By Anna Wysen and  Maya Efrati
Jacob Gardner and JJ Zeng contributed to this story.

Whistleblowers expose crimes that occur under the radar – they bring light to fraud, abuse, and corruption. But what if that fraud leads to death or illness? Such instances are quite possible in healthcare crimes, and whistleblowers have a history of exposing those risky medical practices. From uncovering patient abuse by the Tuskegee Institute, fraudulent blood tests by Theranos, unsafe practices by a doctor in Texas, and a bribery scandal from Beaumont, whistleblowers of healthcare scandals have saved lives.

The Tuskegee Syphilis Experiment

The Tuskegee Syphilis Experiment involved unethical and illegal conduct by the U.S. Public Health Service (USPHS) while conducting a study in Tuskegee, Alabama. Beginning in 1932, the government lured African-American men into an experiment which studied the natural progression of syphilis if left untreated. All participants were misled and given incomplete information about the purpose of the study, denying them informed consent and causing them severe pain and death. The study continued for decades – even after penicillin was accepted as a treatment for syphilis.

Whistleblower Peter Buxtun, an epidemiologist at the USPHS, became aware of this malpractice and brought it to the attention of the press. As a result, Congress was quick to pass the National Research Act of 1974. This act established the Office for Human Research Protections (OHRP), protecting the rights of individuals in clinical studies. Buxtun’s bravery led to protections for those most vulnerable against pernicious ill treatment by the government.

The Nurses of Winkler County, Texas

But healthcare fraud continued to be discovered. In Winkler County, Texas, two nurses discovered in 2009 that a doctor at their hospital was giving unsafe medical care to patients and alerted the hospital board. However, they faced retaliation for speaking up: they were fired from their jobs and faced criminal charges.

As a result of the outcry when the retaliation became public, Texas legislators enacted protection for medical whistleblowers into their existing whistleblower laws.

Faulty Blood Tests by Theranos

Decades later, in October 2015, the Wall Street Journal broke the story that health technology company Theranos was a massive and intentional fraud. The company claimed they invented a new method to make blood tests quicker and cheaper. Theranos instead knowingly provided patients with results that were often false.

Whistleblower Tyler Schultz’s initial attempts to internally report the problem were stymied and disregarded. Schultz worked with journalist John Carreyrou to showcase how Theranos carried out one of the biggest biomedical scandals in history. Criminal indictments were later filed against Theranos founder Holmes and COO Balwani.

Beaumont Health Bribery

Still, medical fraud continues. Just this past month, Dr. David Felten spoke out about blowing the whistle in a $84.5 million Beaumont Health settlement. The doctor served as a neuroscientist and medical director from 2005 to 2013. During this time, Dr. Felten and three other whistleblowers alleged that Beaumont bribed and overpaid eight medical doctors to keep them with the company. According to Dr. Felten, the hospital’s “lack of integrity in their financial dealings” places their “integrity in clinical practice or research” into question.

Unfortunately, Dr. Felten’s case is not unique. Medical misconduct often occurs out-of-sight and insiders such as Dr. Felten are integral to bringing the truth to the public. Unfortunately, whistleblowers are often not acknowledged for their acts of bravery; in fact, many are often ostracized, marginalized, or forced to resign.

Retaliation and the necessity of Reward Laws

When writer Carl Elliot recounted Peter Buxtun’s story in The American Scholar, he noted the heroism and bravery of whistleblowers came at a cost. Elliot analyzed experiences of whistleblowers who exposed healthcare fraud, noting that they took

“extraordinary risks, such as smuggling files out of the company or wearing a wire to meetings, yet federal investigators treated them…as if they were complicit in the crimes.”

Analyses like Elliot’s confirm that unfair retaliation threatens whistleblowing and why reward laws are imperative. Stephen M. Kohn, the Executive Director of the National Whistleblower Center and expert on whistleblower laws, stressed that

“whistleblower reward laws… protect whistleblowers from retaliation [and] compensate them for risking their careers.”

Conclusion

In his 2018 National Whistleblower Day speech, Senator Chuck Grassley, Chairman of the Senate Committee on the Judiciary and the founder of the bipartisan Senate Whistleblower Protection Caucus, affirmed that celebrating whistleblowers should be “a time-honored American tradition,” but unfortunately, it is, “timely, but not always honored.”  Whistleblowers often endure immense backlash despite the nobility of their actions. After exposing fraud at Theranos, Tyler Schultz found himself alienated from his family.  The nurses from Winkler County were unable to find new jobs.  However, over time, there is a greater recognition of the bravery of whistleblowers, and so positive responses to blowing the whistle have been growing. For the nurses in Winkler County, 2010 brought awards for their bravery, and both were later able to restart their careers.

Reparations from the Tuskegee experiment can be considered a paradigm of shifting culture. After the study was halted, the government gave lifetime healthcare and medical benefits to all participants and their families. President Clinton apologized for the misconduct in 1997 on behalf of the government. For his bravery, Peter Buxtun was given the James Madison Whistleblower Award and is widely heralded as an American hero.

Creating a culture of positive reinforcement for whistleblowing is central to the mission of the NWC. Acceptance and appreciation for whistleblowers is imperative if we hope to unearth hidden fraud and abuse in all industries, but especially the medical industry. The goal of ingraining the value of whistleblowers in society is crucial. Whistleblowers should be viewed not as informers (“rats”), but instead as productive and positive members of an active civil society, and as tools for good governance. Corporate culture should welcome whistleblowers as part a well-run internal compliance program to root out malfeasance. As Senator Grassley declared, “history has shown us over and over again how much our country needs whistleblowers.” It’s time that expressing gratitude toward those who disclose malpractice and fraud is part of the American social fabric.