Natalie Khawam, Esq, MBA, MS 400 North Tampa Street, Suite 950

Loretta Poston, Esq. Tampa, Florida 33602

Samantha Postlewaite, Esq. Office: 813.944.7853
Javier Soto, Esq. Fax: 813.434.2173

October 20, 2017

Ms. Ann Brown
Hospital Director
Dept. of Veterans Affairs
Greater Los Angeles Healthcare System
11301 Wilshire Blvd.
Los Angeles, CA 90073
Main Hospital, Building 500, Room 6424
Email: ann.brown@va.gov

RE: Jeffrey Sayers, PharmD

Response to Proposed Removal Under the Authority of 38 U.S.C. §714 dated
September 29, 2017

Dear Director Brown,

On behalf of our client, Dr. Jeffrey Sayers, please accept this letter as his formal response

to the “Proposed Removal,” purported by Agency to be under the authority of 38 U.S.C. §714,

issued to Dr. Sayers on October 6, 2017. The proposal alleges two charges: (a) Failure to

Perform Assigned Duties, and (b) Failure to Follow Instructions. For the reasons discussed

further below, we believe such action is unsupported and unwarranted based on the information

and documents included in the Evidence File, and the statements and evidence we provide here

on behalf of Dr. Sayers. Based on submitted evidence, Dr. Sayers respectfully requests that his

proposed removal be rescinded and all reference to the proposed removal be removed from his

employee record and personnel files.

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 This response is timely pursuant to Mr. Todd Stannard’s email sent to our firm on

October 10, 2017, which granted Dr. Sayers’ request for an extension to respond by close of

business on October 20, 2017. (See Exhibit 1-Extension Email dated October 10, 2017).

The proposed removal is unwarranted and unsupported for the following reasons: (1)

Agency management has failed to establish the alleged factual allegations occurred in the

manner described to justify the severe penalty of removal; (2) the evidence presented in support

of the proposed removal is based on inconsistent, subjective information, which does not reflect

credible evidence, and which further evidences bias and impropriety in the investigation showing

no support for the charges made; and (3) that the application of the Douglas Factors establishes

that the proposed removal is not appropriate for the alleged charge.

Management has failed to satisfy its burden there is even substantial evidence that the

two alleged charges and thirteen specifications occurred, and that Dr. Sayers violated the

referenced Agency policies and regulations. Additionally, the Agency has failed to establish that

application of the Douglas factors would merit the discipline proposed by Management had any

of the allegations occurred as alleged. Lastly, Agency ignores comparative treatment and

responsibility the overall OIG reports puts on senior leadership – such as at the facility office of

director.

Also, there is progressive discipline and appropriate discipline, based on the record of Dr.

Sayers. The evidence noted in the record does not show how Dr. Sayers is individually

responsible for each of the specifications as they are charged and that such purported/alleged

conduct was egregious enough, or accompanied by sufficiently aggravating circumstances, to

warrant removal. Additionally, in the Proposal, management has failed to show that an

application of the Douglas factors warrants the severe penalty of removal by its lack of evidence

2
to support each of the specifications as charged. This appears as a shotgun approach in attacking

a Veteran leader to see what sticks. For example, review of Dr. Sayers actions shown by evidence

displays that Dr. Sayers took all reasonable steps to address and rectify any deficiencies in the

Pharmacy Services at the Greater Los Angeles Health Care System (GLA) during the time that

he was assigned as Chief of Pharmacy.

Dr. Sayers has over thirty-seven years of an exceptional work record and has been noted

for his integrity and conduct in numerous appraisals. The Agency seems to question all the

appraisals given Dr. Sayers at this time, in our view. Simply, the factors required to be

considered by law do not support such a severe penalty for the alleged charges, even if shown

as true, amid senior leadership and their role and obligations, which the OIG report seems to

reflect is the party at fault, if anything.

Based off a review of the Table of Penalties and application of the circumstances

surrounding the alleged charges to the Douglas factors, Dr. Sayers respectfully requests that the

Proposed Removal be rescinded.

I. STATEMENT OF FACTS

Dr. Sayers has been employed with the Department of Veteran Affairs as a Pharmacist

for 37 years and has been the Chief of Pharmacy Service for the Greater Los Angeles Healthcare

System for over fifteen years. In his last thirty-seven years as a licensed pharmacist for the

Agency, Dr. Sayers has been an exceptional employee, beginning his career as a resident with

the Agency and working his way up to the role of Chief of Pharmacy Services by 2002.

Throughout his tenure with the Agency, Dr. Sayers has been a model employee and has never

received an unsatisfactory rating on any of his performance appraisals throughout the entirety of

his career. Additionally, Dr. Sayers is well-regarded in his community and is well liked by his

3
peers and colleagues and has no disciplinary record in thirty-seven years at the Agency.

Furthermore, Dr. Sayers has dedicated his entire career to serving Veteran patients and

consistently performs his job duties as a clinical pharmacist and Chief of one of the largest

Veterans Affairs Medical Center pharmacies in the country, in a professional and above

satisfactory manner – as noted in past appraisals and awards.

On July 8, 2016, prior to receiving this Proposal, Dr. Sayers was detailed out of his role

as Chief, Pharmacy Service, to assist Quality Management Office with Continuous readiness

preparation. (Exhibit 2: Detail Letter dated July 8, 2016). Needless to state, the “detail” seems

inconsistent with the charges now made. Also, from July 8, 2016 to date, Dr. Sayers has not been

in control of the VA Greater Los Angeles Health Care System (VAGLAHCS) as the Chief of

Pharmacy Services. Instead, Irene Marshall, was placed in the role as Acting Chief until Acting

Chief Yusef Dawoodbai arrived. This also confuses the charges as alleged in the proposal.

The underlying facts surrounding the charges as stated in the proposal stem from an

external survey that was conducted on the VAGLAHCS in April/May 2017 and a VACO site

visit that occurred on June 27-29, 2016. However, further review of the evidence that was

provided by management in the evidence file used to support the proposal illustrates that a

majority of the facts alleged in each specification are mischaracterized and or overly broad.

Additionally, it appears that management is attempting to take any issues that were raised in the

Memorandums following each of the VAGLAHCS site visits and utilize any of the deficiencies

as a means to propose removal against Dr. Sayers. However, a closer review of the evidence

demonstrates that Dr. Sayers cannot be held responsible for each of the specifications as

management has alleged them as the evidence does not support such a finding.

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 II. ARGUMENT

i. THE EVIDENCE PRESENTED IN THE PROPOSED REMOVAL FAILS TO

PROVIDE OBJECTIVE CREDIBLE SUPPORT THAT THE ALLEGED
MISCONDUCT OCCURRED BY THE STANDARD REQUIRED.
The evidence used to sustain a proposed removal must be gathered and reported in an

unbiased and independent manner in an effort to determine the validity/accuracy of an allegation.

The evidence presented in support of the proposed removal is based on inconsistent, subjective

information which does is not comprised of credible objective evidence. There is bias and

impropriety in the investigation exemplified by the documents received, and issuance of the

proposed discipline by Management.

Charge (a): Failure to Perform Assigned Duties- Specification 1: May 2017

Per the Proposal, on an unspecified date in May 2017, “it was discovered that between

January 2016 and June 2016 that multiple inappropriate and excessive purchases of Hepatitis

treatment related medication by the VA Greater Los Angeles Health Care System (VAGLAHCS)

Pharmacy Service resulted in a loss to the to the VAGLAHCS of over $7 million dollars due to

the excess medications expiring without use.” However, a review of the evidence associated with

this specification does not show that any purchases for Harvoni and Viekira made from January

2016 through June 2016 resulted in a loss of $7 million dollars to the VAGLAHCS.

To the contrary, the evidence demonstrates that prior to Dr. Sayers being detailed out of the

Pharmacy Services on July 8, 2016, Dr. Sayers was responsible for developing a program that

worked with the VISN 22 Pharmaeconomists and colleagues at VA San Diego to track Hepatitis

drug purchases and costs for the years that he was on a collateral assignment as acting VISN 22

Pharmacist Executive. (Exhibit 3 – Dr. Matthew Goetz Letter and Email dated October 6, 2017).

Furthermore, Dr. Sayers was one of the Chiefs responsible for implementing monthly meetings

with Hepatitis C providers, the Hepatitis Innovation Team (HIT), and site pharmacists to address
5
any deficits in the Hepatitis treatment medications and enrollment numbers. Id. The evidence

illustrates that any decisions to place advance orders for the Hepatitis medicine in 2016, that

management is attempting to use against Dr. Sayers in specification 1, were not the sole decision

of Dr. Sayers. Rather, any decision to purchase advance orders for HCV medications in 2016

were made in anticipation of the expected number of patients who would be treated in the near

future and were the result of a group decision involving multiple Chiefs, pharmacists, and the

HIT. Id. The charge as made is false, and capricious.

