The Department of Veterans Affairs Administrative Investigation Board reports that staff members at the Bay Pines VA hospital intentionally left the body of a dead veteran in the shower room of the facility for more than nine hours, and also lied about the post-mortem care for the body in their documentation.
The report, which was 24 pages long, details the events and is largely redacted to protect the identities of the veteran and the staff members, but it concludes that the employees “failed to provide appropriate post-mortem care.”
According to the report, hospice staff placed the body in the hallway of the facility, leaving it there for an unspecified amount of time, Fox 13 reports.
They then put the veteran’s body in the shower room and left it there, not bothering to “check on the status of the decedent…for over nine hours.”
The report adds that staff members “falsely documented post-mortem care for the decedent,” but it was unclear if this was intentional or not. The hospice staff admitted that there was a higher risk of decomposition of the body while in the shower room.
There are procedures that staff members are supposed to follow to prevent these things from happening. The board also noted that documentation such as patient charts and bed assignment charts were “difficult to follow,” therefore allowing for “inconsistencies that could compromise the evaluation of staffing needs.”
Bay Pines VA released a statement to Fox 13 News, saying, “We view this finding unacceptable, and have taken appropriate action to mitigate reoccurrence in the future. Some of these actions include recommitment by all hospice staff to VA’s core values, education and training, and review of policy and procedures.
Furthermore, hospice nursing professionals were required to provide a signature commitment of understanding and adherence to policy and practice related to post mortem care. Nursing safety rounds were also initiated as a way to ensure ongoing education and oversight within the unit.
Appropriate personnel action was also taken, however, I am not able to provide details as these actions are considered confidential between the agency and employees involved as a matter of professional privacy and respect. We feel that we have taken strong, appropriate and expeditious steps to strengthen and improve our existing systems and processes within the unit.”
