Updated: Jun 29, 2020
No one can dismiss the horrendous impact the coronavirus has had on our seniors. But we have also witnessed the impact of politics on this virus and how those most vulnerable became victims of not only the virus but of incompetent management and a number of decisions made based on political thought processes. Of course, these politicians will deny it, and hide behind the excuse of the virus being "the great unknown", but when closely examined, the answers are clear -- decisions were made and are still being made that were not or are not in the best interest of our seniors or the general public at large.
In an earlier blog, we discussed the situation in New York State, where elderly patients in long term care with COVID-19 were discharged from hospitals and placed back into the nursing homes, exposing both residents and staff to the infection. The result, somewhere between 6,000 and 7,000 dead. Elder advocates in the state say the number is higher, as many elderly died in hospitals and were not counted in the long term care deaths. Sadly, New York was not the only state to take these actions as New Jersey, Pennsylvania, and Michigan, among others, also made these choices.
Pennsylvania's story came with a strange twist as the Commonwealth’s Health Secretary, Rachel Levine, ordered long-term care facilities to continue to accept coronavirus patients who had been discharged from hospitals but unable to return to their homes. According to records, about 70% of the deaths in Pennsylvania were in nursing homes. Now the twist -- Levine moved her 95-year-old mother out of a personal care home after she gave the order, certainly a dubious decision given the order she issued. When confronted by the media, Levine claimed that this had nothing to do with her decision, in other words, nothing to see here folks. Was this a perk of being a politician or just a coincidental move?
The Soldiers' Home Tragedy
Just when we thought it couldn't have gotten any worse comes this absolutely nauseating story from our neighbor, the Commonwealth of Massachusetts, that is purely disgusting and exhibits how political hackery, incompetence, a prolific virus, and mismanagement combined to kill vulnerable American veterans.
This blog is about the Holyoke Soldiers Home and how politics and pandemic conspired with tragic consequences. At the time of writing this article, the official death toll at the facility from the coronavirus stands at 76, and according to experts, makes this the largest number of COVID related fatalities at any long-term care facility in the country. An additional 84 veterans have tested positive for the coronavirus as well as 80 staff members.
The information that spilled from this facility in late March is almost unbelievable on its face and its tie to politics makes it even more reprehensible. As a result of these horrific events, which we will discuss, Governor Charlie Baker hired former federal prosecutor Mark Pearlstein to investigate the Soldier’s Home. This past Wednesday, a 174-page report (click here to read the entire report) was issued where author Pearlstein blasted the facility’s superintendent, Bennett Walsh, stating his actions were “utterly baffling from an infection-control perspective.” But let’s not get ahead of ourselves.
A Political Hiring?
This story begins in 2016 when Walsh, a 24-year military veteran, arrived back in Massachusetts and began talking to politically connected people about career opportunities while eyeing a security position at the recently opened MGM Resorts casino in Springfield. Walsh, no stranger to Bay State politics, comes from a “very powerful” political family in Western Massachusetts. His mother is a Springfield city councilor and his father was the city’s former veteran services director. His uncle, William Bennett, and currently his lawyer, is the former long-serving district attorney for Hampden County, where Holyoke is located.
During his discussions about available jobs, he learned that the superintendent’s position at the Holyoke Soldiers’ Home was open. This led to a coffee shop meeting with John Velis, who at the time was the state rep from Springfield and is now the area’s state senator. The job description for the superintendent’s position stated that the ideal candidate would have a background in operating a “residential/outpatient facility,” which Walsh did not have. However Velis, who said he had never met Walsh before that meeting, informed him that the previous two superintendents didn’t have that type of background either and that his veteran status made him the "ideal candidate".
It was then reported that the board of directors of the Soldiers’ Home would only consider veterans for the superintendent’s post, so they hired Walsh without even bothering to interview another potential candidate who did have a nursing home background as well as being a Vietnam veteran. The Walsh appointment went up the chain of the command in the Baker administration and came back approved, with the caveat that the candidate who was not interviewed, John Crotty - the veteran with experience but not as politically connected as Walsh - become his assistant.