Adding insult to the false accusations, management has grossly mischaracterized the alleged

loss that resulted from the excess hepatitis medication purchases, stating that the VAGLAHCS

Pharmacy Services lost “over $7 million dollars” due to the excess medication that was

purchased between January 2016-June 2016. However, the evidence shows that the

VAGLAHCS Pharmacy Service was actually able to return all the expired product of Harvoni

and Viekera for a 75% return on the current pricing, which only resulted in an estimated loss of

$1,602,208.01 for Harvoni and $1,000,152.58 for Viekera, totaling a net loss of $2,602,360.59,

and again this was a joint decision –not from any one individual. (Exhibit 4- Emails from Patrick

Shin to Acting Chief Dawoodbhai and Chart for Harvoni and Viekera Returns/losses). The only

evidence provided to link Dr. Sayers to the alleged $7 million-dollar loss on the hepatitis

medication, is a memo prepared by Patrick Shin, Pharm. D., Outpatient, Manager, West Los

Angeles, to Yusuf Dawoodbhai, Pharm.D., Acting Chief, Pharmacy Service, which erroneously

states that the total loss from the 2016 purchases of Harvoni and Viekera stands at

$7,034,672.66. (Exhibit 5, Tab 1 of Agency Provided Evidence Packet). The evidence that

management has presented for this specification is a gross mischaracterization the loss the

VAGLAHCS actually sustained, which raises the credibility and veracity of the evidence that is

6
being used to sustain this Proposal against Dr. Sayers. It is a Federal violation to state false

information in any Federal process (18 U.S.C. § 1001). Dr.Shin, being the individual that

provided the VAGLAHCS management staff, with the actual loss the VAGLAHCS received in

April 20, 2017 ($2,602,208.01), was fully aware that the numbers regarding the loss he included

in the memorandum provided to Dr. Dawoodbhai on July 21, 2017($7, 034,672.66) did not

accurately reflect the loss VAGLAHCS sustained from January 2016 through June 2016. (See,

Exhibits 4 and 5). Dr. Shin’s memorandum mischaracterizes the total loss by approximately

$4,397,639.41. (See Exhibit 5). Due to the impropriety in how this evidence is being presented,

this evidence cannot be used to sustain this specification against Dr. Sayers. Further, it reflects

not just bad faith on the present acting pharmacy chief, but misconduct.

Specification 2: July 2017

As noted in the proposal, sometime in July 2017, VAGLAHCS became aware that the VA

Office of Medical-Legal Affairs (OMLA), was reinvestigating an incident involving a Pharmacy

Technician that incorrectly prepared chemotherapeutic agents for four Veterans on August 11,

2011. However, this is mischaracterized as are the facts surrounding this specification. Dr.

Sayers was NOT directly responsible for this matter. However, the charge reads, “the lack of

incompletely trained staff occurred under [his] oversight as the Chief of Pharmacy.” But, a

review of the evidence demonstrates that Dr. Sayers took all the necessary steps to rectify the

performance issue and implemented an appropriate level discipline for any of the Pharmacy

employees that were responsible for the August 11, 2011 incident. This is not mentioned in the

Agency charges and the response is reasonable.

Specifically, the two pages of evidence that management has provided for this specification

details that on July 12, 2017, VAGLAHCS received notice from the VA OMLA, which stated

7
“that based on additional review of the medical record, ABI, as well as any additional

information from Facility staff or practitioners involved in the case [OMLA had previously

investigated], that significant systems related issues contributed” to the incident on August 11,

2011. (Exhibit 6- Tab 3 of Agency Provided Evidence Packet). The evidence does not accurately

reflect that appropriate action was taken by Dr. Sayers and the Pharmacy Services following the

incident on August 11, 2017 involving the technician that prepared the incorrect

chemotherapeutic agents. Specifically, the Pharmacy Technician responsible for delivering the

incorrect medication, was immediately removed from patient care while an investigation was

conducted by Associate Pharmacist, Irene Marshall. Ultimately, the technician and certifying

pharmacist received suspensions and the technician was assigned out of the Pharmacy Services

into another non-patient care service. (Exhibit 7-Email chain to Sayers regarding incident and

action that was taken dated February 2012-March 2012). Therefore, the responsible supervisory

chain took the appropriate action while supervised by Dr. Says. This is irrefutable.

Additionally, the way the specification is framed reads that the VAGLAHCS became aware

of the August 11, 2011 incident in July 2017 upon the notice sent by OMLA on July 12, 2017.

However, this is another mischaracterization of the evidence because a review of the evidence

illustrates that the VAGLAHCS was fully aware of the incident following the occurrence in

August 2011. The Medical Center and network were deeply involved in this situation when it

happened and provided guidance and support in identifying what happened – and in the response

at that time. VAGLAHCS Quality Management Office coordinated the investigation and

corrective actions that were taken following the incident. In addition to the disciplinary action

taken against the pharmacy technician and certifying pharmacist responsible for the incident, Dr.

Sayers’ received a proposed admonishment to which a response was also provided to, however,

8
Dr. Sayers never received any final decision regarding his response to the proposed

admonishment –showing management acquiescing to his defense to the proposed admonishment.

(Exhibit 8-Response to Proposed Admonishment and Proposed Admonishment Letter).

Moreover, in February 2012 through March 2012, following the August 11, 2011 incident,

the VA Office of Inspector General Office of Healthcare Inspections got involved to ensure that

GLA took actions that involved various improvement efforts that were made for 1) the

preparation processes in the pharmacy; 2) the delivery/transport of the medication to the

Sepulveda Clinic, and 3) the administration of injections by Ophthalmology based on knowledge

and information prior to January 2012. (Exhibit 7). Due to the incompleteness in how the

evidence for this specification is being presented, this evidence conflicts with the actual

corrective action that was taken at VAGLAHCS following the August 2011 incident and cannot

be used to sustain this specification against Dr. Sayers – as it is not on point, does not describe

the issues correctly, and therefore does not relate to the matter charged.

Specification 3: April/May 2017

The facts associated with specification 3 mainly arise from an external survey of

VAGLAHCS that occurred on an unspecified date in April/May 2017 regarding security related

issues with the narcotic vault that was found to be lax or not operating in accordance with VA

Handbook 0730 and VHA Handbook 1108.01 (not specified other than issues with keys). The

allegation states that there were issues with the use of keys that were used to access the vault at

“one of the pharmacies for many years.” No further information is noted. However, a review of

the evidence demonstrates that management has again mischaracterized evidence. The evidence

here shows no mismanagement or fault of Dr. Sayers.

9
 Approximately 3-4 years ago, manual key access was installed at the LA Ambulatory

Care Center (LAACC) by the GLA Locksmith, Ron Berru (Exhibit 9- Email from Managing

Pharmacist re LAACC Vault dated October 13, 2017). Manual locks were installed to LAACC’s

narcotic vault because the electronic key pad access were inoperable. The locksmith installed a

manual key door knob and provided keys for the pharmacists to ensure there was secure access

to the vault. Id. Dr. Sayers and the Pharmacy Service took all the requisite steps to fix the key

pad access issue, making at least three attempts to put work orders in for the locks to be fixed. Id.

Additionally, although MCM was awarded a security lock contract approximately 3-4 years ago

for all secured areas of GLAHS, the VAGLAHCS has been waiting for installation of the new

lock systems from MCM to date. Id. Furthermore, VAGLAHCS was finally provided with

working card keys to access the narcotics vault on April 21, 2017, which is nearly a full year

after Dr. Sayers was detailed out of Pharmacy Services. Id. Lastly, the Managing Pharmacist at

LAACC was unaware of any history of keys being left in the doorknob of the vault as specified

in the specification.

Specification 3 also discusses that “vault entry logs for any previous year could not be

found by the pharmacy supervisors who said they had been used for many years.” This is yet

another mischaracterization of the evidence. A closer review of operations at VAGLAHCS

demonstrates that each vault always had a vault log book in the vault, however, not all

pharmacists conducted new controlled substance inventory check-in. Id. It was the practice that

only 5 of the 10 pharmacists would routinely check in controlled substance drugs into the vault,

while being accompanied by either an AM&S employee or a mailroom employee. The procedure

was that the non-pharmacy employee would sign the vault log book, located on the back shelf in

the rear of the vault (near where the controlled drug inventory is broken down) each time he or

10
she would enter the vault. Id. It appears as if the information gathered in the external survey of

VAGLAHCS that occurred on an unspecified date in April/May 2017 may have come from a

pharmacist that was unfamiliar with the policy in place or where the log book was kept., Id.

