How a New Policy Led to Seven Deadly Drugs

How a New Policy Led to Seven Deadly Drugs

http://www.latimes.com/news/nation/reports/fda/lat_fda001220.htm

By DAVID WILLMAN

WASHINGTON–For most of its history, the United States Food and Drug Administration approved new prescription medicines at a grudging pace, paying daily homage to the physician’s creed, “First, do no harm.”

Then in the early 1990s, the demand for AIDS drugs changed the political climate. Congress told the FDA to work closely with pharmaceutical firms in getting new medicines to market more swiftly. President Clinton urged FDA leaders to trust industry as “partners, not adversaries.”

The FDA achieved its new goals, but now the human cost is becoming clear.

Seven drugs approved since 1993 have been withdrawn after reports of deaths and severe side effects. A two-year Los Angeles Times investigation has found that the FDA approved each of those drugs while disregarding danger signs or blunt warnings from its own specialists. Then, after receiving reports of significant harm to patients, the agency was slow to seek withdrawals.

According to “adverse-event” reports filed with the FDA, the seven drugs were cited as suspects in 1,002 deaths. Because the deaths are reported by doctors, hospitals and others on a voluntary basis, the true number of fatalities could be far higher, according to epidemiologists.

An adverse-event report does not prove that a drug caused a death; other factors, such as preexisting disease, could play a role. But the reports are regarded by public health officials as the most reliable early warnings of danger.

The FDA’s performance was tracked through an examination of thousands of pages of government documents, other data obtained under the Freedom of Information Act and interviews with more than 60 present and former agency officials.

The seven drugs were not needed to save lives. One was for heartburn. Another was a diet pill. A third was a painkiller. All told, six of the medicines were never proved to offer lifesaving benefits, and the seventh, an antibiotic, was ultimately judged unnecessary because other, safer antibiotics were available.

The seven are among hundreds of new drugs approved since 1993, a period during which the FDA has become known more for its speed than its caution. In 1988, only 4% of new drugs introduced into the world market were approved first by the FDA. In 1998, the FDA’s first-in-the-world approvals spiked to 66%.

The drug companies’ batting average in getting new drugs approved also climbed. By the end of the 1990s, the FDA was approving more than 80% of the industry’s applications for new products, compared with about 60% at the beginning of the decade.

And the companies have prospered: The seven unsuccessful drugs alone generated U.S. sales exceeding $5 billion before they were withdrawn.

Once the world’s unrivaled safety leader, the FDA was the last to withdraw several new drugs in the late 1990s that were banned by health authorities in Europe.

“This track record is totally unacceptable,” said Dr. Curt D. Furberg, a professor of public health sciences at Wake Forest University. “The patients are the ones paying the price. They’re the ones developing all the side effects, fatal and non-fatal. Someone has to speak up for them.”

The FDA’s faster and more lenient approach helped supply pharmacy shelves with scores of new remedies. But it has also yielded these fatal missteps, according to the documents and interviews:

1. Only 10 months ago, FDA administrators dismissed one of its medical officer’s emphatic warnings and approved Lotronex, a drug for treating irritable bowel syndrome. Lotronex has been linked to five deaths, the removal of a patient’s colon and other bowel surgeries. It was pulled off the market on Nov. 28.

2. The diet pill Redux, approved in April 1996 despite an advisory committee’s vote against it, was withdrawn in September 1997 after heart-valve damage was detected in patients put on the drug. The FDA later received reports identifying Redux as a suspect in 123 deaths.

3. The antibiotic Raxar was approved in November 1997 in the face of evidence that it may have caused several fatal heart-rhythm disruptions in clinical studies. FDA officials chose to exclude any mention of the deaths from the drug’s label. The maker of the pill withdrew it in October 1999. Raxar was cited as a suspect in the deaths of 13 patients.

4. The blood pressure medication Posicor was approved in June 1997 despite findings by FDA specialists that it might fatally disrupt heart rhythm and interact with certain other drugs, posing potentially severe risk. Posicor was withdrawn one year later; reports cited it as a suspect in 100 deaths.

5. The painkiller Duract was approved in July 1997 after FDA medical officers warned repeatedly of the drug’s liver toxicity. Senior officials sided with the manufacturer in softening the label’s warning of the liver threat. The drug was withdrawn 11 months later. By late 1998, the FDA had received voluntary reports citing Duract as a suspect in 68 deaths, including 17 that involved liver failure.

6. The diabetes drug Rezulin was approved in January 1997 over a medical officer’s detailed opposition and was withdrawn this March after the agency had linked 91 liver failures to the pill. Reports cite Rezulin as a suspect in 391 deaths.

7. The nighttime heartburn drug Propulsid was approved in 1993 despite evidence that it caused heart-rhythm disorders. The officials who approved the drug failed to consult the agency’s own cardiac specialists about the signs of danger. The drug was taken out of pharmacies in July after scores of confirmed heart-rhythm deaths. Overall, Propulsid has been cited as a suspect in 302 deaths.

The FDA’s handling of Propulsid put children at risk.

The agency never warned doctors not to administer the drug to infants or other children even though eight youngsters given Propulsid in clinical studies had died. Pediatricians prescribed it widely for infants afflicted with gastric reflux, a common digestive disorder.

Parents and their doctors had no way of knowing that the FDA, in August 1996, had found Propulsid to be “not approvable” for children.

“We never knew that,” said Jeffrey A. Englebrick, a heavy-equipment welder in Shawnee, Kan., whose 3-month-old son, Scott, died on Oct. 28, 1997, after taking Propulsid. “To me, that means they took my kid as a guinea pig to see if it would work.”

By the time the drug was pulled, the FDA had received reports of 24 deaths of children under age 6 who were given Propulsid. By then the drug had generated U.S. sales of $2.5 billion for Johnson & Johnson Co.

Questions also surround the recent approvals of other compounds that remain on the market, including a new flu drug called Relenza. In February of 1999, an FDA advisory committee concluded that Relenza had not been proved safe and effective. The agency nevertheless approved it. Following the deaths of seven patients, the FDA in January issued a “public health advisory” to doctors.

A ‘Lost Compass’
A total of 10 drugs have been pulled from the market in just the past three years for safety reasons, including three pills that were approved before the shift that took hold in 1993. Never before has the FDA overseen the withdrawals of so many drugs in such a short time. More than 22 million Americans–about 10% of the nation’s adult population–took those drugs.

With many of the drugs, the FDA used tiny-print warnings or recommendations in package labeling as a way to justify approvals or stave off withdrawals. In other instances, the agency has withheld safety information from labels that physicians say would call into question the use of the product.

Present and former FDA specialists said the regulatory decisions of senior officials have clashed with the agency’s central obligation, under law, to “protect the public health by ensuring . . . that drugs are safe and effective.”

“They’ve lost their compass and they forget who it is that they are ultimately serving,” said Dr. Lemuel A. Moye, a University of Texas School of Public Health physician who served from 1995 to 1999 on an FDA advisory committee. “Unfortunately the public pays for this, because the public believes that the FDA is watching the door, that they are the sentry.”

The FDA’s shift is felt directly in the private practice of medicine, said Dr. William L. Isley, a Kansas City, Mo., diabetes specialist. He implored the agency to reassess Rezulin three years ago after a patient he treated suffered liver failure taking the pill.

“FDA used to serve a purpose,” Isley said. “A doctor could feel sure that a drug he was prescribing was as safe as possible. Now you wonder what kind of evaluation has been done, and what’s been swept under the rug.”

FDA officials said that they have tried conscientiously to weigh benefits versus risks in deciding whether to approve new drugs. They noted that many doctors and patients complain when a drug is withdrawn. “All drugs have risks; most of them have serious risks,” said Dr. Janet Woodcock, director of the FDA’s drug review center. She added that some of the withdrawn drugs were “very valuable, even if not lifesaving, and their removal from the market represents a loss, even if a necessary one.” Once a drug is proved effective and safe, Woodcock said, the FDA depends on doctors “to take into account the risks, to read the label. . . . We have to rely on the practitioner community to be the learned intermediary. That’s why drugs are prescription drugs.”

In a May 12, 1999, article co-authored with FDA colleagues and published by the Journal of the American Medical Assn., Woodcock said, “The FDA and the community are willing to take greater safety risks due to the serious nature of the [illnesses] being treated.”

Compared to the volume of new drugs approved, they wrote, the number of recent withdrawals “is particularly reassuring.”

However, agency specialists point out that both approvals and withdrawals are controlled by Woodcock and her administrators. When they consider a withdrawal, they face the unpleasant prospect of repudiating their original decision to approve.

