NORWICH, Vt. — Dr. Jennifer Keller’s last performance review at the White River Junction Veterans Affairs Medical Center described a star anesthesiologist.
She received an overall rating of “outstanding,” earning highest marks for her clinical competence, supervisory ability, and personal qualities. The review was signed in November 2017 by Dr. Fima Lenkovsky, chief of the hospital’s anesthesiology department.
But if that strong appraisal represented a pinnacle of Keller’s eight years at the VA, the last 13 months have represented a professional nadir, one involving a tangle of conflicting allegations of assault, medical negligence, and whistle-blower retaliation that has reverberated to the upper levels of the federal agency.
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“This has shaken me to my soul,” said Keller, 51, a clinical assistant professor at Dartmouth College’s medical school who was fired from the VA hospital in October. “I am naive, and this has been an ugly process.”
Hospital officials said Keller, interviewed by the Globe at her lawyer’s office, was fired for endangering patient safety. But Keller and other female employees say her termination was reprisal for speaking out against Lenkovsky for allegedly bullying and harassing female employees, including a reported assault against a nurse during an operation in June 2018.
Keller’s dismissal outraged Dr. Stewart Levenson, a former VA official who served as medical services director for the New England system during 18 years at the agency.
“This is perhaps the most shocking case of misuse of the disciplinary process that I can recall from my VA experience, one that fails on any level to pass the ‘sniff’ test,” he wrote to VA attorneys. “The removal of Dr. Keller is not only extreme but unprecedented.”
Keller is one of four female employees at White River Junction who filed whistle-blower complaints against Lenkovsky with the VA’s Office of Special Counsel. The office has since referred the complaints to the VA medical inspector after determining they contained a “substantial likelihood of wrongdoing.”
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In a whistle-blower complaint filed two days before her dismissal, Keller said that the hospital’s actions against her were punishment “for criticizing her supervisor, whose serious abuse and mismanagement was reported by no less than five different female employees of the VA.”
Two weeks after the alleged assault in the operating room, Keller and three nurses — including the nurse who brought the allegation — met with the hospital’s acting director, Dr. Brett Rusch. At that meeting, Keller told Rusch she did not believe Lenkovsky treated male doctors, nurses, and staff in the “abusive and hostile way he treated the female staff,” according to her whistle-blower complaint.
Later that month, Keller told VA police she was “not surprised” when she heard of the assault allegation, which she described in a witness statement as “consistent with Dr. Lenkovsky’s behavior in the past.”
Christine Murphy, the hospital’s chief nurse anesthetist and the person who leveled the allegation, told Rusch that Lenkovsky intentionally struck her arm during a difficult operation, a blow she said was hard enough to bruise her forearm.
“I had a bruise the size of a quarter on my right arm after the event, which my colleagues observed,” she wrote in a subsequent statement to VA police. At least eight witnesses were present, Murphy has said.
Following the meeting with Rusch, Lenkovsky was suspended pending a five-week internal investigation and returned to work with full clinical privileges Aug. 20. He retired in December and could not be reached by the Globe for comment.
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The alleged assault occurred amid mounting frustration in the operating room after Lenkovsky and a surgeon made repeated, unsuccessful attempts to insert a breathing tube into a patient’s trachea, Murphy told VA police.
In a recent statement to the Globe, VA officials dismissed the allegation as “blatantly dishonest” and “disrespectful to actual assault victims, which Murphy is clearly not.”
They said that the contact was accidental and that Lenkovsky reflexively pushed away an oxygen bag that Murphy had allowed to obstruct his vision. VA officials described Murphy’s action as a “direct violation of protocol” by her at a pivotal and potentially life-threatening moment.
“In doing so, Lenkovsky inadvertently made contact with Ms. Murphy’s hand rather than the bag,” they said.
Phillipa Lilienthal, an attorney who represents Murphy and Keller, said that the veteran nurse vehemently denies she breached protocol and that the hospital’s assertion to the Globe — nearly a full year after the incident — was the first time Murphy had heard that the VA faulted her actions during the surgery.
Murphy did not face any discipline for her alleged mistake and even was rewarded recently with a $400 performance bonus, Lilienthal said.
In addition, the attorney said, the VA’s “claim that she was not an assault victim is appalling and further victimizes her.”
