Despondent Fort Lewis GI fell through system's cracks to his death

Last August, Spc. David Ramsey, a hospital nurse serving in Mosul, Iraq, tumbled into a pit of despair. He penned a suicide note that spoke of his weariness of war and strains upon his marriage. He dry-fired a rifle, and locked and loaded the weapon.

Then he backed down and asked for help.

Front-line leaders took strong action: Ramsey spent several days in a hospital ward and was put on a medevac flight away from the war zone.

" I am confident you are in good hands, and with appropriate treatment ... you will overcome this issue and continue to be a model soldier," wrote a first sergeant in Mosul in a counseling record obtained by The Seattle Times.

But two weeks after his arrival at Fort Lewis, Ramsey killed himself while on home leave at his parents' house in Spanaway.

The disturbing case has triggered an internal review, and changes in record-keeping, at the post's Madigan Army Medical Center.

Madigan faces a mounting emotional toll from the Iraq war, and Ramsey appeared to slip through a fault line in the hospital's mental-health-care system.

Madigan officials say that at the time of Ramsey's Aug. 24 return, they were unaware of his near-suicide attempt in Mosul. A hospital psychologist believed Ramsey was stable, approved his release and scheduled a follow-up appointment for Sept. 6.

Ramsey missed that counseling session, and shot himself on Sept. 7.

Ramsey's death has drawn the attention of Congress, where a House aide asked an Army official about the handling of Ramsey's medical records in a closed-door meeting last month.

The hospital also faces questions from Ramsey's parents, whom he lived with during his final two weeks. They say that the Army never told them about the near-suicide attempt in Mosul, nor did their son.

Only after his death, in a search of a bloodstained upstairs bedroom, did they find a brown Army folder with written medical records that documented several days of despair that culminated in the Mosul incident.

"If I had seen those papers earlier, I would have gone straight to the post — to the commander and Madigan — and tried to get him care," said his father, Joe Ramsey.

Madigan officials, citing confidentiality laws, declined to release the internal review of Ramsey's death. They did respond to written questions from The Seattle Times.

During the initial evaluation, Madigan staff believed Ramsey was evacuated for depression and marital problems, according to the written statement. At the evaluation, Ramsey did not show the written records that documented the near-suicide attempt in Mosul, according to Madigan officials.

The psychologist who evaluated Ramsey did access some electronic patient records. But this staffer lacked a password and account required to read other records that included information about the troubled days in Mosul, according to Madigan officials.

Army officials said at least one individual at Fort Lewis — a first sergeant recently returned from Iraq — did know of the attempt. But the sergeant was prevented by federal privacy laws from sharing that information with Ramsey's family, according to Army officials.

Since Ramsey was not deemed at risk by Madigan, his unit commanders at Fort Lewis were comfortable approving home leave for a soldier who appeared upbeat and planning a return to college.

"There's been a lot of soul-searching," said Maj. Cathy Wilkinson, a Fort Lewis spokeswoman. "His buddies, and guys who barely knew him, are wondering what could have been done differently."

A breaking point in Iraq

David Ramsey is remembered by his family as an honor student and high-school athlete who always had a smile on his face and a soft spot for kids.

Joe Ramsey is a Vietnam veteran who spent the last three years of his 22-year Army career at Fort Lewis. David followed his father into the military. He was a nurse assigned to the 47th Combat Support Hospital, 62nd Medical Brigade, based at Fort Lewis.

In Iraq, Ramsey served in wards filled with wounded Americans and Iraqis, working 12-hour shifts in the critical-care unit. His hospital service "earned nothing but high remarks," according to a counseling document.

In August, during the 11th month of his tour, a homesick Ramsey appeared to wear down. He cried at night over the plight of wounded children in the hospital. In calls home, he appeared to be overwhelmed by the stress and sadness of the job.

His wife, Genesa Richards-Ramsey, said she urged him in telephone calls to hang on until September, when his tour of duty would end.

But on Aug. 15, Ramsey was overcome by depression, and fearful that his wife — whom he had married five months earlier — would not want to stay with him. He confided suicidal feelings to an officer, who removed the firing bolt from Ramsey's weapon, according to Army records.

Ramsey couldn't shake off his bleak mood.

On the evening of Aug. 15, he drafted a suicide note.

"I apologize to everyone for being weak. But I tried, I really tried," Ramsey wrote. "Between being deployed, away from family, marital problems and just dealing with the death & injuries here, it's overwhelming."

The next day, Ramsey loaded an M-16 and prepared to shoot himself.

Instead of going through with the act, Ramsey paged an officer in his unit. He was admitted to the Mosul hospital as a patient. After pledging that he would not try to kill himself, he was medically evacuated to Landstuhl, Germany.

At the time of that flight, Ramsey was sedated, still in pajamas and with an escort who carried restraints "in case of emergency," according to a patient movement request reviewed by The Seattle Times.

"Pt [patient] is still suicidal," the document said.

Ramsey's stay at Landstuhl involved another medical review.

There, doctors offered a starkly different assessment. They said he was "not depressed, suicidal or experiencing any significant emotional distress," according to medical records.

Joe Ramsey had a different impression of his son, who sounded distraught and disoriented in a telephone call home from Germany.

"I told my wife, there's no use getting his room ready because there's no way that the Army will let him come home to stay with us," Ramsey said.

But Madigan doctors, in their Aug. 24 evaluation, thought Ramsey was stable enough for outpatient care.

By the end of the day, Ramsey was sleeping at his parents' house. And, after making several day trips to the post to complete a redeployment process, Ramsey was approved for an extended leave on Aug. 29.

During the leave, Ramsey lived with his parents but talked frequently with his wife.

"He was very gloomy and very sad, and when he told me he was on leave, I was very shocked," said Genesa Richards-Ramsey, who was worried that Ramsey was not taking prescribed medication. "It just didn't make any sense."

Changes in system

After Ramsey's death, Madigan hospital staff accessed the electronic evacuation records that detailed his struggles in Mosul.

Since that time, Madigan officials say, they have made changes in the hospital's record-keeping system. All electronic patient records now include entries regarding evacuations from overseas.

The medical center also now tracks missed appointments more closely, and makes follow-up calls to notify a patient's unit, according to officials.

For the family, Ramsey's death remains a raw wound.

At his parents' house, the American flag that was draped across his coffin is folded on the fireplace mantel.

During lunch breaks from his Pierce County job, Joe Ramsey heads to a Lakewood cemetery to grieve beside a flat granite marker.

"I would like to get some sort of closure. I just don't want to see this happen to another solder," Joe Ramsey said. "That's what I'm thinking about."

Hal Bernton: 206-464-2581 or hbernton@seattletimes.com