The 66-year-old Vietnam veteran and former Green Beret had been diagnosed with a series of psychological problems stemming from his combat service, including post-traumatic stress disorder. He also suffered from advanced Parkinson’s disease.
He was plainly a very sick man. Still, when Dr. Mohit Chopra, then a geriatric psychiatrist at the veterans’ hospital in Brockton, examined Thomas P. Powers in August 2012, he was stunned at what he found.
Powers had been moved from his bed to a recliner, where he was rigidly bent forward, drooling uncontrollably, unable to communicate. His hands trembled violently. Records showed he was being administered a mix of powerful antipsychotic drugs, one of them with side effects that included tremors, also a primary symptom of Parkinson’s.
But amid thousands of notes on his case, there was not a single reference to indicate that Powers, who died last year, had ever been seen by a psychiatrist after being admitted to the long-term care unit seven years earlier.
“Not once,” said Chopra, still sounding shocked. Hospital staff had also not ordered a standard blood test for a patient in his condition taking such medications. “Something like this would be shocking if it happened in a Third World country.”
Chopra described his initial encounter with Powers in an exclusive interview with the Globe after the Office of Special Counsel, an independent federal agency, confirmed Chopra’s allegations that several patients at the Brockton VA’s Community Living Center were given substandard care.
The federal investigation concluded that the Brockton VA had allowed psychiatric patients to languish in a state of “egregious neglect,” in some cases drugged up with powerful antipsychotics administered without sufficient monitoring, according to a final report, dated last week and released to the Globe.
Powers’s daughter, Sharyn Sawyer of Canton, who was unaware until contacted by the Globe that her father’s care was at the center of a federal probe, said the findings — especially the amount of medication Powers was being administered — “shocked me.” But she said Chopra’s concerns substantiated her own long-held fear that “he wasn’t being taken care of.”
“I would think, “Why does he look like this?’ I wondered when the last time someone was in here to see him. He was very sensitive to medicine,” she said.
Chopra’s separate allegations that he was subjected to retaliation by higher-ranking VA officials for raising concerns about quality of care, including being fired in January 2013, remain under investigation.
His case first came to light in June, when the Office of Special Counsel included allegations of negligent care at the Brockton VA in a sweeping report on whistle-blower cases it was reviewing around the country.
The office, in its final report, called Chopra’s experience “a reminder of the VA’s prior pattern of deficient responses to disclosures from VA physicians, nurses, schedulers, and other health care providers.”
Chopra said in the interview that his complaints about conditions at the hospital, which also serves as a teaching facility for Harvard Medical School, fell on deaf ears. The soft-spoken Chopra, who says he is still troubled by his VA experience, recalled he even questioned his own conclusions over the course of a bureaucratic odyssey that he says proved personally and professionally challenging.
“Are your eyes really seeing what you are seeing?”
The first sign of neglect
Chopra, 46, an Indian-American who came to the United States 15 years ago, says he was drawn to work with military veterans in part out of tradition.
His brother-in-law is an Army doctor in India. His uncle, who served in an Indian unit fighting in the European theater of operations during World War II, succumbed to service-related mental illnesses, including what Chopra now believes was post-traumatic stress disorder.
“Working at the VA is as close to the best of both worlds I could bring together,” he explained. “Here I am at an academic institution, a teaching hospital. Not all of the VA is that lousy. There are some parts of it that are pretty good, very good.”
After earning his medical degree in India, Chopra, who lives in Chestnut Hill and now has a private practice, completed his residency at the University of Pennsylvania and worked in under-served areas of Arkansas in exchange for legal residency. Over the years his research has been published in a variety of medical journals and he received a number of awards.
In 2008, he went to work for VA Boston Healthcare System, which includes campuses in Jamaica Plain and West Roxbury. By early 2009, he was promoted to the position at Brockton.
Chopra said the first alarming sign of neglect came in early 2012, when he was asked to consult on a 65-year-old Vietnam veteran who was suicidal and refusing treatment. He learned that the veteran had not had a sufficient psychiatric consultation since being admitted nine years earlier.
“This person had a long history of major depressive disorder,’’ Chopra said. “He had multiple suicide attempts. This included stabbing himself in the stomach and overdosing on pills.”
Chopra also discovered that the patient had not received basic lab tests to identify vitamin or hormone deficiencies that could be contributing to his deep depression. Chopra ordered the tests, which found the levels deficient, and recommended treatment that soon “alleviated the severity of the patient’s depression,” the Office of Special Counsel said in its final report.