Furthermore, each of the vault locations at VAGLAHCS does in fact have log books which are

readily available, have never been misplaces, and have logs dating back to 2006. (Exhibit 10-

Email From Sherry Dozier dated October 12, 2017 and see Exhibit 9).

Lastly, while Dr. Sayers was in charge of Pharmacy Services for VAGLAHCS, any

discrepancies in the security vault were noted in a report and sent to director per the VA

requirements and policy. (Exhibit 12-Memorandums from Chief of Pharmacy to Director of

Hospital). Dr. Sayers diligently oversaw any vault security issues in his Pharmacy prior to his

reassignment and the evidence management has presented under this specification cannot be

used to sustain the charge as multiple employees can attest that the policies and procedures were

being followed or complied with accordingly, and the facility director was notified.

Specification 4: April/May 2017

Specification 4 involves a similar issue as mentioned in Specification 3, relating to an

external survey of VAGLAHCS that was conducted in April/May 2017 which allegedly revealed

that the one of the narcotic vaults was found to have a working “Dutch” door which “allowed

staff to have the open upper half of the door open and reach into the vault to freely access the

narcotic vault.” Additionally, management alleges that during the survey, it was discovered that

the Physical Access Control System (PACS) for some of the vaults were not working for many

years while Dr. Sayers was Chief of Pharmacy. However, management is grossly

mischaracterizing the evidence and situation surrounding the narcotic vaults at VAGLAHCS. It

should be noted that this finding came from a December 2016 survey, during time in which Dr.

11
Sayers was not the Chief Pharmacy Services and that no prior notice was given to Dr. Sayers in

any previous site surveys that were conducted prior to 2016.

First, the evidence used to substantiate specifications 3 through 12 all stem from the

external survey that was conducted on VAGLAHCS in April/May 2017. (See Tab three of

Agency Evidence File). Management has attempted to frame the issues discussed in

specifications 3 through 12 as issues the Agency was unaware of until the conclusion of the

survey in May 2017. However, the evidence establishes that the Agency has been well aware of

issues involving the narcotic vaults at the VAGLAHCS since 2010. (Exhibit 12-Emails from

June 28, 2010-June 20, 2010). Additionally, since 2010, Dr. Sayers diligently sought the

appropriate corrective measures to address any deficiencies in the narcotic vaults at

VAGLAHCS. Specifically, Dr. Sayers has timely made multiple prior requests for additional

surveillance and security items for the narcotic vaults. (Exhibit 13-Surveillance Project Contract

Award Emails). However, due to the how these requests are processed within the Agency and

budgetary issues, the orders were never fully processed. (See Exhibit 14-Email Information

Gathering). While Dr. Sayers may have been aware of the issues with the narcotics vaults, he

consistently took all the appropriate steps under his control and authority to correct the issues

and submitted all required work orders to have the locks and security measures installed. Id. Up

until 2016, the Agency was unable to fulfill the VAGLAHCS Pharmacy Service’s security

requests while Dr. Sayers was in his role as Chief of Pharmacy. Id. Dr. Sayers has regularly

performed the duties assigned with his position. It is unjust that management is now attempting

to blame the Agency’s inability to process the requests for corrective measures that Dr. Sayers

submitted on multiple occasions to address any deficiencies within the VAGLAHCS. As the

evidence shows that Dr. Sayers diligently oversaw any vault security issues in his Pharmacy

12
prior to his reassignment this specification cannot be sustained against Dr. Sayers. This is a

systemic failure and the authority levels above Dr. Sayers are responsible.

Specification 5: April/May 2017

This specification alleges that following the external survey of VAGLAHCS in

April/May 2017, many pharmacy managers did not “fully understand the Reverse Distribution

process and were unable to verbalize or produce any paperwork that showed the full

accountability of controlled substance through the reverse distribution/destruction.”

Again, the only evidence that management has presented to support this specification is

the 8-page memorandum from the external survey of VAGLAHCS conducted in April/May

2017. The evidence provided does state that some of the Pharmacy staff were unaware of VHA

Directive 1087, however, it erroneously mentions that the returns for medications were not held

for return credit. (See Agency Evidence Tab 3, page 3). While Dr. Sayers was acting in his role

as Chief of Pharmacy, prior to his reassignment in July 2016, he initiated a policy of collecting

data regarding all pharmaceutical medication returns. (Exhibit 15-Emails from Susan Zigmond to

Jeff Sayers dated October 18, 2013). Dr. Sayers would review monthly reports that were

prepared by Program Analyst, Susan Zigmond regarding the medication returns for each month.

Dr. Sayers implemented this measure since 2010, and was regularly hitting 100% recovery on all

returned medications. (Exhibit 16-Performance Measure Spreadsheet 2013). Additionally, the

VA Directive that management is citing did not come into effect until August 13, 2014 and prior

to this directive, Dr. Sayers had developed an accurate method for recording and reporting all

pharmaceutical medication returns for the VAGLAHCS. Id. Lastly, since Dr. Sayers was not in

charge of the pharmacy services since July 2016, any lack of knowledge on the pharmacy staff

should also be placed on the current Acting Chief, Yusef Dawoodbhai, and Associate

13
Pharmacist, Irene Marshall, as they were responsible for the VAGLAHCS Pharmacy Services, at

the time that the external surveys were conducted. Therefore, this specification fails.

Specification 6: April/May 2017

The facts underlying this specification are related to specification 5, in that they involve

the financial losses that allegedly resulted from years of failing to make returns under the reverse

distribution system. As discussed above, while Dr. Sayers was in charge of Pharmacy Services

for the VAGLAHCS, he was consistently returning pharmacy medications at close to a 100%

return rate. (See Exhibits 16 and 17). Additionally, management, again, grossly mischaracterizes

the facts of the specification to read that “open bottles were defaced routinely marked with an

“X” and defaced bottles cannot be returned for credit through the Reverse Distributor upon

expiration.” However, the decision to accept marked bottles is dependent on each manufacturers

policy. (Exhibit 17-Email from Tao to Account Rep for Pharma-logistics). Each product has its

own unique policy for returns and some have historically accepted partial drug bottles that were

marked with an “X”. Furthermore, once Dr. Sayers was reassigned out of Pharmacy Services in

July 2016, he was no longer responsible for the returns under the reverse distribution policy.

Instead, any financial losses incurred following Dr. Sayers’ reassignment again falls on the

Acting Chief, Yusfef Dawoodbhai, and Associate Pharmacist, Irene Marshall. Therefore, the

evidence fails to establish that Dr. Sayers was actually responsible for any financial losses over

“many years” as alleged by management in the proposal. As a matter of evidentiary fact = the

evidence fails to show any losses or fault by Dr. Sayers.

Specification 7: April/May 2017

This specification states that following the external survey of the VAGLAHCS in

April/May 2017, it was discovered that multiple pharmacy supervisors did not understand the

14
process to report local controlled substances losses in accordance with VHA Directive 1108.01.

However, while Dr. Sayers was in charge of Pharmacy Services at VAGLAHCS, there was a

policy for reporting local controlled substances losses and it was fully complied with by staff of

the pharmacy. (Exhibit 18-Email from Robert Simonet dated March 10, 2016 to Irene Marshall).

Additionally, these types of losses were a rare event while Dr. Sayers was in charge of

the Pharmacy Service. As each member of the pharmacy staff is able to comply with VHA

Directive 1108.01 individually, Dr. Sayers cannot be held responsible for every individual that

was unable to recite the process under the policy – that is absolutely not supported by any VA

policy (and this is more of an individual performance matter). Furthermore, each Pharmacy

Manager was informed of the procedure prior to Dr. Sayers’ reassignment. (Exhibit 19-Email

from Irene Marshall to Pharmacy Managers).

Specification 8: April/May 2017

This specification states that following the external survey of the VAGLAHCS in

April/May 2017, it was discovered that the “power of attorney for ordering Schedule II

Controlled substances was a source of confusion among pharmacy managers.” Management goes

on to state that the pharmacy managers were unaware of where to find the most recent DEA

power of attorney. This is another mischaracterization of the evidence, as all DEA forms were

processed and renewed accordingly, and all pharmacy managers were fully aware of where the

forms were located – at a certain location and handled by a certain individual. (Exhibit 20-Emails

from Susuan Zigmond April 2016). Additionally, after Dr. Sayers was reassigned out of

Pharmacy Services in July 2016, any expired DEA License that occurred since July 2016 to

current, would not be the responsibility of Dr. Sayers. The Agency is attempting to hold Dr.

