Two former leaders of the Holyoke Soldiers' Home were indicted on criminal neglect charges in what is believed to be the first US prosecution of nursing home caregivers over their handling of the coronavirus pandemic.
The indictments against former superintendent Bennett Walsh and ex-medical director Dr. David Clinton stemmed from the “horrific circumstances” that claimed the lives of at least 76 veterans who contracted COVID-19 at the state-run facility, said Massachusetts Attorney General Maura Healey Friday in announcing the charges.
“It’s truly heartbreaking to think about how residents and staff suffered at this facility,” Healey said at a news conference. “From the time we became aware of this, we made it a priority. We owed it to the families who lost loved ones and these veterans who served our country to get to the bottom of what happened.”
The charges are based on what an independent investigation called the “worst decision” the facility made during the crisis: combining two dementia units into one because of a staffing shortage, putting veterans with the virus in close proximity to those who were possibly infected and those who weren’t showing signs of illness.
The units were combined on the afternoon of March 27, when the outbreak was sweeping through the facility, and brought together 42 veterans without regard for their COVID-19 status, Healey said.
Residents who had tested positive for the virus or were showing symptoms of illness were placed in groups of six and moved into rooms designed for four people, Healey said.
Nine veterans believed to be asymptomatic were moved into a makeshift ward in a dining room, although prosecutors alleged that several of those men showed signs of the virus at the time or shortly thereafter.
Walsh, 50, and Clinton, 71, each face five counts of two charges: that they “wantonly or recklessly” committed or allowed bodily injury to an elderly or disabled person, and they committed or allowed abuse, neglect, or mistreatment to an elderly or disabled person. The criminal neglect charge carries a maximum penalty of three years in prison; the bodily injury charge is punishable by a 10-year prison term, Healey said.
The charges relate specifically to five veterans placed in the dining room, three of whom were infected with COVID-19, including one who died.
Walsh and Clinton were “ultimately responsible” for the decision to combine the units, which Healey described as reckless. Governor Charlie Baker’s administration fired Walsh in June, but he is fighting the termination.
“While this criminal indictment cannot bring back their loved ones, I do hope sincerely that it provides those affected by this tragedy some solace that we are doing everything we can to hold accountable the individuals we believe are responsible,” she said.
Tracy Miner, a lawyer for Walsh, said Healey shouldn’t be “scapegoating” her client, who “relied on the medical professionals to do what was best for the veterans” during the unprecedented outbreak. As of Friday, patients in long-term care facilities accounted for 66 percent of the state’s 9,160 COVID-19 deaths.
“It is unfortunate that the attorney general is blaming the effects of a deadly virus that our state and federal governments have not been able to stop on Bennett Walsh,” Miner said in a statement that noted her client’s military service. “He, like other nursing home administrators throughout the Commonwealth and nation, could not prevent the virus from coming to the home or stop its spread once it arrived there.”
A lawyer for Clinton, who lives in South Hadley, didn’t respond to a request for comment. The Board of Registration in Medicine said it couldn’t comment on Clinton, citing an ongoing investigation.
The men were not arrested and will be arraigned in Hampden Superior Court at a later date.
Donald Bushey, 85, was among three hospice patients in a Holyoke unit that was combined. He died the evening of March 27, the day the units were consolidated.
His wife, Jean, said she visited him in a private room earlier in the day. A week later, she learned her husband had tested positive for COVID-19, she said. She also was infected and spent a week in the hospital.
“Somebody should be held responsible because that wasn’t right,” said Jean Bushey, 83, who lives in Springfield. “It’s just unbelievable what happened.”
Through a spokeswoman, Baker said he appreciates Healey’s investigation and “expects the individuals responsible to be held accountable for their actions, subject to all of the requirements of a full and fair trial.”
In June, a report commissioned by Baker found that leaders at the home made “utterly baffling” mistakes in responding to the fast-spreading outbreak.
In July, the family of a Korean War veteran who died during the outbreak filed a $176 million lawsuit in federal court. The Civil Rights Division of the US Department of Justice and Massachusetts US Attorney Andrew Lelling is also investigating the facility’s handling of the outbreak.
Employees at the home reacted to the indictments with mixed emotions.
“It’s a good start. I know this is going to bring a lot of closure, knowing that systems can hold people accountable and enact justice,” said Cory Bombredi, the Local 888 union organizer for the facility. But he said some members question why other leaders at the home weren’t indicted, including an infection disease control nurse still employed there.
Kwesi Ablordeppey, a certified nursing assistant and union representative, said the outbreak will haunt him for the rest of his life.
“Anytime I go to bed I can’t even sleep more than four hours because of the nightmares and the flashbacks,” he said. “And it makes my blood boil to still see the management that caused this working at the home and with their licenses intact.”
Healey didn’t rule out the possibility of additional criminal charges if new information came to light. Her office is also investigating other long-term care facilities, she said.
In May, she announced an investigation at Life Care Center of Nashoba Valley, which was accused of withholding critical information as patients began to fall ill at the end of March.
Just before the COVID-19 outbreak was declared a pandemic on March 11, the US Department of Justice announced plans to scrutinize nursing homes that provide “grossly substandard care" through the newly formed National Nursing Home Initiative.
Last month, the DOJ announced it was seeking data from New York, New Jersey, Pennsylvania, and Michigan, where nursing homes were ordered to admit COVID-19 patients.
A few weeks ago, FBI agents raided a nursing home near Pittsburgh that experienced Pennsylvania’s deadliest outbreak of COVID-19 at a long-term care facility.
“This was a government focus even before COVID and it stands to reason that it will continue to be,” said attorney Allison DeLaurentis, a partner at Troutman Pepper in Philadelphia.
Patrick Plourde’s father, Louis, died April 1 at the Holyoke home. On Friday, he said he doesn’t have closure because the family hasn’t been able to hold a funeral.
“We’re still angry, upset,” he said. “Every day I wish I could talk to my dad.”
Travis Andersen of the Globe staff contributed to this report.