by Art Levine
Less than three years after Andrew returned from Iraq, their second son was dead, too, killed at twenty-three in his own way from the after-effects of the wars in which both sons fought. The agony of their loss would only be compounded by not knowing for certain what had killed Andrew. After the paramedics had finished their work, Andrew was pronounced dead at 4:09 p.m. on February 12, 2008.
Shirley called Stan on the slopes at Canaan Valley to tell him the terrible news. Still reeling from the phone call, he also thought about the mysterious death of Eric Layne, a fellow member of Andrew’s PTSD group, barely two weeks earlier. They were both taking a similar array of medications, but Stan thought the fault could just as well lie with other risks of the war. “I had a suspicion in my mind that it could be chemical poisons from weapons of mass destruction,” he recalls.
The role Andrew’s prescription drugs played in his death, though, soon became more evident. Because Andrew died at home in questionable circumstances, the police showed up to scour his room and seize the drugs—all legally prescribed—they found. Stan White’s suspicions were heightened when the Marine casualty officer dispatched the next day to help the Whites prepare for the funeral told him some more disturbing news. “By the way, there’s another soldier who died whose funeral we did a couple of weeks ago, and I think there are some similarities there,” he told Stan and Shirley. Indeed, there were: Corporal Nicholas Endicott from nearby Logan County died in his sleep January 29th while being treated for PTSD at Bethesda Naval Hospital. Like Layne and White, his drug cocktail included Paxil, Klonopin and, of course, Seroquel, the VA’s unofficial sedative of choice for PTSD patients. “We had three right there,” Stan White says, all living in the same area and dying within weeks of each other. A week later, he reached out to the mother of Nicholas Endicott, sharing the pain of their sons’ deaths and asking questions about the VA’s prescribing practices they would soon take public.
As for Schauland, he now says, “I feel as badly as I can, it was devastating, but I complied with the patient’s needs. People were trying as hard as they can with this young man.” As he told investigators from the VA Inspector General’s office after White’s death, “If I had done anything that I could look back and say was a mistake, I would tell you, but I can’t.” In Schauland’s view, “I don’t think he was overmedicating.”
Yet as Dr. Grace Jackson, a former staff psychiatrist at Bethesda Naval Hospital who reviewed records of Andrew and Eric Layne’s treatment at my request, points out, “None of these people should be dying. Any sensible physician should know they’re far enhancing risks with polypharmacy of any kind. These are potentially lethal combinations.”
For both Eric Layne and Andrew White, though, the risks they faced from their prescribed drugs were heightened by their apparent sporadic use of non-prescribed painkillers, an all-too-common practice in West Virginia. It wasn’t until the release in April 2008 of the autopsy report for Andrew, for example, that his parents learned that he had relatively small amounts of methadone in his bloodstream along with appropriate levels of Paxil and Seroquel. If taken by itself, the amount of methadone alone almost certainly wouldn’t have killed him, but the report from West Virginia’s Office of the Chief Medical Examiner concluded that “combined drug intoxication” was at fault.
“We were never warned that Andrew shouldn’t take Seroquel with painkillers,” Stan White says. “Seroquel enhances the side effects of methadone, and it is the catalyst, the culprit, that causes cardiac arrest.” The FDA, but few VA doctors, knew about a major study in 2007 showing that Seroquel sharply raises the blood plasma levels of methadone and hence the risk of a deadly heart arrhythmia interaction, yet it took until July 2011 for the warning label to be quietly revised. The VA still has not publicly warned any clinicians in the years since about Seroquel’s cardiac risks or potentially fatal interactions with tranquilizers and painkillers—even in West Virginia, which had been ravaged by opiate overdoses. But one common misconception—still promoted by military leaders, including then-Army Surgeon General, Eric B. Schoomaker—is that the growing number of military prescription deaths is just like the celebrity overdoses of performers like Heath Ledger or Whitney Houston: “a consequence of the use of multiple prescriptions and nonprescription medicines and alcohol,” Schoomaker said in an interview, just four days before Andrew died.