Murphy told the Globe that she was initially afraid to report the assault “because I didn’t know what he [Lenkovsky] would do to me professionally,” but that Keller’s support helped her bring the complaint forward.
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At the meeting with Rusch, Murphy said in her whistle-blower complaint, he asked “if there were any patterns to Lenkovsky’s behavior. The group was afraid to respond, so Keller responded.”
Keller told him that Lenkovsky had bullied and yelled at her, nurses, and anesthesia technicians, she said. In her whistle-blower complaint, Keller also said that Lenkovsky once showed her an image of former US senator Al Franken that had been photoshopped to make him appear to be groping a topless, pre-adolescent girl.
At the meeting, Keller said, Rusch assured the group that they would be protected from retaliation.
But on the day Lenkovsky returned to the hospital last August, Rusch suspended Keller’s clinical privileges, citing unspecified concerns that she potentially posed an “imminent threat to patient welfare.”
“I thought, this can’t be happening,” Keller recalled. “I got the letter, and I was trying to figure out what was wrong.”
Keller said she was not told at that time why she was considered a threat. Despite repeated requests, Keller said, she did not learn the specifics until Sept. 20, when the hospital’s acting chief of staff, Dr. Daniel O’Rourke, proposed she be fired, her attorney said.
By that time, two review committees already had met and recommended that Keller be dismissed, Lilienthal said. Keller had no knowledge of those meetings, her lawyer said.
Keller was fired after an internal review concluded she had walked out of a working operating room for brief periods during two surgical procedures on July 30, leaving an unlicensed, fourth-year medical student alone to provide anesthesiology care.
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Keller has denied she was absent during the second procedure, but acknowledged that she stepped away during the first operation as a training exercise for the medical student.
“Dr. Keller’s intentional absences in the operating room have unnecessarily placed patients at risk, as well as placed students in a position to care for patients for which they do not have appropriate training, qualifications, or licenses,” O’Rourke wrote in his proposal that she be fired.
In a statement to the Globe, hospital officials said “the consensus opinion was this was a life-or-death situation that demanded an immediate correction.”
By leaving the operating room, the officials said, Keller had committed “an egregious breach of protocol during a surgery that could have led to the death of a patient.”
Hospital officials said their investigation also found that Keller had previously “left other anesthetized patients unattended” — a claim that Keller disputed — and that her dismissal was unrelated to Murphy’s assault allegation.
“The bottom line is that at VA, patient safety comes first in all that we do,” a hospital spokeswoman said. “It’s unfortunate that Murphy and Keller are either unaware of or don’t care about this crucial fact.”
The standards of the American Society of Anesthesiologists state that anesthetists “shall be present in the room throughout the conduct of all general anesthetics, regional anesthetics, and monitored anesthetic care.”
Keller described her absences during the first procedure — four times, for no more than a minute each time, a few yards from the patient — as a training exercise to observe the anesthesiology student from a distance. Once was from the entrance to a supply closet; the others were from behind doors in the surgical suite, she said.
Lilienthal said no problems were reported in the immediate aftermath of the two operations. Keller continued to be assigned to serious procedures, including an aortic bypass graft that is the most complex case the hospital handles, the attorney said.
“If you look at what happened and when, a lot of things don’t add up,” Lilienthal said, adding that Keller had compiled a spotless professional record during 17 years of clinical practice. Keller also is being represented by Andrea Amodeo-Vickery, an attorney who has represented whistle-blowers from the VA hospital in Manchester, N.H.
Levenson, the former VA medical services director for New England, said Keller was fired because she dared to confront more powerful men. On April 28, Rusch was appointed executive director of the hospital, which serves veterans in Vermont and four counties in New Hampshire.
“The saddest part of this whole process is that in an era when women can finally be taken seriously with regard to harassment complaints, the VA is still in the dark ages,” he said. “Instead of ‘#MeToo,’ the VA is ‘Old School.’ ”
Keller continues to teach at the Geisel School of Medicine at Dartmouth College, but her future as a physician could be in jeopardy. Lilienthal said the VA has reported her dismissal to the National Practitioner Data Bank, a database run by the US Department of Health and Human Services that collects negative information about physicians.
Keller, however, said she is determined to resume her career.
“I look forward to working as an anesthesiologist again,” said Keller, a single mother with two teenage children. “I will have a strong practice again.”
Brian MacQuarrie can be reached at brian.macquarrie@globe.com.