Hessami v. MSPB ( 2020 )


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  • Case: 19-2291   Document: 46    Page: 1     Filed: 11/09/2020
    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.
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    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 jurisdic-
    tion. We hold that for purposes of the Board’s jurisdiction
    under the Whistleblower Protection Act (“WPA”), when de-
    termining whether an appellant has non-frivolously al-
    leged 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, ac-
    cepted 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 pro-
    ceedings.
    BACKGROUND
    Between 2012 and 2016, Dr. Hessami served as the
    Chief of Pharmacy at the VA Medical Center in Martins-
    burg, 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 enor-
    mously 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 Affi-
    davit, J.A. 989–94 (“Aff.”), ¶ 4. Along with the budget, the
    regional VISN provided treatment guidelines for admin-
    istration 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 guide-
    lines, monitored all purchases of HCV medications, and
    provided weekly reports of purchases and relevant
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    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 re-
    gional VISN, and worked with the Center’s Chief of Staff,
    Jonathan Fierer, and the Chief of Medicine, Deborah Ben-
    nett, 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. Hes-
    sami on multiple occasions raised concerns about the pre-
    scribing practices of Dr. Trent Nichols, M.D., one of the
    physicians at the Center who treated HCV patients. Ac-
    cording to Dr. Hessami, Dr. Nichols did not have any expe-
    rience 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 recom-
    mended 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.
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    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 expos-
    ing 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 be-
    yond the length of treatment guidelines.” Id. at ¶¶ 23, 43.
    Following one such meeting, she sent an email, dated Feb-
    ruary 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 or-
    dering practices regarding Hep C medications,
    which will compromise the reimbursement funds
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    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 pa-
    tients on S&S, he had appeared to understand. She sug-
    gested 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.
    B. Suspension and Demotion
    In late 2015, a pharmacy employee accused Dr. Hes-
    sami of misconduct, and Dr. Hessami was suspended and
    later demoted for charges of conduct unbecoming a super-
    visor. Following her demotion, Dr. Hessami filed a com-
    plaint with the Office of Special Counsel (“OSC”) under the
    WPA alleging that she had been accused of wrongdoing and
    punished as reprisal for her protected disclosures regard-
    ing the agency’s spending on HCV drugs. When OSC de-
    clined to take action, she filed an individual-right-of-action
    (“IRA”) appeal to the Merit Systems Protection Board un-
    der 
    5 U.S.C. § 1221
    .
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    6                                          HESSAMI   v. MSPB
    The VA moved to dismiss her appeal for lack of juris-
    diction, asserting that Dr. Hessami had failed to ade-
    quately establish that she had made protected
    whistleblower disclosures pursuant to the Whistleblower
    Protection Enhancement Act (“WPEA”). 1 J.A. 39–42. Be-
    cause the parties had already completed discovery, the
    Agency set forth a statement of facts as part of its motion
    that cited to affidavits and deposition testimony from both
    parties’ witnesses as well as documentary evidence. See
    J.A. 33–38.
    The Board granted the VA’s motion to dismiss. In its
    decision, the Board adopted many of the VA’s proposed
    statements of fact, relying heavily on statements from
    Agency witnesses. In particular, the opinion set forth the
    following representations from Dr. Bennett as “essentially
    undisputed”:
    •   The appellant did not raise with [Dr. Bennett], nor
    was there ever a concern over, patient safety with
    Dr. Nichols’s prescribing practices.
    •   Dr. Nichols’s treatment plans were discussed with
    the HIT, wherein he would always present research
    and documentation to support his treatment ap-
    proach; and the HIT always approved his treatment
    plans and medications chosen.
    •   With respect to length of treatment, only a small
    number of patients were extended beyond the typi-
    cal course, but those cases presented complex
    1   The WPA, effective since 1989, provides the gen-
    eral framework of the whistleblower protection pro-
    cess. The WPEA of 2012 made certain amendments to the
    existing WPA framework regarding, as relevant to this
    case, the scope of protected disclosures and the definition
    of “personnel action.”
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    HESSAMI     v. MSPB                                           7
    clinical issues and Dr. Nichols looked at their clini-
    cal needs based on his long history and experience.
