R.I.P.PED

Even Former Mr. America Mike Scarcella Wasn't Strong Enough to Beat
the Horrors of GHB Addiction

Shelly Martin was bone tired from the countless hours she spent at the
bedside of her sick friend, but she figured she had better return to
the hospital, and fast. For the last 10 days, Mike Scarcella had been
in the intensive care unit at Presbyterian Hospital of Plano. Now
Martin had learned that his doctors were planning to transfer him to
some psych ward, even though his jaw was wired shut and he was being
treated for pneumonia and a staph infection.

Worse, he was still going through withdrawal from gamma
hydroxybutyrate (GHB). Although lucid at times, he would grow restless
and agitated, suffering from nightmarish hallucinations aggravated by
days without sleep.

In terms of withdrawal, heroin had nothing on GHB. When he came to the
emergency room on August 15, Scarcella told the nursing staff he was a
GHB addict.

He knew that it would be only a matter of hours before he started to
feel the anxiety and tremors of early withdrawal. It would take longer
than that to fix his broken jaw, which was hanging sideways from the
beating he had taken outside a Carrollton bar. He was always a
stand-up guy, but that night he stood up to the wrong men. After he
was cold-cocked from behind, three others joined the fray, kicking him
in the head while he was down. After she arrived at the hospital,
Martin went on her own rampage: He wasn't some destitute druggie who
needed to be dispatched to a detox center without so much as an
explanation. He was Mike Scarcella, a competitive bodybuilder, a
former Mr. America, a personal trainer, a dad. She was one of four
devoted friends who took shifts and maintained a round-the-clock
hospital vigil, caring for him because nurses were afraid of him. At
39, Scarcella was still a massive wall of buffed and bulging muscle.
Since so little is known about GHB withdrawal, even among emergency
room physicians, Scarcella put nurses in touch with Project GHB Inc.,
a clearinghouse for information about the dangers of the drug. While
GHB gained its notoriety as a club drug, used by date rapists preying
on unsuspecting women, bodybuilders had been the first to fall victim
to the "supplement," which was originally sold in nutrition stores and
promised them more muscle mass, less body fat, sound sleep and great
sex. Its "good for what ails you" claims were bolstered by its
clinical use in Europe and medical research, some of it junk science,
that found it nontoxic, nonaddictive and a treatment for certain types
of narcolepsy. Government conspiracy theorists furthered its cause on
the Internet, finding it scandalous that a substance that occurs
naturally in the body could be scheduled as an illegal narcotic.

With some science and many Web sites promoting its safety and
efficacy, it became easier for the casual user to abuse. That is,
until they showed up at emergency rooms, incomprehensible and
sweating, their bodies trembling with anxiety, their hearts racing
toward stroke. "It's the worst withdrawal there is," says Trinka
Porrata, president of Project GHB. "Most detox takes four to five
days. GHB can mean 10 to 14 days of really bizarre and psychotic behavior.

The withdrawal itself can be lethal." Project GHB sent Presbyterian
Hospital a withdrawal protocol, which its doctors had followed, at
least at first.

But when a frantic Martin went to Scarcella's hospital room on the
morning of August 25, her friend seemed to be getting worse.

A strap crisscrossed his formidable chest and shoulders, harnessing
him to the bed. "He was pissed.

He wanted to leave and kept strug gling to get out of bed," Martin
says. "His dementia was so severe, he thought he was driving his car,
shifting gears and going home." The day before, Martin recalls, a
doctor told her that another week would pass before Scarcella was released.

His staph infection had to first resolve itself. But this morning he
was being moved to the psychiatric unit at North Central Medical
Center in McKinney. His doctors had signed a medical certificate that
authorized taking him into protective custody and committing him to a
chemical-dependency facility. "They told me he was outside their scope
of treatment," Martin says. "But it was clear they were pushing him
out the door." Three Plano police officers handcuffed Scarcella,
placed him in a wheelchair and escorted him to a squad car. Martin
says she began to "freak," turning to a nurse and shouting, "No, no,
don't let them do this! How can they take him?" Jim Cardenas, another
bedside-vigil friend, tried to calm her down: The doctors said it was
for the best; they had to trust them. Presbyterian Hospital of Plano
declined to comment, citing patient privacy concerns. But Martin was
inconsolable: She and Scarcella had different plans.

