, verified, and maintained under seal.)

- So once more, for the avoidance of doubt, while the signatures might not be known by the writer, they are not anonymous and are available to be viewed by select trusted members of the Board of Visitors.

- Based on the tone of this writer’s letter, the 128 doctors fears of retaliation were and are legitimate.

Second, facts made by these anonymous writers are simply not true.

- Did the writer really accuse 128 people doctors of lying?

- Did we miss the investigation that reached this conclusion?

- The writer might want to think very carefully about comments that might be construed as libelous. He might consider pointing this out to the communications team that provided the talking points. Perhaps they thought 128 anonymous people doctors can’t be libeled? 

- We wonder if this line of attack will raise concerns among some of the 18,000 employees the writer has oversight of as a Public Member of the Health System Board? Will some see his stance as a cautionary tale against ever bringing forth patient safety issues and concerns about possible malfeasance lest they too be publicly harangued without any attempt at due process?

• They speak of safety issues. UVA Health has recently received A ratings in safety audits for its four hospitals. Our Vizient mortality ratios are at an all-time low suggesting we are saving 2-3 out of 10 patients that were otherwise not expected to live.

- It’s our understanding that one of the allegations that should be investigated involves attempts to alter documentation in order to manipulate safety metrics.

• As to an exodus of faculty talent, this allegation can be disputed by Drs. Kent and Kibbe’s successful recruitment of outstanding faculty from some of the nation’s top academic medical centers. If our work environment were so toxic, these people would not have joined our faculty. Furthermore, the data does not support this claim. UVA Health has a 5.1% turnover rate as compared with the national average of 8.3%. Also, I should add that Forbes magazine recently rated UVA Health as one of the nation’s top employers.

- TL;DR - The writer asserts Craig Kent and Melina Kibbe are why faculty members want to work at UVA Health and live in Charlottesville. And because faculty members want to work at UVA Health and don’t want to leave Charlottesville, ergo there must not be a toxic environment. Also, we should add that a Forbes magazine rating does not prove the allegations in the No Confidence Letter are not true.

- We were under the impression that getting to live in Charlottesville and be affiliated with Thomas Jefferson’s UVA were the primary drivers for those who come here.

- For what it’s worth, we’ve had multiple conversations with doctors who have described the toxic work environment created by Craig Kent and Melina Kibbe and have told us they remain here and endure it because they love caring for their patients, teaching trainees, working alongside their colleagues, and living in Charlottesville.

• As to attacking the values of the University of Virginia, I find these allegations to be totally erroneous. Drs. Kent and Kibbe have made building a strong organizational culture a cornerstone of UVA Health’s new 10-year strategic plan. From what I hear from a cross-section of employees in our health system, the culture has improved dramatically over the past few years.

- We marvel at the writer’s all-knowing conviction in calling the serious allegations of 128 people doctors erroneous. How did the writer find these allegations to be totally erroneous in just four days between the 9/5/24 No Confidence Letter and his 9/9/24 opinion piece? We’ll see how well that ages.

- From what we hear, the culture has deteriorated dramatically over the past few years.

- Has the writer not read the SCHOOL OF MEDICINE FACULTY SENATE RESOLUTION ON One Team | United Access and School of Medicine Culture delivered to Provost Ian Baucom in January 2024? Or is that another document that disappeared in the byzantine reporting processes of Madison Hall?

- Has the writer not been told about the emails, meetings and/or conversations faculty and/or their attorneys have had with Jim Ryan, Ian Baucom, Cliff Iler, and/or John Kosky regarding issues with Craig Kent and Melina Kibbe stretching back over the past few years?

• The assertion that there is excessive spending on C-suite executives is naive.

- Did the writer really just call 128 people doctors naive? How so? Naive because our doctors couldn’t possibly understand how business works? Or naive because the doctors don’t understand why C-suite bloat, cronyism and nepotism should be considered a positive feature of academic medicine?

It is true that new senior-level staff have been hired. However, most of it has been to prepare UVA Health for an even stronger future. Dr. Kent hired an outstanding chief strategy officer to lead our first-ever enterprise-wide strategic plan. Prior to this, we were possibly the only major academic medical center that did not have such a critically important internal function.