    •      Dr. Nichols monitored the patients’ lab values, and
    all cases were presented, justified by research, and
    approved by the HIT.
    •      Dr. Nichols’s treatment choices were recognized as a
    standard of care and cited in current literature
    sources.
    •      There were clinical reasons to support the use of the
    older drugs over the newer, less expensive drugs.
    J.A. 6.
    Based on the record evidence, the Board concluded that
    Dr. Hessami failed to make non-frivolous allegations of a
    violation of law, rule or regulation; or gross mismanage-
    ment, gross waste of funds, abuse of authority, or a sub-
    stantial and specific danger to public health or safety. The
    Board found that Dr. Hessami’s disclosures constituted
    mere disagreement over “fairly debatable” “questions of
    policy” and were thus “not the type of communications pro-
    tected by the WPEA.” J.A. 14–16. With respect to the
    waste of funds and danger to public health or safety factors,
    the Board found that Dr. Hessami had failed to explain
    why the expenditures she discussed were out of proportion
    to the expected benefits of the treatment and had further
    failed to identify any patients who were actually harmed
    by Dr. Nichols’s prescribing practices. J.A. 13–14. On
    these grounds, the Board dismissed Dr. Hessami’s appeal
    for lack of jurisdiction.
    Dr. Hessami petitioned for review in this court. We
    have jurisdiction under 
    28 U.S.C. § 1295
    (a)(9).
    DISCUSSION
    The Board has jurisdiction over an IRA appeal under
    the WPA, 
    5 U.S.C. § 1221
    , if the appellant has exhausted
    her administrative remedies before the OSC and makes
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    8                                            HESSAMI   v. MSPB
    “non-frivolous allegations” that (1) she engaged in whistle-
    blowing activity by making a protected disclosure under
    
    5 U.S.C. § 2302
    (b)(8), and (2) the disclosure was a contrib-
    uting factor in the agency’s decision to take or fail to take
    a personnel action. 
    5 U.S.C. § 1221
    ; Yunus v. Dep’t of Vet-
    erans Affairs, 
    242 F.3d 1367
    , 1371–72 (Fed. Cir. 2001). A
    protected disclosure under Section 2302(b)(8) is one which
    the employee “reasonably believes evidences (i) any viola-
    tion of any law, rule, or regulation, or (ii) gross mismanage-
    ment, a gross waste of funds, an abuse of authority, or a
    substantial and specific danger to public health or safety.”
    5 U.S.C § 2302(b)(8).
    Dr. Hessami contends that the Board erred in crediting
    the agency’s evidence against her in finding that she failed
    to make non-frivolous allegations of a protected disclosure.
    Whether the Board has jurisdiction over an appeal is a
    question of law we review de novo. Forest v. Merit Sys.
    Prot. Bd., 
    47 F.3d 409
    , 410 (Fed. Cir. 1995).
    A. Non-Frivolous Allegation
    We first clarify the appropriate scope of the Board’s in-
    quiry when evaluating its jurisdiction over a whistleblower
    appeal. In Spruill v. Merit Sys. Prot. Bd., this court held
    that the threshold question of whether an appellant has in-
    voked the Board’s jurisdiction should be assessed under a
    “non-frivolous allegation” standard analogous to the “well-
    pleaded complaint rule” used to evaluate federal question
    jurisdiction in federal court. 
    978 F.2d 679
    , 687–89 (Fed.
    Cir. 1992). We explained that “under the ‘well-pleaded
    complaint rule,’ whether a district court has federal-ques-
    tion jurisdiction over a claim ‘must be determined from
    what necessarily appears in the plaintiff’s statement of his
    own claim in the bill or declaration.’” 
    Id. at 688
     (quoting
    Christianson v. Colt Indus. Operating Corp., 
    486 U.S. 800
    ,
    809 (1988)).
    Our subsequent cases have evaluated jurisdiction in
    whistleblower cases based on whether allegations were
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    HESSAMI   v. MSPB                                            9
    facially sufficient. See Johnston v. Merit Sys. Prot. Bd.,
    
    518 F.3d 905
    , 910 (Fed. Cir. 2008); Yunus, 
    242 F.3d at 1372
    . This court has consistently treated “a non-frivolous
    allegation” of an element as one that, “‘if proven, can estab-
    lish the Board’s jurisdiction.’” Cahill v. Merit Sys. Prot.