That’s true enough—up to a point. “They’re being called multi-drug intoxications,” says Dr. Fred Baughman, a longtime critic of psychiatric overprescribing. “But that’s a way to point the finger and blame the soldiers themselves.” But these drugs’ effects are not like a standard drug overdose that produces a protracted coma-like response that can allow the victim to be discovered and saved, Baughman and leading medical journals say. Instead, an atypical antipsychotic like Seroquel can induce sudden cardiac arrest: a rapid, pulseless condition that often causes brain death in under five minutes. Atypical antipsychotics have been identified in over one hundred studies since the 1990s as perhaps the single riskiest class of drugs for inducing a particularly dangerous form of arrhythmia known as the prolonged QT interval, named for the measurement of time between the “Q” and “T” waves of the heart’s electrical cycle.
In some ways, the grassroots challenge to the military’s prescribing policies began at the military funeral held near the White family’s church. Memories of Andrew’s service to his country were evident everywhere, from the grieving faces of the young veterans who knew him well to the American flag taken from his casket, ceremonially folded by the uniformed Marine officer and then handed to the Whites. Yet to Stan White, the determination to find out the truth behind Andrew’s death became another way to honor his son. After his son’s funeral, he made a pact with his wife: “I wanted to find what really caused Andrew to die, and to keep someone else from going through this.” He adds with quiet understatement, “I thought I owed that to Andrew’s memory.”
With three similar deaths within weeks, he recalls, “I was already seeing a pattern.” He soon discovered at least two other Seroquel-related deaths in just West Virginia. The diligent online news research of support group co-founder Diane Vande Burgt (the wife of the National Guard vet Tom Vande Burgt) and others soon found nearly three hundred suspicious, probable sudden cardiac-linked military deaths across the country. By following up with as many families as they could reach, she, Baughman and Stan White seemed to be doing a more thorough investigation of these deaths than any federal agency.
Unfamiliar with the ways of Washington, Stan nonetheless took it upon himself in the months after Andrew’s death to contact his local congresswoman, Rep. Shelley Moore Capito, and the influential Sen. Jay Rockefeller, then the chairman of the Senate Veterans Affairs Committee. “I wanted a congressional hearing to find out, if there is five dead in West Virginia and that’s a large sample from a small state, it’s got to be bigger. Let’s find out what it is, and the best way to do it is to get a congressional hearing,” he says. His quest for truth and answers, it turned out, was only just beginning.
CHAPTER 6
Stan White and the Veterans’ Search for Truth and Answers
AT FIRST, STAN WHITE WASN’T REALLY SURE WHAT HAD KILLED HIS SON and the other returning veterans. “I had a suspicion in my mind that it might be chemical poisons from weapons of mass destruction, or it might be Agent Orange,” he says. But after speaking to Janette Layne, Eric’s widow, then Cheryl Endicott, the mother of Jason Endicott, who was found dead in his bed in late January at Bethesda Naval Hospital, Stan White was moving closer to his final conclusion: “It absolutely was the drugs.” Layne, White and Endicott had died within three weeks of each other. Soon, Stan and Shirley learned about other suspicious deaths in West Virginia, and, eventually, other grieving parents from around the country began contacting them.
The families of the three veterans soon got a chance to air their concerns in March 2008 on WOWK-TV in Charleston. At the time, all the families were still waiting for toxi
cology results, but they knew that all three of the men’s prescriptions included the same combination of Paxil, Klonopin and Seroquel. “Are these three medications—is there any connection with the three of them? Did those three react? Or is there some foreign substance these guys picked up overseas?” Stan White asked on camera. In the first of several public declarations he would make over the years, White pointed out, “You’re always expecting and fearing when your children are at war that they’re not going to make it back. But they don’t come back and lie in the bed, go to sleep and die. That doesn’t happen. That’s not supposed to happen.”