- If a chief strategy officer was such a critically important internal function, why didn’t any of the boards the writer served on at UVA for the past 30 years see that one was hired before now?

Instead, we relied on expensive outside consultants.

- Why didn’t any of the boards the writer served on at UVA for the past 30 years curtail the reliance on expensive outside consultants sooner?

- From our reading of it, continued reliance on expensive outside consultants in addition to the excessive spending on C-suite executives is one of the issues raised in the No Confidence Letter.

We added staff to create our first ever UVA Health Leadership Institute. This is another investment in our future. It will provide us with a tremendous pipeline of outstanding future leaders. And as an occasional lecturer in the program, I can attest that it has been a tremendous morale boost for our participants.

- Wonderful! We’re not exactly sure what this means with regards to the urgent matters of patient safety and public concern in the No Confidence Letter but it was a good opportunity to plug the writer’s stature as a lecturer. We think the next generation calls that a humblebrag? Sign us up for when the writer gives a lecture about what inspired him to write his letter attacking our doctors and what he later learned about rushing to judgement in a public forum before knowing all the facts!

- And you know what else would be wonderful? If someone would provide a morale boost to the doctors, nurses and hospital staff who have been subjected to a hostile work environment at the hands of UVA Health leadership. (Side note: The UVA Health-branded ASPIRE Day Valentine’s candy might not be the answer.)

Other allegations in this letter are vehemently denied by the large number of UVA Health System employees who are emailing us in support of Drs. Kent and Kibbe.

- Great! Problems solved. Patient safety is hereby improved. Integrity is restored. No need for an investigation into the serious allegations. Rescind the No Confidence Letter. However, just a few questions…

- If 128 people doctors represents a small number then what constitutes a large number? Would it be more than 50%? Say, 9,000+ UVA Health employees who have emailed their support?

- And which specific allegations in the No Confidence Letter were vehemently denied by the large number of UVA Health System employees?

- And when the writer writes “emailing us” …. who is “us?”

- We were under the impression that the writer was not writing the letter as a Public Member of the Health System Board but was writing it in the first-person as a friend of the University of Virginia in which case shouldn’t it read — emailing me?

- Did the writer forget to change “us” to “me” when cut-and-pasting from the smear-the-128-people-doctors talking points?

- We look forward to the FOIA requests that produce all the letters from the large number of UVA Health System employees sent to whomever “us” is that vehemently denied the allegations in the No Confidence Letter.

- And did this large number of UVA Health System employees also conduct their own investigations during the last six days?

- If so, we look forward to seeing the evidence from said large number of UVA Health System employees that supports their vehement denials.

- We’re truly amazed by this entire opinion piece. Does the writer actually believe 128 people doctors would risk their careers and reputations by signing a No Confidence Letter to the UVA Board of Visitors that didn’t have any merit?

- Did the writer really read the entire No Confidence Letter and not have any interest — or feel any sort of legal or moral obligation given their standing as a Public Member of the Health System Board — to conduct an open, honest and transparent investigation?

Although not addressed by the anonymous writers, Drs. Kent and Kibbe have been extraordinarily successful in raising financial support. The School of Medicine has attracted a record amount of research funding. This research is an investment in the future of health outcomes. For example, the Paul and Diane Manning Institute of Biotechnology could be a game-changer for not only our community but for the world.

- All together now = Not. Anonymous.

- We were under the impression that it was the world class UVA faculty, doctors, nurses, researchers, and employees that attracted the financial support from donors who loved UVA and Charlottesville?

- Is the writer implying that donors gave their money because of Craig Kent and Melina Kibbe and not because of the entirety of the 18,000 UVA Health employees doing the day-to-day work?

- We were under the impression that donors loved UVA and the Charlottesville community. Is the writer suggesting that if Craig Kent and Melina Kibbe were to work elsewhere, donors to UVA Health would send future donations to their new schools and abandon UVA?

There is another important consideration which is overlooked in this letter. UVA Health is one of only a handful of health systems in the nation which maintained profitability throughout the pandemic. This is a major management accomplishment for which Dr. Kent must be commended.

- That’s rich. We could hear doctors, nurses, and hospital staff gritting their teeth all over Charlottesville when they read that line.

