DES MOINES, Iowa -- On February 15, Iraq war veteran Richard Miles entered the U.S. Department of Veterans Affairs hospital in Des Moines and told the staff: "I need help," according to hospital records.
In this story
- Richard Miles sought help at VA hospital in Des Moines: doctor's notes indicate Miles said he was not a danger to himself
- Days after being sent home, Miles was found dead in the woods
- Related stories
He had told friends he was going to check himself in. He was diagnosed with "worsened PTSD," anxiety and insomnia, but Miles was not admitted to the hospital.
Five days later the 40-year-old father was found dead in the woods, having taken a toxic amount of sleeping pills, according to a toxicology report. He died from exposure to the elements.
Now those who loved him want to know why the VA hospital did not admit him when he showed up that night.
"That was his cry for help and it was not taken seriously or received the way it should have been received," said Katie Hopper, his ex-girlfriend and mother to their daughter Emmalynn.
Miles was one of the premiere presenters at the Science Center of Iowa, a beloved employee popular with the staff and guests.
"He was passionate and knowledgeable about science himself and it went beyond that. His passion extended to sharing that knowledge with others," said Science Center of Iowa President and CEO Curt Simmons. Miles' image was featured prominently in YouTube videos and advertisements for the museum; a large photograph bearing his image stands outside the center.
What this popular Iraq war veteran did not share with most, is that he suffered from post-traumatic stress disorder, or PTSD.
"He knew the date, and where he was when he had shot and killed people in the war," says Hopper. "He was very, very aware of what he was doing, that he was ending people's lives, even if it was for the greater good." The memory of an interrogation incident with a frail, old Iraqi man upset him quite a bit, she recalled.
Medical records obtained state that after Miles returned from Iraq in 2004, he "began to experience depression with suicidal attempts." He recalled seeing dead bodies, and often had graphic, violent dreams.
One record from 2011 says Miles "described onset of anger, outburst and irritability beginning after his return from deployment in Iraq during October 2004." He "recalled his war related experiences about 'being on alert and seeing dead bodies.' He further noted sleep disturbance with troublesome dreams 'about combat and military-related content.'"
Miles had "many dreams about death and violence," the records state. "The dreams are graphic and often involve themes of needing to protect someone, and an outcome of killing someone in the course of protecting someone else. Mr. Miles awakens from the dreams anxious and sad. This occurs 2-3 times per week."
Friends and family saw Miles struggle with his PTSD, but say he was doing generally fine until January, when he disappeared. A missing person report was filed with local law enforcement.
He finally responded days later to friends such as Harry Aller, who had sent Miles text messages.
"He wrote back ... 'I didn't mean to get people worried I just need to spend some time at the hospital to figure things out,'" Aller said.
Thankfully, Miles returned, and chose to stay with Hopper.
"I said do you feel like you need to get out of the house, do you want to go for a drive, do you want to go for a walk? He said, ' No, I'm going to go to the VA.' Right now? 'Yeah, right now,'" Hopper said.
"He had to be of in a place where he was going to harm himself, mentally. And the thought of that would lead him to want to get help because he would be letting down his daughter, his son, his friends, and that was not an option for him," said Aller.
On February 15, Miles left several of his belongings with Hopper and went to the hospital. It was a familiar place to the veteran whose medical records show a long history of suicidal acts and thoughts.
He'd been hospitalized at the Iowa VA hospital four times for PTSD between 2008 and 2009, after he "made 2 attempts to hang himself," according to records. At one point he had brought a gun into a different hospital ward planning to kill himself.
Records show friends called the VA to look for him and later filed a missing persons report with local law enforcement.
Files from that day show Miles told the hospital attendant he needed help. When the attending doctor asked him whether he was a danger to himself, Miles responded, "No, I won't harm myself, but I do need some medicine so I can just rest," according to the notes.
"He came home about three hours later," said Hopper, who was surprised at the quick return. "I thought you were going to be days or weeks even," she recalled saying to him.
"He said, 'Yeah, me too, but they just gave me medication and sent me home, said my psychiatrist would follow up with me this week to set up an appointment,'" she said.