Woodcock, 52, received her medical degree at Northwestern University and is a board-certified internist. She alluded in a recent interview to the difficulty she feels in rejecting a proposed drug that might cost a company $150 million or more to develop. She also acknowledged the commercial pressures in a March 1997 article.

“Consumer protection advocates want to have drugs worked up well and thoroughly evaluated for safety and efficacy before getting on the market,” Woodcock wrote in the Food and Drug Law Journal. “On the other hand, there are economic pressures to get drugs on the market as soon as possible, and these are highly valid.”

But this summer–following the eighth and ninth drug withdrawals–Woodcock said the FDA cannot rely on labeling precautions, alone, to resolve safety concerns.

“As medical practice has changed . . . it’s just much more difficult for [doctors] to manage” the expanded drug supply, Woodcock said in an interview. “They rely upon us much more to make sure the drugs are safe.”

Another FDA administrator, Dr. Florence Houn, voiced similar concern in remarks six months ago to industry officials: “I think the lessons learned from the drug withdrawals make us leery.”

Yet the imperative to move swiftly, cooperatively, remains.

“We are now making decisions more quickly and more predictably while maintaining the same high standards for product safety and efficacy,” FDA Commissioner Jane E. Henney said in a National Press Club speech on Dec. 12.

Motivated by AIDS
The impetus for change at the FDA emerged in 1988, when AIDS activists paralyzed operations for a day at the agency’s 18-story headquarters in Rockville, Md. They demanded immediate approval of experimental drugs that offered at least a ray of hope to those otherwise facing death.

The FDA often was taking more than two years to review new drug applications. The pharmaceutical industry saw a chance to loosen the regulatory brakes and expedite an array of new products to market. The companies and their Capitol Hill lobbyists pressed for advantage: If unshackled, they said, the companies could invent and develop more remedies faster.

The political pressure mounted, and the FDA began to bow. By 1991, agency officials told Congress they were making significant progress in speeding the approval process.

The emboldened companies pushed for more. They proposed that drugs intended for either life-threatening or “serious” disorders receive a quicker review.

“The pharmaceutical companies came back and lobbied the agency and the Hill for that word, ‘serious,’ ” recalled Jeffrey A. Nesbit, who in 1991 was chief of staff to FDA Commissioner David A. Kessler. “Their argument was, ‘Well, OK, there’s AIDS and cancer. But there are drugs [being developed] for Alzheimer’s. And that’s a serious illness.’ They started naming other diseases. They began to push that envelope.”

The wielding of this single, flexible adjective–“serious”–swung wide the regulatory door knocked ajar by the AIDS crisis.

New Order Takes Hold
In 1992, Kessler issued regulations giving the FDA discretion to “accelerate approval of certain new drugs” for serious or life-threatening conditions. That same year a Democrat-controlled Congress approved and President Bush signed the Prescription Drug User Fee Act. It established goals that call for the FDA to review drugs within six months or a year; the pharmaceutical companies pay a user fee to the FDA, now $309,647, with the filing of each new drug application.

The newly elected Clinton administration climbed aboard with its “reinventing government” project. Headed by Vice President Al Gore, the project called for the FDA, by January 2000, to reduce “by an average of one year the time required to bring important new drugs to the American public.” As Clinton put it in a speech on March 16, 1995, the objective was to “get rid of yesterday’s government.”

For the FDA’s medical reviewers–the physicians, pharmacologists, chemists and biostatisticians who scrutinize the safety and effectiveness of emerging drugs–a new order had taken hold.

The reviewers work out of public view in secure office buildings clustered along Maryland’s Route 355. At the jet-black headquarters building, the decor is institutional, the corridors and third-floor cafeteria without windows. The reviewers examine truckloads of scientific documents. They are well-educated; some are highly motivated to do their best for a nation of patients who unknowingly count on their expertise.

One of these reviewers was Michael Elashoff, a biostatistician who arrived at the FDA in 1995 after earning degrees from UC Berkeley and the Harvard School of Public Health.
“From the first drug I reviewed, I really got the sense that I was doing something worthwhile. I saw what a difference a single reviewer can make,” said Elashoff, the son and grandson of statisticians.

Last year he was assigned to review Relenza, the new flu drug developed by Glaxo Wellcome. He recommended against approval.

“The drug has no proven efficacy for the treatment of influenza in the U.S. population, no proven effect on reducing person-to-person transmissibility, and no proven impact on preventing influenza,” Elashoff wrote, adding that many patients would be exposed to risks “while deriving no benefit.”

An agency advisory committee agreed and on Feb. 24 voted 13 to 4 against approving Relenza. After the vote, senior FDA officials upbraided Elashoff. They stripped him of his review of another flu drug. They told him he would no longer make presentations to the advisory committee. And they approved Relenza as a safe and effective flu drug.

Lost Faith in the System
Elashoff and other FDA reviewers discern a powerful message.
“People are aware that turning something down is going to cause problems with [officials] higher up in FDA, maybe more problems than it’s worth,” he said. “Before I came to the FDA I guess I always assumed things were done properly. I’ve lost a lot of faith in taking a prescription medicine.”

Elashoff left the FDA four months ago.

“Either you play games or you’re going to be put off limits . . . a pariah,” said Dr. John L. Gueriguian, a 19-year FDA medical officer who opposed the approval of Rezulin, the ill-fated diabetes drug. “The people in charge don’t say, ‘Should we approve this drug?’ They say, ‘Hey, how can we get this drug approved?’ ”

Said Dr. Rudolph M. Widmark, who retired in 1997 after 11 years as a medical officer: “If you raise concern about a drug, it triggers a whole internal process that is difficult and painful. You have to defend why you are holding up the drug to your bosses. . . . You cannot imagine how much pressure is put on the reviewers.”

The pressure is such that when a union representative negotiated a new employment contract for the reviewers last year, one of his top priorities was to defend what he called the “scientific integrity” of their work.

“People feel swamped. People are pressured to go along with what the agency wants,” said Dr. Robert S.K. Young, an FDA medical officer who in 1998 formed a union chapter to represent the reviewers. “You’re paying for these highly educated, trained people, and they’re not being allowed to do their job.”

Each new drug application is accompanied by voluminous medical data, enough at times to fill 1,000 or more phone books. The reviewers must master this material in less than six months or a year, while juggling other tasks.

“The devil is in the details, and detail is something we no longer have the time to go into,” said Gurston D. Turner, a veteran pharmacologist with the FDA’s scientific investigations division who retired this year. “If you know you must have your report done by a certain date, you get something done. That’s what they [top FDA officials] count, that’s all they count. And that is really, to me, a worrisome thing.”
The FDA did spur reviewers to move at record speed.

In 1994, the FDA’s goal was to finish 55% of its new drug reviews on time; the agency achieved 95%. In 1995, the goal was 70%; the FDA achieved 98%. In 1996, the goal was 80%; the FDA achieved 100%. In both 1997 and 1998, the goal was 90% and the FDA achieved 100%.

From 1993 to 1999 the agency approved 232 drugs regarded as “new molecular entities,” compared with 163 during the previous seven years, a 42% increase.

The time-limit goals quickly were treated as deadlines within the FDA–imposing relentless pressure on reviewers and their bosses to quickly conclude their work and approve the drugs.

“The goals were to be taken seriously. I don’t think anybody expected the agency to make them all,” said William B. Schultz, a deputy FDA commissioner from 1995 to 1999.

Schultz, who helped craft the 1992 user-fee act as a congressional staff lawyer, added: “You can meet the goal by either approving the drug or denying the approval. But there are some who argue that what Congress really wanted was not just decisions, but approvals. That is what really gets dangerous.”

Indeed, the FDA drug center’s 1999 annual report referred to the review goals as “the law’s deadlines.” And, Dr. Woodcock, the center director, elaborated in a subsequent agency newsletter:

“In exchange [for the user fees], FDA makes a commitment to meet certain goals for review times. [The agency] has exceeded almost all of the goals, and it expects to continue to exceed them. Basically, the number of new approved drugs has doubled, and the review times have been cut in half.”

The user fees have enabled the FDA to hire more medical reviewers. Last year, 236 medical officers examined new drugs compared with 162 officers on duty in 1992, the year before the user fees took effect.

Even so, Woodcock acknowledged in an FDA publication this fall that the workloads and tight performance goals “create a sweatshop environment that’s causing high staffing turnover.”

An FDA progress report in 1998, describing the work of agency chemists, said that “too many reviews are coming ‘down to the wire’ against the goal date. . . . This suggests a system in stress.”