    Bd., 
    821 F.3d 1370
    , 1373 (Fed. Cir. 2016) (quoting Garcia
    v. Dep’t of Homeland Sec., 
    437 F.3d 1322
    , 1330 (Fed. Cir.
    2006) (en banc)). Most recently, in Piccolo v. Merit Sys.
    Prot. Bd., we stated that “at the jurisdictional stage, a pe-
    titioner need only assert non-frivolous allegations—allega-
    tions that are not ‘vague, conclusory, or facially
    insufficient,’ and that the petitioner ‘reasonably believe[s]’
    to be true—of a protected disclosure that was a contrib-
    uting factor to a reprisal.” 
    869 F.3d 1369
    , 1371 (Fed. Cir.
    2017) (quoting Johnston, 
    518 F.3d at 910
    ). We held there
    that evidence concerning “a petitioner’s credibility includ-
    ing . . . consideration of affidavits submitted by an allegedly
    retaliatory supervisor . . . ‘relates to the merits of the
    claim’” rather than jurisdiction. Piccolo, 869 F.3d at 1371
    (quoting Johnston, 
    518 F.3d at 911
    ).
    In 2015, the Board codified the non-frivolous allegation
    standard in its regulations at 
    5 C.F.R. §§ 1201.57
    (b) and
    1201.4. See Practices and Procedures, 
    80 Fed. Reg. 4489
    (Jan. 28, 2015). Section 1201.57(b) provides that an appel-
    lant who initiates a whistleblower appeal “must make non-
    frivolous allegations . . . with regard to the substantive
    jurisdictional elements” 2 of the appeal.          
    5 C.F.R. § 1201.57
    (b). Section 1201.4 defines a “nonfrivolous alle-
    gation” as “an assertion that, if proven, could establish the
    matter at issue” and specifies that “[a]n allegation gener-
    ally will be considered nonfrivolous when, under oath or
    penalty of perjury, an individual makes an allegation that:
    2  This excludes the non-merits elements of exhaus-
    tion and standing, which must be established by prepon-
    derance of the evidence.
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    10                                           HESSAMI   v. MSPB
    (1) Is more than conclusory; (2) Is plausible on its face; and
    (3) Is material to the legal issues in the appeal.” 
    Id.
     at
    § 1201.4(s).
    We recognize that this court has, on at least one occa-
    sion, analogized the standard for establishing non-frivo-
    lous allegations to the standard for summary judgment.
    See Kahn v. Dep’t of Justice, 
    528 F.3d 1336
    , 1341 (Fed. Cir.
    2008) (“The standard for determining whether non-frivo-
    lous disclosures exist ‘is analogous to that for summary
    judgment.’” (quoting Dorrall v. Dep’t of the Army,
    
    301 F.3d 1375
    , 1380 (Fed. Cir. 2002))). We did not, how-
    ever, actually apply the summary judgment standard to
    authorize jurisdictional dismissal of a whistleblower ap-
    peal based on evidence submitted by the agency. To the
    extent the “summary judgment” analogy suggests that
    such a dismissal would be proper, it is plainly contrary to
    both the Board’s current regulations and our holding in
    Spruill. 3
    3   The “summary judgment” analogy in Kahn was
    borrowed from Dorrall, 
    301 F.3d at 1380
    , which turned on
    the question of constructive discharge, a question that we
    have since held to be subject to a “preponderance of evi-
    dence” test for jurisdictional purposes rather than non-friv-
    olous allegations. See Garcia, 
    437 F.3d at 1325
    . Although
    in certain pre-Spruill cases, we approved of the Board’s re-
    liance on the agency’s evidence in finding no jurisdiction,
    those cases involved direct appeals under 
    5 U.S.C. § 7513
    (d), where the threshold jurisdictional question was
    whether the employee suffered an appealable personnel ac-
    tion, a determination that is subject to the preponderance
    of the evidence standard. See Manning v. Merit Sys. Prot.
