The Institute

One morning in May 2023, a hospital employee opened her email and read through a woman’s complaint about how her husband’s cancer care was deteriorating. A senior administrator had forwarded the message with a terse note: “Another one.”

The employee, who worked in patient relations, reviewed the other complaints — more than six in three months, all about the same doctor — then wrote a summary for hospital leaders.

The doctor “changes the plan of care without involving peers, he is not attentive to needs of patients, he lacks follow up,” she wrote in an email obtained by Spotlight PA. “I fear he might be a liability to the organization and the care we provide our patients.”

The doctor was Raymond Hohl, the director of the Penn State Cancer Institute, one of the university’s highest-paid employees, and a pillar of administrators’ hopes for the organization. Almost a decade prior, Penn State recruited Hohl to lead the cancer center to a prestigious federal status, designation by the National Cancer Institute. The recognition could attract patients, boost fundraising, and make it easier to recruit top doctors.

By some measures, he was an excellent choice, records and interviews show. One internal review, from January 2022, touted Hohl’s “clear vision” and “outstanding leadership.” The center appeared on the brink of achieving the goal that had eluded university leaders for decades. Some patients and their family members recalled Hohl as a warm and caring clinician, the kind of doctor who’d give out his personal cellphone number.

But there was another side to the director.

Hohl, the doctor chosen to lead Penn State to the highest standards, was a major obstacle to the cancer center reaching its goals, a Spotlight PA investigation found. Penn State repeatedly investigated Hohl in recent years, documenting serious problems with his conduct as a leader and a physician. Internal reviews found alarming lapses in his care of patients. Penn State Health’s chief executive officer and chief operating officer, who have both since left the organization, as well as the hospital’s then-chief medical officer and two medical school deans, had extensive knowledge of these problems, records show.

The university’s reviews concluded that Hohl perpetuated a toxic culture of fear and mistrust that chewed up doctors and researchers, who left the organization in droves. Getting federal designation was Hohl’s top priority, but after nearly a decade under his leadership and some $410 million invested, the cancer institute was “significantly behind where it needs to be,” a December 2022 review found. Hohl disputed the findings and offered a rosier assessment, records show.

Between early 2022 and mid-2023, internal reviews conducted by other Penn State doctors also found a series of problems with Hohl’s care of at least 10 patients. His sloppy recordkeeping caused multiple errors. Several of Hohl’s patients received extra doses of chemotherapy by accident. Others faced unexplained delays in changing their treatment, or having scans done to check whether their cancer had progressed. Hohl was also often weeks or months behind on his notes from seeing patients, six people connected to the cancer institute told Spotlight PA, which led to gaps in the patients’ medical records that alarmed some colleagues.

Some patients complained that he was inattentive or unresponsive; several said they didn’t want him to be their doctor anymore. One surgeon, in a July 2023 email obtained by Spotlight PA, wrote to the chair of her department that because of problems with Hohl’s care, she would no longer refer patients to him, saying: “I refuse to allow any more [patients] to be harmed by him.”

In the wake of these reports, Penn State leaders privately weighed removing Hohl as director or stopping him from treating patients, according to records and three people familiar with the conversations. However, leaders elected to keep him in the top job after monitoring his performance for two months, while many of those who spoke up about problems later left the organization. When additional reports showed little improvement in Hohl’s behavior toward colleagues, Penn State again stood by him.

Penn State declined to make top officials, including Hohl, available for interviews. In a statement, health system spokesperson Scott Gilbert said: “Penn State operates a world-class Cancer Institute, constantly working to expand our ability to treat many different types of cancers, including rare and difficult-to-treat cancers. Our Penn State Cancer Institute physicians, nurses, researchers and staff members maintain the deepest commitment to high quality standards of care and leading-edge research as they treat cancer patients at Penn State Health every day.”

