Iraq war veteran Justin Bailey checked himself in to the West Los Angeles VA Medical Center just after Thanksgiving.
Among the first wave of Marines sent into battle, the young rifleman had been diagnosed since his return with posttraumatic stress disorder and a groin injury. Now, Bailey acknowledged to his family and a friend, he needed immediate treatment for his addiction to prescription and street drugs.
"We were so happy," said his stepmother, Mary Kaye Bailey, 41. "We were putting all of our faith into those doctors."
On Jan. 25, Justin Bailey got prescriptions filled for five medications, including a two-week supply of the potent painkiller methadone, according to his medical records.
A day later, he was found dead of an apparent overdose in his room at a VA rehabilitation center on the hospital grounds. He was 27.
The Los Angeles County coroner's office is awaiting toxicology reports and has not ruled on the cause of death. Numerous other investigations are underway, including one by the Department of Veterans Affairs.
Whatever the outcome, Bailey's family and friend Dimitris Rentzis hold the VA directly responsible. The young man's medical records, reviewed by The Times with his father's consent, contain multiple references to his history of abusing prescription drugs -- even a note about a warning from his concerned mother.
In view of that, his father wonders, why was Bailey allowed to administer his own medication?
"My son had made a decision to get help, and they didn't help him," said Gulf War veteran Tony Bailey, 47, of Las Vegas. "They gave him the bullet."
Hospital officials say the death has prompted immediate reforms -- including more random urine tests, increased staffing on weekend nights and room checks for drugs.
"Our programs are excellent, but they're not perfect," said Dr. Dean Norman, the hospital's chief of staff. "And we always strive to make them better."
The death comes amid a national furor over the poor treatment and squalid conditions experienced by some patients at Walter Reed Army Medical Center in Washington, D.C.
Even before the scandal broke, however, questions had arisen nationally about the ability of military and VA hospitals to handle the influx of Iraq veterans with post-traumatic stress disorder, or PTSD.
An Army-funded study published in January in the American Journal of Psychiatry found that almost one in five combat veterans returning from Iraq suffered from PTSD, which increases the risk of substance abuse. Many of those returning troops also suffer physical pain.
The dilemma, said Dr. Andrew Shaner, deputy chief of psychiatry and mental health at the West Los Angeles VA Medical Center, is that "most drugs to treat pain hold potential for abuse."
That, said Bailey's family, is precisely why Justin should have been watched more closely.
Justin Bailey joined the Marine Corps in 1998, one month shy of his 18th birthday. He had a big heart and many friends, his family said -- but he also had gotten into trouble with marijuana and alcohol.
Both he and his parents thought the Marines would help straighten that out.
He signed up for four years. Then came the Sept. 11 terrorist attacks. On the eve of war, his tour of duty was extended and he was deployed to Nasiriya, Iraq, southeast of Baghdad.
After his honorable discharge in April 2004, Bailey didn't talk much about what he'd done and seen in the war -- at least not to his father.
"It seemed like something happened over there that really changed him a lot," Tony Bailey said. "It wasn't easy for him to ask for help, at least from his parents."
Tony Bailey said his son had trouble adjusting: He ran up traffic warrants. He couldn't keep a job. He couldn't pay the rent.
To his mother, he spoke of guilt over civilian casualties.
"He came back saying, 'Mom, I shot women and children. I can't deal with this,' " said Danielle Floyd, 53, of Henderson, Nev., who is divorced from Justin's father.
He studied sound engineering in Los Angeles, where he met Rentzis, an animation timer. But because of his difficulties in keeping a job and an apartment, he moved back to Las Vegas to be near his family.
He and his father had run-ins over drug use. Tony Bailey did what he called "the hard dad thing," telling his son not to call home until he was ready to get help.
That was what Justin finally sought from the VA. "He said, 'Enough,' " said Rentzis, 35. "He was young enough, he could still turn his life around."
Justin Bailey first went into the VA medical center's psychiatric ward in November.
A psychiatrist wrote in his record: "vet continuously using benzos [benzodiazepines, which include the anti-anxiety drug Xanax] along with pain meds.... Going thru mood swings and having flashbacks and dreams of the war daily."
Two weeks later, Bailey was discharged to the residential rehabilitation program, or domiciliary. He had a new prescription -- methadone -- to treat his groin pain.
Methadone has come under increased scrutiny since the death last month of Playboy model Anna Nicole Smith, who may have suffered an overdose. But it attracted the medical community's attention well before that.
A synthetic opiate best known for curbing the cravings of heroin addicts, methadone has been increasingly prescribed as a low-cost treatment for chronic and nerve pain. Overdose deaths have risen in tandem, up 390% since 1999.
"That upswing in popularity has been in the name of better patient care and compassion for people with serious and often emotionally troubling pain," said Dr. David J. Clark, who runs the pain center at the Palo Alto VA Medical Center.
"On the other hand, you don't have to practice long before you have a few unmitigated disasters, people who abuse the drugs or display some problematic behaviors."
Methadone stays in the body for up to 59 hours but relieves pain for just four to eight, leading some patients to take the next dose too soon. Some supplement methadone with other drugs, creating potentially lethal cocktails.