A nationally renowned expert in GHB withdrawal worked at Southwestern
Medical School. If they could get Scarcella to Parkland hospital, the
expert would be brought in for consultation. After detox, Scarcella
would live with Martin until he got back on his feet. "Just let him
come home with me," she pleaded with the police.

But they had their orders, and she wasn't even family. She watched
them stuff him into the backseat of a squad car, all 240 pounds of
we both are.'" Anti-depressants would stem their longing for a while,
but when a friend would score some G, "we would be back on it again."
The GHB brought even more drama to their relationship, which a friend
describes as "kind of Jerry Springer." While Scarcella could somehow
function on GHB, at least for a time, Gleisner had a harder time
coping--passing out, wrecking her car and eventually getting arrested
for DWI. Scarcella had his own legal problems.

In May 1999, he was busted for felony possession of steroids and
possession with the intent to deliver GHB. Although prosecutors sought
to put him in prison for 15 years, numerous character witnesses, three
of whom were police officers, convinced a Denton County judge to
probate his sentence for 10 years. Even though they had a son in
common, it wasn't enough to salvage Gleisner and Scarcella's
relationship. They lived in different worlds and wanted different
things. "I wanted to settle down, and he didn't know how to be content
with one person," Gleisner says. Their breakup would enable her to
confront her addiction, and she managed to recover with the help of
Narcotics Anonymous. She and Scarcella continued to be close friends;
he was so easy to forgive, and Brock loved him so much. But
nothing--not his trouble with the law, not his feelings for his son,
not his inner sense of discipline--could curb his GHB habit. Sometimes
he would show up late for sessions, sometimes not at all, and he ran
off much of his clientele. "No one wants to train with a fucked-up
trainer," says Randy Edwards, a close friend who owns The Gym.
Scarcella filed for bankruptcy and had a federal tax lien placed
against his house, which he eventually was forced to sell. He slept on
the couch of whichever friend was kind enough to have him. With his
resources limited, he resorted to selling GHB, again. "Kitchen GHB"
can be made on the cheap, synthesizing it in great batches by adding
its analogue, gamma butyrolactone (GBL), commonly found in industrial
solvents, to sodium hydroxide.

The GHB that Scarcella dealt, however, was pure. "After you took it,
you had to drive straight home," says Edwards, who is himself a
recovering GHB addict. "It would knock you out for at least four
hours." Scarcella knew he had to get clean, and he tried to self-detox
several times, but the withdrawal brought on panic attacks so
crippling, he was certain he was going to die. In spring 2002, he
broke down crying in front of training partner Chad Marr. "His
depression and anxiety were getting out of hand," Marr recalls. "He
loved his son and didn't want to die just like his mother had." Marr
brought him to Green Oaks Hospital in Dallas, but he was moved to
Medical City's intensive care unit after his blood pressure soared.
"He went through some badass hallucinations," Marr recalls. "He was
standing on a bed, buck naked, swinging at everyone.

They sedated the hell out of him, but it still took five security
guards to hold him down." He ripped the bed sheets apart and was
restrained to his bed, and there was some concern he had suffered a
stroke.

But after three weeks, he checked himself out of the hospital,
convinced he had kicked the habit.

A week later, Marr says, it was obvious he hadn't. "He showed up at
the gym, and his speech was slurred.

He was using again and blamed the hospital for not fixing him." His
downward spiral continued unabated as his drug use grew worse.

His few remaining clients were mostly friends trying to help him stave
off ruin. He knew GHB had beaten him but was afraid the withdrawal was
going to kill him. If he was going to be there for his son, he knew he
would have to face rehab again. What was stopping him was his vanity.
"He told me that he wanted to keep taking steroids and keep working
out," Marr says. "He had lost everything, and the only part of his
identity that he had left was the way he looked." By the late summer
of 2003, Scarcella convinced himself that if the rehab didn't kill
him, the drug would.

So he allowed Shelly Martin and Crystal Gleisner to intervene on his
behalf, researching Web sites to find an affordable facility capable
of treating his GHB addiction.