Sayers responsible for oversights of the current Acting Chief, Yusef Dawoodbhai, and Associate

15
Pharmacist, Irene Marshall, who have been in charge of the VAGLAHCS since Dr. Sayers’

reassignment. (Exhibit 21-Emails to Yusef October 3, 2017). As such, this evidence cannot be

used to sustain this specification against Dr. Sayers. There is simply no evidence to support this

specification.

Specification 9: April/May 2017

This specification states that following the external survey of the VAGLAHCS in

April/May 2017, it was discovered that automation equipment inside the pharmacy was outdated

and not functioning correctly. Management further alleges that this resulted in an unnecessary

waste of resources for the Agency – but does not specify what waste occurred. A review of the

evidence shows that Dr. Sayers took all the requisite steps to ensure that the automation

equipment inside of the VAGLAHCS Pharmacy was renewed and that the GLA pharmacy had

machines such as ScriptPro. (Exhibit 22- ScriptPro Order from 2016). Additionally, since 2014,

the AO underneath Dr. Sayers’ took all appropriate steps and requirements to place the orders for

the automation equipment. (Exhibit 23-Emails from December 17, 2014). However, due to

budgetary concerns and issues with Agency having the orders filled, the VAGLAHCS did not

have receive the automated equipment. Furthermore, upon Dr. Sayers’ reassignment, Acting

Chief Yusef Dawoodbhai, failed to renew the maintenance contract the AO alerted him off. Id.

The evidence presented from Dr. Sayers demonstrates that Dr. Sayers cannot be held

accountable for the alleged waste of resources relating to the failure to have the Automation

equipment that he had previously attempted to purchase for the VAGLAHCS Pharmacy Service

– but those above his position did not authorize it for budgetary reasons.

16
 Specification 10: April/May 2017

This specification states that following the external survey of the VAGLAHCS in

April/May 2017, it was discovered that “pharmacy have been unaware of and not practicing the

necessary separation of duties for many years in regard to procurement.” Management further

alleges that VAGLAHC was out of compliance with the VA Policy that requires different

pharmacy staff members place and receive orders. However, a review of the evidence shows that

Pharmacy Services under Dr. Sayers received monthly confirmations from ordering sites,

confirming there was a separation of duties when ordering controlled substances. (Exhibit 24-

Email to Michael Sprague). Again, management is attempting to charge Dr. Sayers for failure to

perform the assigned duties of Chief Pharmacist, but the evidence shows that to the contrary, Dr.

Sayers had been practicing the necessary separation of duties for many years in regard to the

procurement. There is no evidence to support this specification.

Specification 11: April/May 2017

This specification states that following the external survey of the VAGLAHCS in

April/May 2017, it was discovered that “important High Alert/NIOSH drug lists were outdated

for many years in multiple Pharmacy areas with one pharmacy having their most recent drug list

being from 2010.” A review of the evidence shows that it was not the responsibility of the Chief

of Pharmacy to update the high alert med list, as it actually was Quality Management that is the

group responsible for updating the list. (Exhibit 25-Email from Lim RE high alert /NIOSH drug

list). Separately, another office and department was responsible for updating the NIOSH list.

Therefore, to hold this against Dr. Sayers is not justified - and not supported by the evidence

presented by management. This specification fails.

17
 Specification 12: April/May 2017

This specification states that following the external survey of the VAGLAHCS in

April/May 2017, it was discovered that “many pharmacy managers, supervisors and staff were

unaware of many local and national pharmacy related policies.” None of these policies were

specified in the proposal. Management further alleges that GLA pharmacy intranet site lists

expired and outdated policies as old as 2005. As stated above, updating the policies and Intranet

were not the sole responsibility of Dr. Sayers, as other departments and administrative officers

were also charged with updating the local and national pharmacy related policies. (Exhibit 25).

Additionally, while Dr. Sayers was Chief of Pharmacy Services, he did in fact take the requisite

steps to update policies as he and his staff were intimately involved with the development

process as it relates to their area of supervision. (See Exhibit 26-Emails from Sayers to Staff RE

updating policies). The evidence clearly establishes that Dr. Sayers made sure to update his

pharmacy managers and staff of any updated policies as he became aware of them. Id.

Management is again attempting to mischaracterize the evidence as failures on Dr. Sayers,

however, a review of the evidence reveals that Dr. Sayers did in fact update his employees of

local and national policies. Therefore, to hold Dr. Sayers accountable for the actions of the VA

facility web personnel that failed to update the policy, or other parties that were involved in this

process, is not just unfair, but shows the proposed removal is in bad faith – as all specifications

seem based on no support and contortion of facts by leaving out critical details.

Charge (b): Failure to Follow Instructions –Specification: June 27-29, 2016

This specification states that during a VACO site visit that took place on June 27-29,

2016, it was discovered that VAGLAHCS pharmacy staff had been using a CPRS templated

pharmacy disposition note that allowed staff to inappropriately discontinue pending medication

18
orders. Management further alleges that Dr. Sayers had twice been instructed to remove the note,

and that he never ultimately removed the note. However, a closer review of the evidence shows

that management is mischaracterizing the evidence to frame it as if Dr. Sayers himself was

responsible for the not removing the CPRS templated pharmacy note which in turn allegedly

resulted in pending orders for veterans being inappropriately discontinued by pharmacy staff.

Dr.Sayers did notify his staff that they were “not to discontinue a flagged pending order” and

that he wanted the managers to be responsible for performing this function when working with

the provider or care line supervisor. (Exhibit 27-Emails from Dr. Sayers to staff dated June

2016). Additionally, a further review of the evidence demonstrates that VAGLAHCS pharmacy

managers were aware that they were “not to discontinue a flagged pending order” and that

Manager’s would be responsible for following up on the CPRS Pharmacy Disposition Note. Id.

Furthermore, there is additional evidence that Dr. Sayers and his staff were not discontinuing

pending medication orders, but rather “flagging” the orders. (See Exhibit 29- Emails from IM

and staff October 2015).

This is yet another instance that illustrates how management is mischaracterizing the

evidence associated with this charge to and the Proposal to make it appear as though Dr. Sayers

was directly responsible for issues associated this this specification. Therefore, based on the

evidence that is being used to support this specification, this charge cannot be sustained against

Dr. Sayers.

ii. APPLICATION OF THE DOUGLAS FACTORS ESTABLISH THE

AGENCY’S PROPOSED REMOVAL IS NOT APPROPRIATE FOR THE
ALLEGED CHARGE.

Pursuant to the Merit System Protections Board’s decision in Douglas v. Veterans

Administration, M.S.P.R. 280 (1981) criteria have been establish for which supervisor’ must

19
consider in determining an appropriate penalty to impose for an act of employee misconduct. In

Dr. Sayers’ proposed charges, the following factors are highly relevant and factors must be

considered:

(1) The nature and seriousness of the offense, its relation to the employee’s, duties,
position, and responsibilities, including whether the office was intentional or
technical or inadvertent, or was committed maliciously or for gain, or was
frequently repeated;

The related events have no bearing on Dr. Sayers’ duties, position, or responsibility

or his performance of those duties, such that the alleged facts, even if true, would indicate any

inability of Dr. Sayers to perform efficiently and appropriately in his position as pharmacist. Dr.

Sayers’ impeccable performance appraisals and years of service illustrate how he diligently

upholds the safety and health standards critical to a pharmacy operating in a safe manner for the

Agency’s patients. (Exhibit 29-Performance Appraisals). Never has a concern ever been

previously brought forth regarding Dr. Sayers and the way he interacts with the other employees

or how he managed the GLA Pharmacy Service. The Management Officials involved in making

the allegations against Dr. Sayers have categorized a few single incidents into the various

specifications. Additionally, as stated above, the evidence that is being used to sustain the

allegations is inconsistent.

As such, when Management considers this factor, it weighs strongly in favor of the

Proposed removal being rescinded, or the most minimal discipline in the first offense category

being implemented – involving no suspension. Simply, this matter appears to be systemic issue

outside the control of Dr. Sayers.

(3) The employee’s past disciplinary record;

20
 Dr. Sayers has no past disciplinary record, which is a critical factor to be considered to

ensure the penalty determined is proportionate and reasonable. Notably, Dr. Sayers has never had

even one proposed action for discipline or performance in over thirty-seven years of service to the

Agency. This weighs strongly in favor of the Proposal being rescinded, or the most minimal

discipline instituted. Dr. Sayers is a model employee, and such an impeccable record is of great

value to the Agency, and is considered heavily by governing bodies such as the Merit Systems

Protection Board in reviewing the appropriateness of a determination of discipline. (Exhibit 30-SF

50).