    Bd., 
    742 F.2d 1424
    , 1428 (Fed. Cir. 1984) (relying on agency
    evidence in concluding that employee was not suspended
    for more than 14 days); Wilson v. Merit Sys. Prot. Bd.,
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    HESSAMI   v. MSPB                                         11
    Permitting jurisdictional dismissal of an appeal based
    on a summary review of the evidence on the core merits
    issues would undermine Congress’s express intent that the
    merits of employee appeals be resolved through a hearing
    rather than summary judgment. As we explained in Cris-
    pin v. Dep’t of Commerce, Section 7701 expressly provides
    that in any appeal to the Board, “[a]n appellant shall have
    the right to a hearing for which a transcript will be kept,”
    and the legislative history made clear that the provision
    was meant to bar summary judgment. 
    732 F.2d 919
    , 922
    (Fed. Cir. 1984) (citing 
    5 U.S.C. § 7701
    (a)(1); H.R. REP.
    NO. 95–1717, at 137 (1978), as reprinted in 1978
    U.S.C.C.A.N. 2860, 2871). Thus, this court held in Crispin
    that even when the documentary record clearly supports
    judgment for the agency, the appellant is nonetheless enti-
    tled to a hearing on the merits as a matter of statutory
    right. 4 Crispin, 
    732 F.2d at 922
    . A summary judgment
    standard for “non-frivolous allegations” would allow the
    agency to circumvent that rule and obtain the equivalent
    of summary judgment on the merits by merely framing its
    motion as one for jurisdictional dismissal.
    We thus clarify and hold that when evaluating the
    Board’s jurisdiction over a whistleblower action, the ques-
    tion of whether the appellant has non-frivolously alleged
    protected disclosures that contributed to a personnel action
    
    807 F.2d 1577
    , 1583 (Fed. Cir. 1986) (relying on agency ev-
    idence in concluding that employee had not been reduced
    in grade).
    4    The Board, in recognition of our holdings, declined
    to promulgate a process for summary judgment. Practices
    and Procedures, 
    77 Fed. Reg. 62350
    , 62352 (Oct. 12, 2012)
    (rejecting suggestion to create summary judgment proceed-
    ings because “[t]he Court of Appeals for the Federal Circuit
    has found that the MSPB lacks authority to order sum-
    mary judgment.”).
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    12                                            HESSAMI   v. MSPB
    must be determined based on whether the employee al-
    leged sufficient factual matter, accepted as true, to state a
    claim that is plausible on its face. 5 The Board may not
    deny jurisdiction by crediting the agency’s interpretation of
    the evidence as to whether the alleged disclosures fell
    within the protected categories or whether the disclosures
    were a contributing factor to an adverse personnel action.
    With these principles in mind, we turn to the allega-
    tions in this case.
    B. Protected Disclosures
    Fairly construed, the crux of Dr. Hessami’s allegations
    is that a VA physician, Dr. Nichols, was prescribing the
    more expensive S&S regimen to patients rather than the
    substantially less expensive alternatives, Harvoni and Vie-
    kiri, and he was prescribing S&S to patients for substan-
    tially longer courses of treatment than necessary or
    recommended. She alleges that she was knowledgeable
    about the local and national HCV treatment guidelines,
    and that Dr. Nichols’s prescription practices were contrary
    to those guidelines. She alleges that the extended treat-
    ment exposed patients to substantially increased exposure
    5     It does not follow from this, however, that the
    Board is restricted to considering these allegations in a vac-
    uum. As the Supreme Court has explained regarding the
    analogous well-pleaded complaint rule, “[d]etermining
    whether a complaint states a plausible claim for relief
    will . . . be a context-specific task that requires the review-
    ing court to draw on its judicial experience and common
    sense.” Ashcroft v. Iqbal, 
    556 U.S. 662
    , 679 (2009). And,
    consistent with that analogous rule, the Board may also
    consider sources such as “matters incorporated by refer-
    ence or integral to the claim, items subject to judicial no-
    tice, [and] matters of public record.” See A & D Auto Sales,
    Inc. v. United States, 
    748 F.3d 1142
    , 1147 (Fed. Cir. 2014).
