At least 72 elderly veterans who were residents of the Holyoke Soldiers’ Home have died of COVID-19. That’s the highest number of coronavirus-related deaths at any single long-term care facility in the country.
So far, Governor Charlie Baker has had little to say about it. He’s awaiting the findings of an investigation by Mark Pearlstein, the former federal prosecutor he appointed to look into the matter. Massachusetts Attorney General Maura Healey and US Attorney Andrew Lelling are also conducting their own reviews. And Senators Elizabeth Warren and Edward J. Markey, along with Representatives Richard Neal and Ayanna Pressley, have joined forces to ask federal veterans affairs authorities to hold Soldiers’ Home officials accountable.
In this case, however, accountability should extend all the way to the governor’s office. Bennett Walsh, the Soldiers’ Home superintendent now on paid administrative leave, was appointed by Baker. So was Francisco Ureña, the state Veterans’ Services secretary to whom Walsh directly reports. Both have political connections and no previous background in health care management.
When veterans at the Soldiers’ Home first started dying of COVID-19, the initial concern centered on an apparent delay in reporting the dire situation to families, as well as to state and local officials. Because of staffing issues, sick residents were not separated from healthy ones, leading to more infections and deaths. Baker said he didn’t know about the situation until days later; however, Walsh insists he alerted state officials. He hired a lawyer and got an injunction to stop efforts to remove him from the position, and a court hearing on the matter has been put off until July.
According to a report by the Globe’s Brian MacQuarrie and Hanna Krueger, Walsh’s leadership style has been a problem. According to the Globe report, Walsh once got into a dispute with a fellow employee and threatened to “belt” him. The incident was reported by a witness, and Walsh was mandated to attend anger management meetings. The Globe also reported that Ureña told a job applicant that her first loyalty must be to Baker and his administration. A spokeswoman for Baker said she could not comment on that report.
Also, according to the Globe’s reporting, Marylou Sudders, Baker’s secretary of Health and Human Services, knew of longstanding staffing and management issues at the facility. A 2019 report that Sudders ordered found that nurses there struggled to find colleagues to help move disabled patients. The facility’s management, however, insisted that staffing was sufficient and that nurses needed to “increase productivity.” What does it mean to “increase productivity” when you can’t lift a disabled person out of bed on your own?
As reported by the Globe, the state chapter of the Disabled American Veterans has called for an overhaul at the Department of Veterans’ Services. “This incident represents a catastrophic failure of leadership,” the DAV wrote to Baker on March 31. “We hope that your administration will make swift changes at all levels of the Department of Veterans’ Services and the Holyoke Soldiers’ Home.”
The Baker administration owes that much to the dead veterans and their families. If the investigations show, as the DAV charges, that the Veterans’ Services office was nowhere “on the ground,” then a new secretary of Veterans’ Services is needed. Meanwhile, as the inquiries proceed, Ureña should hand off day-to-day leadership of the agency to an interim head who can make sure veterans get the services they desperately need at this time.
Of course, no one knew a pandemic was coming. But to have a veterans’ home with these kinds of conditions — run by a manager with no relevant health care experience, who reported to another state official who also lacked relevant health care experience — was a catastrophe waiting to happen. With the coronavirus, the catastrophe happened. So far, no one but the veterans who lived there have paid a price for the poor decisions that led up to it.
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