Since 2023, the center has undergone “substantial adjustments,” including a restructuring of its leadership, increases in staffing, and improvements to the medical records system, Gilbert said. This year, the Milton S. Hershey Medical Center received accreditation from the American College of Surgeons’ Commission on Cancer, which Gilbert said demonstrates “our continued efforts to set higher standards of excellence for safety, innovation and patient care.”

In May 2024, Penn State quietly scaled back Hohl’s oversight of patient care. The spokesperson declined to say why.

Arriving at Penn State in 2014, Hohl had a clear mandate: Obtain National Cancer Institute designation.

“It’s a gold star we can put on our lapel,” Hohl said about the significance of federal recognition in a 2017 video. “It’s something we can hang out on our shingle.”

National Cancer Institute designation was created in 1971 as part of President Richard Nixon’s “war on cancer.” Obtaining designation is a rigorous process that requires major institutional investment and years of coordinated effort. Designated centers often highlight the fact that they are among the roughly 5% of U.S. cancer centers that have achieved this distinguished status, which recognizes their research prowess.

Experts say designation matters for patient care too. Such cancer centers tend to be larger, provide more specialized care, and can offer the most innovative clinical trials. One study of adult cancer patients in California found that those who received their initial care at a designated center had better survival rates than people treated elsewhere.

There are also financial incentives to pursue designation. The label grants access to a special pool of federal funding only available to designated centers. For many hospitals, cancer care — which involves doctors across a variety of specialties — is a major profit driver.

Hohl played a key role in the rise of the University of Iowa’s cancer center. When a prominent family donated $25 million to Iowa in 2000, they cited Hohl’s care as motivation. Months later, the center achieved the top tier of National Cancer Institute designation.

Stephen Collins, who led the board of an experimental drug company Hohl co-founded in 2005, remembered the doctor as an “extremely warm clinician and a hell of a nice guy.”

As director of Penn State’s cancer institute, located at Hershey Medical Center, Hohl sat on the health system’s executive committee and oversaw oncology services, records show. He found a vocal ally in Dennis Brenckle, the chair of the hospital’s board of directors, according to four people connected to the program.

Between 2013 and 2017, the Pennsylvania Department of Health awarded Penn State $712,500 in taxpayer funds to hire researchers and expand its operations in pursuit of National Cancer Institute designation, state records show. In 2018, the center secured a $25 million grant from Highmark Health, the multibillion-dollar insurance company, to recruit cancer researchers.

Pennsylvania already has five designated cancer centers, among the most of any state. But Penn State leaders argue that 4.2 million people across central Pennsylvania — roughly 30% of the state’s residents — lack easy access to a designated center because all five are in either Philadelphia or Pittsburgh. If Hershey got recognition, patients could bypass the hourslong drives to major urban hospitals and receive cutting-edge treatment in a rural setting, under the same blue-and-white banner they cheer for on autumn afternoons.

Penn State’s designation attempt in 2011, before Hohl started as director, failed.

But by early 2022, the cancer institute’s progress toward applying for designation was “substantive,” according to a report by the center’s board of external advisors. There were obstacles, the report noted, including low numbers of patients entering clinical trials, a relatively low level of funding for research, and confusion over where Hohl, as director of the cancer institute, fit into the intricate hierarchies of Penn State Health.

Still, the report said, Hohl had recruited faculty, secured funding, and provided “outstanding leadership.” The goal was to apply for designation in 2025.

“We’ve already met with the NCI,” Hohl said during a 2020 presentation. “They know who we are, and they know we’re coming.”

In late 2022, not long after starting as Penn State University president, Neeli Bendapudi commissioned an analysis of the cancer center. Penn State had been pursuing designation for more than two decades, and she wanted health system and medical college employees to assess how close the institute was to its goal, according to records and two people familiar with the review.

The answer arrived on her desk in December 2022. The report, prepared by senior medical college administrators and outside consultants, punctured the idea that the cancer center was anywhere near designation.