Looking back, this short local broadcast was one of the first news accounts in the country addressing deadly psychiatric prescribing to soldiers and veterans. But until the Tomah VA opiate deaths were exposed in 2015, the issue never emerged as a major national scandal. In May 2008, Julie Robinson of The Charleston Gazette became arguably the first journalist in the country to write about the early signs of a psychiatric medication crisis apparently causing veterans’ deaths in West Virginia or anywhere else in the nation. By this time, Stan White had learned of eight similar medication-related deaths in the nearby tri-state area of Kentucky, Ohio and West Virginia. Robinson identified by name a fourth West Virginia victim, twenty-two-year-old Derek Johnson of Hurricane, who died in his sleep on May 2nd; he had been taking the same combination of Paxil, Klonopin and Seroquel that was given to Layne, Endicott and White. He was also taking a prescribed painkiller for a back injury he suffered in a car accident the week before his death, even though his wife warned the ER doctor about other drugs he was taking that were known to have deadly interactions with opiates and other painkillers. The night before he died, Johnson called his grandfather Duck Underwood to come pick up Derek’s five-year-old son, one of three young children he and his wife Stacie were raising. Underwood came by, but there was no answer when he first knocked—until he heard Stacie screaming that she couldn’t wake up her husband.
Ray Johnson, Derek’s father, told Robinson, “I want to know the cause of death. Stacie said he was fine that night. Everything was normal. He kissed her goodnight and went to sleep.”
Stan and Shirley White met the Johnson and Underwood families at Derek’s funeral and offered to help them in their own search for the truth of what happened. “When I talked to his family about Derek, I realized it was the same old story,” White told The Charleston Gazette. “It was all too familiar. He was taking those same drugs as the others.”
After that, other families started contacting Stan White from West Virginia and other states. In addition, Baughman, a retired California neurologist who was best known for denouncing ADHD diagnosis and medications as a “fraud,” found the Charleston Gazette article online in June and realized its broader national implications. “This struck me as really different, a unique occurrence: four similar deaths of guys found dead in bed in the same area,” he recalls. “None of these guys were suicidal and none of them overdosed,” he points out, in terms of taking higher than prescribed dosages of the drugs. As a researcher, he had seen a peer-reviewed article in Expert Opinion on Drug Safety first published online in March 2008, reviewing the extensive medical literature since 2000. The troubling meta-analysis was headlined: “Sudden cardiac death secondary to antidepressant and antipsychotic drugs.” He reached out to Stan White to flag for him the evidence for dangerous psychiatric prescribing that Stan and Shirley saw firsthand with Andrew’s death. By June 2008, he issued a press release denouncing the lack of informed consent and the polypharmacy that caused what he called a “cluster of veterans’ deaths.” He pointed out, “The more drugs given simultaneously, the less the science and the greater the risk of injury and death.”
Baughman never managed to win much media interest over the deaths of veterans caused by medications. But over time, he and some West Virginia veterans’ families, led by the research of activist Diane Vande Burgt, worked to compile through news accounts a list of veterans and soldiers dying suspiciously in beds and barracks, a list which eventually grew to over four hundred. Over the years, he also launched a drumbeat of letters to Senate leaders and committee staffers, network TV producers, medical journals (only a few which were published) and the VA Inspector General’s office asking them to take seriously the issue of cardiac risk of antipsychotics, nearly always starting by pointing to the tragedies in West Virginia. His argument, backed by medical citations on the cardiac risks of antipsychotics and polypharmacy, was blunt: “There is an epidemic of sudden deaths occurring throughout the US military.”
His determination—and that of Stan White and other concerned families—to get to the bottom of what led to the medication-linked deaths didn’t seem to be matched by the VA’s Inspector General’s skewed inquiry into the West Virginia deaths. At first, it seemed to the Whites that the agency was doing a thorough job. The investigators spoke to the families at length; interviewed all the VA health-care providers including those at the Huntington VA, the Charleston community clinic and the Cincinnati VA medical center where Eric Layne was treated before he died; and reviewed medical, autopsy and toxicology records.
But when the report focusing on the White and Layne deaths was released in August 2008, it became clear that other institutional priorities were more important than solving and preventing the deaths of veterans. It would take a few years before the full scope of the deliberate omissions and distortions in the report became even more apparent. In retrospect, it can be seen as a dry run for the Inspector General’s cover-up and inaction in response to the deaths at Tomah.
