PARENTS BLAME VA IN FATAL OVERDOSE

An Iraq war veteran should have been watched more closely, his family
says, because of his abuse of drugs.

Iraq war veteran Justin Bailey checked himself in to the West Los
Angeles VA Medical Center just after Thanksgiving.

Among the first wave of Marines sent into battle, the young rifleman
had been diagnosed since his return with posttraumatic stress disorder
and a groin injury. Now, Bailey acknowledged to his family and a
friend, he needed immediate treatment for his addiction to
prescription and street drugs.

"We were so happy," said his stepmother, Mary Kaye Bailey, 41. "We
were putting all of our faith into those doctors."

On Jan. 25, Justin Bailey got prescriptions filled for five
medications, including a two-week supply of the potent painkiller
methadone, according to his medical records.

A day later, he was found dead of an apparent overdose in his room at
a VA rehabilitation center on the hospital grounds. He was 27.

The Los Angeles County coroner's office is awaiting toxicology reports
and has not ruled on the cause of death. Numerous other investigations
are underway, including one by the Department of Veterans Affairs.

Whatever the outcome, Bailey's family and friend Dimitris Rentzis hold
the VA directly responsible. The young man's medical records, reviewed
by The Times with his father's consent, contain multiple references to
his history of abusing prescription drugs - even a note about a
warning from his concerned mother.

In view of that, his father wonders, why was Bailey allowed to
administer his own medication?

"My son had made a decision to get help, and they didn't help him,"
said Gulf War veteran Tony Bailey, 47, of Las Vegas. "They gave him
the bullet."

Hospital officials say the death has prompted immediate reforms -
including more random urine tests, increased staffing on weekend
nights and room checks for drugs.

"Our programs are excellent, but they're not perfect," said Dr. Dean
Norman, the hospital's chief of staff. "And we always strive to make
them better."

The death comes amid a national furor over the poor treatment and
squalid conditions experienced by some patients at Walter Reed Army
Medical Center in Washington, D.C.

Even before the scandal broke, however, questions had arisen
nationally about the ability of military and VA hospitals to handle
the influx of Iraq veterans with post-traumatic stress disorder, or
PTSD.

An Army-funded study published in January in the American Journal of
Psychiatry found that almost one in five combat veterans returning
from Iraq suffered from PTSD, which increases the risk of substance
abuse. Many of those returning troops also suffer physical pain.

The dilemma, said Dr. Andrew Shaner, deputy chief of psychiatry and
mental health at the West Los Angeles VA Medical Center, is that "most
drugs to treat pain hold potential for abuse."

That, said Bailey's family, is precisely why Justin should have been
watched more closely.

Justin Bailey joined the Marine Corps in 1998, one month shy of his
18th birthday. He had a big heart and many friends, his family said -
but he also had gotten into trouble with marijuana and alcohol.

Both he and his parents thought the Marines would help straighten that
out.

He signed up for four years. Then came the Sept. 11 terrorist attacks.
On the eve of war, his tour of duty was extended and he was deployed
to Nasiriya, Iraq, southeast of Baghdad.

After his honorable discharge in April 2004, Bailey didn't talk much
about what he'd done and seen in the war - at least not to his father.

"It seemed like something happened over there that really changed him
a lot," Tony Bailey said. "It wasn't easy for him to ask for help, at
least from his parents."

Tony Bailey said his son had trouble adjusting: He ran up traffic
warrants. He couldn't keep a job. He couldn't pay the rent.

To his mother, he spoke of guilt over civilian casualties.

"He came back saying, 'Mom, I shot women and children. I can't deal
with this,' " said Danielle Floyd, 53, of Henderson, Nev., who is
divorced from Justin's father.

He studied sound engineering in Los Angeles, where he met Rentzis, an
animation timer. But because of his difficulties in keeping a job and
an apartment, he moved back to Las Vegas to be near his family.

He and his father had run-ins over drug use. Tony Bailey did what he
called "the hard dad thing," telling his son not to call home until he
was ready to get help.

That was what Justin finally sought from the VA. "He said, 'Enough,' "
said Rentzis, 35. "He was young enough, he could still turn his life
around."

Justin Bailey first went into the VA medical center's psychiatric ward
in November.

A psychiatrist wrote in his record: "vet continuously using benzos
[benzodiazepines, which include the anti-anxiety drug Xanax] along
with pain meds=8A. Going thru mood swings and having flashbacks and
dreams of the war daily."

Two weeks later, Bailey was discharged to the residential
rehabilitation program, or domiciliary. He had a new prescription -
methadone - to treat his groin pain.

Methadone has come under increased scrutiny since the death last month
of Playboy model Anna Nicole Smith, who may have suffered an overdose.
But it attracted the medical community's attention well before that.

A synthetic opiate best known for curbing the cravings of heroin
addicts, methadone has been increasingly prescribed as a low-cost
treatment for chronic and nerve pain. Overdose deaths have risen in
tandem, up 390% since 1999.

"That upswing in popularity has been in the name of better patient
care and compassion for people with serious and often emotionally
troubling pain," said Dr. David J. Clark, who runs the pain center at
the Palo Alto VA Medical Center.

"On the other hand, you don't have to practice long before you have a
few unmitigated disasters, people who abuse the drugs or display some
problematic behaviors."

Methadone stays in the body for up to 59 hours but relieves pain for
just four to eight, leading some patients to take the next dose too
soon. Some supplement methadone with other drugs, creating potentially
lethal cocktails.

