Philadelphia Daily News had an article about the sad death of Harold Chapman, a vet who was allowed to wander away from Delaware Valley Veterans Home.   Chapman, diagnosed with dementia and work-related brain damage, wore only pajamas when he stepped past a manned security desk at 5:30 p.m. Dec. 31, 2007, and into the winter cold. Two hours later, a staffer reported that she could not find Chapman, a Korean War veteran, in his room or anywhere else.  Ten hours passed before Chapman’s lifeless body was found a few yards from the state-run nursing home.  Details about Chapman’s death emerged in a lawsuit his daughters filed against the state.  Evidence produced for the lawsuit includes surveillance tapes of the former policeman leaving the home.

Records from the Delaware Valley Veterans Home show that there were multiple failures by staffers, first by not monitoring Chapman’s movements and, after he was belatedly discovered missing, by failing to immediately follow established emergency procedures. Staffers didn’t notify the home’s commander until after 9 p.m., more than three hours after Chapman disappeared. They didn’t call police until 9:15 p.m.

Surveillance tapes show that Chapman left his restricted area by riding the elevator with an employee who was not authorized to be in the building at that time. One staffer, one of the last to be seen with Chapman, abruptly quit his job when told he would be questioned. Called "a person of interest" by investigators, the aide later was discovered to have a criminal record for stalking.

"If he were any closer, they would have tripped over him," his widow, Barbara Chapman, said in a recent interview.  "It was New Year’s Eve, and everyone was getting ready for a party. He walked right by them," said Barbara Chapman, who viewed the tape. "He couldn’t find his way back, and got lost. They told me it was painless, but I later found out it can be a very horrible death."

The Pittsburgh Tribune-Review has been investigating state veterans’ homes and has found serious deficiencies at two of them, in Hollidaysburg and Scranton. The U.S. Department of Health and Human Services rated those facilities below average in meeting inspection requirements, giving them the lowest possible ranking: one star out of five, while other homes in the system fared better.

The 1,632-bed state veterans health system, dating to the Civil War era, costs $165 million a year to operate. It is separate from the federal Veterans Affairs. The state facilities include nursing-home beds, personal care facilities and locked dementia units, where many of the serious violations occurred.


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