Toxicology reports and multiple investigations are still pending, and Dr. Dean Norman, chief of staff of the hospital, says that details of the five overdose deaths vary by case. But veterans treated at the hospital say that lax supervision of prescription drugs was a serious problem, particularly in the domiciliary, the dorm-like residential halls the VA uses to help veterans make the transition to life outside the hospital. “They were handing the meds out like candy,” said Joe Romo, a member of the local AMVETS post.
At least one of the deaths, that of 28-year-old Marine Lance Cpl. Justin Bailey, was the result of over-prescription of methadone, a highly addictive drug that has traditionally been used to treat heroin addiction but is increasingly prescribed for pain relief. After suffering a groin injury in Iraq, Bailey was operated on at the VA hospital. When the pain did not subside, he was prescribed methadone. After being given a 30-day supply, Bailey suffered a nonfatal overdose in December.
Hospital records indicate that Bailey’s parents then alerted the hospital that he should be watched more closely. He was suffering from post-traumatic stress disorder (PTSD), which resulted, in part, he told friends, from having taken part in accidentally killing civilians in Iraq. After the first overdose, VA doctors reduced his prescription to a 14-day supply, which he self-administered in combination with at least four other prescription medications. On Jan. 26, Bailey was found passed out in his bed in the domiciliary and he died shortly after. “The man suffered from PTSD, and this was a terrible tragedy,” said Norman.
Last November, the Food and Drug Administration issued an “FDA Alert” warning of “Death, Narcotic Overdose, and Serious Cardiac Arrhythmias” as a result of unintended methadone overdoses and urged physicians to “closely monitor” methadone patients. When asked if he had seen the FDA Alert, Norman said, “I haven’t seen this particular alert, but I know, in recent weeks, there’s been quite a bit on methadone, questioning its use in chronic pain.”
Although there has been no indication of a systemwide problem in the VA of accidental overdoses, the experience at the L.A. facility is expected to cause other hospitals to review their practices. The VA says it generally trusts patients in the domiciliary to take their own medications in order to help them prepare for life at home without direct medical supervision. But when another patient, a Vietnam-era veteran, died just a week after Bailey–bringing the total to five in 10 weeks–Norman changed policies. Because at least two of the other overdoses involved illegal narcotic use, he beefed up security, implementing law-enforcement sweeps, complete with drug-sniffing dogs. And hospital administrators say they will no longer routinely offer multiweek supplies of methadone, especially for new patients. “Our idea initially would be to give them a single-day supply, and on the weekends a two-day supply,” said Norman.
The facts in this case were brought to light thanks to Dmitris Rentzis, a production assistant on the television show “King of the Hill,” who met Bailey when the veteran was working in a sandwich shop near the studio. After Bailey’s death, Rentzis was so appalled by the VA’s handling of his friend’s case that he collected first-hand accounts of efforts to alert seven different nurses and doctors to Bailey’s condition. “I prepared a nine-page declaration that documents at least 17 attempts by me, his mom and by other patients trying to alert the staff, and they were totally ignored,” Rentzis said. The declaration includes the names of the hospital personnel and the dates on which they were warned that Bailey was abusing his prescriptions.
“Our staff is denying that they received these multiple warnings,” Norman said.
Bailey’s father, Tony Bailey of Las Vegas, Nev., feels betrayed by the VA. “I always thought they [the VA] were good health care,” he said. “It shouldn’t be just a place to hand out drugs.”
The fact that four of the five drug-overdose deaths occurred among Vietnam-era veterans points up the continuing problems facing veterans of that war, which ended 32 years ago. Thousands still suffer from PTSD and substance-abuse problems. One resident of the VA domiciliary, Mike Vasquez of Los Angeles, says the experience of Vietnam veterans–who make up a sizable part of Los Angeles’ homeless population–should give the public an indication of what lies ahead. “If you want to know what’s going to happen to the Iraq veteran,” said Vasquez, who has served time in prison on drug charges, “look at the Vietnam veteran.”