Crotty, according to the Pearlstein report, said Walsh viewed himself as the “outside man” for the Soldiers’ Home while Crotty was the “inside man,” an arrangement that worked relatively well until Crotty became fed up with Walsh’s bullying management style and quit in 2019. No one was hired to replace Crotty in that position.
A "Bullying" Management Style
During his time as superintendent, Walsh was best described as a polarizing figure, popular with veterans and their families but not at all liked by his staff. Some staff members complained that he lacked even the most basic understanding of health concepts and made no effort to learn despite training being made available to him. Others disliked his personal style, his poor communication skills, and the fact that he often retaliated against those who questioned his decisions, leading to poor morale and high staff turnover. Others reported that in meetings, he would quickly go through the important discussions of facility operations, often losing focus and had trouble staying on topic during meetings, preferring to spend more time talking about movies and sports.
Francisco Urena, the secretary of veterans services at the time in Massachusetts (he resigned his post this past Tuesday, the day before the report was issued), told Pearlstein’s team that there were multiple red flags on Walsh. The high staff turnover was just one. Urena said that he made an unannounced visit to the Holyoke Soldiers’ Home during Walsh’s first year on the job, which prompted Walsh to phone Health and Human Services Secretary Marylou Sudders demanding that Urena would have to seek permission for future visits pulling political strings.
Then came employee complaints regarding Walsh's angry outbursts. To address this, an executive coach was hired to work with him on anger management issues. The initial six-month contract with the executive coach was extended when another employee raised additional concerns about Walsh’s anger.
Ignoring Guidance from Federal Health Agencies
Then on March 17, the smoldering fire's first flame hit the air as a veteran tested positive for COVID-19 after showing symptoms for weeks and testing negative for other respiratory conditions, which should have raised alarms. As a reminder, the concerns about the virus and the vulnerable population -- seniors with multiple co-morbidities -- had been known for months. The symptoms exhibited by this patient should have been a red flag with the resident placed in isolation in the weeks prior to the positive test coming back. This did not occur as the resident was allowed access to the unit and other veterans for the entire time.
The obvious question, of course, is why? The symptoms of the virus were well-publicized, closings were occurring around the country, health bulletins were being issued by the CDC, and yet inaction continued at the Soldiers' Home. According to the medical doctor in charge, the patient had "already been walking around so the whole unit should be considered contaminated", an obvious justification for a decision which we now know had deadly consequences. To make matters worse, other veterans on that floor, who exhibited similar symptoms as the one who tested positive, were not tested.
Now, things began moving quickly. As stated earlier, the health concerns for the elderly around the coronavirus were well known at this point with suggestions made to medical and healthcare facilities to close congregate areas in a prophylactic attempt to keep COVID at bay, yet at the Soldiers Home, no such contingency plans were discussed until late in the crisis.
As long-term care facilities around the country began locking down to contain the virus, veterans at the Soldiers' Home were permitted in common rec rooms until mid-March with the canteen remaining open until late in the month, where both residents and staff continued to gather. Residents were also permitted to gather in indoor smoking rooms until March 28 and according to one staff member, the resident who was the first to test positive for COVID was observed sleeping on the couch in the common gathering area with other residents.
The administration of the Soldier's Home was aware of the CDC guideline issued for nursing facilities to freeze staff in on specific floors to avoid any cross-contamination between units, however, this was also ignored. The administration allowed staff members to float between floors and from unit to unit, an obvious transmission risk and, according to records, a number of staff members who floated tested positive for the virus.
Fear of Using PPE
Then came this troubling incident. A nurse’s aide on the unit where the resident who first tested positive for COVID reported that during a shift, he donned personal protective equipment (PPE) to treat another veteran who was vomiting and had diarrhea. When word got back to the administration that PPE was used on the unit, he received a written reprimand for “causing panic and anxiety among other staff members”. As a result, other staff felt that they were being discouraged from wearing protective equipment in an effort to conserve a limited supply and avoid "panic", and that they felt “annoyed, paranoid and fearful for their lives because they could not find masks,” the report said.
