Doris Craig received the telephone call two days after she left her brother, depressed and crying, at the Veterans Affairs Medical Center in Salem, Va. Carl McKenzie had "left the premises," she was told; the hospital grounds had been searched thoroughly, and he was gone.
That was last November. Four months later, on March 25, McKenzie's body was discovered by another psychiatric patient at the edge of the woods near his hospital building, in a thicket under a white pine tree. He had died of exposure, an autopsy said.
Later that same day, a groundskeeper found the body of Leonard Cunningham, 44, a Vietnam War veteran who had been missing since Feb. 22, hanging by a nylon rope from the branch of a pine not far from the same spot.
The discoveries prompted a cleanup of the thick underbrush that covers large parts of the 240-acre campus in the Roanoke Valley. Last weekend, workers clearing the growth discovered the skeleton of yet another patient - identified through an arm bracelet as a man who had been missing from the center's nursing home for 15 years. His name has not been released.
"In the history of the Veterans Administration, I don't know any other place where they've found three bodies in two months' time," said Alma Lee, president of the American Federation of Government Employees local, the union that represents about 550 of the hospital workers and already had criticized the facility for what it said was poor morale and stressful working conditions.
"If they continue to look, there's no telling what they will find. I hesitate to think what would happen if they drag the lake," she said.
QUALITY OF CARE IS PROBED
The discoveries come at a time when the care provided by VA hospitals nationwide to more than 1 million veterans is under question. After the problems at Salem, VA officials reassigned the facility's director, and the General Accounting Office is investigating the employees' complaints.
This week, the VA medical inspector's office concluded that the policy for looking for missing patients at the facility was "totally inadequate" and that the only searches for the most recent missing men were "cursory" checks of roads and hospital buildings.
The VA investigation also found that after McKenzie was listed as an "unauthorized absence," a nurse noted in his medical records that he had slept well through the night and had made no complaints.
After Cunningham was reported missing in February, a nurse and a doctor wrote orders twice to renew his medication, privilege status and diet - the last time a month after Cunningham had disappeared.
"Since the patient was obviously not present on the ward," the report said, "written renewal orders reveal the staff's lack of concern or awareness of the patient's status."
The recent events - documented in Roanoke and Richmond newspapers and mentioned on network television broadcasts - have produced a crisis at the medical center, which previously had a reputation as one of the Department of Veterans Affairs' leading facilities for psychiatric and general medical care.
Founded in 1934, it serves about 1,000 veterans a day from Southwest Virginia, including about 700 inpatients and nursing-home residents, employs 1,500 people and operates on a budget of $70 million a year.
In the midst of an ambitious construction program, the facility recently postponed the dedication of a new $55 million clinical building until the investigations are completed.
"Certainly the sequence of events that has transpired has been terribly unfortunate," said Acting Director Michael Phaup, who succeeded Clark Graninger on April 15. "I feel strongly that as we effect the changes that need to be made that we will get through this period."
POLICIES BEING REVISED
Among other things, Phaup is working to revise the center's missing-patient policies, has dispatched a team of groundskeepers to examine "the campus from one end to the other" and has ordered a review of all patients who have left the facility without their doctors' advice. "We are going through our history files," he said.
Asked if he anticipated finding any other lost patients, Phaup said, "We have no reason to believe that what we discovered on Saturday (the third body) exists elsewhere on the campus." Noting that the center is not a high-security facility, he said most patients who leave simply return home, and that all 70 committed patients who had been reported missing since January 1991 have been accounted for.