Said Nesbit, the former aide to Commissioner Kessler: “The clock is always running, whereas before the clock was never running. And that changes people’s behavior.”

Dozens of officials interviewed by The Times made similar observations.

“The pressure to meet deadlines is enormous,” said Dr. Solomon Sobel, 65, director of the FDA’s metabolic and endocrine drugs division throughout the 1990s. And the pressure is not merely to complete the reviews, he said. “The basic message is to approve.”

Over the last seven years, “there has been a huge shift,” said Kathleen Holcombe, a former FDA legislative affairs staffer and congressional aide who now is a drug industry consultant. “FDA, historically, had an approach of, ‘Regulate, be tough, enforce the law [and] don’t let one thing go wrong,’ ” Holcombe said, adding that now, “the FDA sees itself much more in a cooperative role.”

How Deaths Were Calculated
Reports of adverse drug reactions to the Food and Drug Administration are considered by public health officials to be the most reliable early warnings of a product’s danger. The reports are filed to the FDA by health professionals, consumers and drug manufacturers. The Los Angeles Times inspected all reports filed in connection with seven drugs that were approved and withdrawn since 1993. By hand and by computer, The Times counted 1,002 deaths in which the filer identified the drug as the leading suspect. Since fall 1997, this top category has been termed “primary suspect.” The Times did not count any death in which the drug was identified as the “secondary suspect” or less. The methodology and results were reviewed by Sheila R. Weiss, a former FDA epidemiologist who is an assistant professor at the University of Maryland’s department of pharmacy practice and sciences.

The perception of coziness with drug makers is perpetuated by potential conflicts of interest within the FDA’s 18 advisory committees, the influential panels that recommend which drugs deserve approval or should remain on the market. The FDA allows some appointees to double as consultants or researchers for the same companies whose products they are evaluating on the public’s behalf. Such was the case during committee appraisals of several of the recently withdrawn drugs, including Lotronex and Posicor, The Times found.

Few doubt the $100-billion pharmaceutical industry’s clout. Over the last decade, the drug companies have steered $44 million in contributions to the major political parties and to candidates for the White House and both houses of Congress.

The FDA reviewers said they and their bosses fear that unless the new drugs are approved, companies will erupt and Congress will retaliate by refusing to renew the user fees. This would cripple FDA operations–and jeopardize jobs.

The companies’ money now covers about 50% of the FDA’s costs for reviewing proposed drugs–and agency officials say that persuading Congress to renew the user fees into 2007 is now a top priority.

Yet even if the user fees remain, the FDA is prohibited from spending the revenue for anything other than reviewing new drugs. So while the budget for pre-approval reviews has soared, the agency has gotten no similar increase of resources to evaluate the safety of the drugs after they are prescribed.

“It’s shocking,” said Dr. Brian L. Strom, chairman of epidemiology at the University of Pennsylvania. “How can you say, ‘Release drugs to the market sooner,’ and not know if they’re killing people? . . . It really is a dramatic statement of public priorities.”

More than 250,000 side effects linked to prescription drugs, including injuries and deaths, are reported each year. And those “adverse-event” reports by doctors and others are only filed voluntarily. Experts, including Strom, believe the reports represent as few as 1% to 10% of all such events. “There’s no incentive at all for a physician to report [an adverse drug reaction],” said Strom, who has documented the phenomenon. “The underreporting is vast.”

Even when deaths are reported, records and interviews show that companies consistently dispute that their product has caused a given death by pointing to other factors, including preexisting disease or use of another medicine.

To be sure, a chain of events affects the safe use of a prescription drug: The companies’ conduct of clinical studies; the FDA’s regulatory actions; the doctor’s decision to prescribe; the pharmacist’s filling of a handwritten prescription; the patient’s ability to take the drug as directed. A lapse at any link could prove fatal.

And once a pill is approved by the FDA, the manufacturer often spends heavily on promotion to seize the largest possible market share. This can exacerbate the risk to public health, according to experts.

“Aggressive promotion increases exposure–and doesn’t give you the time to find the problem before patients get hurt,” said Dr. Raymond L. Woosley, pharmacology department chairman at Georgetown University and a former FDA advisory committee member.

When serious side effects emerge, the FDA officials have championed using package labeling as a way to, in their words, “manage” risks. Yet the agency typically has no way to know if the labeling precautions–dense, lengthy and in tiny print–are read or followed by doctors and their patients.

The FDA often addresses unresolved safety questions by asking companies to conduct studies after the product is approved. But the research frequently is not performed–prompting the inspector general of the Department of Health and Human Services to say in 1996 that “FDA can move to withdraw drugs from the market if the post-marketing studies are not completed with due diligence.”

Since that report was issued, the FDA has not withdrawn any drug due to a company’s failure to complete a post-approval safety study. Officials conceded this week that they still do not know how often the studies are performed.

One consequence is that greater risk is shifted to doctors and patients.

For example, Woodcock and her senior aides allowed Rezulin to remain on the U.S. market nearly 2 years after it was withdrawn in Britain in December 1997. The FDA recommended frequent laboratory testing of patients using the drug but had no scientific assurance that the tests would prevent Rezulin-induced liver failure.

“They kept increasing the number of liver-function tests you should have,” noted Dr. Alastair J.J. Wood, a former FDA advisory committee member who is a professor of medicine at Vanderbilt University. “That was clearly designed to protect the FDA, to protect the manufacturer, and to dump the responsibility on the patient and the physician. If the patient developed liver disease and he hadn’t had his [tests] done, somebody was to blame and it wasn’t the manufacturer and it wasn’t the FDA.”

Industry Assurances
Leading industry officials say Americans have nothing to fear from the wave of drug approvals.

“Do unsafe drugs enter and remain in the marketplace? Absolutely not,” said Dr. Bert A. Spilker, senior vice president for scientific and regulatory affairs for the Pharmaceutical Research and Manufacturers of America, in remarks last year to industry and FDA scientists.

But during interviews over the last two years, current and former FDA specialists cited repeated instances when drugs were approved with less than compelling evidence of safety or effectiveness. They also said that important information has been excluded from the labels on some medications.

Elashoff, for instance, was surprised at the labeling for a drug called Prograf, approved in 1997 to prevent rejection of transplanted kidneys. The drug first had been approved in 1994 for use among liver-transplant patients.

The new label notes that Prograf was proved effective in a study of 412 U.S. kidney transplant patients. But no mention is made of the company’s 448-patient European study, in which 7% of the patients who took Prograf died–double the 3.5% death rate among those who received a different anti-rejection drug, documents show.

Contributors to this Report
Design director: Joe Hutchinson
Photographer: Brian Walski
Photo editor: Steve Stroud
Graphics: Rebecca Perry
Graphics editor: Chris Erskine
Researchers: Janet Lundblad, Sunny Kaplan
Editors: Roger Smith, Nan Williams, Steve Devol, Bobbi Olson, Kathie Bozanich
Web site Editors: Sarah D. Wright, Clare Sup

An auditor from the FDA’s scientific investigations unit, Antoine El-Hage, examined the European study results and concluded the “data are reliable.” Elashoff agreed in his review.
Yet the only way for doctors or patients to find that data is to search the medical literature or seek the FDA’s review documents.

Excluding the European study from the Prograf label, Elashoff said, “was just a total whitewash. . . . I think any rational person would reconsider taking this drug if they knew what happened in Europe.”

A spokesman for the manufacturer of Prograf said the company had no objection to including the European study results in the labeling. William E. Fitzsimmons, a vice president of drug development for Fujisawa Healthcare Inc., said the decision to exclude the results was entirely the FDA’s.

“We submitted that data,” he said. “It came down to what the FDA was comfortable putting in the label. We certainly have no interest in trying to hide that information. We presented it at major meetings on transplantation. . . . We’re comfortable with that information being out in the public domain.”

But if the FDA had included the European results in the label, it would have impugned the agency’s basis for approving the new, expanded use for Prograf, according to Elashoff and others.

Asked why the agency excluded the information, Woodcock said the European results were “unreliable and could be potentially misleading to doctors and patients in the U.S. if these were included in the label.”

Copyright 2000 Los Angeles Times

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ANTIDEPRESSANTS: FT CARSON Soldier (Freeman) Attempted Murder

Freeman said the hospital staff prescribed him antidepressants and told him they were so busy that he wouldn’t receive counseling for a month.

A few weeks later, on Feb. 22, 2006, Freeman got in a fight with a man he had never met, Kenneth Tatum, in the China Express restaurant on B Street. Freeman pulled out his .357 and, before he knew it, he said, Tatum was bleeding on the ground. He had shot him through the thigh.