Despite Penn State’s $410 million investment in the 10 years prior, Hohl was not leading a high-caliber enterprise on the verge of federal recognition, the report found.

Instead, the institute was “significantly behind” on every metric the report analyzed and remained a decade, and $1.2 billion, from its goal. The center’s lack of a cohesive strategy made it difficult to recruit workers, which would be key for an NCI push — the report estimated more than 200 additional employees were needed. Current staffers reported a “low-safety” culture, declining patient safety standards, and fears of retaliation if they spoke up about problems.

Blame for the institute’s predicament could justifiably be pointed in multiple directions, the report said. There were no quick fixes.

The analysis was shared with Penn State Health’s CEO Steve Massini, who has since retired, and top university officials. In Hohl’s view, the document was riddled with inaccuracies, according to emails and three people who spoke with Hohl at the time. However, his name appeared on the cover page as a contributor.

Undeterred, Hohl sent his own, more optimistic, analysis to university and health system leaders two months later. In his view, designation would require more than 200 new employees, but only five more years and another $845 million. Hohl marked nearly every budget item as “high priority” or “very high priority.”

The original report identified workplace culture issues as a major challenge, but Hohl’s analysis did not mention the subject.

Yet during this period, Penn State leaders — including Massini, then-health system chief operating officer Deborah Addo, and then-interim medical college dean Kevin Black — received multiple reports that the work environment in the cancer institute was miserable.

A human resources investigation in late 2022 documented Hohl’s tendency to yell and pound his fist into furniture. At a cancer center town hall several months earlier, emails obtained by Spotlight PA show, employees said repeatedly that Hohl “normalized” bad behavior toward colleagues.

In response to the HR investigation, the leaders discussed sending a letter to Hohl asking him to improve, according to emails and drafts of the document obtained by Spotlight PA. One version warned that if he didn’t change his behavior, he might not keep his job. “This is not our desired outcome, but we cannot continue to allow a work environment that all parties label as ‘toxic’ to exist within our Health System.”

Whether the letter was ever sent to Hohl is unclear — Penn State declined to say. But problems at the cancer center persisted, and months later, in May 2023, a separate internal review of the center concluded “there appears to be a culture where bad behavior has been allowed without any repercussion.”

Tasha Messmer’s supervisor once described her as “the hallmark of nursing.” During a formal evaluation, one of her colleagues added: “There are many days I wish she could be cloned.”

When work was difficult, the registered nurse would flip open a pink plastic binder stuffed with thank-you notes from patients she had treated over her nearly two decades at Penn State Health. She sometimes went in early or stayed after a shift to paint the nails of women undergoing treatment — a small effort to help them feel beautiful amid sickness and hair loss.

But by late 2022, Messmer had begun to dread her job.

In the years prior, about 20 doctors resigned or retired, and more than 110 clinic employees left, records show. “I didn’t bother learning people’s names who were staffing the clinic,” a doctor connected to the program at the time told Spotlight PA.

“I’m ashamed to say that. But I didn’t bother learning their names because they were going to be gone in two or three months.”

The turnover created a heavy workload for the remaining oncologists. In one case, 500 patients had to be absorbed after a resignation, according to a 2023 internal report.

Hohl packed his schedule — seeing as many as 30 or 40 patients per day — to a degree that unnerved some hospital employees, including Messmer, who began working with him after other doctors left.

The cancer center paid physicians extra to see additional patients. But this incentive was offered only to a select group of physicians, including Hohl, according to records and three people connected to the program. Messmer said the disparity fueled animosity between some doctors, adding to an already tense work environment. A Penn State Health employee who evaluated the incentive program warned in a February 2023 email that its structure could encourage oncologists to cram patients into their existing schedules.

Cancer patients sometimes waited hours to see a doctor because of low staffing or overscheduling. On at least two occasions, Hohl scheduled meetings when he was supposed to meet patients, emails show. One day in December 2023, clinic staff searched for the doctor. Three of his patients, who had waited more than an hour to see him, were becoming frustrated. Hohl was moderating an academic presentation.