Martin received several local referrals from Project GHB's president,
Trinka Porrata, who believed that once in recovery, a former Mr.
America would be the perfect national spokesman for her nascent
organization. "Mike was so excited," Martin recalls. "Finally, he had
found a venue where he could be celebrated again, where he could be in
the limelight again.

He wanted to do something that would make his son proud."

McKinney, August 25, 2003, about 9:30 p.m. "McKinney 911," answered
the voice of the female dispatcher. "What is the address of your
emergency?" A nurse mumbled that she was calling from the psychiatric
unit of North Central Medical Center. "I have a code blue [cardiac
arrest] in progress, and I need help immediately..." "How old is the
person?" "I don't know," she said frankly. "...I am sending the
paramedics right now," assured the dispatcher. "Ma'am, I have some
questions for you." The nurse searched for Mike Scarcella's chart but
couldn't seem to find it. The dispatcher sounded annoyed. "Ma'am, is
he having breathing difficulties?" "He has stopped breathing, and they
have started to...hold on." She paused to speak to another nurse. "Are
you sure this is the right Mike?" "...OK, is he conscious at all?"
"No, he's not conscious right now." "And he's still not breathing?"
"They're doing CPR, and we're looking for his chart," said the nurse.
"Do you have his chart over there?" "...Is he able to talk to you at
all?" "No, no." "Is he changing color at all?" "Yes, yes," she said.
"That's when we noticed he went down on the floor, and he was banging
his head on the floor." "...Does he have a history of heart problems?"
"That I don't know. Actually I don't know anything about the patient."
"Do you have an AED there?" The nurse repeated the letters, acting as
if she had no idea what they meant. "An automatic electronic
defibrillator," instructed the dispatcher. "Oh, no. Well, they might
have one on the fourth floor..." "Do you want me to send an officer
with an AED?" "Yeah, I guess it couldn't hurt..." Precious seconds
were passing. "Do you know anything about this man?" asked the
dispatcher. A second nurse answered, ostensibly more knowledgeable
than the first. "I don't know that much about the man except that he's
very psychotic.

And the last thing that I saw was that he threw himself down on the
ground and banged his head on the ground." "Did he choke on anything
first?" the dispatcher asked. "...He didn't appear to be choking," she
said. "Does he have a history of seizures?" "That I don't know." Seven
minutes into the 911 call, medical personnel found his chart. "He has
been having withdrawal from GHB," she informed the dispatcher.
"Hallucinating and inaudible.

He was apparently on a medical floor." She was referring to the
intensive care unit of Plano Presbyterian Hospital, where Scarcella
had been a patient for 10 days after suffering the broken jaw. Despite
his mouth being wired shut, despite his being treated for pneumonia,
despite his being in the throes of psychosis induced by GHB
withdrawal, the Plano hospital had him involuntarily committed to
North Central Medical Center's psych unit. This was not what he and
his friends had envisioned when they planned his rehab. "My fire
department is on location," said the dispatcher. "I am going to
disconnect. Thank you so much." At 10:12 p.m., less than six hours
after leaving intensive care, Mike Scarcella was pronounced dead.

For those friends who had maintained a hospital vigil for Scarcella,
his sudden death seemed impossible to comprehend. For Scarcella to get
his jaw busted in a bar fight was so out of character; his physical
presence was enough to intimidate the drunkest of challengers. No
police report was filed, and no witnesses were interviewed, so rumors
filled the void. His criminal attorney, Mike Bragg, attempted to get
the police involved, but the Dallas, Plano and Carrollton (where the
bar was located) police departments each claimed it wasn't their case.
"It really pissed me off," says Bragg, who did his own cursory
investigation. "The four guys who beat him up were known GHB drug dealers.

