Deceased Homeless Veteran Not Found for Weeks

The grounds containing the larger VA Medical Centers would seem, superficially, to be completely within the control of the VA itself. However, on many of these VA "campuses” there are private, not-for-profit organizations. Very often, these organizations serve veterans homeless veterans and VA will lease space to these organizations.


This puts the veterans they serve closer to other veterans services, such as medical care. However, when VA leases property, which entity - VA or the not-for-profit organization - is responsible for the property or only part of the property is defined by the lease agreement. Who is responsible for what in these circumstances can be a question, unless they are both familiar with the responsibilities outlined in the lease.


In June of 2020, confusion over who was responsible for certain areas of a building on a Bedford, Massachusetts VA campus contributed to a particularly unsettling scenario. A homeless U.S. Army veteran who had been staying in a room managed by a non-profit organization, Caritas, disappeared in May of that year. At the time that he went missing, those who were informed about his disappearance — including Caritas management, Bedford police, and VA police and staff — never searched the emergency exit stairwell. That stairwell was, of course, where he was found a month later. So decayed, that the coroner could not determine the cause of his death.


The VA's Office of Inspector General opened an immediate investigation and the results of that investigation were recently released. Month's before this veterans disappearance, the VA police chief ordered his officers to stop patrolling this particular building because the lease made this building something other than VA property. However, in this case, the lease did not include the basement and the emergency exit stairwells, which remained VA’s responsibility. Had they searched those spaces during the veteran’s initial disappearance, he would have been found. They believed - incorrectly - that it was Caritas' responsibility to search that area. So – despite what one might assume was common sense – nobody searched there.


The Veteran was only found after a nurse randomly wandered into that hallway.


No one should have to suffer this. This is, however, a type of negligence for which VA should be held accountable.



More information:

https://www.bedford.va.gov/

https://www.va.gov/oig/pubs/VAOIG-20-03465-243.pdf

https://www.va.gov/oig/publications/report-summary.asp?id=5012

https://www.armytimes.com/veterans/2021/09/10/report-slams-police-for-not-finding-dead-vet-on-va-campus-for-more-than-a-month/

https://www.bostonglobe.com/2021/09/09/metro/bedford-va-violated-federal-law-by-failing-search-missing-veteran-later-found-dead-federal-watchdog-finds/