Wednesday, April 16, 2008

Vet Says Dallas VA Medical Center "Worse Than Hell"

Vet: VA Psych Ward 'Worse Than Hell'
April 16, 2008
Dallas Morning News
The voices in Jack Edenburn's head began soon after he returned from Vietnam. They told him to end it all.

He ignored them for almost 40 years, until the day he stood at the railroad tracks near his Lancaster home, fantasizing about stepping in front of a train. That's the day he went to Dallas VA Medical Center. And some days, he says, he regrets that decision.

"Imagine hell," he said of his five days in the psychiatric unit, "then think worse."

Patients soiled with feces and soaked in urine wandered aimlessly, screaming, rolling delirious on the floor. One woman, he said, removed ceiling tiles and crawled into the space above the day room.

"I was more traumatized after five days in the VA than I was when I was admitted," said Edenburn, who works in the mail room of an insurance office. "And remember, I was suicidal when I went there."

Officials for the VA North Texas Health Care System say more than $250,000 has been spent in the last six months to improve safety on the ward, part of the VA hospital on South Lancaster Road.

But after four patient suicides in four months -- including those of two men who hanged themselves during treatment in the 51-bed psychiatric unit -- hospital officials effectively closed the ward two weekends ago.

Investigators from the Department of Veterans Affairs ordered patient records and other material after the latest suicide on April 4. They are expected to tour the hospital and begin assessing its safety next week.

VA officials in Washington declined to comment Tuesday.

U.S. Sen. John Cornyn and U.S. Rep. Michael Burgess, both Texas Republicans, called on Secretary of Veterans Affairs James Peak to investigate the deaths.

"Our nation's veterans have made tremendous sacrifices to ensure our safety and defend the freedoms we hold dear," Cornyn wrote. "These men and women deserve the best medical care America has to offer. As you would agree, we must not tolerate anything less."

Chris Demopoulos, a 58-year-old Marine Corps and Vietnam veteran, was released from the Dallas VA on Jan. 22. The next day he hanged himself from the second story of a La Quinta Inn in Plano.

His body was discovered by Pat Ahrens, a friend he had met in the veterans hospital. Two nights later, Ahrens, a 50-year-old landscaper and Air Force veteran, backed his silver Lincoln Navigator into an oversized storage unit on 14th Street in McKinney.

Family members said he swallowed handfuls of pills and washed them down with Bacardi and Coke. He died later that day.

Larry Johnson, a 55-year-old Air Force veteran, hanged himself using a modified wheelchair while he was a patient in the psychiatric ward on Feb. 5.

Two months later, another patient committed suicide at the hospital by attaching a sheet to a door frame and tossing a noose over the other side of the door.

A local psychiatrist who finished his residency at the Dallas VA said it's difficult to predict what mentally ill patients like Demopoulos and Ahrens will do once discharged from a hospital.

"But when you have suicides on the unit, where people should be checked every 15 minutes, that's well within the control of the VA," said the physician, who requested anonymity out of fear of professional retribution. "When that happens once, that's really a problem. And then it happens again, that's really unconscionable."

He said the psychiatric unit does not meet the safety standards of other hospitals because of its age.

As recently as a few months ago, he said, most patients were cared for by resident physicians, the least experienced psychiatrists on the unit. The attending physicians, he said, only meet with patients at admission -- never during their treatment, and they do not personally make the decisions about when patients are ready for discharge.

Dr. Catherine Orsak, head of mental health for the VA's North Texas health system, said attending physicians see patients at least three times during their stay, including at discharge.

She said the age of the 68-year-old facility presents risks to suicidal patients. Door knobs, shower curtains and power cords can be used in hanging deaths. Windows can be broken, and even pencils can be instruments of self-destruction.

"It's a challenge in an older facility and in older units to maintain the highest level of care," Dr. Orsak said. "And yet we've put a lot of money and energy into it."

She pointed to the more than $250,000 spent in the last six months.

"We thought we had completed everything we had identified," she said. "The point is to identify risks and then determine how significant that risk is. It seems there is always something else to do."

Dr. Orsak has said she does not know when the psychiatric ward would begin admitting patients again. So far, she said, about 50 veterans have been moved to government hospitals in Waco and Temple, as well as Parkland Memorial Hospital in Dallas and private treatment centers such as Green Oaks and Timberlawn.

Ray Daniel, a 35-year-old veteran of the Persian Gulf War, said he has been going to the Dallas VA psychiatric unit since he was discharged from the Army in 1998. He estimates he has been admitted to the ward 20 times.

He said care has improved over those 10 years.

Nurses are more respectful, he said, and doctors seem less rushed and more focused. He said his psychiatrist called him last week.

"He told me they were getting real concerned about me and they were thinking about coming and getting me and putting me back in," he said. "They've been calling a lot and checking on me and making sure I'm all right, and I appreciate it."

Daniel said if someone wants to end their life, there's not much doctors can do. He said the beguiling voices are always in the back of his mind.

"There are times I want to give up, man, and end it all," he said. "I have those thoughts and I understand how those vets feel -- no one cares, I served my country, and sometimes they feel worthless. I feel that way sometimes, too; I feel used."

When the depression comes, Daniel said, he takes medicine and fixes his eyes on his children.

"I'm not saying I'm better than these guys," he said. "All I'm saying is there's a reason to live and they need to hang in there."

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