The leadership at the Soldier’s Home in Holyoke, Massachusetts made some decisions that were “utterly baffling from an infection-control perspective,” according to a probe that was ordered by Governor Charlie Baker and led by former Federal prosecutor Mark Pearlstein. The poor planning and decision-making led to 76 deaths earlier this year. Another 84 veterans and 80 hospital workers tested positive.

“The details of this report are nothing short of gut-wrenching. In fact, this report is hard to read,” Baker said adding that the events at the Holyoke Soldier’s Home were “horrific and tragic.”

“Veterans who deserve the best from state government got exactly the opposite, and there is no excuse or plausible explanation for that.” Baker added that there was a failure in leadership and a “complete lack of compassion for these vulnerable heroes.”

“Some of the critical decisions made by Mr. Walsh and his leadership team during the final two weeks of March 2020 were utterly baffling from an infection-control perspective,” the report said.