- We presume in his role serving on the UVA Health System Board, the writer would have been aware that UVA Health instituted furloughs and a 20% pay cut at times during the pandemic?

- We’re stunned that the writer would then make the argument that the profit margins that resulted from our doctors and nurses working for reduced pay at the state-owned non-profit UVA Medical Center during the pandemic should now be cited as a major management accomplishment and shoved back in the faces of many of those same doctors because they felt a moral obligation to sign the No Confidence Letter?

- That’s appalling.

- Every single doctor, nurse, and hospital staff who worked through the pandemic should be rewarded and thanked as community heroes for the rest of their lives.

Had we not maintained profitability, our ability to fund construction and acquisitions could have been handicapped. This would have become an impediment to our ability to provide world-class healthcare to our service areas.

- The writer is a brave man to cite how profitability — some of which resulted from doctors being furloughed and taking pay cuts during COVID — funded acquisitions and UVA Health’s expansion into other service areas.

- Note the section in the No Confidence Letter about FAILURE TO BE FORTHCOMING ON SIGNIFICANT FINANCIAL MATTERS:

Concerns include audit performance, the communication regarding the recent transition of the Chief Financial Officer, Community Health acquisitions, Revenue Cycle, and UPG funds flow.

- We’ve been told UVA’s former CFO might be able to share some insights into this.

Finally, I have a serious philosophical concern about these anonymous writers.

- There’s that word again. If the writer keeps repeating it, we’ll keep repeating this — referring to the writers as anonymous is simply not true.

The Hippocratic Oath is an oath of ethics historically taken by physicians.

- That’s audacious to lecture 128 people doctors at the University of Virginia about the Hippocratic Oath. We wouldn’t dare presume to lecture a U.S. Air Force veteran about the oath they took to defend our beloved country.

Often attributed to it is the phrase “First do no harm.” These anonymous writers are doing harm to UVA Health and, in turn, to our patients.

- It’s one thing to lecture. Now the writer’s accusing 128 people doctors of harming their patients they are trying to protect by writing a No Confidence Letter about urgent patient safety concerns? We’re not flexible enough to do those mental gymnastics.

- And again, they are not anonymous. We realize the writer was just following the template and using the same term repeatedly in an attempt to gaslight and brainwash readers while simultaneously dehumanizing the people doctors. But once again, referring to them as anonymous is simply not true.

If a small cabal of people hiding behind anonymity can force outstanding leaders out of U.Va., it will make it extremely difficult to recruit outstanding new physicians, nurses, technicians, and administrators.

- Trying to character assassinate 128 people doctors and faculty at the University of Virginia who made an urgent plea for help by branding them as a secret political faction certainly adds some zest to these proceedings.

- You know where this is going…they are not hiding behind anonymity. They are not secret. Select trusted members of the UVA Board of Visitors have an open invite to view the signatures.

- Did the communications team offer bonus points based on how many times the writer labeled the people doctors as anonymous? Every time we read another reference to the word anonymous, we agree more strongly with the doctors’ decision to protect their names.

- And we’re unclear how this small cabal would force anyone out with just a letter?

- Rector Robert Hardie wrote among other things in his tactful and respectful communication with the doctors on 9/6/24:

“Both the Board of Visitors and University Administration take these allegations seriously, and we are in the process of determining appropriate next steps.”

- Contrary to that message from the Board of Visitors, however, is the writer suggesting Craig Kent and Melina Kibbe are beyond reproach because he has declared them outstanding leaders?

- We have very different definitions of outstanding leaders. 

- Nevertheless, we think we get the message. The writer — as a friend of the University of Virginia — was able to declare four days after the No Confidence Letter was released that the leaders in question are “outstanding” and therefore if they are forced out it will be extremely difficult to find other similarly “outstanding leaders” who would want to live in Charlottesville and work at UVA Health.

- Where does this clarity and conviction come from? Was there a top secret, speedy, and thorough investigation into all of the serious allegations in the last four days? Did the UVA Board of Visitors review the findings and reach their conclusion?

- And in the course of this rapid top secret investigation, were the doctors and nurses who raised serious concerns via official channels over the past months and years interviewed by an unbiased party?

