By Ray Stern
By Ray Stern
By New Times
By Amy Silverman
By Stephen Lemons
By Stephen Lemons
By Monica Alonzo
By Chris Parker
The new VA model sounded promising on paper: In part, it proposed shifting the emphasis of treating veterans from inpatient to less costly outpatient settings, and to provide easy access to community-based services for mentally ill vets.
But its detractors say that the new VA system never has served the mentally ill adequately. They say long waiting lists for specialized treatment, overworked clinicians, bureaucratic snafus and a managed-care-like emphasis on cutting costs continue to be VA hallmarks, in Arizona and elsewhere.
Beyond that, says NAMI's Fred Frese, VA psychiatrists rarely are able to provide mentally ill vets with the newest and most effective -- but more expensive -- medications. That would have profound implications for Brian Callan.
In late 1999, Callan met for the first time with Phoenix-based psychiatrist Dennis Grant and mental health nurse Kathleen Monroe. Over the next two and a half years, records show, Callan on average met every few months with the pair.
Typically, he first would spend 30 to 45 minutes in "individual supportive counseling" with Monroe, mostly a venting session for the ex-Marine. Then Callan routinely would spend just a few minutes with Dr. Grant, who also heads the Phoenix VA's PTSD clinic.
Like most public-sector psychiatrists, Grant serves far more as a dispenser and monitor of prescription medications to his patients than as a psychotherapist. And dispense to Callan he did.
But Grant's drug regimen for Callan largely ran counter to that recommended in a January 2002 article in the respected New England Journal of Medicine titled "Current Concepts -- Post-Traumatic Stress Syndrome."
(The VA would not allow Grant to comment about his treatment of Brian Callan, even though Callan's mother says she told the psychiatrist that she and her family wished to waive confidentiality. "In the interest of patient care, we feel it is inappropriate for our physicians to provide any information in this regard," public affairs officer Paula Pedene wrote in response to a New Times interview request.)
For example, Grant continued to prescribe such drugs as Klonopin to Callan for anger management. The journal article stresses that Klonopin "should be avoided or used very judiciously in patients with PTSD." The journal adds that the drug works no better than a placebo pill in trying to steady a PTSD patient after a traumatic event.
Grant also prescribed an outdated but relatively inexpensive antidepressant with the brand name of Elavil. The doctor's daily dosage recommendation to Callan was only about a third of the usual therapeutic dose, according to two psychiatrists contacted by New Times.
And though Callan's daily dosage of Elavil wasn't large, the psychiatrists point out that the drug is known for flipping certain patients -- especially those with a propensity for sudden rages and the like -- from depression into a manic state.
Callan also was on Tegretol, an antiseizure medication also used for helping with mood swings and anger management. However, that drug is not designed to help those suffering from major depression, as Callan was.
It's also uncertain why Dr. Grant never did prescribe Zoloft or Paxil, the only drugs approved by the federal Food and Drug Administration for treatment of PTSD.
The VA also provided Callan little in the way of real therapy. The recent New England Journal of Medicine article speaks of successes in treating PTSD victims who also suffer from major depression.
Any lasting improvement, the article notes, comes after intensive interpersonal and other therapies designed to promote a feeling of safety and support. The article also suggests that group therapy may also help disturbed vets better cope.
Callan didn't feel comfortable in groups, not unusual for those suffering from chronic PTSD, according to the literature. But he knew very well that he needed intensive therapy -- the one-on-one kind -- and he wasn't getting it.
Says his father, Laurence Callan, "One of the last observations Brian had with me was that every time he had a complaint, they would throw a pill at him, and that's about all the therapy he got. My son pulled the trigger out there. But I feel strongly that the VA has a lot to answer to for what happened to him."
Brian Callan spent much of his time after he moved back to Phoenix in constant battle with the VA over his disability payments, his diagnoses and, for much of 2001, why the agency kept postponing his scheduled second spinal-fusion surgery.
He also spent a lot of time with his young granddaughters up in Flagstaff, religiously attended ASU football games, read voraciously as always, and regularly e-mailed his devoted network of friends and family.
In April 2000, Callan drove to Fort Defiance to attend a memorial service for the father of his old friend Ken Todakonzie. During the service, Todakonzie recalls, Callan showed some of his old spunk.
"I was sitting in the back with Brian feeling really bad, and he nudged me. Hey, Toad, I heard the best place to pick up women is at weddings and funerals. You got to introduce me to all your aunts.' We just broke up laughing."
But those moments of levity became more fleeting, adds Todakonzie. "He told me about a year ago, Dude, I really feel like eating a bullet.' I was so worried about him, but I didn't know what to do."