Freeman was arrested for attempted murder and pleaded guilty to felony menacing. He served two years and got out in January. He is unemployed, living at his mother’s house in Alabama. He said he still has headaches and memory problems and is getting therapy for PTSD at a nearby Veterans Affairs hospital.

Because of his crime, he is not eligible for most Army benefits.

“I was a good soldier before this,” he said. “Now I’m a screwed-up Iraq vet with a felony conviction. I don’t have many prospects. I was good at what I did in the infantry. . . . Too bad it followed me home.”

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Casualties of War, Part I: The hell of war comes home

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July 26, 2009 3:30 PM
THE GAZETTE

Before the murders started, Anthony Marquez’s mom dialed his sergeant at Fort Carson to warn that her son was poised to kill.

It was February 2006, and the 21-year-old soldier had not been the same since being wounded and coming home from Iraqeight months before. He had violent outbursts and thrashing nightmares. He was devouring pain pills and drinking too much. He always packed a gun.

(A word of caution about the language and content of this story: Please see Editor’s Note)

“It was a dangerous combination. I told them he was a walking time bomb,” said his mother, Teresa Hernandez.

His sergeant told her there was nothing he could do. Then, she said, he started taunting her son, saying things like, “Your mommy called. She says you are going crazy.”

Eight months later, the time bomb exploded when her son used a stun gun to repeatedly shock a small-time drug dealer in Widefield over an ounce of marijuana, then shot him through the heart.

Marquez was the first infantry soldier in his brigade to murder someone after returning from Iraq. But he wasn’t the last.

Hear the prison interviews with Kenneth Eastridge.

Marquez’s 3,500-soldier unit — now called the 4th Infantry Division’s 4th Brigade Combat Team — fought in some of the bloodiest places in Iraq, taking the most casualties of any Fort Carson unit by far.

Back home, 10 of its infantrymen have been arrested and accused of murder, attempted murder or manslaughter since 2006. Others have committed suicide, or tried to.

Almost all those soldiers were kids, too young to buy a beer, when they volunteered for one of the most dangerous jobs in the world. Almost none had serious criminal backgrounds. Many were awarded medals for good conduct.

But in the vicious confusion of battle in Iraq and with no clear enemy, many said training went out the window. Slaughter became a part of life. Soldiers in body armor went back for round after round of battle that would have killed warriors a generation ago. Discipline deteriorated. Soldiers say the torture and killing of Iraqi civilians lurked in the ranks. And when these soldiers came home to Colorado Springs suffering the emotional wounds of combat, soldiers say, some were ignored, some were neglected, some were thrown away and some were punished.

Some kept killing — this time in Colorado Springs.

Many of those soldiers are now behind bars, but their troubles still reach well beyond the walls of their cells — and even beyond the Army. Their unit deployed again in May, this time to one of Afghanistan’s most dangerous regions, near Khyber Pass.

This month, Fort Carson released a 126-page report by a task force of behavioral-health and Army professionals who looked for common threads in the soldiers’ crimes. They concluded that the intensity of battle, the long-standing stigma against seeking help, and shortcomings in substance-abuse and mental-health treatment may have converged with “negative outcomes,” but more study was needed.

Marquez, who was arrested before the latest programs were created, said he would never have pulled the trigger if he had not gone to Iraq.

“If I was just a guy off the street, I might have hesitated to shoot,” Marquez said this spring as he sat in the Bent County Correctional Facility, where he is serving 30 years. “But after Iraq, it was just natural.”

More killing by more soldiers followed.

In August 2007, Louis Bressler, 24, robbed and shot a soldier he picked up on a street in Colorado Springs.

In December 2007, Bressler and fellow soldiers Bruce Bastien Jr., 21, and Kenneth Eastridge, 24, left the bullet-riddled body of a soldier from their unit on a west-side street.

In May and June 2008, police say Rudolfo Torres-Gandarilla, 20, and Jomar Falu-Vives, 23, drove around with an assault rifle, randomly shooting people.

In September 2008, police say John Needham, 25, beat a former girlfriend to death.

Most of the killers were from a single 500-soldier unit within the brigade called the 2nd Battalion, 12th Infantry Regiment, which nicknamed itself the “Lethal Warriors.”

Soldiers from other units at Fort Carson have committed crimes after deployments — military bookings at the El Paso County jail have tripled since the start of the Iraq war — but no other unit has a record as deadly as the soldiers of the 4th Brigade. The vast majority of the brigade’s soldiers have not committed crimes, but the number who have is far above the population at large. In a one-year period from the fall of 2007 to the fall of 2008, the murder rate for the 500 Lethal Warriors was 114 times the rate for Colorado Springs.

The battalion is overwhelmingly made up of young men, who, demographically, have the highest murder rate in the United States, but the brigade still has a murder rate 20 times that of young males as a whole.

The killings are only the headline-grabbing tip of a much broader pyramid of crime. Since 2005, the brigade’s returning soldiers have been involved in brawls, beatings, rapes, DUIs, drug deals, domestic violence, shootings, stabbings, kidnapping and suicides.

Like Marquez, most of the jailed soldiers struggled to adjust to life back home after combat. Like Marquez, many showed signs of growing trouble before they ended up behind bars. Like Marquez, all raise difficult questions about the cause of the violence.

Did the infantry turn some men into killers, or did killers seek out the infantry? Did the Army let in criminals, or did combat-tattered soldiers fall into criminal habits? Did Fort Carson fail to take care of soldiers, or did soldiers fail to take advantage of care they were offered?

And, most importantly, since the brigade is now in Afghanistan, is there a way to keep the violence from happening again?

Maj. Gen. Mark Graham, who took command of Fort Carson in the thick of the murders and ordered marked changes in how returning soldiers are treated, said he hopes so.

“When we see a problem, we try to identify it and really learn what we can do about it. That is what we are trying to do here,” Graham said in a June interview. “There is a culture and a stigma that need to change.”

Under his command, nearly everyone — from colonels to platoon sergeants — is now trained to help troops showing the signs of emotional stress. Fort Carson has doubled its number of behavioral-health counselors and tightened hospital regulations to the point where a soldier visiting an Army doctor for any reason, even a sprained ankle, can’t leave without a mental health evaluation. Graham has also volunteered Fort Carson as a testing ground for new Army programs to ease soldiers’ transition from war to home.

Eastridge, an infantry specialist now serving 10 years for accessory to murder, said it will take a lot to wipe away the stain of Iraq.

“The Army trains you to be this way. In bayonet training, the sergeant would yell, ‘What makes the grass grow?’ and we would yell, ‘Blood! Blood! Blood!’ as we stabbed the dummy. The Army pounds it into your head until it is instinct: Kill everybody, kill everybody. And you do. Then they just think you can just come home and turn it off. … If they don’t figure out how to take care of the soldiers they trained to kill, this is just going to keep happening.”

Satan’s throne

The violence started to take root in Iraq’s Sunni Triangle, where the brigade landed in September 2004.

“It was actually beautiful. There were lots of palm trees,” said Eastridge, who is a working-class kid from Kentucky who had never really been anywhere before he joined the Army.

But, he said, “the situation was ugly.”

It was a little more than a year after President George W. Bush had landed on an aircraft carrier in front of a “Mission Accomplished” banner to announce the end of major combat operations. But the situation was growing worse. Rival militias of Sunnis and Shiites were gaining strength. Looting had crippled cities. And in a war with no clear front or enemy, the average monthly body count for U.S. soldiers was up 25 percent from a year earlier.

The brigade was in the worst of it.

None of it bothered Marquez.

In high school, he had been a co-captain on the football team and had run track. After graduation, he joined the infantry because the Army commercials full of guns and helicopters looked like the coolest job in the world.

Eastridge felt the same way. He was the closest thing to a criminal in the group of soldiers later arrested for murder. He was trying to get his life together after growing up with a mother addicted to cocaine. He had been arrested for reckless homicide when he was 12, after he accidentally shot his best friend in the chest while playing with his father’s antique shotgun. He pleaded guilty and was sentenced to counseling. After that, his record had been clean.

Felons cannot join the Army unless they get a waiver from a recruiter. Eastridge said he called a dozen until one told him, “Son, it looks like you just need someone to give you a chance.”

Like Marquez, Eastridge wanted to join the infantry because, he said, “that’s where you get to do all the awesome stuff.”

After basic training, the Army sent both men to South Korea.