(4) The employee’s past work record, including length of service, performance on the
job, ability to get along with fellow workers, and dependability;

Dr. Sayers has devoted his entire career to the VA at the Greater Los Angeles Healthcare

System since 1980, working for over thirty-seven years, beginning as a resident and working his

way up to Chief of Pharmacy. In that time, Dr. Sayers has scored nothing lower than excellent or

outstanding ratings on his performance reviews, and has never had any reported performance

issues. Furthermore, Dr. Sayers has been an exceptional employee and is well-liked by his peers

and his colleagues respect him and the work he has done for the Agency as a practitioner.

(Exhibit 31-Letters of Support). Additionally, he has never received any discipline, or proposals

for discipline, or had any issues during his employment with the Agency prior to this Proposal.

In conclusion, when Management considers this factor, it weighs strongly in favor of the

proposed removal being rescinded on all charges, or the most minimal discipline in the first

offense category being implemented.

(5) the effect of the offense upon the employee’s ability to perform at a satisfactory
level and its effect upon supervisors’’ confidence in the employee’s work ability to
perform assigned duties;

21
 The nature of each of the alleged offenses bare absolutely no detrimental impact on Dr.

Sayers’ ability to perform at a satisfactory level –they are not supported. In fact, as previously

stated, the few fragments of truth mixed in with the allegations that come from exorbitantly

exaggerated facts, show that Dr. Sayers diligently upholds the safety and health standards critical

to maintain a pharmacy operating in a safe manner for Veterans and other Agency patients. He

has consistently displayed his competency and ability to continue to in an excellent manner in his

position and has diligently performed his job duties as Chief of Pharmacy during his tenure.

As such, when Management considers this factor, it weighs strongly in favor of the

Proposal being rescinded on all charges, or the most minimal discipline in the first offense

category being implemented.

(7) Consistency of the penalty with any applicable Agency table of penalties;

The proposed penalties are not only inconsistent with the table of penalties, but also

violate the Agency’s policy on progressive discipline. In his over three decades of service to the

Agency and its patients, Dr. Sayers has never received a proposed action for discipline, much

less a decision implementing discipline. As such, despite the charges being proposed against Dr.

Sayers being exaggerated, as evidenced throughout this response, the proposed discipline is

inconsistent with the Table of Penalties, and the Agency’s policies implementing progressive

discipline. These charges would be “first offenses” for Dr. Sayers, as he has never had any of

these offenses, if the evidence is determined to exist by the deciding official. As such, when

comparing the charges proposed against Dr. Sayers with the penalty ranges in the Agency’s

Table of Penalties, regardless of the number of specifications, the proposed discipline should fall

within the first offense range only.

22
 When reviewing the Table of Penalties, the proposed discipline is greatly

disproportionate with each charge and specification given the mischaracterized evidence that

management has attempted to use to sustain the removal and therefore removal is inconsistent

with the Table of Penalties and violates the policy of progressive discipline.

(8) the notoriety of the offense or its impact upon the reputation of the Agency;

There is no notoriety of the alleged charges proposed against by Dr. Sayers, nor is there

any relation with patient safety or the public that would have any impact whatsoever on the

reputation of the Agency. If anything, the record shows Dr. Sayers has done his job within the

rules of the Great Los Angeles VAMC directorships. The evidence discussed in this response

shows the majority of all facts based upon the allegation to be exaggerated, mischaracterized,

fabricated, or lacking credibility, such that to move forward with the charges, rather than rescind

charges based on absent evidence, would be the greatest harm to the Agency’s reputation. The

notoriety of moving forward with charges based off such flimsy allegations and evidence is even

more concerning for the Agency’s reputation.

As such, when Management considers this factor, it weighs strongly in favor of the

Proposal being rescinded on the charge, or the most minimal discipline in the first offense

category being implemented.

(9) the clarity with which the employee was on notice of any rules that were violated
in committing the offense, or had been warned about the conduct in question;

Dr. Sayers had no warning or notice that any rules were being violated, and as discussed

in other sections of this response, the factual allegations, even if taken all as true, are

inappropriately categorized as the offenses charged in the Proposal based off a plain language

and review of the table of penalties. Dr. Sayers did not have any notice from Management or any

23
other employees that any problems arose until he received his Proposal. Prior to being detailed

out of Pharmacy Services in July of 2016, Dr. Sayers had been diligently performing his job

duties as a model employee. He took all requisite steps to correct any deficiencies within the

VAGLAHCS Pharmacy Service as they arose and any delays in the corrective action was not the

result of negligence on his part. Dr. Sayers never had any issues with his performance as a

pharmacist or Chief of Pharmacy for the thirty-seven years that he has been employed with the

Agency, and to the contrary has always gone above and beyond to make sure employees within

the pharmacy are informed on updates and procedures to do his part in ensuring a well-

functioning environment, especially for one of the largest VA Medical Centers in the country.

As such, when Management considers this factor, it weighs strongly in favor of the

Proposal being rescinded on all charges, or the most minimal discipline in the first offense

category being implemented.

(10) the potential for the employee’s rehabilitation;

Even if the facts alleged within the proposed charges were true, the “potential for the

rehabilitation” is good. Any issues that arose while Dr. Sayers was Chief of Pharmacy were

properly addressed. To date, Dr. Sayers has taken all the requisite steps to resolve any issues

within the pharmacy. Additionally, Dr. Sayers has been a well-performing, well-liked, diligent of

the Agency for over thirty-seven years. There is nothing demonstrated in the evidence submitted

by Management that Dr. Sayers would be unable to continue to be anything but a well-

performing, compassionate employee, serving Veterans and working with those within the

pharmacy – that he knows very well, more so that the current Acting Chief, amid the

inconsistency in information about the status of operations noted in this response. If this was a

24
real issue that affects his ability to perform his job, he should be given the opportunity for

rehabilitation prior to removal.

As such, when Management considers this factor, it weighs strongly in favor of the

Proposal being rescinded on the charge, or the most minimal discipline in the first offense

category being implemented.

(12) the adequacy and effectiveness of alternative sanctions to deter such conduct in
the future by the employee or others.

As discussed, many of the allegations for which the proposed charges are based show that

the actions alleged to have been taken by Dr. Sayers are exaggerated and mischaracterized.

However, even if the factual allegations alleged were accurate, removal from federal service

after over thirty-seven years of service with the Agency is a severe penalty and deterrence of

such conduct can be obtained with a far less severe penalty. Dr. Sayers has never had any

proposed discipline for similar conduct prior to this and does not have a history of failing to

follow instructions or perform his job duties. To the contrary, Dr. Sayers has operated the

VAGLAHCS Pharmacy Service in a responsible and respectable manner. As such, a lesser

penalty than removal would be sufficient to address the alleged misconduct. Thus, rescission of

this Proposal is more than merited upon consideration of this factor and the other factors as

required by Douglas.

III. CONCLUSION

Removing Dr. Sayers from his federal duties would end the career of a high performing,

diligent public servant, and is likely to cause irreparable harm to Dr. Sayers’ professional

reputation, and the Agency. Considering Dr. Sayers’ long established and positive work history

with the Agency for over thirty-seven years and the above-mentioned reasons, the removal of Dr.

25
Sayers from federal service would also be un-substantiated. Under the forgoing evidence, the

Agency cannot credibly assert that a decision to remove Dr. Sayers from federal service would

promote the efficiency of service or be in the interest of justice. Contrary to this standard, it

seems to set the Agency backwards.

Therefore, Dr. Sayers respectfully requests that the Proposed Removal be rescinded and

removed from his record and personnel file and replaced with any mitigated discipline action if

any is to be taken.