With so many patients to juggle, Hohl often fell weeks or months behind on documenting patient visits, six people who worked at the cancer institute told Spotlight PA. As a result, employees would sometimes open a patient’s electronic medical record to find blanks, with no information about what was discussed or decided at the prior visit. In some cases, Messmer said, Hohl’s failure to promptly document visits led to problems with patients’ insurance companies, which questioned covering the cost of treatments that lacked appropriate documentation.

“It was like I couldn’t even take care of my patients properly,” she said.

Experts, including two oncologists, told Spotlight PA that while documentation delays are not uncommon, they can lead to errors and endanger patients.

“If somebody gets seen again, and their note’s not in there, it interferes with knowing what’s going on,” said Deborah Mayer, a retired professor of nursing at the University of North Carolina at Chapel Hill.

The clinician who sees the patient is responsible for updating the records in a timely manner, Mayer said. Consistent problems with documentation, she said, raise questions about whether the health system provides enough oversight.

For a time, Messmer thought that if she reported Hohl’s behavior internally, things would improve. She took screenshots of what she saw as evidence of the problems and shared them with a senior administrator. In December 2022, she also discussed her concerns with the administrator in a winding, anguished phone call. “The mismanagement of patients makes me feel ashamed that I’m part of this,” Messmer said during the call, according to a written summary of the conversation obtained by Spotlight PA.

The administrator shared what Messmer had said with senior hospital leaders and told them she would address it with Hohl. “However, I have not had success with these types of conversations up to this point,” she wrote.

Over the months Messmer worked with Hohl, guilt gnawed at her. Her stomach ached. At night, she dreamed about being trapped underwater, her lungs desperate for air. In the mornings, she’d sit frozen in her car. She took several weeks off in late 2022 for her mental health.

“It’s just so hard when you know these things that are really wrong are happening and there’s nothing you can do to fix it, to stop it,” she said. “And you can’t be honest with the patient and tell them, ‘If I were you, I’d go somewhere else.’”

In April 2023, Messmer resigned.

A month later, an internal Penn State review of the cancer center described a “hostile workplace” with a culture “where people do not feel appreciated, heard, or want to work.”

Penn State records show that, from early 2022 to mid-2023, Hohl’s patient care was repeatedly under internal review by other doctors and administrators.

The health system’s patient relations office received more than six reports about his care in three months. Some of Hohl’s patients complained about delays in their treatment, while others said that he ran very late or was not attentive. These reports were shared with Addo and Robert Harbaugh, the hospital’s chief medical officer at the time, records show.

Several patients asked not to see Hohl anymore. Employees who worked with him, including doctors, also complained.

Three people with direct knowledge of the situation said the flurry of reviews was striking. “I have never dealt with so many patient issues — complaints, concerns about practice — in my entire career from any one person, let alone one person in this short period of time,” a former hospital leader familiar with the problems told Spotlight PA.

Hohl’s medical licenses in Pennsylvania and Iowa show no formal sanctions or discipline.

At Penn State, records show, many of the problems stemmed from Hohl’s lack of communication.

In a letter sent to health system leaders, one family described the emotional turmoil of receiving conflicting information about test results. A nurse had called them with the “good news” that an urgent biopsy showed the patient’s cancer had not spread — only to receive a call the next day from someone else offering comfort because the cancer was, in fact, spreading. Throughout this confusion, the family heard nothing from Hohl, they said. “Why am I hearing two different stories?” the family wrote. “What am I supposed to believe?”

A patient with thyroid cancer was exasperated after learning that a sample taken months earlier, which could have helped clarify what kind of cancer she had, was never sent out for testing. After a tense phone call during which she felt Hohl dismissed her concerns, the patient did not want him to be her doctor anymore. She relayed her concerns to a friend who sat on the hospital’s board, who brought them up with Addo, then the health system’s chief operating officer.

