What if clinical leadership refuses to protect research time? I'm a physician-scientist currently on year 4 of a K23 (early career grant for physician scientists in the US), recently awarded first R01 (multi-year major research grant for biomedical science in the US) with 20% effort.  Problem is that despite the 'protected' time from these awards, my division/section chief refuses to commit, and as the only non-full time clinician in the section I seem to to be the first one asked to cover the clinical scut work (calls, service, etc.).  My division chief specifically said, "No one really holds to the protected time", so it doesn't matter if I get three more grants, it's not clear they'll ever actually protect my time.

It seems like the only option (other than leave) is to sacrifice myself by reporting to NIH, in which case I'd probably just lose the grants.  Has anyone ever successfully managed this situation without leaving?  Anyway brought in ombudsman, or other independent institutional resources?  

Obviously, I'm posting this anonymously...
Take a look at the rules governing the ombudsperson before you go there. Good rules will ensure confidentiality and that the ombudsperson won't take any action unless you say so. That will allow you to freely discuss your problem. If your institution offers an ombudsperson with good rules, then talking to an ombudsperson would actually be very useful in your case. I would not start with the idea of taking action, but just as exploring what is possible. 

Also don't take this personal. The leadership has to make sure that all tasks are performed with the resources at hand: if you do less, somebody else has to do more. If your grant compensated your department for that in full, then that should not be a problem. Though even then, if the departments resources are stretched already, then the leadership will still be faced with impossible choices. It should not be the case, and solving those impossible problems when they happen is not your problem, but understanding it can help not to take those choices personal. If your grant contains no or only partial compensation, then the "protection" from the granting agency is very cheap: basically the granting agency is not spending its own resources but your department's resources. Your department can be forgiven for saying that that is not going to work.