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    HESSAMI   v. MSPB                                          13
    to adverse drug reactions and side effects for patients and
    that Dr. Nichols’s choice of drugs and duration of therapy
    resulted in hundreds of thousands of dollars in excess costs
    for the Center. We can infer from her allegations that at
    the time Dr. Hessami made her disclosures, she believed,
    as she suggested to others, that Dr. Nichols’s decisions to
    depart from treatment guidelines were not otherwise justi-
    fied. This is supported by her allegations that she con-
    fronted Dr. Nichols during meetings to ask him to justify
    his prescribing practices, and that afterwards, Dr. Bennett
    felt it was appropriate to block all prescriptions of S&S and
    to require Dr. Nichols to justify his prescription decisions
    in writing. See Cahill, 821 F.3d at 1373–74 (reading alle-
    gations “with an eye on likely inferences appropriate to the
    context” in assessing whether they were non-frivolous and
    plausible).
    These allegations are “non-frivolous” within the mean-
    ing of 
    5 C.F.R. § 1201.4
    . They were made “under oath” in
    Dr. Hessami’s affidavit. They describe a “facially plausi-
    ble” series of events. They are not merely “conclusory” be-
    cause they set forth specific facts supporting Dr. Hessami’s
    beliefs of wrongdoing.
    The allegations are also “material” because, if accepted
    as true, they are sufficient to support a reasonable belief of
    gross waste, gross mismanagement, and danger to public
    health. Specifically, assuming that Dr. Hessami’s allega-
    tions reflect the facts reasonably known to her at the time
    she made her disclosures, a person in her position could
    reasonably believe that the additional cost of the therapy
    prescribed by Dr. Nichols constituted gross waste because
    it was significantly out of proportion to the additional “ben-
    efit reasonably expected to accrue to the government.” See,
    e.g., Chambers v. Dep’t of Interior, 
    515 F.3d 1362
    , 1366
    (Fed. Cir. 2008). We assume, as we must at this stage, that
    Dr. Hessami reasonably believed that Dr. Nichols failed to
    provide clinical justification for his prescribing decisions.
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    14                                           HESSAMI   v. MSPB
    A reasonable person could also conclude that the same
    prescribing practice constituted gross mismanagement be-
    cause the unjustified higher cost of the therapies was likely
    to have a substantial detrimental impact on the Center’s
    ability to complete its mission of providing care to HCV pa-
    tients because the prescriptions were rapidly depleting the
    Center’s HCV budget. See Wen Chiann Yeh v. Merit Sys.
    Prot. Bd., 527 F. App’x 896, 900 (Fed. Cir. 2013). This be-
    lief could be reasonable even if it was eventually confirmed
    that the Center would be able to secure additional funding.
    Similarly, if we accept as true Dr. Hessami’s allegation
    that Dr. Nichols was prescribing S&S to patients for longer
    than their recommended durations without clinical justifi-
    cation for doing so, a reasonable person in Dr. Hessami’s
    position could conclude that those prescriptions created a
    substantial and significant danger to public health. The
    mere fact that the prescription policy for HCV treatments
    was heavily debated does not strip whistleblower protec-
    tion from disclosures about specific prescription decisions
    that the whistleblower reasonably believes endangered pa-
    tients. See Chambers, 
    515 F.3d at 1368
     (“[G]eneral criti-
    cism by an employee of the Environmental Protection
    Agency that the Agency is not doing enough to protect the
    environment would not be protected under this subsection.
    However, an allegation by a Nuclear Regulatory Commis-
    sion engineer that the cooling system of a nuclear reactor
    is inadequate would fall within the whistle blower protec-
    tions.” (quoting S. REP. NO. 95–969, at 21 (1978), as re-
    printed in 1978 U.S.C.C.A.N. 2723, 2744)). Here, Dr.
    Hessami’s allegations amount to more than a general as-
    sertion that the VA is neglecting the health of its HCV pa-
    tients. Even if she is unable to identify specific patients
    who were harmed, the allegation that a specific govern-
    ment physician is directing patients to take medications
    with known risks and side effects for an unnecessarily long
    period of time, paired with her reasonable belief that there
    was no clinical justification for doing so, does not represent
    Case: 19-2291        Document: 46   Page: 15   Filed: 11/09/2020
    HESSAMI   v. MSPB                                         15
    a “negligible, remote, or ill-defined peril that does not in-
    volve any particular person, place, or thing, is not pro-
    tected.” Chambers, 
    515 F.3d at
    1368–69 (citation omitted).
