February 28, 2009 – A North Idaho family blames the U.S. Department of Veterans Affairs for the death of a Navy veteran who killed himself last year amid a sharp increase in suicides among patients receiving care at the Spokane VA Medical Center.
Richard Kinsey-Young, 35, was found dead at his Rathdrum home on April 5, 2008, after a 16-month struggle with pain and depression that his medical providers were unable to assuage with more than a dozen prescriptions, including morphine, antidepressants and antipsychotic drugs.
“They never did anything,” said Jo Ann Porter, the mother of Kinsey-Young’s only child, Cody Young. “They just kept changing his medication.”
Cody, 15, and his mother believe Kinsey-Young’s depression and death were caused by his addiction to narcotics first prescribed by military physicians treating his back and shoulder injuries and continued by VA physicians in Spokane after his discharge from the Navy.
At a meeting with VA officials a month after Kinsey-Young’s death, Porter said, the family was offered $750,000 in exchange for not suing the medical center. Porter said her family declined the offer.
A Spokane VA official said compensation was never discussed with the family.
As with the other five 2008 cases that ended in the suicides of veterans who had contact with Spokane VA, medical center officials declined comment on Kinsey-Young’s case, citing medical privacy laws and VA policy.
But interviews with family and friends, and medical records they provided, reveal much about Kinsey-Young’s demise, which may have had more to do with the lack of continuity of patient care than with any one medical error.
At 31, he was older than most recruits when he joined the Navy in 2005. But Kinsey-Young, a weightlifter and former wrestler who stood more than 6 feet tall, was in top physical shape. In fact, powerlifting was central to his identity, according to one VA psychologist’s notes.
In February 2005, while working as an aviation mechanic at Whidbey Island Naval Air Station, he wrenched his back moving a 300-pound transmitter. The back problem reappeared when Kinsey-Young slipped on the ice in December 2006.
Magnetic resonance imaging revealed bulging lower vertebrae and degenerative disk disease. A military neurosurgeon recommended surgery, but Kinsey-Young, who had had less than satisfactory results with a previous operation on his shoulder, chose physical therapy, oral steroids and pain medications instead.
Upon his discharge in August 2007, Kinsey-Young walked away from the Navy with the help of a cane. He had to self-catheterize himself daily to urinate.
Upon his initial visit to Spokane VA on Sept. 17, 2007, the veteran told Dr. Stephen Lloyd-Davies that he was now interested in surgery. Since the beginning of the year, he had been taking pain medications that included oxycodone and morphine, as well as antidepressants.
The physician’s notes stated that the patient needed an updated MRI and may need surgery, and recommended that his medications should continue for the time being.
“I am very concerned about the degree of his pain, which seems out of proportion to the MRI findings,” Lloyd-Davies wrote. “I am very concerned about the level of narcotics he is consuming as he seemed very sedated today, and I worry about prescription narcotic addiction or diversion.”
On Sept. 26, Kinsey-Young saw Dr. Rajakumari Vegunta, a primary care provider at Spokane VA. Vegunta’s notes from the appointment show that he discussed with the veteran the risk of chronic narcotic use, including the potential for interaction with other medications, dependence and addiction.
That fall, Kinsey-Young experienced panic attacks. He began superficially cutting his forearms and wrists, and was experiencing auditory hallucinations. Friends and family saw a dramatic change in the veteran, who seemed to live in a fog, and they confronted him about his drug use.
“He said, ‘I’m only taking what they’re telling me to take,’?” said Blaine Porter, Jo Ann’s husband, a Coeur d’Alene firefighter and emergency medical technician.
On Oct. 9, 2007, Kinsey-Young met with Dr. Minerva Arrienda, a Spokane VA psychiatrist, who diagnosed “major depressive disorder with psychotic features.” The psychiatrist recommended medication management, counseling and drugs.
Kinsey-Young’s active medications now included duloxetine for depression, diazepam for anxiety and insomnia, risperidone for hallucinations and paranoia, as well as morphine and oxycodone for pain.
On March 4, 2008, Kinsey-Young was voluntarily admitted to the adult psychiatric unit of Spokane VA Medical Center after calling the VA’s suicide prevention hot line with suicidal and homicidal ideation – he was not only thinking about suicide, but how to commit it. His chief complaint, according to medical records: “I was cutting myself.”
While in the psychiatric unit, Kinsey-Young saw Dr. William L. Brown, a staff psychiatrist, who raised red flags once again about the amount of prescription medication the veteran was taking.
“There are a number of references to Richard taking more of the benzodiazepines, sleeping pills, and opiate mediations than have been prescribed for him to take,” Brown wrote. “However, I did not see any of these notes in the past month of two, so maybe this problem has gone away. Certainly, this should be closely monitored.”
Brown urged Kinsey-Young to stay in the psychiatric unit so that a treatment plan could be developed, but the veteran was discharged to his home a day after being admitted.
