Two whistleblowers say they suffered retaliation after they called out the VA San Diego Healthcare System over what they say was dangerous medical research conducted on veterans.

The whistleblowers – Mario Chojkier and Martina Buck – claim that between 2014 and 2016, Samuel Ho performed medically unnecessary liver biopsies on veterans with alcoholic liver disease. They said the biopsies were dangerous to the veterans who were at risk of excessive bleeding due to their liver problems.

At the time, Ho was the division chief at VA San Diego Healthcare System, which serves nearly 250,000 veterans. He has since left the facility and now works in Dubai at the Mohammed Bin Rashid University for Medicine and Health Sciences.

Chojkier and Buck are married. Chojkier is the director of the liver and transplant clinics at the VA and a professor of medicine at the University of California San Diego. Buck is a research scientist specializing in liver disease.

Both said they have suffered harassment after becoming whistleblowers – Buck has since been terminated at both the VA and UCSD.

A regular standard of care?

Ho’s research was part of a $6 million federal project to study liver inflammation caused by liver damage. In 2013, Ho approached the San Diego’s VA’s research safety panel with a program to receive $150,000 as part of the grant. The panel, chaired by Buck at that time, rejected Ho’s initial request because the study called for using X-rays on pregnant women – a practice that is a known risk for fetuses.

Ho amended his proposal to study 10 liver tissue samples already in existence. The problem was that those samples didn’t exist, so Chojkier and Buck allege Ho oversaw 28 transjugular liver biopsies on veterans with alcoholic liver disease. This procedure involves inserting a catheter in the neck and, using X-rays, guiding it to the liver and extracting a piece.

While the technique is considered safe, it is not considered essential to patients with alcoholic liver disease, Chojkier and Buck said. They said Ho justified the procedure as a regular standard of care even though it had never been done at the San Diego VA for patients with this problem.

Ho ended up with 28 biopsies and co-authored three papers, they say.

A torturous investigative path

After reporting their concerns to the VA in San Diego, there was no record of an internal investigation nor were Chojkier and Buck’s concerns sent to the VA’s ethics or research committees.

This prompted Chojkier and Buck to file complaints with the VA in Washington. In 2016, the independent Office of the Special Counsel sent the allegations to the VA Office of the Medical Inspector for investigation. The VA concluded there was no danger to public health at the San Diego facility. The VA defended Ho’s standard of care claim using an opinion from a doctor who trained under Ho and co-authored several of the papers that resulted from the research.

The Office of the Special Counsel responded by finding inconsistencies in the VA’s findings and said the VA didn’t address the foundation of Chojkier and Buck’s allegations. The office also questioned the conflict of interest presented by using an opinion by Ho’s protégé. Chojkier and Buck also provided proof that Ho overruled colleagues who didn’t recommend the procedure at least seven times.

San Diego VA Director Robert Smith said the bulk of the allegations were not substantiated, but where problems were identified they were addressed.

This is the eighth time in two years the Office of the Special Counsel has found that the VA’s internal investigation has been unreasonable.