Penn State Health conducted internal peer reviews of this case and at least nine others, according to records obtained by Spotlight PA.

In one case, the medical team agreed to continue a patient’s treatment and monitor their brain after scans showed the cancer had spread there. Yet more than six months passed before the patient’s brain was scanned again, despite multiple messages sent to Hohl encouraging him to order new imaging, an internal review found. General guidance, two cancer experts told Spotlight PA, is to take new scans every three months.

When the scan was eventually done, it revealed that the number of lesions on the patient’s brain had increased fivefold. The patient had an aggressive form of cancer, so the delay likely did not reduce their chance of survival, four cancer experts told Spotlight PA. Still, they had to undergo a much more intensive form of radiation treatment — with greater risk of unpleasant side effects — than if the scan had been done sooner.

Another patient with incurable cancer continued on the same treatment for nearly two months after a scan showed their cancer was growing and new lesions were forming. The patient’s treatment was not changed until weeks later, despite multiple follow-up visits with Hohl.

Spotlight PA shared redacted documents and summaries of the case with four cancer experts based outside Pennsylvania — including a radiation oncologist, two cancer nurses who’ve served in national leadership roles, and a senior administrator at a federally designated cancer center. The experts questioned why the treatment was not adjusted. The radiation oncologist said that the scan was a “textbook” example showing that the patient’s original treatment was not working and that the patient should have been presented with other options sooner.

In several cases, records show, Hohl did not respond to repeated requests for information from the hospital’s internal review committee or patient safety department.

Penn State found that at least three of Hohl’s patients received extra doses of chemotherapy in error. In two instances, the mistakes stemmed from inaccurate information that was copied and pasted in the patient’s medical records, leading to a miscount of the number of doses they had received. In one 2022 case, almost all of the dates recorded for a patient’s chemotherapy treatments were incorrect — “the entire treatment history appears to be wrong,” wrote a Penn State doctor who reviewed the case, according to records obtained by Spotlight PA.

Experts, who were provided summaries of the cases by Spotlight PA, said that while the extra chemotherapy likely did not harm the patients, the additional doses could have increased their risk of side effects with no clear benefit. They also questioned why nurses and pharmacists did not catch the mistakes before patients actually received the extra doses.

Penn State’s reviews also found that two patients under Hohl’s care had the wrong type of cancer documented in their medical records. In one case in 2022, the documentation error resulted in the patient receiving treatment tailored for a type of lung cancer they did not have. Penn State’s review determined that, according to national guidelines, “the patient did not receive the best course of treatment” for their disease.

Records show top Penn State leaders — including Massini, Addo, and Harbaugh — were aware of complaints about Hohl. In the summer of 2023, they weighed major changes to the cancer institute. Karen Kim, who was about to start as the dean of the medical college, was also involved in the discussions.

They considered various options. They could add more clinic time to reduce the crush of patients, or limit Hohl to only seeing patients in his specialty of blood disorders, such as leukemia and lymphoma.

They could stop Hohl from seeing patients altogether. Or, they could remove him as director of the cancer institute. Administrators discussed drafting a job description for the position and suggested another doctor who could serve on an interim basis.

Then another complaint arrived.

A surgeon at Hershey Medical Center fired off a long, outraged message to her department chair about a patient under her and Hohl’s care. She had been trying to get a response from Hohl for weeks.

The patient, who had an aggressive skin cancer, had undergone surgery and was scheduled to receive follow-up radiation to reduce the likelihood of the disease returning. But after meeting with Hohl, the patient had decided against radiation and agreed to start medication therapy instead.

The surgeon felt that Hohl had misled the patient into thinking radiation, the traditional follow-up care for the disease, was risky because the patient had an underlying gene mutation. Such a concern was “unfounded,” the surgeon wrote.

Doctors at Penn State who discussed the case at the time — as well as three outside oncologists who specialize in these types of treatments and spoke to Spotlight PA — said the particular gene mutation would not be a reason to avoid radiation therapy.