I heard they hit him with a lead pipe. But what the fight was over, I
don't know." When Gleisner received a phone call from North Central
Medical Center informing her of Scarcella's death, "the hospital said
he died in transit to the emergency room," she says. But two days
after he died, Gleisner's fiance, Jim Cardenas, received an anonymous
phone call from a nurse at North Central Medical Center, who told him
"that a grave injustice had been done." In a later call, the nurse
revealed his name was Robert Meskunas and that he helped admit
Scarcella to the McKinney hospital, although he was off-duty when he
died. Meskunas' knowledge was secondhand, a compilation of what others
had observed, but he was convinced Scarcella was too unstable to be in
a psych unit. "He said they should have stepped him down from critical
care to regular care for three or four days," recalls Cardenas, who
took notes on the conversation. Meskunas told him there was a
concerted effort on the part of North Central Medical Center officials
to say that Scarcella died while paramedics were transferring him to
the emergency room, but that just wasn't the case. He was dead before
they arrived, and the nurses charged with his care improperly
responded to the code blue. He and another nurse had filed complaints
about the incident with the Texas Department of Health. Meskunas told
the same story to the McKinney Courier-Gazette, as did a second nurse,
who wished to remain anonymous but gave the newspaper a copy of her
complaint.

Meskunas was removed from the "nurses schedule" and no longer works at
North Central Medical Center. Meskunas has not returned phone calls
seeking comment, but the Dallas Observer has obtained the findings of
those complaints, which fault North Central Medical Center for
violating three federal regulations, including the "failure to
supervise and regulate the nursing care [of Scarcella]." "The
hospital's Cardiac Arrest/Code Blue policy was not followed," says a
statement of deficiency prepared by the Department of Health and Human
Resources. "No cardiac monitor was attached to determine the
rhythm...no IV access was obtained, and the suction was not set up and
prepared to intubate." A spokesman for the hospital expressed "our
condolences to Mr. Scarcella's family and friends" and cited the
Collin County medical examiner's report, which "makes it clear that
Mr. Scarcella's death from natural causes was not the result of the
care he received during the short time he was our patient."
Referencing patient privacy laws, the hospital specifically declined
to comment on whether the violation of its own code blue policy might
have contributed to Scarcella's death. Cardenas and Gleisner weren't
the only ones contacted by whistle-blowing nurses. Upon hearing about
Scarcella's death, Shelly Martin says she "flipped out," phoning the
hospital and demanding to know what had happened. She spoke with an
ICU nurse, whose anonymity she is protecting, who felt that Scarcella
was in no condition to be transferred in the first place. "She said
doctors thought he was difficult, and they had a heart patient who
needed the bed," Martin recalls.

The nurse was later fired, Martin says, on grounds she had breached a
"confidential relationship." The nurse also spoke with attorney Rachel
Montes, who was hired by Gleisner to investigate the circumstances
surrounding Scarcella's death. "The information I have gathered comes
from an informant [the same nurse] who wishes to remain anonymous and
says Mike wasn't stable enough to be released and was dumped because
he didn't have insurance." Before filing a lawsuit, Montes had to wait
on the autopsy report, whose preliminary findings revealed that
Scarcella suffered from an undiagnosed subdural hematoma (blood clot
in the brain), which resulted from the blow he took to his head.
Gleisner and Cardenas say they saw hospital charts, which recommended
a CAT scan that was never performed.

But the quality of his care became less relevant after the medical
examiner ruled that Scarcella suffered "sudden cardiac death" because
of a "hypertensive enlargement of the heart" and withdrawal from
GHB--making litigation, at least against Plano Presbyterian, less
attractive unless an expert can be found to say that Scarcella
wouldn't have died if he hadn't been transferred in the first place.
More relevant were the deep feelings of loss suffered by the 150
people who attended Mike Scarcella's funeral on August 29. "I can't
explain to you how much my heart hurts," says Martin, who gave one of
five eulogies.

All eyes were fixed on 5-year-old Brock, who did his best to remain
seated, fidgeting anxiously and looking uncomfortable in an oversized
tie. Finally, Brock couldn't contain himself.

He marched toward his father's coffin and lingered in front of a large
portrait of a younger, formally clad Mike Scarcella. Brock traced his
fingers over the photograph, placing his hand over his father's heart
and bringing it back to touch his own. Huge strongmen and everyday gym
rats broke into tears.

It seemed the perfect moment to preach about the dangers of GHB and
the havoc of getting hooked, just as Scarcella had. Gleisner had laid
out a stack of Narcotics Anonymous literature, which all but
disappeared. Nearly a dozen people thanked her for saying what they
needed to hear. "Mike just wanted his story told," Gleisner says. "We
just hoped for a different ending."