They were in different battalions of what became the 4th Brigade Combat Team. Marquez was in the 1st Battalion, 9th Infantry Regiment; Eastridge, the 1st Battalion, 506th Infantry Regiment. Both were foot soldiers. Both were surrounded by other young, gung-ho GIs with no battle experience. And both learned in the spring of 2004 that they were going to Iraq.

“We thought it would be cool. It was what we signed up for,” Marquez said.

It turned out not to be cool at all.

Ramadi, where Marquez landed, had a population the size of Colorado Springs but had no dependable electricity, let alone law and order. Sewage ran in rubble-choked streets. The temperature sometimes rose to 120 degrees.

And when roadside bombs blew civilians to bits, soldiers said, packs of feral dogs fought over the scraps.

Pat Dollard, a documentary filmmaker embedded in the area at the time, wrote that it looked like “Satan had punched a hole in the Earth’s surface, plopped down his throne, and set up shop.”

Marquez was assigned to hunt terrorists in the city. Eastridge patrolled the highway between Ramadi and Fallujah. With him was Bressler, a quiet, friendly gunner later arrested with Eastridge for murder.

Going on a mission usually meant tramping house to house in dust-colored camouflage, loaded down with rifles, pistols, body armor, ammo, grenades and water to fight the incessant heat.

Soldiers went out day and night, knocking on doors — sometimes kicking them in. They set up checkpoints. They seized weapons. They clapped hoods over suspected insurgents. They rarely found terrorists, but the terrorists found them.

A few days into the deployment, a sniper’s bullet killed Marquez’s lieutenant. Then another friend died in a car bombing. Then another.

Combat brigades always take higher casualties than the rest of the Army because they fight on the front lines, but, even by those standards, the 3,500-soldier brigade got pummeled. Sixty-four were killed and more than 400 were injured in the yearlong tour, according to Fort Carson — double the average for all Army brigades that have deployed to Iraq and Afghanistan.

As the insurgents learned their craft, attacks became more gruesome.

A truck loaded with explosives careened into Eastridge’s platoon, killing his squad leader, blowing fist-size holes in his platoon sergeant and pinning the burning engine against the baby of the unit, Jose Barco.

Bombs meant to kill soldiers shredded anyone in the area. Women had their arms ripped off. Old men along the road were reduced to meat.

“It just got sickening,” said David Nash, a then-19-year-old private and Eastridge’s best friend. “There was a massive amount of hate for us in the city.”

One of the jobs of the infantry was to bag Iraqi bodies tossed in the streets at night by sectarian murder squads.

“First thing in the morning, all we would do is bag bodies,” Eastridge said. “Guys with drill bits in their eyes. Guys with nails in their heads.”

Eastridge said he was targeted by snipers twice. Both bullets smashed against walls so close to his face that they peppered his eyes with grit. He laughed at his luck. He loved being a soldier.

In February 2005, Eastridge was in the gun turret of his Humvee when it drove over an anti-tank mine. A deafening flash tore off the front end. Eastridge woke up a few minutes later, several feet from the smoking crater.

He sucked it up. He was bandaged up and sent back on patrol. He said cerebral fluid was leaking out of his ear.

That was the job of the infantry. Eastridge’s battalion was created in World War II and became known as the “Band of Brothers.” It parachuted into Normandy on D-Day and fought in the Battle of the Bulge. In Vietnam, it helped turn back the Tet Offensive and take Hamburger Hill.

Men who heard the stories of past glory almost never got a chance for their own in Iraq. The enemy was invisible. The leading cause of death was hidden roadside bombs.

Sometimes, Marquez felt his only purpose was to drive up and down roads in an armored personnel carrier called a Bradley to clear away hidden bombs.

To unwind, soldiers spent hours playing shoot-’em-up video games. They even played one based on their own unit in Vietnam. They said it offered a release. They could confront a clearly defined enemy. They could shoot, knowing they had the right guy. They could win.

In Ramadi, Marquez and other soldiers said, it felt like they were losing.

“It just seemed like the longer we were there, the worse it got,” said Marquez’s friend in the 1st Battalion, 9th Infantry Regiment, Daniel Freeman.

Freeman was knocked unconscious by a roadside bomb, but the most rattling thing, he said, was driving through the eerie calm, knowing an improvised explosive device, or IED, could kill every soldier in a Humvee without warning, or maybe just smoke one guy in the truck, leaving the others to wonder how, and why, they survived.

Hatred and mistrust simmered between soldiers and locals. Locals who waved to them one day would watch silently as they drove toward an IED the next.

“I’m all about spreading freedom and democracy and everything,” said Josh Butler, another soldier in the 1st Battalion, 506th Infantry Regiment. “But it seems like the Iraqis didn’t even want it.”

Soldiers said discipline started to break down.

“Toward the end, we were so mad and tired and frustrated,” Freeman said. “You came too close, we lit you up. You didn’t stop, we ran your car over with the Bradley.”

If soldiers were hit by an IED, they would aim machine guns and grenade launchers in every direction, Marquez said, and “just light the whole area up. If anyone was around, that was their fault. We smoked ’em.”

Other soldiers said they shot random cars, killing civilians.

“It was just a free-for-all,” said Marcus Mifflin, 21, a friend of Eastridge who was medically discharged with PTSD after the tour. “You didn’t get blamed unless someone could be absolutely sure you did something wrong. And that was hard. So things happened. Taxi drivers got shot for no reason. Guys got kidnapped and taken to the bridge and interrogated and dropped off.”

Soldiers later told El Paso County sheriff’s deputies investigating Marquez for murder that, in Iraq, he got his hands on a stun gun similar to the one he later used on the Widefield drug dealer. They said he used it to “rough up” Iraqis.

Stun guns are banned by the Geneva Conventions. Using one is a war crime, but four soldiers interviewed by The Gazette said a number of soldiers ordered the stun guns over the Internet and carried them on raids. The brigade refused to make other soldiers who served during the tour available for interviews. The Army said it destroys disciplinary records after two years, so it has no knowledge of whether soldiers in the unit were punished.

After 10 months, Marquez said, all he wanted to do was go home.

In June 2005, with a month to go, his platoon was walking across a field when a sniper’s bullet smashed through his best friend’s skull under the helmet.

The platoon circled its guns and grenade launchers, Marquez said, and “tore that neighborhood up.”

That night, Marquez got hit. His squad had just finished hosing his friend’s blood out of their Bradley when they were called out on another mission. They loaded into two Bradleys and rolled toward downtown Ramadi.

Marquez was riding in the dark, cramped rear of the lead Bradley. In a flash, a blast tore through the floor. The engine exploded. Diesel fuel spewed everywhere in a plume of fire. Marquez said he watched the driver scramble out screaming, flames leaping from his clothes.

Marquez and the others clambered into the dark street, rifles ready. Another bomb slammed them to the ground.

Then came a flurry of bullets spitting across the dirt. Marquez was hit four times in the leg.

As blood spurted from his femoral artery, Marquez said, he raised his grenade launcher to return fire and realized the storm of bullets had come from the heavy machine gun on the other Bradley, which had just come around the corner.

“They must have seen our Bradley on fire, figured it was an attack and thought we were all dead,” he said this spring, shaking his head, “then just started shooting.”

According to the Army, two soldiers died. Marquez said three others were wounded. Brigade commanders didn’t make anyone familiar with the incident available.

Marquez was flown to Walter Reed Army Medical Center in Washington, D.C.

He was still bleary on morphine on the Fourth of July weekend that he was told Bush was coming to award him a Purple Heart.

Marquez’s sister, who was visiting, didn’t want to see the president because she was so angry about the war and her brother’s wounds, but Marquez was honored.

“I had gotten hurt, but it is part of the job. I wasn’t mad at nobody,” Marquez said.

He was in the hospital for three months and had 17 surgeries so he could keep his leg. Marquez was being medically discharged from the Army and could have stayed at the hospital, but he transferred to Fort Carson on Sept. 13, 2005, to spend his remaining months with his war buddies, who had just returned from Iraq.

He eventually learned to walk without a cane, but other wounds proved harder to heal. He started having nightmares about the war. He felt worthless and crippled, depressed and angry. On a visit home to California, he made his mom put away all his high school sports trophies.

The only things that made him feel better were the pain pills the doctors prescribed for him — and only if he took too many.

‘Kumbaya period’

Post-traumatic stress disorder is like a roadside bomb.

The symptoms can remain hidden for months, then explode. They can cripple some soldiers and leave others untouched. And just like bombs disguised as trash or ruts in the road, PTSD can look like something else.

