by James A. Bacon

Three former rectors of the University of Virginia have written a letter defending Craig Kent, the UVA Health system CEO who resigned in February after an investigation into alleged abuses at the UVA Medical Center.

“We have a strong impression that there may be just a very small handful of doctors who, for entirely personal reasons, have for some years fomented discontent at UVA,” UVa’s past three rectors wrote in a March 7 letter, according to The Daily Progress. “And have done so with utter disregard for the damage they might be doing to the reputations of UVA and their fellow physicians.”

Discord between hospital administrators and physicians at UVA long preceded Kent’s arrival in 2020, but got worse when Kent tried to impose far-reaching structural changes needed to survive the COVID epidemic and make the health system more competitive in the long run, said the rectors, who include Frank “Rusty” Conner III, Jim Murray Jr. and Whitt Clement.

The letter represents a serious argument made by serious people. The rectors join others — health system board member and electronics-retailer Bill Crutchfield and neurosurgeon-scientist Neal Kassell — who have argued that Kent was unjustly maligned.

The UVA Health system board (which overlaps significantly with the UVA Board of Visitors) hired an outside law firm, Williams & Connolly, to investigate the allegations against Kent and Medical School Dean Melina Kibbe. The board met in closed session February to discuss the findings and took no action. But Kent submitted his resignation after the meeting. Kibbe did not.

The board declined to release the report: not even a redacted version; not even a summary of conclusions. The public has no idea whether all of charges against Kent and Kibbe, some of them, or any at all, were backed by the facts. (Presumably, the report was damning to some degree, or Kent would not have resigned.) Furthermore, the public has no way to know if the abuses alleged by the dissident doctors have been corrected, or if the board has done its job cleaning up the mess.

Some version of the Williams & Connolly report, whether redacted or otherwise, needs to be released.

The letter from Conner, Murray and Clement did not address the abuses allegedly committed by Kent and Kibbe, which ran the gamut from putting patients’ lives in jeopardy to upcoding billings to maintaining a culture of fear and retaliation. Rather, the letter writers provided context that has been missing from the controversy so far.

First, the three rectors wrote, there was an inherent tension between the physicians and hospital management. The docs get their paychecks from the UVA Physicians Group (UPG).

“Over some three decades, UPG had metastasized into a large enterprise that managed hundreds of millions of dollars in revenue, with millions more held in capital reserves,” they wrote. “Over the years UPG had built a big team of accountants and finance staff whose job it was to maximize physician incomes.”

The UPG system is an “unwieldy, duplicative, and expensive employment structure” costing UVa millions, and Kent wanted to fix it, stated the letter, as summarized by The Daily Progress. Kent’s predecessor, Rick Shannon, had tried to take on the UPG but fell victim to a “small group of vocal and politically well-connected physicians” who petitioned to “have him removed.”

UVa and UPG financial departments were “monthly rehashing the same data,” costing UVa Health millions of dollars on “duplicative accounting and administrative staff” before Kent’s arrival, the rectors wrote. “Patient safety ratings were poor, accident and mortality rates were high, patients were unhappy, and no one was being held accountable.”

The Daily Progress continued its summary:

Kent began implementing reforms across UVa’s health system. He enacted stringent patient care policies and launched an expansion program to combat the extreme job losses hospitals nationwide reported throughout the COVID-19 pandemic. He brought the nation’s foremost surgeons and medical researchers to Charlottesville — “sometimes appointed to roles that long-time UVA physicians thought they deserved.”

The results followed. The health system’s annual revenues nearly doubled to $4.7 billion just five years after Kent’s arrival, and the number of doctors employed increased from around 400 to more than 1,000 in that time — the latter largely due to UVa Health’s acquisition of other hospitals. National publications, including U.S. News & World Report and Becker’s Hospital Review, ranked UVa Health, its flagship medical center and children’s hospital in Charlottesville, and its various departments among the top in the nation.…

“Long term UPG board members lost their prestigious titles,” wrote the rectors. “Many younger physicians with active clinical practices saw their compensation increase, others were less fortunate. For some the old, low-accountability ways were sorely missed.”

Of course, it is possible that two things can both be true: Kent undertook a necessary restructuring of operations and committed (or tolerated) unpardonable abuses. Conner, Murray and Clement make a strong case that the former is the case. As long as the Williams & Connolly report remains secret, we may never know if the latter is as well.