Report Slams State Veterans Agency in Covid-19 Response

By Walter F. Roche Jr.

A 116-page report concludes that state officials and managers at a state veterans home share responsibility for an outbreak of Covid-19 that took the lives of 42 residents of a state run veterans nursing home.
The report, which was commissioned by Pennsylvania Gov. Thomas Wolf, cited three crucial decisions that resulted in the deadly caronavirus spreading like wildfire through the 292 bed facility in Chester County.
Those findings include the failure of managers at the Southeastern Veterans Center to quickly end communal dining even as the outbreak was becoming apparent.
Those same managers misunderstood guidance from health officials about separating those patients who had been exposed to the virus and those who had tested negative. As a result dozens of residents who were free of the virus were needlesly exposed to the virus.
A third deficiency was the failure of the facility's management to utilize a vacant 32 bed unit to separate the infected residents from those free of the virus. Instead the vacant unit was set aside for a few employees to occasionally spend the night.
While much of the report focuses on the failures of the home's administrator, Rohan Blackwood and Director of Nursing Deborah Mullane, the report faults officials of the state Department of Military and Veterans Affairs(DMVA) for failing to provide adequate oversight.
"DMVA failed to exercise sufficient authority" over the Chester County facility," the report states.
In fact the panel concluded DMVA failed to provide sufficient oversight for all six state veterans homes.
And, the report continues, Blackwood and Mullane, who ultimately were fired, "managed by intimidation and dictate." The attorney for Blackwod and Mullane issued an extensive rebuttal of the report, charging that they were being scapegoated when the blame belonged to DMVA officials. Citing a culture of a lack of accountability both at the facility and the DMVA, the report states,"Ultimately the buck seems to have stopped nowhere."
The panel noted a lack of experience among DMVA managers in medical matters or the administration of long term care facilities.
The report praises the frontline workers at the facility for trying to perform their duties despite an openly hostile work environment and the lack of Personal Protective Equipment.
The report also cites the home management for the widespread and apparently indiscriminate use of a cointroversial drug, hydroxychloroquine, on patients diagnosed with Covid-19 or suspected of being infected.
The report states that the drug was used on patients despite warnings that it could have severe adverse effects on patients with coronary conditions. And, the report stated, the drugs were administered without proper disclosure either to the patients themselves or their families.
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