    At the jurisdictional stage, the allegations have sufficient
    specificity and substantiality to support a reasonable belief
    that Dr. Nichols’s prescribing practices constituted a sub-
    stantial and specific danger to public health.
    In concluding that Dr. Hessami’s disclosures were not
    entitled to protection, the Board found that the substance
    of the disclosures constituted “disagreement over questions
    of policy” and “evidence of robust debate on how effective-
    ness of the Hep[atitis] C care should be measured and how
    disputes concerning such treatment should be managed.”
    J.A. 14. However, in enacting the WPEA in 2012, Congress
    made clear that policy decisions and disclosable miscon-
    duct under the WPA are not mutually exclusive. See
    S. REP. NO. 112–155, at 7–8 (2012), as reprinted in 2012
    U.S.C.C.A.N. 589, 595–96. The fact that there was an on-
    going debate about the most effective and efficient means
    for providing HCV care to patients does not exclude allega-
    tions of misconduct about such care from whistleblower
    protection.
    In finding that the substance of Dr. Hessami’s allega-
    tions could not amount to misconduct, the Board assumed,
    based on the testimony of agency witnesses as cited in the
    opinion, that Dr. Nichols’s prescribing choices were clini-
    cally justified, and that this should have been known to Dr.
    Hessami. That assumption was impermissible at the stage
    of the proceedings, where the question is the sufficiency of
    Dr. Hessami’s allegations to invoke the Board’s jurisdic-
    tion. Regardless of whether the agency may ultimately
    prove on the merits that Dr. Nichols’s prescribing decisions
    were discernibly reasonable, Dr. Hessami has adequately
    alleged a reasonable belief that they were not. The issue
    should therefore be resolved at a hearing.
    Case: 19-2291     Document: 46    Page: 16   Filed: 11/09/2020
    16                                          HESSAMI   v. MSPB
    For these reasons, the Board erred in dismissing Dr.
    Hessami’s appeal for failure to allege protected disclosures
    as to gross mismanagement, a gross waste of funds, and a
    substantial and specific danger to public health. 6 We
    therefore vacate the Board’s dismissal and remand for fur-
    ther proceedings.
    C. Contributing Factor in Personnel Action
    To establish jurisdiction, an appellant must establish
    not only that she exhausted her administrative remedies
    and made protected disclosures, but also that the disclo-
    sures were a contributing factor in a “personnel action”
    within the scope of the WPEA. Because the Board dis-
    missed Dr. Hessami’s appeal based on failure to allege pro-
    tected disclosures, the Board did not reach whether she
    had sufficiently alleged contribution to a personnel action.
    Because neither the Board nor the VA provided any rea-
    soning for why Dr. Hessami’s allegations are inadequate to
    show that her disclosures contributed to her demotion or
    that her demotion constituted a personnel action, we are
    unable to make that determination in the first instance
    based on the record before us. Thus, on remand, the Board
    should evaluate the remaining substantive element for
    WPA jurisdiction before proceeding with a hearing on the
    merits.
    6  We agree with the Board that Dr. Hessami made
    no specific allegation for why she reasonably believed that
    her disclosures evidenced a violation of law, rule, or regu-
    lation. Even on appeal, she fails to raise any colorable ar-
    gument for why Dr. Nichols’s departure from treatment
    guidelines would constitute a violation of law, and she
    points to no other sources of law that were violated by the
    conduct she disclosed.
    Case: 19-2291        Document: 46   Page: 17   Filed: 11/09/2020
    HESSAMI   v. MSPB                                         17
    CONCLUSION
    For the reasons discussed, we conclude that Dr. Hes-
    sami made non-frivolous allegations that she made disclo-
    sures she reasonably believed evidenced gross
    mismanagement, a gross waste of funds, and a substantial
    and specific danger to public health. We thus vacate the
    Board’s dismissal of Dr. Hessami’s appeal and remand for
    the Board to assess in the first instance whether she non-
    frivolously alleged that her disclosures were a contributing
    factor to a personnel action against her, so as to invoke the
    Board’s jurisdiction. If her allegations are adequate in this
    regard, then the Board must provide her with a hearing on
    the merits of her claim.
    VACATED AND REMANDED
    COSTS
    Costs to petitioner.