Best,

____________________________
Natalie K. Khawam, Esq., MBA, MS
Whistleblower Law Firm, P.A.
400 N. Tampa St., Suite 950
Tampa, FL 33602-4700
Office: (813) 944-7853
Nataliek@813whistle.com
Attorney for Complainant

26
 EXHIBIT INDEX

1. Exhibit 1: Extension Email dated October 10, 2017;

2. Exhibit 2: Detail Letter dated July 8, 2016;
3. Exhibit 3: Dr. Matthew Goetz Letter and Email dated October 6, 2017;
4. Exhibit 4: Emails from Patrick Shin to Acting Chief Dawoodbhai and Chart for Harvoni
and Viekera Returns/losses;
5. Exhibit 5: Tab 1 of Agency Provided Evidence Packet;
6. Exhibit 6- Tab 3 of Agency Provided Evidence Packet;
7. Exhibit 7-Email chain to Sayers regarding incident and action that was taken dated
February 2012-March 2012;
8. Exhibit 8-Response to Proposed Admonishment and Proposed Admonishment letter;
9. Exhibit 9- Email from Managing Pharmacist re LAACC Vault dated October 13, 2017;
10. Exhibit 10-Email from Sherry Dozier dated October 12, 2017;
11. Exhibit 11-Memorandums from Chief of Pharmacy to Director of Hospital;
12. Exhibit 12-Emails from June 28, 2010-June 20, 2010;
13. Exhibit 13-Surveillance Project Contract Award Emails;
14. Exhibit 14-Email from Information Gathering;
15. Exhibit 15-Emails from Susan Zigmond to Jeff Sayers October 18, 2013;
16. Exhibit 16-Performance Measure Spreadsheet 2013;
17. Exhibit 17-Email from Tao to Account Rep for Pharma-logistics;
18. Exhibit 18-Email from Robert Simonet dated March 10, 2016 to Irene Marshall;
19. Exhibit 19-Email from Irene Marshall to Pharmacy Managers;
20. Exhibit 20-Emails from Susuan Zigmond dated April 2016;
21. Exhibit 21-Emails to Yusef dated October 3, 2017;
22. Exhibit 22- ScriptPro Order from 2016;
23. Exhibit 23-Emails from December 17, 2014;
24. Exhibit 24-Email to Michael Sprague;
25. Exhibit 25-Email from Lim RE high alert /NIOSH drug list;
26. Exhibit 26-Emails from Sayers regarding updating policies;
27. Exhibit 27-Emails from Dr. Sayers to staff dated June 2016;
28. Exhibit 28- Emails from IM and staff October 2015;
29. Exhibit 29-Performance Appraisals;
30. Exhibit 30-SF 50;
31. Exhibit 31-Letters of Support
Letter to myself: Jeffrey Sayers

On July 2, 1980 I started my pharmacy residency at the VA Los Angeles Outpatient clinic. It was a small
standalone VA doing cutting edge pharmacy work. We were assigned patients to longitudinally follow
and allowed to make changes in their medication regimen. This would eventually be called
pharmaceutical care and then therapeutic drug monitoring. This experience engrained in me what a
pharmacist could do for patients, beyond “counting, pouring, licking and sticking”. It also fashioned my
career and what I wanted to achieve.

On July 1, 1981, I went to the VA Sepulveda, in the San Fernando Valley. Although, my post-graduate
training was in primary care, I interned in a hospital and wanted a site that provided both an acute care
and ambulatory care setting. I became an acute care pharmacist, and along with 5 post-graduate
residents implemented a decentralized, unit dose pharmacy service. We literally were assembling the
shelves in the satellite phar macies. Once the pharmacies were established, we provided a 24/7/365
service and educated nursing and provider staff on what a pharmacist can provide. We developed a
nutrition and pharmacokinetic service. We were available answering medication related questions,
something that was done remotely from another building by a faceless person on the phone.

Around 1982, the HIV epidemic started. I was working with the Infectious Disease Service already on
the pharmacokinetic service, as well as on cost avoidance on inappropriately dosed antibiotics. I was
heavily involved with them on the management of these patients, especially when we had our first
treatment, zidovudine, to ration out. It was an amazing time for healthcare, but scary as well;
something I believe we take for granted today. Eventually I cost justified a full time Infectious Disease-
Pharmacokinetic pharmacist position.

In 1985, I became the Clinical Coordinator of the training and Pharmacy Residency Program. This was a
collateral assignment for me, but did allow me to continue teaching students and residents; something I
really enjoy. I created experiences that demonstrated to future pharmacists what a pharmacist can do
and their importance in patient care. In 1991, I became a full time Clinical Coordinator and turned over
the Infectious Diseases position to others.

In January 1994, a terrible earthquake struck the San Fernando Valley. Our hospital was damaged
beyond repair and had to be destroyed by a wrecking ball. Interestingly, the first time the ball hit the
building, it still stood there. So many memories went down with that building. It was an amazing place
to work with so many staff that cared for our patients and cared about doing the right thing.

In October 1994, I transferred to the VA in West Los Angeles, as their clinical coordinator. Honestly, I
was intimidated by the scope and size of the facility, but I am a firm believer that this was my next step
on my VA Pharmacy journey. Bill Fischer, The Chief of Pharmacy, was a strong leader with a track record
of developing many Chiefs of Pharmacy. He was supportive of my ideas to move our pharmacists
forward and practice to their highest potential. He over sought the merger of the Sepulveda, LA
Downtown Clinic and West LA facility, into the VA Greater Los Angeles Healthcare System. Yes, all the
sites that I had previously worked were together. I was reunited with a lot of colleagues. Together we
continued to make our institution a place pharmacists wanted to work.
In January 2000, due to the merger, a new section was developed called the Pharmacy Benefit
Management Service. I became the program manager and was tasked with developing their role in
formulary management and quality management. We developed a computerized consult service,
medication related events tracking and trending, and on-going cost analysis of expenditures. It was an
amazing time, where innovation was rewarded and failure was a sign of innovation. I was a member on
the VISN Pharmacy Benefit Management Committee and eventually the National Pharmacy Benefit
Management Committee. These continued until May 2016.

In September 2002 I became the Acting Chief of Pharmacy at VA greater Los Angeles and accepted the
permanent position in December 2002. My decision was strongly based that I was now able to direct
staff to my vision, recalling my days as a resident in the downtown clinic and the impact that had on me.
For six years, I led this large organization without the two Associate Chiefs I had in my approved
organizational chart. I continued managing the Pharmacy Benefit Management section collaterally, to
use that manager position for the second Associate Chief of Pharmacy. These two positions were part of
a cessation plan as well. Our strength was based on the many years of experience our Program
Managers had. I will always thank them for this, but it wasn’t easy. A lot of personal family time had to
scarified. Eventually I received permission to hire the Associate Chief of Pharmacy for Outpatient, but
still wasn’t approved for the Associate Chief, Acute/Long Term Care. In fact, I never received approval to
recruit for this position.

During my tenure as Chief of Pharmacy, I also became Chair of the VISN Formulary Committee, as well as
sharing the VISN Pharmacist Executive duties with the Chief of Pharmacy at the VA Long Beach. Our
Network didn’t have a full time VISN Pharmacist Executive until August 2011. Looking back, not sure if
there was an announcement. Eventually he retired at the end of 2014 and I became the Acting VISN
Pharmacist Executive and continued as the Chief of Pharmacy. Yes, another collateral assignment.
These were exciting times, with the development of the academic detailing program, Hep C treatment
cures, opioid safety initiatives, etc. Our small pharmacy VISN pharmacists were excellent and
hardworking, creating programs and databases that were outstanding.

In September 2015, there was a whistleblower investigation of VA Greater Los Angeles pending order
process. This is an outpatient function, under the responsibility of the Associate Chief of Pharmacy over
Outpatient Clinics. It was identified that our Pharmacy Service was not in compliance and I was
removed from my acting VISN Pharmacist Executive position. The investigation generated a report and
required an action plan. I was never allowed, despite several requests, to my supervisor, PBM staff at
Central Office and others, until June 2016. I was appalled that one section implied that we were placing
orders on hold. The implication being to reduce our numbers and delay patient care. The fact was that
orders were flagged for clinical reasons and that is what the Associate Chief of Pharmacy stated she told
them. The investigators were incorrect and I strongly feel this could have been clarified if in fact, I was
allowed to respond.

In June 2016, a team from Central Office PBM came to follow up on the September 2015 review. This
team identified that we had a policy of discontinuing medications if after 14 days providers couldn’t
resolve clinical discrepancies in an order. They didn’t feel this policy which was a Pharmacy and
Therapeutics policy since 2005, was good. They told both my Associate Chief and myself to stop
discontinuing the drugs. We worked with the Program Managers and within two hours all staff was
notified. We were working on a process to require a manager and possibly a provider hierarchy to be in
place to resolve any discrepancies.

One week later, In July 2016, I was detailed from my position for not following an order. The order I was
supposedly given, was to stop using a note title when an order was discontinued. I told Leadership I
heard them tell me to stop discontinuing orders. The Director then stated to me it is in the report. I said
what report? She said you didn’t see the report? I said no. She stated it was in her office and asked the
Chie of Staff and Nurse Executive if they saw the report. They stated they didn’t. She told me to go to
her Executive Administrative Secretary and get a copy. When I received it, I noticed it was sent the prior
day to the Executive GLA Leadership. Yes, it stated to stop using the note. Within a few hours, the note
title was discontinued. Later that afternoon I was detailed to Quality Management. This happened on
July 8, 2016, a little over 36 years of VA work. On September 20, 2017 I was detailed to a System
Redesign position, and my supervisor was a detail from VA Fresno. Her detail ended on October 6, 2017.

On October 6, 2017 I received a proposed removal. On October 20, 2017 I replied to the proposed
action. On November 1, 2017, the removal was sustained. I will be removed as of November 7, 217.