It will make it extremely difficult to attract important strategic alliances.

- We’re not sure what important strategic alliances means but it sounds impressive. And we think we understand this is another way to keep making one of the writer’s primary arguments in this opinion piece — It is better to squash dissent than investigate serious allegations that might turn out to be true. 

- That’s an ominous implied message from a Public Member of the UVA Health System Board.

And it will make it extremely difficult to raise needed philanthropic support.

- Ah! Certainly can’t risk having problems come to light through an investigation that might prove embarrassing. Better to discredit and silence the messengers to avoid the discomfort of having to level honestly with donors. 

If these things happen, the quality of health care in our community will be harmed.

- Based on what we have heard from doctors and nurses for the past year, the quality of health care in our community has already been harmed and that’s why the doctors are calling for help:

- Has the writer walked through the UVA Emergency Department lately?

- Does the writer know how many boarders the UVA Emergency Department is routinely holding on a daily basis?

- Is the writer aware of the incredible stress on UVA’s Emergency Department due to serious staffing issues which threatens UVA’s status as a Level 1 Trauma Center?

- We look forward to the speaker series at the UVA Health Leadership Institute about the burn-out in Emergency Departments caused by unrealistic (and according to some, possibly negligent) transfer policies allegedly driven by chasing revenue targets.

To me, those who inflict harm to the patients of UVA Health may be violating the Hippocratic Oath.

William G. Crutchfield Jr.
Health Services Foundation Board, 1993-1997; U.Va. Board of Visitors, 1997-2005; UVAHealth System Board, 2018-present.

Crutchfield is the founder and CEO of Charlottesville’s Crutchfield Corp. He is a U.Va. graduate and a member of the Consumer Electronics Hall of Fame. 

- The writer might have been been pleased about framing the final paragraph around the Hippocratic Oath but we’re stunned that someone who spent 30 years on boards at UVA would stoop to such a low level of condescension towards our doctors.

- We wonder if the writer realizes how many respected faculty and doctors he managed to offend with his final sentence?

- We suggest the writer re-read the UVA Health No Confidence Letter one day in the future. With the benefit of hindsight, perhaps the writer might realize what we grasped at first reading…

- Trying to prevent further harm to their patients, their colleagues, UVA Health, and our community was why our 128 doctors took the courageous and commendable risk to sign the No Confidence Letter.

- In recognition of admirable service to UVA, Charlottesville and the United States of America, we will afford the respect to the writer that was not extended to our doctors in his opinion letter…

- We will give this writer the benefit of the doubt that he has not seen the evidence that is well known among Craig Kent, Melina Kibbe, Jim Ryan, other senior leaders, the former Chair of the Health System Board, and members of the Board of Visitors…

- We will give the writer the benefit of the doubt that he is acting as an unwitting agent of Craig Kent, Melina Kibbe and Jim Ryan’s propaganda campaign against our doctors…

- We will give the writer the benefit of the doubt that he has been deceived just as our doctors, nurses, hospital staff, fellow patients, Charlottesville citizens, alums, and donors were deceived in some of the messages sent from official UVA emails over the previous five days.

- We will all find out the truth soon enough if the UVA Board of Visitors conducts a thorough and transparent investigation. 

- And who knows…

This entire saga might be taught as a case study one day in an Applied Ethics course at the UVA Darden School of Business.

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What is going on at UVA Health?

We are Concerned Citizens of Charlottesville and Patients of UVA Health who are troubled by what we have heard from many UVA Health professionals over the past year.

These professionals are not only our doctors and nurses but also our friends, family and neighbors. We believe our community should value and protect its health care workers who have dedicated their lives to helping UVA patients.

A Parrhesiastes is someone who speaks the truth in a clear and honest way…

It's about the courage to speak one’s mind even when it's difficult or unpopular…to prioritize truth over social niceties or personal gain...

But speaking the truth can be dangerous. A Parrhesiastes understands this risk and is willing to face the consequences, from social disapproval to vindictive employers or even violence...

Because ultimately Parrhesiastes act out of a sense of duty.

They believe speaking the truth is necessary for the greater good and to protect the people and institution they love.