This incident, combined with inconsistent and conflicting policies, led to confusion around the use of PPE. Unlike other hospitals where a lack of equipment was an issue, this was not the problem at the Soldiers' Home. There, staff reported that there was enough PPE present, but the policies around using them were restrictive and dispensers that contained these items were removed to prevent “pilfering”.
The Inexplicable - Combining Units
Then came the inexplicable. During the weekend of March 28 and 29, staffing was so short at the home that two units were hurriedly combined, a decision one employee described as “the most insane thing I ever saw in my entire life.”
Even the "greenest" of employees in a healthcare setting are taught that a key tenet of infection control is to isolate those who are exhibiting symptoms from those who are not. However, when the decision was made to combine the two units, 40 veterans were crammed into a space designed for 25. Rather than controlling the infection, it put everyone on the unit at risk.
According to the report, a social worker described hearing the chief nursing officer say “something to the effect that this room will be dead by Sunday, so we will have more room here.” Another social worker recalled seeing a supervisor point to a room and say, “All this room will be dead by tomorrow.” And a third social worker told investigators that she “felt like it was moving the concentration camp, we were moving these unknowing veterans off to die.”
Several staff members told investigators that, in the confusion, some of the dying men did not receive adequate pain relief medication. None of the facility’s top administrators acknowledged taking part in the decision to combine the two wards, and its medical director, Dr. David Clinton, told investigators he was not consulted. “We find this not to be credible, and at the very least, that Dr. Clinton was aware (or should have been aware) of the move and did nothing to stop it,” the report said.
A nurse at the facility, Joan Miller, stated, "Veterans were on top of each other. We didn't know who was positive and who was negative and then they grouped people together and that really exacerbated it even more. That's when it really blew up."
"It Was Like a War Zone"
The report stated that an experienced healthcare administrator was called to the home three days later to assist with the crisis. The administrator described the unit as a “war zone” with some of the veterans dressed, some undressed, and many dying from the virus. A social worker told the investigators:
I was sitting with a veteran holding his hand, rubbing his chest a little bit. Across from him is a veteran moaning and actively dying. Next to me is another veteran who is alert and oriented, even though he is on a locked dementia unit. There is not a curtain to shield him from the man across from him actively dying and moaning, or a curtain to divide me and the veteran I am with at the time, from this alert, oriented veteran from making small talk with the confused little fellow. He is alert and oriented, pleasantly confused, and talking about the Swedish meatballs at lunch and comparing them with the ones his wife used to make. I am trying to not have him concentrate on the veteran across from him who is actively dying or the one next to him who I am holding his hand while he is dying. It was surreal . . . I don’t know how the staff over in that unit, how many of us will ever recover from those images. You want to talk about never wanting this to happen again.
The question was raised as to the validity of Walsh's statement that the leadership at the home had no choice but to combine the units, as he stated that he made authorities aware that a crisis was ongoing at the Soldiers Home but there was no response from the Commonwealth. The report calls this assertion untrue.
According to investigators, within hours of assistance arriving on March 30, the Commonwealth's emergency response team “assessed the acuity of the patients and quickly sent many of them to hospitals and other acute care facilities. The same option was available to Mr. Walsh and his team.”
From Infection Containment to Waiting for Death
As the coronavirus spread throughout the Home, the leadership team appeared to stop its attempt to contain the virus from spreading in the locked dementia units and instead prepared for the deaths of scores of residents as evidence by a troubling revelation in the report.
It said that facility supervisors had instructed social workers to call the families of sick veterans and try to persuade them to change their end-of-life health care preferences in order to avoid sending the sick veterans to a hospital. The reason, as some speculated, was to avoid the truth of what was occurring at the Home. Even more disturbing, on the afternoon that the decision was made to put the two units together, supervisory staff ordered 13 additional body bags and a refrigerated truck arrived to supplement the Soldiers' Home morgue.
As this was occurring, the question is then asked, what was Governor Charlie Baker doing? According to the report, he was listed as having been interviewed but there is no information provided on what he was asked or how he responded. Pearlstein did say that he concluded Baker and Lt. Gov. Karyn Polito first learned of the rising death toll at the Soldiers’ Home on Sunday, March 29.