Eventually, a half-billion-dollar federal settlement in 2010 with AstraZeneca and an emerging research consensus prodded AstraZeneca itself to reluctantly change its warning labels to concede Seroquel’s cardiac and diabetes risks, which it had previously downplayed. At the time the VA Inspector General did its review of the two veterans’ deaths, though, Seroquel and other new-generation atypical antipsychotics were already implicated in “QT prolongation” and sudden cardiac deaths in nearly seventy medical studies.
Yet the Inspector General’s report’s central finding was that the treatments Layne and White received met “community standards of care,” supplemented by a claimed wide-ranging review of the medical literature that concluded there was no link between Seroquel and other leading antipsychotics with sudden cardiac death. This conclusion was reached despite the known dangers being widely cited in the research literature at the time that the Inspector General’s medical consultant, Dr. Michael Shepherd, helped prepare the dubious report. Its findings completely ignored the most salient medical research and the VA’s own prescribing guidelines that said there was no evidence supporting the use of antipsychotics for PTSD. Among the studies ignored: the comprehensive review of over 120 studies on the cardiac risks of all psychotropic drugs—the one from Expert Opinion on Drug Safety that Baughman cited in his June 2008 press release and flagged for Stan White. It also recommended that electrocardiograms be given before antipsychotic treatment begins and checked during the course of treatment to ensure patient safety. If those recommended ECGs were given as the research indicated to Andrew White and Eric Layne, the risks of arrhythmia could have been flagged and they might still be alive today.
In contrast, out of the numerous studies on antipsychotics’ cardiac risk since Seroquel was approved in 1997, the VA only cited the safety reassurances in one (1) out-of-date study, published in 2001, concluding that there was “no association” between the atypical antipsychotics and cardiac risk. The VA also leaned on that archaic study to contend that agency officials were “unaware” of any recommendations to use ECG monitoring with young patients receiving Seroquel. Even the co-author of that 2001 study, Columbia University cardiology professor Dr. J. Thomas Bigger, doesn’t defend the study’s obsolete conclusions today and declines to discuss it, and would only tell me, “There’s been more research on that topic since then.”
“They turned a blind eye to the medical consens
us,” says Baughman of the Inspector General’s conclusions on the cardiac risk of antipsychotics. The most telling sign of a research cover-up, he contends, is the failure to mention the most thorough review then available on the topic: the Expert Opinion review, published several months before the IG report. “It took an overt act of omission to miss this article,” he says, noting how widely cited it was in the medical literature. Dr. Stephen Xenakis, a former Army psychiatrist who believes that appropriately prescribed psychiatric drugs can be helpful for PTSD along with psychotherapy and thorough medical workups, is just as blunt as Baughman about this IG report’s failings: “They cherry-picked the studies. They find the information that justifies what the VA is doing,” a “protective” pattern he’s found throughout the Inspector General’s work over the years.
The VA’s main finding that the treatments Layne and White received met “community standards of care” wasn’t particularly credible, either—especially if their care flouted the VA’s own guidelines. Dr. Grace Jackson, the former Navy psychiatrist and author of Rethinking Psychiatric Drugs, says after reviewing the IG report and White’s prescription history, “This is a whitewash that sanitizes his [White’s] medical records. It’s a complete embarrassment: the way these drugs were used was overkill.” Xenakis agrees: “I wouldn’t have treated those soldiers with high doses of antipsychotics. It’s not appropriate: There’s a risk of sudden death.”
In fact, as the Inspector General’s legal counsel, Maureen Regan, concedes, the term “community standards of care” in the report isn’t a scientific judgment, but merely a legal term used in malpractice lawsuits. “It’s the standard measured under tort law: what a reasonable practitioner would do in like or similar circumstances,” Regan says. But, as Jackson points out, giving PTSD patients like White up to 1,200 mg of off-label Seroquel in defiance of the VA’s own guidelines is a “very dangerous community standard of care.” In fact, given how wildly overused antipsychotics are in civilian and VA settings, the risky prescribing that played a key role in the deaths of Layne and White “does sort of fit with community standards,” Xenakis says ruefully. Still, Jackson observes that for PTSD patients, “I don’t think it’s reasonable or prudent to give a neurotoxin like Seroquel unless you absolutely have to do it.”