In November, just before Bailey checked into the VA medical center, the Food and Drug Administration ordered the addition of a "black box" warning -- the strongest label warning it can impose -- advising that using methadone for pain can result in life-threatening changes in breathing and heartbeat.
When methadone is handed out in heroin treatment programs, users get only one dose a day, reducing opportunities for overdose.
Bailey's two-week prescription, however, fell within the 30-day norm for the drug's use as a pain medication.
"We're always struggling in this practice with trying to treat that pain while controlling the risk," said Dr. Lynn R. Webster, medical director of a Salt Lake City pain clinic and a nationally recognized expert on pain management and addiction. Patients with PTSD or anxiety who tend to "self-medicate," or take more drugs than prescribed, have to be watched especially closely.
"If it's someone who demonstrates egregious behaviors and has a serious addiction problem, two weeks of the medication may be too much," he said.
In the 310-bed domiciliary where Bailey was housed, residents are expected to administer their own medications, which they keep in their rooms in a locker. No staff member dispenses or counts pills.
Tony and Mary Kaye Bailey said they didn't know that until after Justin died. "They call it a treatment facility," she said. "But he went to the domiciliary with more drugs than he was taking when he went into the hospital."
Rentzis and Floyd say that they repeatedly tried to warn VA doctors, nurses and social workers about Justin.
According to Bailey's medical records, his mother called a domiciliary nurse practitioner Dec. 20.
"Received a telephone call from a Mrs. Danielle Floyd, who identifies herself as patient's mother," the staffer wrote. "She expresses concern about his long history of substance abuse, including Xanax and opiate abuse and crack cocaine. He has been in several programs in Nevada ... and attempts to obtain drugs."
Norman, the hospital's chief of staff, said he could not address the concerns without knowing more about what happened but that the investigations were looking into them.
About 75 of the domiciliary's 200 residents have some kind of substance abuse problem, he said, and learning to be responsible for themselves is part of their therapy. The doctors and nurses he talked to, Norman added, "were optimistic and thought [Bailey] was doing well."
Domiciliary residents interviewed by The Times said that during Bailey's six-week stay, he often appeared groggy, missed meals and classes, and once was removed from a group session on addiction because he kept twitching and falling out of his chair.
"Nobody intervened, though many of us brought it up to staff that it seemed like there was something really wrong with this young man," said Isaiah Michaels, 30, who lived four rooms down from Bailey.
Interviewed separately, three other current and former residents echoed Michaels' account.
"The program is absolutely a good program for people who are willing to work it," said domiciliary resident Joseph St. Angelo, 46. "But there are people who shouldn't be in this program, who have special needs, and they should be better screened. In Justin's case, it was an oversight."
According to his medical records, Bailey picked up a second, two-week supply of methadone Jan. 25, a Thursday. He also obtained 30-day supplies of a blood-vessel relaxer prescribed for PTSD; a sedative and antidepressant for insomnia and nightmares; generic Xanax; and a new two-week prescription for another antidepressant.
He and Rentzis had planned to see "The Departed" the next night.
Rentzis said he arrived about 6:15 p.m. Friday. Visitors are not allowed beyond the lobby, so a resident went upstairs and found Bailey in bed, unconscious. His lips were blue.
Bailey was taken by paramedics to the main hospital, where St. Angelo went to see him later than night. Staff members there asked if he was Bailey's father.
St. Angelo said, "I'm his brother," meaning a fellow veteran. They whisked him to Bailey's bedside in the intensive care unit.
"I squeezed his hand and said, 'I love you, brother,' " St. Angelo said.
Bailey died at 10:20 p.m.
It was Rentzis, not the VA, who called the Baileys that Friday night when their son was rushed to the emergency room. They called the hospital and learned that he had died.
"Nobody called me," Tony Bailey said, "except at 2 a.m., somebody called wanting my son's eyeballs. It was an organ collection thing."
That Sunday, Tony and Mary Kaye Bailey drove to Los Angeles. First they went to the main hospital, where they were told to come back on Monday. Then they went to the domiciliary.
"There was nobody in charge," Tony Bailey said. "There was a dom assistant. The guy called his supervisor, and was basically told over the phone not to talk to us."
On Monday, the Baileys said, they were called into a tiny office while a man at the desk talked on the phone. Eventually, he gave them papers and forms to sign.
As they were leaving, the man took a box from a stack in the corner and handed it to them. It contained their son's burial flag, used to cover the casket of deceased veterans.
"The guy says, 'Oh, by the way, here's your flag,' " Tony Bailey said. "No, 'I'm sorry for your loss.' I spent 20 years in the military, and my dad spent time in the military. They don't care."
Norman, the hospital's chief of staff, said he regretted what happened, blaming a communication breakdown. He himself had not been informed that Justin Bailey had died. Now the head nurse and the domiciliary director are notified whenever a domiciliary patient is hospitalized, he said.
"That won't happen again," he said. "The secretary [VA Secretary Jim Nicholson] wanted to be personally sure that the family knew he was very sorry and this would be investigated."
Tony Bailey says he just wants the program fixed.
"I've never considered myself special," he said. "If it happened to me and my son, it's happening someplace else."