Overall my first 36 years of VA employment were incredible. It was very challenging trying to staff for
vacancies not approved to recruit for. During 2015/2016 we were down up to 30-40 positions without
permission to hire. Introduction of new technology took years to get approved, if it was approved. Still I
developed a practice site pharmacists wanted to work in. Our process of moving forward was slow, but
we were moving forward.

What I see now is very disturbing. I have never experienced this in my life. I received outstanding
employment assessments, except for one exceptional, over my years as Chief of Pharmacy. The charges
leveled at me were intentionally mischaracterized and predominately unsubstantiated. It appears the
organization I devoted my life to has changed for the worse. There is no respect for employees,
especially those with years of experience and dedication. It appears the new mission of leadership is to
rid the VA of seasoned employees, without assessing the impact it may have on patient care. The truth
is, you need an experienced staff to navigate the Federal bureaucracy. You need seasoned staff, so that
there is a proper cessation plan in place. As the Chief of Pharmacy, I still worked in a rheumatology
clinic for over twenty years building my own personal relationship in caring for patients. I always
expected to continue my involvement as a WOC employee. That is not going to happen.

As of now I feel very anxious as the termination will mean a loss of my income and healthcare benefits.
As of this writing I haven’t been given any guidance on the checkout procedure or who can I go to
discuss my benefits options, if any, with. They intentionally targeted me, harassed me, created a hostile
work environment with the hope that I would retire. I see that now.

Prior to July 2016, I was the biggest advocate for VA Employment. I can’t say that now. Any
organization that does this to an employee is not one I can recommend to anybody. I am not alone as
several staff have told me that the environment here is toxic. I can’t agree more. Who is going to come
and work here?

Dear Honorable Secretary Dr. Shulkin,

I am writing to you regarding 38 U.S.C. 714, the VA Accountability and Whistleblower Protection Act
(ACT). I am a former VA Employee with over 37 years of service. I am currently in litigation appealing
the decision to remove me with the Merit Protection System Board. Our first hearing began on February
21, 2018. Two more hearing days are currently awaiting scheduling.

As a former service chief (Chief of Pharmacy at the VA Greater Los Angeles Healthcare System) for
nearly 14 years, I can understand and appreciate the benefits this ACT can provide to management staff.
As a victim of its use, I can see the abuse potential this ACT can lead to. Let me outline these points
below.

Unchecked Power: The ACT can remove an employee in 15 business days. The basis of the removal is
subjective and left in the hands of one individual: the medical center director. If sustained, it transfers
the burden and expense to the affected employee to conduct an appeal. A reasonable person would
understand that the incredible expense to carry out an appeal would be prohibitive. Most employees
cannot afford an appeal. This results in a higher number of employees being removed without a fair due
process. It has also been used a tool to force pension eligible employees into retirement to avoid
removal.

Protection is Not Really Protection: The ACT protects whistleblowers. This is factually true, but
practically false. If an employee can be removed in 15 business days, isn’t it reasonable for
whistleblower protection to be completed in the same time frame? If not, an employee that is removed
goes without a salary and benefits, while waiting for a whistleblower protection decision. This doesn’t
seem fair. The employee is now removed and has to wade through the protection process of an
overburdened OSC, EEO or OIG process, often without access to their evidence, as they no longer work
for the agency.

Guidance: It is my understanding that no guidance or training was given to Medical Center Directors.
Shortly after the ACT was signed you shared an e-mail with all staff discussing how you perceive it would
be used. Leaving the interpretation to diverse individuals leaves the VA vulnerable to litigation, while
the Judiciary branch adjudicates the ACT. We know Regional Counsels, OSC, OAWP, and EEO agencies
are overburdened with cases. This is a waste of resources that could be utilized on caring for those that
served, our Number One goal.

New laws are not perfect and this ACT certainly has issues. Laws are eventually tweaked to address
issues that arise after implementation. I offer you the following suggestions.

National Review Board: Removing an employee is a serious action that shouldn’t be taken lightly.
Livelihood and reputation are impacted. The result burdens an employee financially and most likely
impacts family life. I suggest creating a National Review Board consisting of individuals with diverse
professional backgrounds. This board would be tasked to review all removals in order to ensure proper
application and decisions are consistent throughout the systems. This way the power will be taken away
from a potentially “Rogue Director.”

Consistent Timeframes: If employees are really protected, ensure the timetable for whistleblower
protection is within the same time table as a removal. If it is 15 business days to remove, then it should
be 15 business days to protect an employee. An employee shouldn’t be removed while waiting for
protection. This is fair and levels the playing field.

Guidance: All executives who utilize this ACT, should be required to complete an annual mandatory
training program on the ACT. A table or list needs to be developed defining circumstances when the use
may be appropriate. Most likely, this would lead to less litigation, saving the Agency financial resources.

The VA Accountability and Whistleblower Protection Act has created a culture of fear in the VA. As
Secretary, you report the number of employees who have been removed, but how many have retired
because they see the abuse this ACT has created? This leads to brain drain and is detrimental to an
organization, as well as being harmful in a health care setting. As a healthcare provider yourself, an
open system is valuable for patient safety.

As my case moves forward, I hope you consider the points I have raised in the letter. My wife’s father,
aunt and uncle all served this country. I have a deep respect for our veterans and cared for so many
during my career. Yes, even as a pharmacy service Chief, I still participated in a half-day rheumatology
clinic. It is amazing to me that 38 U.S.C. 714 can remove an employee who worked for 37 years, who
received 14 outstanding and one excellent in his past 15 performance evaluations, who did not receive a
rating in FY16 and FY17, can be removed so easily.

 MERIT SYSTEMS PROTECTION BOARD
Appeal Form--Appellant and Agency Information

Please type or print legibly. OMB No. 3124-0009

1. Name (last, first, middle initial)
Sayers, Jeffrey , F.
2. Present Address (number and street, city, state, and zip code)
Address: 1977 S. Durango Ave

City, State, Zip Code: Los Angeles, California, 19344, United States of America
3. Telephone numbers (include area code) and E-Mail Address
You must notify the Board in writing of any change in your telephone number(s) or e-mail address while your appeal is pending.

Home: Work:
Fax: Cell: (310) 429-1313
E-mail Address: lakings31@gmail.com Other Phone Type: Mobile
4. Do you wish to designate an individual or organization to represent you in this proceeding before the Board? (You may designate a
representative at any time. However, the processing of your appeal will not normally be delayed because of any difficulty you may
have in obtaining a representative.)
✔ Yes No
5. Name, address, and telephone number of the agency that took the action or made the decisions you are appealing (include bureau
or division, street address, city, State and Zip code)
Agency Name: Department of Veterans Affairs
Bureau: VETERANS HEALTH ADMINISTRATION
Address:
11301 Wilshire Boulevard

City, State, Zip code: Los Angeles , California, 90073, United States of America
Agency Phone: (818) 891-7711 x38002
6. Your Federal employment status at the time of the decision 7. Type of appointment (if applicable):
or action you are appealing:

Temporary ✔ Permanent Applicant ✔ Competitive SES Excepted

Term Retired Seasonal Postal Service Other
None
8. Your occupational series, position title, grade, and duty station at the time of the 9. Are you entitled to veteran's preference?
decision or action you are appealing (if applicable): See 5 U.S.C. 2108.
Occupational Series Position Title:
0660 Chief, Pharmacy Service Yes ✔ No
or Cluster:
Duty Station:
Grade or Pay Band: GS 15 W/Los Angeles, CA

10. Length of Government Service (if applicable): 11. Were you serving a probationary, trial, or initial service period at
the time of the action or decision you are appealing?

37 Years 4 Months
Yes ✔ No

Appeal Number: 201704776

MSPB Form 185-1, Page 1 (5/13/2013)
Submission Date: 11/9/2017 5:26:32 PM 5 CFR Parts 1201, 1208, and 1209
Confirmation Number: 198418
 MERIT SYSTEMS PROTECTION BOARD
Appeal Form--Appellant and Agency Information

Please type or print legibly.

HEARING: You may have a right to a hearing before an administrative judge. If you elect not to have a hearing, the
administrative judge will make a decision on the basis of the submissions of the parties. Do you want a hearing?

12. Do you want a hearing? ✔ Yes No

E-Filing: Registration as an E-Filer enables the appellant to file any or all of his/her pleadings with the Board in electronic form.
Registration also means he/she consent to accept service of all pleadings filed by other registered E-Filers and all documents
issued by the Board in electronic form. he/she will receive these as PDF documents at the e-mail address you provided the
Board. If registered as an E-Filer, he/she may file any pleading, or portion of a pleading, by non-electronic means. The appellant
can withdraw his/her registration as an e-filer at any time.

