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INDIANAPOLIS (WISH) — The U.S. Office of Special Counsel substantiates there was “gross mismanagement” when it came to home care for veterans who had gone to the Richard L. Roudebush VA Medical Center in Indianapolis. 

The report, sent to the president on Wednesday, said there were “significant delays to care,” a “lack of adequate training” and a “risk to public health” from its employees’ actions. 

That included one veteran losing part of his leg after treatment at Roudebush in 2017.

According to government documents, that veteran went to Roudebush with a foot infection and life-threatening complications to his diabetes. After he was discharged, the vet was supposed to have a social worker at his home twice a day to dress his wound. 

However, the VA confirmed on the first day, the care was incomplete and then canceled. On the second day, no one showed up.

“He had been unable to change the dressing by himself for the 3 days post-discharge,” reads part of a VA document obtained by News 8.

Special Counsel Henry Kerner said the veteran’s foot became infected, part of his leg had to be amputated because “of a mistake by the agency entrusted to take care of them.”

Government investigators found what happened to that veteran at home was part of a larger issue.  Social workers were being told not to do home health care visits because it was not in their “scope of practice.”  

However, Kerner said the VA has taken steps to fix these issues. The confusion about whether home health care visits are part of the social workers job is no more. Staff has been trained and told it is part of it.    

If there’s an incomplete home visit, like what happened to the veteran who needed an amputation, that worker must help make sure someone else comes to help.

Kerner said these are positive steps but is “distressed that such a situation occurred in the first place.”

(Photo by WISH-TV.)