In many cases, it looks like a bad soldier. In addition to flashbacks and nightmares, Army studies say, symptoms can include heavy drinking, drug use, domestic violence, slacking off at work or disobeying orders.

You can often see it coming, said the most recent commanding general of Fort Carson, if you know what to look for.

Soldiers usually go through a jubilant high for a few months after they come home, Graham said. He calls this time “the Kumbaya period.”

“Soldiers have served their country, they’ve made it back, they’re home. It’s all great. It’s later that problems start to surface,” Graham said.

Usually, problems don’t show up for three to six months, he said.

When the brigade landed in Colorado Springs, most soldiers had spent a year in Iraq and a year in South Korea. Most had saved several thousand dollars. Many were old enough to legally drink in the United States for the first time. They had survived the worst of Iraq, and they were jonesing to blow off steam.

All they had to do was go through a few post-deployment debriefings that Fort Carson still uses.

Soldiers sit through classes that warn them that troops often have unrealistically rosy notions of home. They are told to be understanding with spouses and loved ones. They are cautioned to be careful with drinking and driving, and they are warned that the time for carrying a gun everywhere ended in Iraq.

All personal guns must be stored in the post’s armory — not in soldiers’ barracks, not in their cars and not tucked in their belts.

Then Fort Carson screens every soldier for PTSD and other combat-related problems.

If there are no red flags, the soldier can go on leave. If there are, they are referred for further diagnosis, officials at Fort Carson’s Evans Army Community Hospital said.

The screening asks soldiers a long list of questions about the deployment: Do you have trouble sleeping? Are you depressed? Did you clear houses or bunkers? Were you shot at? Did you witness brutality toward detainees? Did you have friends who were killed?

“Did you shoot people? Did you kill people? Did you see dead civilians? Did you see dead Americans? Did you see dead babies? No. No. No. No.” Eastridge said, mimicking how he answered the questionnaire.

“I had seen and done all that stuff, but you just lie to get it over with.”

Several soldiers said the same: They lied because they didn’t want the hassle of more screening.

When the young infantrymen were set free in Colorado Springs, many packed Tejon Street bars such as Rendezvous Lounge and Rum Bay. When the bars closed, soldiers said, they often picked fights in the street.

By 2006, the police were being called to break up bar brawls almost every night. Extra police were assigned to the area.

The Colorado Springs Police Department doesn’t track the crime statistics of individual units, but according to the El Paso County Sheriff’s Office, jail bookings of military personnel as a whole increased 66 percent in the 12 months after the brigade returned.

The “Kumbaya period” lasted about six months, soldiers said.

Eastridge said he blew through almost $27,000, mostly drinking at bars, but the first thing he did was buy guns: pistols, shotguns and an assault rifle similar to the one he carried in Iraq.

“After being in Iraq, it feels like everyone is the enemy,” he said. “You feel like you need a gun so they don’t come to get you.”

His friends all felt the same way.

Nash slept with a loaded .45 under his pillow.

Butler kept a Glock .40-caliber with him all the time, even when he rocked his newborn baby.

Marquez bought three pistols, a riot-style shotgun and an assault rifle like the one he carried in Iraq. He carried a pistol constantly, he said, even when he went to church.

His buddy, Freeman, said he bought himself a “big, scary” snub-nose .357 revolver.

“I couldn’t go anywhere without it,” he said. “I took it to the mall. I took it to the bank. I even had it right next to me when I took a shower. It makes you feel powerful, less scared. You have to have it with you every second of every day.”

Some returning soldiers, especially those with family members to notice their behavior, went into counseling.

More than 200 Fort Carson soldiers have been referred to First Choice Counseling Center, a private counseling service in Colorado Springs. Davida Hoffman, the director, said her counselors were unprepared for what they heard.

“We’re used to seeing people who are depressed and want to hurt themselves. We’re trained to deal with that,” she said. “But these soldiers were depressed and saying, ‘I’ve got this anger, I want to hurt somebody.’ We weren’t accustomed to that.”

In units that have seen the toughest combat in Iraq, one in four soldiers can screen positive for PTSD, the director of psychiatry at Walter Reed, Dr. Charles Hoge, said in an e-mail interview.

“Many soldiers continue to be able to perform their duties very well despite having significant symptoms,” Hoge wrote. But others show what he called “serious impairment,” and the worse the combat and the longer units are exposed, the worse the effects.

The affliction is as old as war itself.

Eric Dean, an author in Connecticut who specializes in war’s psychological toll, reviewed records from the Civil War for his 1997 book, “Shook Over Hell,” and found the same surge of crime and suicide that Fort Carson has seen.

“They have been in every war,” he said. “They never readjusted. They ended up living alone, drinking too much.”

They were “the lost generation” of World War I. They are the veterans of Vietnam who disproportionately populate homeless shelters and prisons today.

The psychological casualties may be particularly heavy in Iraq, he said.

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ANTIDEPRESSANTS, ETC: FT CARSON Soldier (Eastridge) Multiple Murders

Eastridge showed up for duty shortly before the brigade shipped out. He was happy to be there. He never felt more alive than when he was in a war zone.

“It’s almost like a religious experience to see a battlefield,” he said. “To hear the explosions — to see a person bleeding out and die — see everything on fire and smell the smoke and burning flesh. It makes you truly realize what it is to be alive. Combat is the biggest rush you can have.”

Since the start of his first deployment, he had covered himself in tattoos.

On his arm was a memorial to his sergeant killed by a car bomb. On his wrists were red dotted “kill lines” marking where, if needed, he could slit them. On his arm were the twin lightning bolts of the Nazi SS. Wrapping his neck like a collar were the words “BORN TO KILL, READY TO DIE.”

If the Army had followed its own rules, he would not have returned to Iraq for another tour.

Army regulations bar anyone with a pending felony from deploying.

Eastridge was awaiting trial for putting a gun to his girlfriend’s head. He said his commanders knew it.

But when the young soldier showed up and begged his sergeant to let him go back to Iraq, they did. The Army was evasive about if, and why, commanders knowingly deployed Eastridge with a felony hanging over his head.

Eastridge said there was a reason the unit wanted him back. He was one of the best gunners in the battalion.

Soldiers said he was “surgical” with a machine gun and utterly fearless.

“He was really good. If I had 10 Eastridges, my job would be a lot easier,” said his platoon sergeant, Michael Cardenaz.

Eastridge had the most kills of anyone in his company, Cardenaz said.

He was exactly the type of soldier to have in the Heart of Darkness.

Not even the veterans were prepared for how bad Baghdad would be, Eastridge said.

At one point, the unit was losing a soldier a day to the hospital or the morgue.

At first, Eastridge said, he enjoyed the intensity of it. He had a competition going with Bressler to see who could kill more bad guys. His final count, he said — and his sergeant confirmed — was about 80.

But after a few months, the raids, gore and constant threat of roadside bombs started to get to him. He couldn’t sleep. He was on edge all the time. Doctors at the base diagnosed him with PTSD, depression, anxiety and a sleep disorder. They gave him antidepressants and sleeping pills and put him back on duty.

When he went back to the doctors a few weeks later saying the pills were not working, his medical records show, they doubled his dose.

In the spring of 2007, as part of the surge to take back Baghdad, the 500 Lethal Warriors were moved out of their central base into 100-soldier Combat Outposts, known as COPs, scattered in the neighborhoods.

“Once we got to the COPS, it was way worse,” Eastridge said. “We would have mortars and rocket fire and drive-bys every single day.”

. . . Often, his squad would come in from an all-night mission, pull off their body armor, get attacked and have to slap their armor right back on and go out. Sometimes, he said, they wouldn’t sleep for days.

Eastridge’s Iraqi translator introduced him to Valium as a way to relax. At first, he would just take a couple before missions. Then he was taking a couple all the time. Then he was taking a lot more.

Eastridge started to crumble around the same time.

He had been a decorated soldier during his first tour. But in the second, his judgment melted away.

He started searching medicine cabinets for Valium while raiding houses.

Then he started stealing cash and weapons from civilians, which he said he would sell back to the Shiite militia.

He was disciplined by his battalion for stealing once, he said, after he ransacked a house, but only because it belonged to a well-connected man. Most of the time, he got away with it.

He was disciplined again when he flipped out on patrol. Someone shot at his squad from a nearby farmhouse. Eastridge fired about 20 grenades into the house, then stormed in and said he found a farmer and his two dogs in the back and spotted a shell casing from an AK-47 on the ground.

Eastridge demanded to know where the shooter was.

The man said he didn’t know.

