The former Marine who was shot and killed by police outside the Togus Veterans Affairs Medical Center in July had repeatedly complained about the hospital’s poor communication and discontinuity of care, and a prescription regimen that denied him needed drugs.

James Popkowski grew increasingly depressed, and eventually made threats against the medical staff at the clinic where he was being treated, according to a report by the Department of Veterans Affairs’ Office of the Inspector General.

The report acknowledges failures in Popkowski’s treatment and recommends changes to the way veterans’ care is administered.

Popkowski, 37, of Medway, died July 8 from a gunshot wound to the neck, after a confrontation with a Veterans Affairs police officer and two game wardens near the entrance to the medical center.

The Maine Attorney General’s Office is still investigating, spokeswoman Kate Simmons said Monday. Investigators have said that preliminary information indicates officers felt threatened by Popkowski, who had what witnesses said looked like a rifle.

U.S. Rep. Mike Michaud of Maine requested that the Office of the Inspector General investigate Popkowski’s care. Results were released on Thursday.

“The death of Lt. James Popkowski was a tragedy,” Michaud said. “His family deserves to have all the answers, and all veterans stand to benefit from a thorough review of what happened.”

Popkowski was a first lieutenant when his service was cut short in 2003 by a rare form of leukemia. He left the Marines with an honorable discharge and later complained of graft-versus-host disease from a stem cell transplant he received as part of the cancer treatment.

Popkowski first went to Togus in December 2005. At the time, he was being treated elsewhere for cancer, depression and chronic pain, according to Assistant Inspector General Dr. John Daigh Jr., the report’s author.

Over the next four years, Popkowski was assigned at least four primary care physicians at three facilities, and became frustrated by what he perceived as inadequate care.

Popkowski wrote a letter to Michaud in May 2006 expressing “dissatisfaction with the timeliness of obtaining prescription medication refills at the medical center, the assignment of a physicians assistant as his primary care physician and the ‘low caliber’ of VA medical employees.”

More than four years later, on July 8 of this year, Popkowski was shot after officers responded to reports of gunfire coming from the woods near the medical center. A witness who was walking in a Togus parking lot said after the shooting that he had heard bullets flying in the direction of the hospital.

Popkowski allegedly left a painted note on his property accusing doctors of “killing him” by depriving him of his stem cell medication.

The investigation recommends review and changes to Togus’ policy for assigning case managers and coordinating care.

It also urges Togus to improve internal communications and develop better procedures to assess and communicate risks associated with veterans who show disruptive behavior.

“Whether addressing these three issues previously would have resulted in a different outcome for (Popkowski) is unknown,” Daigh wrote. “However, addressing these issues now will help facilitate a more patient-centered environment, especially for those veterans with complex and unique medical, mental health and psychosocial issues.”

The report includes Togus’ plans to address the recommendations by the end of February. Michaud said he will push for the report’s recommendations to be implemented across the VA medical system.

“In the weeks and months ahead, I’ll be working to keep up the pressure on the VA to get this done,” Michaud said.