From what I can gather from experts familiar with the approval process, none of this has followed normal FDA licensing approval regulations. Peter Marks has been overseeing this farce licensing application approval from the beginning and Gruber may have had little input. Whatever her contributions on this application, it was probably ignored and she was overruled. If she was not allowed to do her job, why bother. Marks is now acting director of Gruber's office. Therefore, his title matches what he has been doing all along.

Having worked in public health, this kind of practice is not unusual. I worked for the VA doing research. I also had worked for the US Public Health Services. There would be individuals that would call the shots from behind the scenes while someone else was given the official title of an office as department head. There was a hidden command structure in the facility that did not necessarily match what was presented as their leadership hierarchy.

There could be any number of reasons why the person behind the curtain is not given the official job title. For example: The medical director of the medical center had a brother that also worked in the same facility. According to the Department of Veteran's Affairs, their employment rules state that the other brother cannot be recognized as a department head in the same facility run by his brother, the medical director. No problem. They just place someone else officially in the position to look good on paper while behind the scenes, the untitled brother pulls the strings and is in charge. It is the perfect cover - all the authority without any of the liability when the fertilizer hits the fan. The person with the department head title may or may not be fully aware they are not the one really in charge - especially when they are put in charge of a department where they have little to no expertise. Yes, I witnessed this very scenario. It would take about a year or two while this newbie got their land legs and finally put all the pieces together. They came to the realization that it was their asteroids that would be hung out to dry if anything went wrong. They resigned the position and then a new search would begin to find a next patsy - rinse and repeat. I witnessed this turnover three times during my tenure at one VA medical center.

I wonder if this may be the scenario that is occurring in this situation. It would not surprise me.