Hessami v. MSPB

979 F.3d 1362
Court of Appeals for the Federal Circuit·Decided November 9, 2020·No. 19-2291·Published·Cited by 146 cases

Opinion

United States Court of Appeals for the Federal Circuit

NEGAR HESSAMI,

Petitioner

v.

MERIT SYSTEMS PROTECTION BOARD, Respondent

2019-2291

Petition for review of the Merit Systems Protection Board in No. PH-1221-17-0271-W-2.

Decided: November 9, 2020

KELLEE BOULAIS KRUSE, The Employment Law Group, Washington, DC, argued for petitioner. Also represented by ROBERT SCOTT OSWALD.

JEFFREY GAUGER, Office of General Counsel, United States Merit Systems Protection Board, Washington, DC, argued for respondent. Also represented by KATHERINE MICHELLE SMITH, TRISTAN LEAVITT.

Before NEWMAN, REYNA, and STOLL, Circuit Judges.

2 HESSAMI v. MSPB

REYNA, Circuit Judge.

The petitioner, Dr. Negar Hessami, a former Chief of Pharmacy for a Department of Veterans Affairs medical center, challenges the Merit Systems Protection Board’s dismissal of her whistleblower appeal for lack of jurisdiction . We hold that for purposes of the Board’s jurisdiction under the Whistleblower Protection Act (“WPA”), when determining whether an appellant has non-frivolously alleged that she disclosed information that she reasonably believed evidenced misconduct under the statute, the Board’s inquiry should be limited to evaluating whether the appellant has alleged sufficient factual matter, accepted as true, to state a claim that is plausible on its face. Because the Board erroneously relied on the testimony of agency witnesses in dismissing Dr. Hessami’s appeal for lack of jurisdiction, we vacate and remand for further proceedings .

BACKGROUND

Between 2012 and 2016, Dr. Hessami served as the Chief of Pharmacy at the VA Medical Center in Martinsburg , West Virginia (“the Center”). During that time, the first curative therapies for Hepatitis C Virus infection (“HCV”) entered the market, and the Center grappled with the challenge of providing patients with access to the enormously expensive but life-saving new therapies. The new medications were funded through a budget assigned by the Regional Veteran Integrated Service Network (“VISN”) specifically for HCV patients at the Center. Hessami Affidavit , J.A. 989–94 (“Aff.”), ¶ 4. Along with the budget, the regional VISN provided treatment guidelines for administration of HCV therapies. Id. at ¶ 16. Dr. Hessami was responsible for overseeing the ordering and dispensing of the HCV medications at the Center. Id. at ¶ 19. As part of her role, she became familiar with HCV treatment guidelines , monitored all purchases of HCV medications, and provided weekly reports of purchases and relevant

HESSAMI v. MSPB 3

treatment information to the VISN. Id. at ¶¶ 7–11. She also served as the pharmacy’s point of contact for the regional VISN, and worked with the Center’s Chief of Staff, Jonathan Fierer, and the Chief of Medicine, Deborah Bennett , to assemble a hepatitis interdisciplinary team (“HIT” or “IDT”) that met weekly to coordinate the treatment of HCV patients at the facility. Id. at ¶¶ 5–6.

The first of the curative HCV medications, simeprevir and sofosbuvir, were approved by the FDA in 2013. These drugs, which were often prescribed together in a regimen referred to as “S&S,” were priced at hundreds of dollars per pill. According to national guidelines and manufacturing prescribing information, the typical length of therapy was 12 weeks, but patients could be treated for longer periods under certain circumstances. Id. at ¶ 11. In the fall of 2014, two new combination therapies for the treatment of HCV were approved under the brand names Viekira and Harvoni. Id. at ¶ 15. The newer drugs were available to the Center at a fraction of the cost of S&S. The regional VISN pharmacy benefits manager recommended that all new patients be started on the new products rather than S&S beginning in January 2015. Id. at ¶¶ 37, 40.

A. Whistleblower Disclosures Between November 2014 and February 2015, Dr. Hessami on multiple occasions raised concerns about the prescribing practices of Dr. Trent Nichols, M.D., one of the physicians at the Center who treated HCV patients. According to Dr. Hessami, Dr. Nichols did not have any experience prescribing HCV drugs to patients before he began working at the Center around September of 2014. Id. at ¶¶ 17–18. Dr. Hessami raised concerns that Dr. Nichols was departing from the recommended treatment protocols by continuing to prescribe S&S when the guidelines recommended using the newer therapies, and by prescribing S&S to patients for longer than the typical 12-week course. Id. at ¶¶ 20–26, 28–30, 33–34, 38, 42–44. According to Dr.

4 HESSAMI v. MSPB

Hessami, in multiple meetings, one-on-one discussions, and emails, she informed senior members of the clinical and financial staff at the VISN and at the Center that Dr. Nichols’s treatment decisions were (1) unnecessarily exposing patients to increased risk of adverse drug reactions and side effects, and (2) overspending the Center’s HCV funds. Id.

For example, Dr. Hessami alleges that during IDT meetings, she directly and publicly confronted Dr. Nichols and “asked that [he] at least justify why he was going beyond the length of treatment guidelines.” Id. at ¶¶ 23, 43. Following one such meeting, she sent an email, dated February 17, 2015, to Dr. Bennett and several others regarding Dr. Nichols’s decision to continue prescribing S&S to new patients. She explained that the VISN was “adamantly asking the facilities to start new patients on Harvoni or Viekira,” and was “not funding [the Center] for the patients newly started on S&S.” She further explained the financial consequences of Dr. Nichols’s decisions:

The cost of S&S drugs combined is ~$52,000.00 vs. for Viekira is ~$8,000.00 and Harvoni is ~$14,000.00 per month/per patient. Since the beginning of February, Dr. Nichols has started 4 patients on the old two drugs (S&S) for total cost of almost $208,000.00 that the medical center has to absorb since VISN is not reimbursing Martinsburg for the old drugs. Last Thursday, in our weekly meetings, I brought this issue to Dr. Nichols[’s] attention again and yet he has started a new patient on S&S on Friday (02- 13-2015). This is $52,000.00 that we are not going to get reimbursed for. I would like to humbly ask you to monitor his ordering practices regarding Hep C medications, which will compromise the reimbursement funds

HESSAMI v. MSPB 5

and providing an excellent patient care that we all strive for.

J.A. 125. Dr. Bennett responded to the group that when Dr. Nichols had previously been asked not to start new patients on S&S, he had appeared to understand. She suggested that one option for addressing the problem was to ask Dr. Nichols to provide a written explanation for the new S&S prescriptions and another was to simply not fill the new prescriptions. She later informed the team that she had decided to block S&S prescriptions going forward and that any discussions regarding “necessity” would need to be discussed with her directly. J.A. 122–23.

In other emails and meetings, Dr. Hessami voiced more general concern that the Center was overspending on HCV medication, including that it had spent $9 million of its $13 million annual budget for HCV medication by January 2015. J.A. 9, 297–98. After one such meeting during which Dr. Hessami raised the issue, Dr. Fierer instructed her not to mention the $9 million publicly again. J.A. 10, 977.

Dr. Hessami alleges that she continued to voice her concerns throughout 2015 and that her comments were at times met with hostile, derogatory statements by Dr. Fierer. Aff. ¶ 29.

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