Eastridge shot one of the man’s dogs, then asked where the shooter was.

The man said he didn’t know.

Eastridge shot the man’s other dog.

His lieutenant told him he needed to cool off and go sit in the truck.

On the way out, Eastridge passed the man’s herd of a dozen goats. He leveled them with a machine gun. Then he ordered a private to shoot the man’s two cows. Then he shot his horse.

“I was really (expletive deleted) losing it,” Eastridge said, shaking his head.

The Army hasn’t supplied disciplinary records for Eastridge or several other soldiers requested under the Freedom of Information Act, but Eastridge’s account was confirmed by his platoon sergeant.

Eastridge went on one more mission.

He was the gunner manning the M240 machine gun on a Humvee — a big gun that shoots 600 rounds per minute. He said he was ordered to guard the street while the rest of his platoon searched a house.

Eastridge said he told his lieutenant he was going to kill people as soon as the officer was out of sight. Then he asked the driver to put some heavy-metal “killin’ music on.”

His lieutenant laughed and walked off, Eastridge said.

Families were out playing soccer and barbecuing. Eastridge said he just started shooting. He pumped a long burst of rounds into a big palm tree where a few old men had gathered in the shade.

People started running. They piled into their cars and sped away. There was a no-driving rule in effect in the neighborhood, so, Eastridge said, he put his cross hairs on every car that moved.

“All I could think of was car bombs, car bombs, car bombs, and I just kept shooting,” he said.

Orders came over the radio to cease fire, he said, but he kept yelling, “Negative! Negative!”

Eastridge said he shot more than 1,700 rounds. When asked how many people he killed, he said, “Not that many. Maybe a dozen.”

He was court-martialed a short time later on nine counts, including drug possession and disobeying orders. Killing civilians wasn’t one of them.

For that, he said, he was put on guard duty.

Then, in August 2007, sergeants found him with 463 Valium pills in his laundry and a naked female soldier in his bed, according to court testimony. His staff sergeant confronted him about the woman, and Eastridge lashed out, according to his mother, Leanne Eastridge, screaming that he would kill the sergeant, suck out his blood and spit it at his children. Eastridge was court-martialed for disobeying orders and drug possession and sent to a prison camp in Kuwait for a month.

This spring, Eastridge said it was funny that sex and drugs were what got him court-martialed, considering the things he did in Iraq, “Things that can never be told, but that everybody knew about and approved of — basically war crimes.”

He got a health screening as part of the court-martial. Doctors diagnosed him with chronic PTSD, antisocial personality disorder, depression, anxiety and hearing loss. In late September 2007, his commanders decided he was too unstable and dangerous to stay in Iraq, so the Army sent him back to Colorado Springs.

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Casualties of War, Part I: The hell of war comes home

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July 26, 2009 3:30 PM
THE GAZETTE

Before the murders started, Anthony Marquez’s mom dialed his sergeant at Fort Carson to warn that her son was poised to kill.

It was February 2006, and the 21-year-old soldier had not been the same since being wounded and coming home from Iraqeight months before. He had violent outbursts and thrashing nightmares. He was devouring pain pills and drinking too much. He always packed a gun.

(A word of caution about the language and content of this story: Please see Editor’s Note)

“It was a dangerous combination. I told them he was a walking time bomb,” said his mother, Teresa Hernandez.

His sergeant told her there was nothing he could do. Then, she said, he started taunting her son, saying things like, “Your mommy called. She says you are going crazy.”

Eight months later, the time bomb exploded when her son used a stun gun to repeatedly shock a small-time drug dealer in Widefield over an ounce of marijuana, then shot him through the heart.

Marquez was the first infantry soldier in his brigade to murder someone after returning from Iraq. But he wasn’t the last.

Hear the prison interviews with Kenneth Eastridge.

Marquez’s 3,500-soldier unit — now called the 4th Infantry Division’s 4th Brigade Combat Team — fought in some of the bloodiest places in Iraq, taking the most casualties of any Fort Carson unit by far.

Back home, 10 of its infantrymen have been arrested and accused of murder, attempted murder or manslaughter since 2006. Others have committed suicide, or tried to.

Almost all those soldiers were kids, too young to buy a beer, when they volunteered for one of the most dangerous jobs in the world. Almost none had serious criminal backgrounds. Many were awarded medals for good conduct.

But in the vicious confusion of battle in Iraq and with no clear enemy, many said training went out the window. Slaughter became a part of life. Soldiers in body armor went back for round after round of battle that would have killed warriors a generation ago. Discipline deteriorated. Soldiers say the torture and killing of Iraqi civilians lurked in the ranks. And when these soldiers came home to Colorado Springs suffering the emotional wounds of combat, soldiers say, some were ignored, some were neglected, some were thrown away and some were punished.

Some kept killing — this time in Colorado Springs.

Many of those soldiers are now behind bars, but their troubles still reach well beyond the walls of their cells — and even beyond the Army. Their unit deployed again in May, this time to one of Afghanistan’s most dangerous regions, near Khyber Pass.

This month, Fort Carson released a 126-page report by a task force of behavioral-health and Army professionals who looked for common threads in the soldiers’ crimes. They concluded that the intensity of battle, the long-standing stigma against seeking help, and shortcomings in substance-abuse and mental-health treatment may have converged with “negative outcomes,” but more study was needed.

Marquez, who was arrested before the latest programs were created, said he would never have pulled the trigger if he had not gone to Iraq.

“If I was just a guy off the street, I might have hesitated to shoot,” Marquez said this spring as he sat in the Bent County Correctional Facility, where he is serving 30 years. “But after Iraq, it was just natural.”

More killing by more soldiers followed.

In August 2007, Louis Bressler, 24, robbed and shot a soldier he picked up on a street in Colorado Springs.

In December 2007, Bressler and fellow soldiers Bruce Bastien Jr., 21, and Kenneth Eastridge, 24, left the bullet-riddled body of a soldier from their unit on a west-side street.

In May and June 2008, police say Rudolfo Torres-Gandarilla, 20, and Jomar Falu-Vives, 23, drove around with an assault rifle, randomly shooting people.

In September 2008, police say John Needham, 25, beat a former girlfriend to death.

Most of the killers were from a single 500-soldier unit within the brigade called the 2nd Battalion, 12th Infantry Regiment, which nicknamed itself the “Lethal Warriors.”

Soldiers from other units at Fort Carson have committed crimes after deployments — military bookings at the El Paso County jail have tripled since the start of the Iraq war — but no other unit has a record as deadly as the soldiers of the 4th Brigade. The vast majority of the brigade’s soldiers have not committed crimes, but the number who have is far above the population at large. In a one-year period from the fall of 2007 to the fall of 2008, the murder rate for the 500 Lethal Warriors was 114 times the rate for Colorado Springs.

The battalion is overwhelmingly made up of young men, who, demographically, have the highest murder rate in the United States, but the brigade still has a murder rate 20 times that of young males as a whole.

The killings are only the headline-grabbing tip of a much broader pyramid of crime. Since 2005, the brigade’s returning soldiers have been involved in brawls, beatings, rapes, DUIs, drug deals, domestic violence, shootings, stabbings, kidnapping and suicides.

Like Marquez, most of the jailed soldiers struggled to adjust to life back home after combat. Like Marquez, many showed signs of growing trouble before they ended up behind bars. Like Marquez, all raise difficult questions about the cause of the violence.

Did the infantry turn some men into killers, or did killers seek out the infantry? Did the Army let in criminals, or did combat-tattered soldiers fall into criminal habits? Did Fort Carson fail to take care of soldiers, or did soldiers fail to take advantage of care they were offered?

And, most importantly, since the brigade is now in Afghanistan, is there a way to keep the violence from happening again?

Maj. Gen. Mark Graham, who took command of Fort Carson in the thick of the murders and ordered marked changes in how returning soldiers are treated, said he hopes so.

“When we see a problem, we try to identify it and really learn what we can do about it. That is what we are trying to do here,” Graham said in a June interview. “There is a culture and a stigma that need to change.”

Under his command, nearly everyone — from colonels to platoon sergeants — is now trained to help troops showing the signs of emotional stress. Fort Carson has doubled its number of behavioral-health counselors and tightened hospital regulations to the point where a soldier visiting an Army doctor for any reason, even a sprained ankle, can’t leave without a mental health evaluation. Graham has also volunteered Fort Carson as a testing ground for new Army programs to ease soldiers’ transition from war to home.

Eastridge, an infantry specialist now serving 10 years for accessory to murder, said it will take a lot to wipe away the stain of Iraq.