13. Do you wish to register the appellant as an E-Filer in this appeal?

✔ Elect to E-file for appellant Decline to E-file for appellant

14. I certify that all of the statements made in this form and all attached forms are true, complete, and correct to
the best of my knowledge and belief.

Natalie Khawam, Appellant's Representative Date:

Appeal Number: 201704776

MSPB Form 185-1, Page 2 (5/13/2013)
Submission Date: 11/9/2017 5:26:32 PM 5 CFR Parts 1201, 1208, and 1209

Confirmation Number: 198418

 MERIT SYSTEMS PROTECTION BOARD
Designation of Representative Form

A representative helps and counsels a party in the preparation,
presentation, or defense of the case. The representative appears
with, or for, the party at hearings, settlement discussions,
teleconferences, or other proceedings before the Board. The
representative does not have to be an attorney. You may
proceed without a representative and represent yourself. You
may use this form to designate an organization or a person who
has agreed to represent you in your case before the Board. If
you are representing yourself, you do not need to fill out this
form. (The Board’s regulations on representatives are found at 5
CFR 1201.31.) By designating a representative, you agree to
allow the Board to give your representative all information
concerning the appeal.
The address and telephone number of the representative must
be correct so that all communications are received on time by
the representative. Any changes of this designation must
be sent in writing to the MSPB office handling the case
and to the other party.
If you file this designation WITH your appeal, the Board
will send a copy of the designation, along with a copy of
your appeal, to the other party. If you file this designation
AFTER you have filed your appeal, you MUST send a copy
to the other party and you MUST send proof to the Board
that you have sent a copy to the other party.

Please type or print legibly. OMB No. 3124-0009

DESIGNATION: The individual or organization named below is hereby designated to represent:

NAME AND ADDRESS OF APPELLANT:

Khawam, Natalie
"I hereby designate ____________________________________ to serve as my representative during the course of
this appeal. I understand that my representative is authorized to act on my behalf. In addition, I specifically delegate to
my representative the authority to settle this appeal on my behalf. I understand that any limitation on this
settlement authority must be filed in writing with the Board."

Representative's address (number and street, city, State and Zip Representative's telephone numbers (include area code)

Address: Office: (813) 944-7853

400 N. Tampa Street
Fax: (813) 434-2173
Other:
City, State, Zip Tampa, Florida, 33602, United States of
code: Other Phone Type:

Representative's Whistleblower Law Firm

employer name: E-mail Address: nataliek@813whistle.com

Representative's Entity Type: Private Attorney

Service Method for Representative :

✔ Electronic Filing US Postal Mail

Jeffrey F. Sayers
Appellant's Signature Date

Please send this form with your appeal if you are designating a representative. If you do so after you have filed your appeal,
send this form to the Board office where your appeal is pending, and provide a copy to the other party. Board regulations
require that all copies of your communications with the Board after an appeal has been filed be served on the other party.

Appeal Number: 201704776

MSPB Form 185-4 (5/13/2013)
Submission Date: 11/9/2017 5:26:32 PM 5 CFR Parts 1201, 1208, and 1209
Confirmation Number: 198418
 MERIT SYSTEMS PROTECTION BOARD
Appeal of Agency Personnel Action or Decision (Non-retirement)

Complete this form and attach it to MSPB Form 185-1 if you are appealing an agency personnel action or decision (other than a
decision or action affecting your retirement rights or benefits) that is appealable to the Board under a law, rule, or regulation. If the
personnel See 5 CFR 1201.3(a) for a list of appealable personnel actions and action or decision is appealable to the Board, you
should have received a final decision letter from the agency that informs you of your right to file an appeal with the Board.

Please type or print legibly. OMB No. 3124-0009

Please submit only the attachments requested in this form at this time. You will be afforded the opportunity to submit detailed evidence
in support of your appeal later in the proceeding.

Name (last, first, middle initial) Sayers, Jeffrey , F.

1. Check the box that best describes the personnel action or decision taken by the agency you named in MSPB Form 185-1 that you are
appealing. (If you are appealing more than one action or decision, check each box applies.)

Veterans Administration Senior Executive Service Removal Veterans Administration Senior Executive Service Transfer to
from civil service general schedule
✔ Removal (Termination after completion of probationary or initial service period) Involuntary Resignation
Termination during probationary or initial service period Involuntary Retirement
Reduction in grade or pay Suspension for more than 14 days
Separation, demotion, or furlough for more than 30 days by reduction in force (RIF) Furlough of 30 days or less
Denial of within-grade increase Failure to restore/reemploy/reinstate or improper restoration/reemployment/reinstatement
Negative suitability determination
Other action or decision (describe):
2. 3.
Date you received the agency's final decision letter (if any) Effective date (if any) of the agency action or decision (month, day,
(month, day, year) (Attach a copy) year)

11/01/2017 11/07/2017
4.
Prior to filing this appeal, did you and the agency mutually agree in writing to try to resolve the matter through an alternative dispute
resolution (ADR) process?
Yes ✔ No

5. Explain briefly why you think the agency was wrong in taking this action. In challenging such an action, you may choose to allege that
the agency engaged in harmful procedural error, committed a prohibited personnel practice, or engaged in one of the other claims
listed in Appendix A. Attach the agency's proposal letter, decision letter, and SF-50, if available.

See Continuation Sheet for Response.

Appeal Number: 201704776 MSPB Form 185-2, Page 1 (5/13/2013)

Submission Date: 11/9/2017 5:26:32 PM 5 CFR Parts 1201, 1208, and 1209
Confirmation Number: 198418
 MERIT SYSTEMS PROTECTION BOARD
Appeal of Agency Personnel Action or Decision (Non-retirement)

Please type or print legibly.

6.
With respect to the agency personnel action or decision you are appealing, have you, or has anyone on your behalf, filed a grievance
under a negotiated grievance procedure provided by a collective bargaining agreement?

Yes ✔
No

7.
If your answer to question 6 is "Yes," on what date was the grievance filed (month, day, year)?
NOT APPLICABLE

8. If your answer to question 6 was "Yes," has a decision on the grievance been issued?

NOT APPLICABLE

9. Did you file a whistleblowing complaint with the Office of Special Counsel (OSC)?

Yes ✔ No

10. Have you received written notice that the Office of Special Counsel made a decision or terminated its investigation?

NOT APPLICABLE

11.
Did you file a complaint on this matter with the Department of Labor (DOL)?

Yes ✔ No

12. Has the Department of Labor notified you that your USERRA or VEOA complaint could not be resolved?

NOT APPLICABLE

Appeal Number: 201704776

MSPB Form 185-2, Page 2 (5/13/2013)
Submission Date: 11/9/2017 5:26:32 PM
5 CFR Parts 1201, 1208, and 1209
Confirmation Number: 198418
 Merit Systems Protection Board Form 185-2
Appeal of Agency Personnel Action or Decision (Non-retirement)

Continuation Sheet

5. Explain briefly why you think the agency was wrong in taking this action. In challenging such an action, you may choose to
allege that the agency engaged in harmful procedural error, committed a prohibited personnel practice, or engaged in one of
the other claims listed in Appendix A. Attach the agency's proposal letter, decision letter, and SF-50, if available.

The agency action:

(1) Shows harmful error in the application of the agency's procedures in arriving at its decision (as defined in § 1201.4(r));
(2) Shows that the decision was based on any prohibited personnel practice described in 5 U.S.C. 2302(b); or
(3) Shows that the decision was not in accordance with law.

Appeal Number: 201704776 MSPB Form 185-2 Continuation Sheet

Submission Date: 11/9/2017 5:26:32 PM
Page 1
Confirmation Number: 198418
 e-Appeal Attachment Transmittal
Appeal Number: 201704776
Appellant Name: Dr. Jeffrey F Sayers
Agency Name: Department of Veterans Affairs

Please check the box for each document included with this transmittal.

Name of Attachment Attachment Processing Status File Name/Delivery Method

Agency Proposal Letter Upload with e-Appeal J. Sayers Notice of Proposed Removal and
Evidence File .pdf
Agency Decision Letter Upload with e-Appeal Sayers Decision signed 11:01:17.pdf

Designation of Representative Document not available or not N/A

Form applicable
SF-50, Notification of Personnel Document not available or not N/A
Action applicable
2 copies must be submitted of all documents submitted in hardcopy.
Send documents to be submitted in paper form to:
Western Regional Office
1301 Clay Street, Suite 1380N
Oakland, California 94612-5217
United States of America

Phone: (510)273-7022
Fax: (510)273-7136

Appeal Number: 201704776 Attachment Transmittal Sheet

Submission Date: 11/9/2017 5:26:32 PM
Page 1
Confirmation Number: 198418