Since the outbreak and subsequent intervention, the home’s superintendent Bennett Walsh was placed on administrative leave on March 30 and the state is moving to fire him. But, Walsh is fighting back. His attorneys, led by his uncle, William Bennett, have denied that Walsh did not inform the state of his need for help.
Documents were released that included incident reports Walsh filed with the state, emails, and texts updating officials on the outbreak, and a March 27 formal request for assistance from the National Guard as the virus spread wildly out of control. And who is to blame? Walsh was upfront about his lack of healthcare experience or managing a medical facility, yet was awarded the position. This approval came directly from the Governor's office. It is unclear at this time if any charges will be filed in this tragic event as this story continues to develop.
Questionable Decisions Abound
This is just the latest story of the politics of the pandemic. Governors throughout the nation have had the power to pick winners and losers. This includes closing down small businesses, resulting in the destruction of the lives of those who invested their life earnings, without any real plan or explanation as to why some businesses were considered essential and others were not, examples are gyms and health clubs. These are businesses where exercise offers obvious benefits to individuals including support of their immune system, control of diabetes, and advocating general healthy lifestyles. Yet liquor stores remained open, where tobacco products were also sold as well as lottery tickets. Three vices all in one location - essential or tax generators?
More Deaths than COVID-19
It can be argued that gyms make it difficult to social distance and could spread the virus and increase the death count, but let's look at the "essential businesses" we just discussed. Liquor and tobacco are responsible for the deaths of 568,000 Americans and 10.3 million annually worldwide annually. During this shutdown, liquor stores have stayed open and cigarette sales have been allowed to go on. Puzzling given the furor over the COVID deaths, because alcohol is directly responsible for 88,000 American fatalities annually according to the National Institute on Alcohol Abuse and Alcoholism and 3.3 million deaths worldwide, while the Centers for Disease Control reports tobacco use kills 480,000 Americans and 7 million across the world annually. Far more deaths than COVID.
Then we have the shutdown of doctor offices and outpatient hospital services. Scott W. Atlas, a physician and senior fellow at Stanford University’s Hoover Institute released some alarming data about the “other” health effects of this shutdown. According to his numbers, those with chronic health conditions who were not able to see their medical provider due to the “quarantine” may lead to deaths in greater numbers than the coronavirus.
Atlas, in consultation with colleagues, came up with these numbers:
Among neurologists, half of their patients have not appeared for treatment of disease which, left untreated, risks brain hemorrhage, paralysis, or death;
Emergency stroke evaluations are down 40 percent;
Of the 650,000 cancer patients receiving chemotherapy in the United States, an estimated half are missing their treatments. Of the 150,000 new cancer cases typically discovered each month in the U.S., most – as elsewhere in the world – are not being diagnosed, and two-thirds to three-fourths of routine cancer screenings are not happening because of shutdown policies and fear among the population;
Nearly 85 percent fewer living-donor transplants are occurring now, compared to the same period last year;
More than half of childhood vaccinations are not being performed, setting up the potential of a massive future health disaster.
And what are the results of these treatment delays? According to Atlas’ report, the COVID-19 deaths will be minute compared to the loss of life as a result of missed appointments and treatment. His report stated:
These delays are resulting in 8,000 U.S. deaths per month of the shutdown or about 120,000 years of remaining life;
Missed strokes are contributing to an additional loss of 100,000 years of life for each month of the shutdown;
And, if even 10 percent of vaccinations are not done, the result is an additional 24,000 years of life lost each month.
These consequences of missed health care amount to more than 500,000 lost years of life per month, not including all the other known skipped care.
The bottom line is this, politics and political appointments have been the norm for decades - on both sides of the political aisle. The incident at the Holyoke Soldier’s Home shows the results of such patronage. But other questionable decisions have occurred as well during this pandemic, and the consequences will be felt far into the future, documenting the dangers of mixing politics, healthcare and the lack of accountability. Unfortunately, if the past is any indication of holding elected officials responsible for their decisions, those veterans who died will be considered collateral damage of a broken system, and politicians will continue to be re-elected while performing the old magicians' technique of misdirection and deception. And if we continue with the status quo, we have no one but ourselves to blame.