May 4, a Wednesday.
Luis Mariscal Munoz called the Phoenix VA Health Care System to say he wouldn’t be coming in to work. He drove to a shooting range at the Table Mesa Recreation Area off Interstate 17 and parked. At about 6:30 p.m., having walked about 70 feet from the car, he put a borrowed nine-millimeter handgun to his head and pulled the trigger.
An hour later, Luis’ wife, Lisa Mariscal, arrived at the West Phoenix home the couple shared with their two dogs. Luis had texted her: something about how he was sorry and to read the note he’d left for her. She’d tried to call and text him back, but there was no reply.
Lisa knew that for the past month, her husband had been attending weekly therapy appointments at the VA on Indian School Road, where he worked as a medical laboratory technologist. She was aware that a psychiatrist there had prescribed an antidepressant. But Luis had told her he was just suffering from anxiety.
Then she read the note.
“Please do not feel guilt about my decision,” he had written. “I would like you to feel happy or relieved that I am no longer suffering. You never did anything wrong. No one could have changed my mind.”
Though the note did not explicitly mention suicide, Lisa knew. And she was blindsided. She called Luis’ mother. She called her parents and she called his friends. Everyone hurried to the house.
At about 9:30 p.m., the police came to the door. Luis had killed himself. He was 29.
“Everyone in his life was just in shock and upset,” says Lisa, who is 26. “No one ever would have thought he would have done something like that.”
Weeks later, seeking closure, Lisa requested copies of her husband’s medical records from the VA. When she read through his therapy “Progress Notes,” she was stunned.
A month prior to his death, when Luis had first sought help at the VA, he confided that he’d been having suicidal thoughts. The medical staff members who saw him noted that Luis had said he’d attempted suicide twice before — once at age 17 and again in March 2016.
“Based on my evaluation of this patient, I have determined that: The patient is acutely suicidal and is at personal risk,” a registered nurse had noted. “The patient is being sent for further evaluation by psychiatry today.”
The psychiatrist who saw Luis that day started him on an antidepressant and prescribed an anti-anxiety medication.
But the VA did not take the further step of admitting Luis for inpatient treatment.
Nor did doctors clue in Lisa about the extent of her husband’s inner turmoil — or, for that matter, anything at all about his condition. This, despite the fact that Luis signed a consent form explicitly naming her and authorizing VA officials to inform her if the “patient may do harm to him/herself.”
Paul Coupaud, chief media officer for the Phoenix VA Health Care System, told New Times he is unable to publicly comment on Luis’ case owing to laws preventing the disclosure of a patient’s health information.
“We are deeply saddened by the loss of any veteran, and want to express our sorrow and condolences to Mr. Mariscal-Munoz’s family,” Coupaud says.
Coupaud adds that all veterans are assessed annually to determine whether they’re dealing with complex mental-health issues such as depression and suicidal ideations.
“I feel like he reached out to appropriate people, he reached out to professionals,” Lisa Mariscal says. “And for them not to have done their job — that’s where I am mad.”
Lisa Mariscal was born and raised in Phoenix. Her mother worked at a bank; her dad owned a fast-food franchise. She was 16 and a junior at Barry Goldwater High School when she met Luis at a wedding. He was three years older and training as a combat medic at a military base in Texas.
“He was very handsome and very fit. He was funny — he had a really good sense of humor,” Lisa remembers.
Luis was born in Nayarit in western Mexico, but grew up mostly in Virginia. When he was 15, his mother moved to Arizona and later had four other children. (His parents never married, and his father left when he was a baby.) Lisa says he loved music, fishing, technology, and animals. He was very social, she says, and he had a large network of friends. He’d been inspired to go into the medical field because his brother had a brain tumor as a kid but recovered.
The two began dating, and in 2008, right after Lisa’s high school graduation, they married. Lisa moved to Texas and they lived together in military housing. In 2009, Luis became a U.S. citizen.
But sometime earlier, he’d injured his foot during a training exercise and it didn’t heal properly. Nine months after the wedding, he was medically discharged owing to the injury. He had served in the military for just three years.
“He really wanted to deploy with his unit,” Lisa says now. “And I think not being able to do what he signed up for was kind of devastating for him.”
After Luis’ discharge, the couple moved to Phoenix to be closer to their families. He attended Arizona State University and earned a degree in biochemistry in 2013. He’d go on to graduate from DeVry University with a second bachelor’s degree in medical laboratory science. In 2015, he was hired to work at the VA.
“He figured he would give back by working at the VA hospital,” Lisa says. “Even though he didn’t have patient contact, he felt good working in that environment.”
“He was very ambitious,” says Vince Tsang. A fellow veteran, Tsang met Luis at ASU, and they became close friends. “When he had his mind set to something, he would definitely do it.”
Lisa, meanwhile, graduated from ASU and began her career as a vet tech, planning to go back to school to become a veterinarian.
After eight years of marriage, Lisa says, she was excited for the future.
“He finally got a job he liked, and I was supposed to move further along with my education,” she says. “We wanted kids. That was the talk the last few months: when we were going to have a kid.”
But the pain from Luis’ injury lingered.
“He was always in pain from his ankle and his back,” says Tsang. “He told me sometimes it’s just excruciating, and he can’t even sit down, so he’d have to sleep on the floor.”
Two months before his death, the pain was so bad that Lisa had to drive Luis to the ER. He followed up with the VA to schedule an MRI on his back.
It took more than three weeks to get an appointment. Thinking back, Lisa believes the medical issues triggered Luis’ depression. But at the time, she had no idea he was battling anything more than physical pain.
In early 2012, an emergency-room physician at the Phoenix VA Health Care System raised a red flag with the facility’s director, Sharon Helman, about conditions in the ER. As other doctors came forward over the ensuing two years and the VA’s Office of the Inspector General investigated, it became apparent that veterans were dying while awaiting medical care at the VA, even as higher-ups were falsifying records to make it seem as if conditions were improving.
The scandal spread to other states, ultimately costing U.S. Secretary of Veterans Affairs Eric Shinseki his job. Arizona was something of a Ground Zero: Helman was fired and subsequently convicted of criminal misconduct in office, a felony.
Dr. Sam Foote, an internist who was the director of the Phoenix VA’s outpatient clinic, was one of the more vocal whistleblowers. Testifying before Congress, he estimated that 9,000 patients came to the VA in 2013, and 293 of them died while awaiting treatment.
“How many of those patients, if they’d known that the VA was not going to have an appointment, might have gone elsewhere to seek treatment?” Foote says today.
Like most of the VA whistleblowers, Foote endured retribution from his superiors. He wound up taking early retirement, citing the harassment.
“I had no idea the magnitude of what this would all take and how hard I was going to have to defend myself,” he says. “They made life miserable.”
Most of the whistleblowers received settlements; some have returned to work at the VA. Paula Pedene, a public-affairs officer at the Phoenix VA, is one of those who went back.
“Our exposure actually opened Pandora’s box,” Pedene says now. “That was a good day for veterans, because it shone a spotlight on what was happening. But it was a horrible day for the VA.”
And it took its toll on Pedene.
“I was the number-one VA cheerleader,” she says. “I just don’t feel that way any more. It affected me. It affected my family. There’s no coming out ahead on any of it.”