In November, just before Bailey checked into the VA medical center,
the Food and Drug Administration ordered the addition of a "black box"
warning - the strongest label warning it can impose - advising that
using methadone for pain can result in life-threatening changes in
breathing and heartbeat.

When methadone is handed out in heroin treatment programs, users get
only one dose a day, reducing opportunities for overdose.

Bailey's two-week prescription, however, fell within the 30-day norm
for the drug's use as a pain medication.

"We're always struggling in this practice with trying to treat that
pain while controlling the risk," said Dr. Lynn R. Webster, medical
director of a Salt Lake City pain clinic and a nationally recognized
expert on pain management and addiction. Patients with PTSD or anxiety
who tend to "self-medicate," or take more drugs than prescribed, have
to be watched especially closely.

"If it's someone who demonstrates egregious behaviors and has a
serious addiction problem, two weeks of the medication may be too
much," he said.

In the 310-bed domiciliary where Bailey was housed, residents are
expected to administer their own medications, which they keep in their
rooms in a locker. No staff member dispenses or counts pills.

Tony and Mary Kaye Bailey said they didn't know that until after
Justin died. "They call it a treatment facility," she said. "But he
went to the domiciliary with more drugs than he was taking when he
went into the hospital."

Rentzis and Floyd say that they repeatedly tried to warn VA doctors,
nurses and social workers about Justin.

According to Bailey's medical records, his mother called a domiciliary
nurse practitioner Dec. 20.

"Received a telephone call from a Mrs. Danielle Floyd, who identifies
herself as patient's mother," the staffer wrote. "She expresses
concern about his long history of substance abuse, including Xanax and
opiate abuse and crack cocaine. He has been in several programs in
Nevada =8A and attempts to obtain drugs."

Norman, the hospital's chief of staff, said he could not address the
concerns without knowing more about what happened but that the
investigations were looking into them.

About 75 of the domiciliary's 200 residents have some kind of
substance abuse problem, he said, and learning to be responsible for
themselves is part of their therapy. The doctors and nurses he talked
to, Norman added, "were optimistic and thought [Bailey] was doing well."

Domiciliary residents interviewed by The Times said that during
Bailey's six-week stay, he often appeared groggy, missed meals and
classes, and once was removed from a group session on addiction
because he kept twitching and falling out of his chair.

"Nobody intervened, though many of us brought it up to staff that it
seemed like there was something really wrong with this young man,"
said Isaiah Michaels, 30, who lived four rooms down from Bailey.

Interviewed separately, three other current and former residents
echoed Michaels' account.

"The program is absolutely a good program for people who are willing
to work it," said domiciliary resident Joseph St. Angelo, 46. "But
there are people who shouldn't be in this program, who have special
needs, and they should be better screened. In Justin's case, it was an
oversight."

According to his medical records, Bailey picked up a second, two-week
supply of methadone Jan. 25, a Thursday. He also obtained 30-day
supplies of a blood-vessel relaxer prescribed for PTSD; a sedative and
antidepressant for insomnia and nightmares; generic Xanax; and a new
two-week prescription for another antidepressant.

He and Rentzis had planned to see "The Departed" the next
night.

Rentzis said he arrived about 6:15 p.m. Friday. Visitors are not
allowed beyond the lobby, so a resident went upstairs and found Bailey
in bed, unconscious. His lips were blue.

Bailey was taken by paramedics to the main hospital, where St. Angelo
went to see him later than night. Staff members there asked if he was
Bailey's father.

St. Angelo said, "I'm his brother," meaning a fellow veteran. They
whisked him to Bailey's bedside in the intensive care unit.

"I squeezed his hand and said, 'I love you, brother,' " St. Angelo
said.

Bailey died at 10:20 p.m.

It was Rentzis, not the VA, who called the Baileys that Friday night
when their son was rushed to the emergency room. They called the
hospital and learned that he had died.

"Nobody called me," Tony Bailey said, "except at 2 a.m., somebody
called wanting my son's eyeballs. It was an organ collection thing."

That Sunday, Tony and Mary Kaye Bailey drove to Los Angeles. First
they went to the main hospital, where they were told to come back on
Monday. Then they went to the domiciliary.

"There was nobody in charge," Tony Bailey said. "There was a dom
assistant. The guy called his supervisor, and was basically told over
the phone not to talk to us."

On Monday, the Baileys said, they were called into a tiny office while
a man at the desk talked on the phone. Eventually, he gave them papers
and forms to sign.

As they were leaving, the man took a box from a stack in the corner
and handed it to them. It contained their son's burial flag, used to
cover the casket of deceased veterans.

"The guy says, 'Oh, by the way, here's your flag,' " Tony Bailey said.
"No, 'I'm sorry for your loss.' I spent 20 years in the military, and
my dad spent time in the military. They don't care."

Norman, the hospital's chief of staff, said he regretted what
happened, blaming a communication breakdown. He himself had not been
informed that Justin Bailey had died. Now the head nurse and the
domiciliary director are notified whenever a domiciliary patient is
hospitalized, he said.

"That won't happen again," he said. "The secretary [VA Secretary Jim
Nicholson] wanted to be personally sure that the family knew he was
very sorry and this would be investigated."

Tony Bailey says he just wants the program fixed.

"I've never considered myself special," he said. "If it happened to me
and my son, it's happening someplace else."