Miles did not make it that long. A few days later, after giving Emmalynn a big hug goodbye, he instead walked into the woods -- where he and Hopper used to go -- and never came back.
The toxicology report shows Miles had ingested a toxic but not fatal number number of lorazepam sleeping pills, which he had been prescribed just a few days before at the VA, and froze to death.
His was found with no jacket, no shoes, and most infuriatingly, no clear reason why his life had to end like this.
"The VA failed him. They failed him," said Hopper.
Emergency room staff "followed proper mental health screening procedures and then scheduled an outpatient psychotherapy appointment for seven days from that point," the Department of Veterans Affairs said in a statement, adding that Miles was "given anxiety and insomnia medication upon his departure from the emergency room -- medication he indicated had helped him in the past."
CNN provided the more than 1,200 pages of Miles' records to Dr. Elspeth Cameron Ritchie, a longtime Army psychiatrist and former chief clinical officer for the District of Columbia's Department of Mental Health. She's now retired from the Army.
"This seems like it was a very tough situation," Ritchie said. "In retrospect -- and this happens very commonly after a suicide -- you look back and you look back and you see all kinds of red flags or information that one person knew but another person didn't know, and if you put it all together, yes, maybe he should have been hospitalized."
But, Ritchie added, "my reading of it is that the emergency room physician didn't have that information and that he denied feeling suicidal, and that's really tough for psychiatrists. We can't read people's minds we can only look at the information available and make a judgment."
CNN asked Ritchie, is it not enough that he had tried suicide before and that he had had a missing person report filed for him in recent days?
"Again, in retrospect, perhaps we would have done things differently but his suicide attempts were back in '08 and '09. This was 2015. I don't know that the physician knew about the missing person report, and we weren't there at the time to see what actually happened. That's one of the challenges with looking at medical records afterward and why it's so important to do good documentation," he said.
If proper procedures were indeed followed, are VA procedures in dealing with suicidal veterans adequate? Brandon Coleman says they are not. Coleman developed a suicide prevention program at the VA hospital in Phoenix, where he says it's desperately needed. Now the disabled Marine Corps veteran says he's blowing the whistle on insufficient care for his peers.
"We're missing the boat with these most at-risk veterans, and not enough is being done systemically in order to protect them. ... We can't just hand these guys pills, (that) is not the answer," said Coleman.
"I came forward mainly because of the veteran suicides. They're not being handled properly," Coleman said.
He told the VA Office of Special Counsel in December 2014 that suicidal veterans "are not properly monitored at the Phoenix VA and oftentimes they leave after being deemed suicidal because they are not properly watched by trained professionals." When Coleman tried to discuss issues with the care of suicidal veterans to his supervisors they "always fell on deaf ears."
On January 23, another concerned employee at the Phoenix VA secretly recorded a staff meeting, where officials discussed that suicidal veterans there had "bolted out the door."
"It has been a high number like five in the last week," emergency room staff is heard saying on the recording.
"We have been really lucky that nothing bad has happened in these instances where vets have split. It was sheer luck that nothing happened," a supervisor says.
Coleman is now nearing his second month of paid administrative leave, retaliation for being a whistleblower, he says.
In a statement, the Phoenix VA said "we have strengthened our protocols and approaches for how we care for suicidal veterans ... we continue to look for ways improve the care and appreciate suggestions made by our employees and others."
It is a different VA, but part of the same troubled system. A 2012 VA report suggests about 22 veterans commit suicide each day.
Some of them sought help at VA centers and other hospitals and didn't get the treatment they needed.
"I think the VA is in the lead on treatment of PTSD. Are they doing as much as they could be? It's no secret that the VA is an overwhelmed system," said Ritchie. "And it's no secret to anybody that the VA can't handle it all."
The friends and family of Richard Miles want the VA to learn from their tragedy. They want the VA to figure out what they could have done differently with Miles, so the next veteran is admitted and helped.
"I don't have a friend. My daughter doesn't have a father. He touched so many people, he was so great. He was such an inspiration," Hopper said, crying. "I really do feel as though the VA failed him, and ultimately I feel it's kind of on them."
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