Palo Alto VA Hospital Missed Opportunities in Recent Suicides

Suicides Highlight Failures of Veterans’ Support System

by Aaron Glantz
Bay Citzen, March 24, 2012

Francis Guilfoyle, a 55-year-old homeless veteran, drove his 1985 Toyota Camry to the Department of Veterans Affairs campus in Menlo Park early in the morning of Dec. 3, took a stepladder and a rope out of the car, threw the rope over a tree limb and hanged himself.

It was an hour before his body was cut down, according to the county coroner’s report.

“When I saw him, my heart just sank,” said Dennis Robinson, 51, a formerly homeless Army veteran who discovered Mr. Guilfoyle’s body. “This is supposed to be a safe place where a vet can get help. Something failed him.”

Mr. Guilfoyle’s death is one of a series of recent suicides by veterans who live in the jurisdiction of the Department of Veterans Affairs Palo Alto Health Care System. The Palo Alto V.A. is one of the agency’s elite campuses, home to the Congressionally chartered National Center for Post-Traumatic Stress Disorder. The poor record of the Department of Veterans Affairs in decreasing the high suicide rate of veterans has already emerged as a major issue for policy makers and the judiciary.

William Hamilton, former soldier who served in Iraq, stepped in front of a train last May after attempts to get him inpatient PTSD care at VA Palo Alto failed.

On Wednesday, the V.A. Inspector General in Washington released the results of a nine-month investigation into the May 2010 death of another veteran, William Hamilton. The report said social workers at the department in Palo Alto made “no attempt” to ensure that Hamilton, a mentally ill 26-year-old who served in Iraq, was hospitalized at a department facility in the days before he killed himself by stepping in front of a train in Modesto.

The Bay Area was also shocked by the March 14 death of Abel Gutierrez, a 27-year-old Iraq war veteran, who the police said killed his mother and his 11-year-old sister before shooting himself. Two weeks earlier the Gilroy Police Department intervened to ask the V.A. to help Mr. Gutierrez.

An examination of each case reveals faulty communication inside the V.A. system, which missed opportunities to help the veterans.

“I know people at the V.A. care a lot and work hard, but it’s a pattern that’s disturbing,” said Representative Jerry McNerney, a Democrat from Pleasanton who serves on the House Veterans Affairs Committee. “It doesn’t look good.”

Last May, a three-judge panel of the United States Court of Appeals for the Ninth Circuit accused the department of “unchecked incompetence” and ordered it to overhaul the way it provides mental health care and disability benefits.

Noting that an average of 18 veterans commit suicide every day, Judge Stephen Reinhardt wrote, “No more veterans should be compelled to agonize and perish while the government fails to perform its obligations.” The department appealed, and Judge Reinhardt’s opinion has been temporarily vacated, pending a ruling from a an 11-judge panel of the Ninth Circuit.

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