The surgeon reported that Hohl did not respond to messages about the case for weeks or discuss the change in treatment with the patient’s other doctors. “This is a huge patient safety concern and it is completely unacceptable that [patient] care continues to suffer whenever Dr. Hohl sees them,” the surgeon wrote.

The surgeon’s comments, along with details of the case, were sent to a senior doctor for an internal review.

A leader in the hospital’s surgery department also sent the information directly to Massini, Addo, Harbaugh, and Black. “I pose the following question to you all,” he wrote to the leaders. “How many more people need to be hurt before you take action and do the right thing?”

In August 2023, Penn State leaders put Hohl on a two-month performance improvement plan.

The plan identified “areas of patient safety concern” including incorrect chemotherapy doses, delayed scans, and a lack of communication with patients and other team members. Hohl was asked to adhere to national guidelines for cancer treatment, demonstrate active listening skills, and show that he was a team player, among other goals.

The two months passed, and Hohl kept his job. The outcome left some employees confused and disappointed.

And some of the cultural problems blamed on Hohl’s leadership persisted.

More than a year earlier, a senior Penn State administrator told colleagues that, according to cancer center employees’ feedback, Hohl had “normalized” bad behavior toward co-workers.

“We need to publicly commit to not tolerating it moving forward,” the administrator wrote in an email.

But in early 2024, leaders were again faced with a similar set of complaints.

Cancer center employees met around this time to discuss ongoing issues with doctors’ behavior. On sticky notes, they wrote down their biggest frustrations.

Doctors blamed nurses for lost paperwork and resisted learning how to use a new electronic system for medical records. They arrived in the clinic late, or left early, leaving nurses to calm down angry patients; they skipped internal meetings​​ about patient issues; they were behind on documentation, which caused problems with insurance approvals. The doctors were disrespectful to the nurses and appeared to see them as their personal secretaries; one had reportedly said about a nurse, “I’ll have my girl take care of it.”

“When there’s been a request to Dr. Hohl to address the behavior of physicians, at times it has been laughed off in front of the staff that expressed the concern,” the administrator who organized the gathering wrote in an email to the hospital’s then-chief medical officer Harbaugh, Addo, and hospital President Don McKenna.

The problems were widespread, the administrator wrote, but staff agreed that Hohl was the worst offender and, as director, set the wrong example for others.

“What you say does not surprise me,” Harbaugh wrote in a February 2024 email.

An outside consulting group that interviewed cancer center staff concluded, in January 2024, that fears of retribution had “fractured” trust between employees and leaders of the cancer center, medical college, and health system. Workers were so scared of retaliation that they were reluctant to discuss their fears with the consultants, the report noted.

Not long after the report was written, as the consultants were implementing a monthslong improvement plan, the medical college abruptly canceled their contract. A Penn State Health spokesperson declined to say why, or specify what changes were made in response to the findings.

In May 2024, Penn State quietly removed Hohl’s oversight of clinical care, a move the spokesperson also declined to explain. Hohl remains director of the cancer institute and was still seeing patients as of early 2025.

A former Penn State senior administrator, who worked in the medical college and was familiar with the cancer center’s problems, told Spotlight PA that Kim, the college’s dean, acknowledged in private that the medical school lacked the funds to replace Hohl. He is one of Penn State’s highest-paid employees, university records show, with a salary of more than $750,000 in fiscal year 2024.

“Firing Ray would raise questions [Penn State leaders] don’t want to answer,” the former executive told Spotlight PA. “And firing Ray would suggest their cancer program is in the shitter.”

The search for a new center director could also further delay Penn State’s application for National Cancer Institute designation. Five people connected to the cancer center told Spotlight PA they felt that Penn State leaders believe getting the title will solve the cancer institute’s problems.

Last June, Kim told the university trustees that the cancer institute plans to apply for designation again in 2027.