He was scheduled for follow-up with Arrienda and another primary care physician, Dr. Sara Memon, in the VA’s Coeur d’Alene Clinic.
Among his active medications were gabapentin, a drug used to treat seizures associated with epilepsy but also used for nerve pain; the muscle relaxant methocarbamol; risperidone for his hallucinations; zolpidem for insomnia; diazepam for anxiety; and both long-acting and short-acting morphine.
On Saturday, March 15, after running out of long-acting morphine, Kinsey-Young attempted to get more at the Spokane VA emergency room. He was told it was against policy and given a few short-acting narcotics to get him through the weekend.
Two weeks later, the veteran again visited the ER with suicidal ideation that he believed was due to a change in his antidepressant prescription. But he grew tired of waiting to see a provider and left “angry and agitated,” according to an ER nurse’s notes.
On March 30, Kinsey-Young called the VA suicide hot line, resulting in an emergency room provider calling Rathdrum police, who took the veteran into custody. Officers took him to Kootenai Medical Center, where he spent the night.
On April 1, the veteran saw his primary care provider in Coeur d’Alene. Dr. Memon had Kinsey-Young sign a “medication-use agreement” outlining conditions for receiving opiate medications.
The veteran complained that his back pain was worse. He had the flu and was taking an over-the-counter decongestant at night. His gabapentin prescription was doubled.
In an addendum, Memon wrote, “If patient has difficulty with pain management, I am considering to increase his morphine extended release to 60mg (every) 8 hours. Patient is high risk of suicide, mainly due to pain-related issues.”
An appointment was made to see his psychiatrist, Arrienda, on April 7. It was a date he never kept.
On April 5, Porter’s father found Kinsey-Young dead in his home, in his favorite chair.
Dr. Robert West, Kootenai County coroner, ruled his death a suicide caused by cardio-respiratory arrest due to combined drug toxicity from morphine, diazepam, mirtazapine, methocarbamol and pheniramine, an over-the-counter antihistamine.
Kinsey-Young’s stepfather, Edward Young, does not believe it was suicide. He thinks the veteran unintentionally overdosed.
Nevertheless, he thinks somebody should be held accountable for what he called “less than professional treatment.”
“There should have been some continuity with the doctors,” Young said. “It’s not just him. There’s hundreds of other (veterans) out there.”
An expert in psychiatric pharmacy who was asked to review the list of Kinsey-Young’s 14 active prescriptions at the time of his death stressed the importance of a health care team discussing all of the medications.
“He was on several drugs that together can actually have an impact on breathing,” said Lawrence J. Cohen, professor of pharmacotherapy at Washington State University’s College of Pharmacy and assistant director for psychopharmacology research and training at Washington Institute for Mental Illness Research and Training. “The main thing here is: Who was monitoring all this?”
Were he the clinical pharmacist, Cohen said, he would be asking whether everything the patient was taking from all sources, prescription and nonprescription, was medically necessary.
Spokane VA officials said a pharmacist is regularly integrated into a patient’s care.
“Certainly that’s done on inpatient wards,” said Dr. Gregory Winter, head of behavioral health. “It’s done probably less regularly in the outpatient environment, but there is a lot of communication between pharmacy and the treatment teams.”
Medical center director Sharon Helman was more emphatic.
“To make the assumption that it was not done is just an assumption,” Helman said, adding that the VA’s electronic records system provides a coordinated approach to a veteran’s care.
Spokane’s VA Medical Center currently has seven psychiatric care providers seeing 5,000 patients. It is recruiting for three more psychiatrists, according to Winter. A caseload of about 500 patients per provider is the standard of care in the VA, he said.
Soon after Kinsey-Young’s death, the Porters asked for a meeting with VA officials. Although she and Kinsey-Young were never married, Jo Ann Porter, a nurse’s assistant at Kootenai Medical Center, is the beneficiary and legal representative of his estate.
In May 2008, the family met with Winter and Dr. Nirmala Rozario, then the acting director of the medical center.
Jo Ann Porter said she was offered money not to sue.
“What do you want from us?” Porter recalls Winter asking. “I said I want this fixed, and he said, ‘Well, you know with these lawsuits, people don’t get any more than $750,000.’?”
She said Winter’s words were chosen cautiously but his intent was clear – “He was offering us money to drop it. But money was the farthest thing from our minds.”
In an interview this week, Winter denied the allegation.
“The family had requested this meeting because they were grieving and distraught and because they said they had some questions,” he said. “The nature of the meeting was supportive, and I asked them if there was anything we could do that would be helpful to them at all.”
When Winter directed the same question to Cody, he first responded, “I want my dad back,” his mother recalled. Then he said, “I just want something from you to show me that you are going to fix this, as in fix the system, so it doesn’t happen to somebody else’s dad.”
Reach Kevin Graman at (509) 459-5433 or firstname.lastname@example.org.