About a month later the patient got out of bed — for the first time in eight years — to ask his nurses for his morning medicines.
Chopra also raised concerns about a World War II veteran who had not been administered recommended doses of medication for nearly two years and the treatment of a Korean War veteran who was abruptly moved from the room that he had lived in for years, a traumatic experience for a man in his fragile state, one that Chopra believes contributed to his death a few weeks later.
When he encountered Powers, Chopra rechecked his psychiatric record several times to determine if he had overlooked an evaluation. He had not. There was none.
“I would call it mind-boggling or beyond for something like this to have happened here . . . at a teaching facility for the Harvard Medical School,” he said. Powers was the “saddest, the most tragic” of the several cases that led Chopra to come forward and speak out.
Powers, a native of Somerville, was identified by the Globe through public records; government documents did not identify the affected patients for privacy reasons and Chopra declined to disclose their names.
While Powers’s daughter lauded the hospital’s nursing staff for being especially attentive to her father in the months before his death, she said, “I never felt secure. He was never peaceful. But I didn’t know what to do. It wasn’t where I wanted him to end up but I didn’t know what else to do.’’
A close family friend who spent considerable time visiting Powers at the hospital similarly expressed surprise, especially that Powers had not been examined by a psychiatrist in so long.
“I thought he had been from what they were telling us,” said the friend, who for privacy reasons asked not to be identified.
Chopra reported that he felt “these instances of patient mistreatment were not isolated and that other patients may have been similarly neglected at the facility.”
Chopra says that after he complained to superiors he encountered a more strained environment at work and found it harder to get basic orders followed. His frustration came to a head in a December 2012 meeting with top VA Boston officials in which he blurted that he would like to “crack the skull” of one of his superiors whom he accused of dismissing his concerns. His dismissal a few weeks later, however, made no mention of the outburst, which Chopra says he deeply regrets.
The three VA Boston doctors whom Chopra says he approached with his concerns — Ronald J. Gurrera, associate chief of psychiatry; John C. Bradley; chief of psychiatry and deputy director of the VA Boston’s mental health service; and Dr. Gary B. Kaplan, director of VA Boston’s mental health service — declined to be interviewed.
“Due to confidentiality laws, we cannot comment regarding former employees,” said Diane Keefe, a VA spokeswoman. “Drs. Gurrera, Kaplan, and Bradley will not be able to speak about him or his claims.”
The VA insists that it has taken steps in the wake of Chopra’s actions to improve care, including requiring “regularly scheduled psychiatry visits rather than relying upon a psychologist’s request for consultation,” according to a July 2 department memo.
All patients suffering from mental illness will now “be examined by a psychiatrist at least once a year,” it noted, be regularly screened for side effects from medication, and be subject to a pharmacological profile drawn up to include “recommendations to the clinical staff about tapering, discontinuing, or adjusting medications during ongoing, monthly reviews.”
In a statement Friday, Keefe said, “We continue to review and improve nursing home care to assure that all long-term care patients receive the best care possible.”
VA care questions remain
Chopra says he is enormously relieved that most of his assertions about substandard care have been corroborated by other medical professionals, including another geriatric psychiatrist. “I wasn’t imagining something,” he said.
Chopra’s complaints and his treatment alarmed many veterans’ advocates, including Representative Stephen Lynch of South Boston, who toured the Brockton facility after the allegations were made public in June.
“These instances of patient mistreatment and neglect as described by whistle-blower complaints are totally unacceptable,” Lynch said.
Still, Chopra is not convinced that the VA is prepared to make the necessary institutional changes in patient care or to take seriously the complaints of employees like himself.
For instance, the hospital’s decision in the wake of his complaints to require all patients on antipsychotic medications be examined by a psychiatrist “at least once annually” is less than the facility’s own official standard, he points out, which requires such evaluations every six months.
Chopra has questioned how the facility “could set lower standards, especially given the substantiation of these allegations,” according to a letter to investigators from his legal team.
He also believes strongly that the patients’ rights were violated, a claim the VA has strongly resisted.
He is not alone. The Office of Special Counsel, in its final report to President Obama, expressed dismay at how the VA could acknowledge the neglect but insist that the veterans’ rights were not violated.
“This is an unreasonable conclusion given the confirmed facts,” it wrote.