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On Veterans Day 2010, former Navy corpsman Kelli Marie Grese, 37, swallowed an unknown quantity of the antipsychotic Seroquel — her fourth suicide attempt in eight months using the same drug.
That time, she succeeded. She never regained consciousness.
Her death is the subject of a $5 million lawsuit filed against the Veterans Affairs Department in the U.S. District Court in Newport News, Va., alleging VA physicians failed to monitor her medications and prescribed them excessively.
Her twin sister, Darla Grese, also a former Navy corpsman, filed the suit, saying physicians at Hampton VA Medical Center, Va., ignored her pleas to quit doling out prescriptions to her sister, a known addict deemed at "moderate risk for suicide."
"I'm hoping better attention will be placed on how many pills are being written and quantities," said Darla Grese.
She traces her twin's mental health problems to 1996, when she was diagnosed with post-traumatic stress disorder after a break-in at the sisters' off-base housing in Naples, Italy.
Although migraine headaches and anxiety followed the burglary, Kelli Grese continued to succeed in her job, earning a promotion to petty officer second class and nomination as junior sailor of the quarter.
But her separation from the Navy in 1997 appeared to spark a downward spiral in her mental health. She sought VA treatment for symptoms including anxiety, depression and insomnia.
Darla Grese said her sister was prescribed clonazepam, a highly addictive benzodiapine meant for short-term treatment of anxiety, and later the stimulant Adderall, even though she had no record of attention deficit disorder, for which that drug is prescribed.
The Adderall triggered a cascade of mental symptoms, including auditory and visual hallucinations, paranoia and full-blown psychoses.
"She thought the CIA was after her," Darla Grese said. "At one point, she shaved half her head because she thought she had something implanted in it."
Medical records later noted that her psychosis was induced by the Adderall, a rare but known side effect.
In 2002, she was prescribed Seroquel to treat the psychotic episodes and hallucinations. Bouncing from VA doctor to VA doctor and civilian physicians, as well, Kelli Grese became adept at acquiring medications.
By 2009, she started having suicidal thoughts. The overdoses on Seroquel began in 2010.
Days before she died, she renewed her prescription, which was to be mailed to her house. She then persuaded a VA doctor to give her a second prescription, which she filled at a pharmacy.
She then took mass quantities of Seroquel. "We don't know how many," Darla Grese said. "It was paste in her stomach, the medical examiner told me."
During her decade of VA care, Kelli Grese was prescribed at least 25 medications, some simultaneously.
The practice of prescribing multiple medications for hard-to-treat mental illnesses is on the rise, although studies indicate that effectiveness varies.
Dr. David Reiss, a psychiatrist in San Diego who has treated hundreds of veterans with PTSD and is not associated with Grese's case, said the practice sometimes is appropriate, especially when using antipsychotics with an activating medication that can boost their efficacy.
But hard-to-treat patients should be handled "very carefully," Reiss said.
Without consistent and careful care, "short-term strategies turn into permanent prescriptions and ‘stacking,'" he said.
VA and the U.S. Attorney's Office for the Eastern District of Virginia declined to comment on the Grese case.
Darla Grese said she filed the lawsuit because she would like to see VA doctors communicate better and pay closer attention to their own patients' records.
"I don't understand how a physician can write a prescription for 450 pills and two months later write another prescription for 450," she said. "Something's broken. The system is broken."