NORTH ANDOVER, Mass. -- A probe into the deaths of 76 veterans at a Massachusetts soldiers home from COVID-19 has prompted the resignation of a top state official, himself a decorated ex-Marine.

The state secretary of veterans services, Francisco Urena, resigned a day before this week’s release of a report that sharply criticized management and care at the Holyoke Soldiers’ Home.

The scathing report described poor decisions before and during the spread of COVID-19 in the home this spring, starting with the choice of the facility’s superintendent, Bennett Walsh, a combat veteran with no experience as a healthcare administrator.

Veterans with COVID-19 were knowingly placed with those who had no symptoms due to staffing shortages at the home. A therapist told investigators that moving veterans into the ward was like “walking them to their death.”

The report by former federal prosecutor Mark Pearlstein described separate units with “some veterans who were COVID-19 positive, some who were suspected of having the disease, and others who were displaying no COVID-19 symptoms.”

“Rather than isolating those with the disease from those who were asymptomatic — a basic tenet of infection control — the consolidation of these two units resulted in more than 40 veterans crowded into a space designed to hold 25,” the report stated.

Gov. Charlie Baker on Wednesday described the findings in the 174-page report as "nothing short of gut wrenching" and "hard to read." Conditions at the home, he said, were "truly horrific and tragic.”

The next day the governor released a series of reforms meant to improve oversight of the facility.

"Veterans who deserve the best from state government got exactly the opposite," Baker said.

Management of the home, which had more than 230 veteran residents at the outset of the pandemic, is under the purview of the state Department of Veterans Services. Investigators said Urena had recommended Walsh for the job despite his lack of qualifications.

Baker said he asked Urena for his resignation, and he “gracefully” complied, saying he was sorry for what had happened.

The state replaced the home’s management in late March, as the tally of coronavirus related deaths mounted. Baker deployed the National Guard to stabilize the situation.

The governor has said he will also move to fire Walsh, who was placed on administrative leave March 30.

A former veterans services director in Lawrence, Mass., Urena served as Boston’s commissioner of veterans services before his appointment to Baker’s cabinet in 2015. He has also served on a national advisory committee for Veterans Families, Caregivers and Survivors chaired by former U.S. Senator Elizabeth Dole. 

Jill Harmacisnki and Bill Kirk write for The Eagle-Tribune in North Andover, Massachusetts.

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