“The Army trains you to be this way. In bayonet training, the sergeant would yell, ‘What makes the grass grow?’ and we would yell, ‘Blood! Blood! Blood!’ as we stabbed the dummy. The Army pounds it into your head until it is instinct: Kill everybody, kill everybody. And you do. Then they just think you can just come home and turn it off. … If they don’t figure out how to take care of the soldiers they trained to kill, this is just going to keep happening.”

Satan’s throne

The violence started to take root in Iraq’s Sunni Triangle, where the brigade landed in September 2004.

“It was actually beautiful. There were lots of palm trees,” said Eastridge, who is a working-class kid from Kentucky who had never really been anywhere before he joined the Army.

But, he said, “the situation was ugly.”

It was a little more than a year after President George W. Bush had landed on an aircraft carrier in front of a “Mission Accomplished” banner to announce the end of major combat operations. But the situation was growing worse. Rival militias of Sunnis and Shiites were gaining strength. Looting had crippled cities. And in a war with no clear front or enemy, the average monthly body count for U.S. soldiers was up 25 percent from a year earlier.

The brigade was in the worst of it.

None of it bothered Marquez.

In high school, he had been a co-captain on the football team and had run track. After graduation, he joined the infantry because the Army commercials full of guns and helicopters looked like the coolest job in the world.

Eastridge felt the same way. He was the closest thing to a criminal in the group of soldiers later arrested for murder. He was trying to get his life together after growing up with a mother addicted to cocaine. He had been arrested for reckless homicide when he was 12, after he accidentally shot his best friend in the chest while playing with his father’s antique shotgun. He pleaded guilty and was sentenced to counseling. After that, his record had been clean.

Felons cannot join the Army unless they get a waiver from a recruiter. Eastridge said he called a dozen until one told him, “Son, it looks like you just need someone to give you a chance.”

Like Marquez, Eastridge wanted to join the infantry because, he said, “that’s where you get to do all the awesome stuff.”

After basic training, the Army sent both men to South Korea.

They were in different battalions of what became the 4th Brigade Combat Team. Marquez was in the 1st Battalion, 9th Infantry Regiment; Eastridge, the 1st Battalion, 506th Infantry Regiment. Both were foot soldiers. Both were surrounded by other young, gung-ho GIs with no battle experience. And both learned in the spring of 2004 that they were going to Iraq.

“We thought it would be cool. It was what we signed up for,” Marquez said.

It turned out not to be cool at all.

Ramadi, where Marquez landed, had a population the size of Colorado Springs but had no dependable electricity, let alone law and order. Sewage ran in rubble-choked streets. The temperature sometimes rose to 120 degrees.

And when roadside bombs blew civilians to bits, soldiers said, packs of feral dogs fought over the scraps.

Pat Dollard, a documentary filmmaker embedded in the area at the time, wrote that it looked like “Satan had punched a hole in the Earth’s surface, plopped down his throne, and set up shop.”

Marquez was assigned to hunt terrorists in the city. Eastridge patrolled the highway between Ramadi and Fallujah. With him was Bressler, a quiet, friendly gunner later arrested with Eastridge for murder.

Going on a mission usually meant tramping house to house in dust-colored camouflage, loaded down with rifles, pistols, body armor, ammo, grenades and water to fight the incessant heat.

Soldiers went out day and night, knocking on doors — sometimes kicking them in. They set up checkpoints. They seized weapons. They clapped hoods over suspected insurgents. They rarely found terrorists, but the terrorists found them.

A few days into the deployment, a sniper’s bullet killed Marquez’s lieutenant. Then another friend died in a car bombing. Then another.

Combat brigades always take higher casualties than the rest of the Army because they fight on the front lines, but, even by those standards, the 3,500-soldier brigade got pummeled. Sixty-four were killed and more than 400 were injured in the yearlong tour, according to Fort Carson — double the average for all Army brigades that have deployed to Iraq and Afghanistan.

As the insurgents learned their craft, attacks became more gruesome.

A truck loaded with explosives careened into Eastridge’s platoon, killing his squad leader, blowing fist-size holes in his platoon sergeant and pinning the burning engine against the baby of the unit, Jose Barco.

Bombs meant to kill soldiers shredded anyone in the area. Women had their arms ripped off. Old men along the road were reduced to meat.

“It just got sickening,” said David Nash, a then-19-year-old private and Eastridge’s best friend. “There was a massive amount of hate for us in the city.”

One of the jobs of the infantry was to bag Iraqi bodies tossed in the streets at night by sectarian murder squads.

“First thing in the morning, all we would do is bag bodies,” Eastridge said. “Guys with drill bits in their eyes. Guys with nails in their heads.”

Eastridge said he was targeted by snipers twice. Both bullets smashed against walls so close to his face that they peppered his eyes with grit. He laughed at his luck. He loved being a soldier.

In February 2005, Eastridge was in the gun turret of his Humvee when it drove over an anti-tank mine. A deafening flash tore off the front end. Eastridge woke up a few minutes later, several feet from the smoking crater.

He sucked it up. He was bandaged up and sent back on patrol. He said cerebral fluid was leaking out of his ear.

That was the job of the infantry. Eastridge’s battalion was created in World War II and became known as the “Band of Brothers.” It parachuted into Normandy on D-Day and fought in the Battle of the Bulge. In Vietnam, it helped turn back the Tet Offensive and take Hamburger Hill.

Men who heard the stories of past glory almost never got a chance for their own in Iraq. The enemy was invisible. The leading cause of death was hidden roadside bombs.

Sometimes, Marquez felt his only purpose was to drive up and down roads in an armored personnel carrier called a Bradley to clear away hidden bombs.

To unwind, soldiers spent hours playing shoot-’em-up video games. They even played one based on their own unit in Vietnam. They said it offered a release. They could confront a clearly defined enemy. They could shoot, knowing they had the right guy. They could win.

In Ramadi, Marquez and other soldiers said, it felt like they were losing.

“It just seemed like the longer we were there, the worse it got,” said Marquez’s friend in the 1st Battalion, 9th Infantry Regiment, Daniel Freeman.

Freeman was knocked unconscious by a roadside bomb, but the most rattling thing, he said, was driving through the eerie calm, knowing an improvised explosive device, or IED, could kill every soldier in a Humvee without warning, or maybe just smoke one guy in the truck, leaving the others to wonder how, and why, they survived.

Hatred and mistrust simmered between soldiers and locals. Locals who waved to them one day would watch silently as they drove toward an IED the next.

“I’m all about spreading freedom and democracy and everything,” said Josh Butler, another soldier in the 1st Battalion, 506th Infantry Regiment. “But it seems like the Iraqis didn’t even want it.”

Soldiers said discipline started to break down.

“Toward the end, we were so mad and tired and frustrated,” Freeman said. “You came too close, we lit you up. You didn’t stop, we ran your car over with the Bradley.”

If soldiers were hit by an IED, they would aim machine guns and grenade launchers in every direction, Marquez said, and “just light the whole area up. If anyone was around, that was their fault. We smoked ’em.”

Other soldiers said they shot random cars, killing civilians.

“It was just a free-for-all,” said Marcus Mifflin, 21, a friend of Eastridge who was medically discharged with PTSD after the tour. “You didn’t get blamed unless someone could be absolutely sure you did something wrong. And that was hard. So things happened. Taxi drivers got shot for no reason. Guys got kidnapped and taken to the bridge and interrogated and dropped off.”

Soldiers later told El Paso County sheriff’s deputies investigating Marquez for murder that, in Iraq, he got his hands on a stun gun similar to the one he later used on the Widefield drug dealer. They said he used it to “rough up” Iraqis.

Stun guns are banned by the Geneva Conventions. Using one is a war crime, but four soldiers interviewed by The Gazette said a number of soldiers ordered the stun guns over the Internet and carried them on raids. The brigade refused to make other soldiers who served during the tour available for interviews. The Army said it destroys disciplinary records after two years, so it has no knowledge of whether soldiers in the unit were punished.

After 10 months, Marquez said, all he wanted to do was go home.

In June 2005, with a month to go, his platoon was walking across a field when a sniper’s bullet smashed through his best friend’s skull under the helmet.

The platoon circled its guns and grenade launchers, Marquez said, and “tore that neighborhood up.”

That night, Marquez got hit. His squad had just finished hosing his friend’s blood out of their Bradley when they were called out on another mission. They loaded into two Bradleys and rolled toward downtown Ramadi.

Marquez was riding in the dark, cramped rear of the lead Bradley. In a flash, a blast tore through the floor. The engine exploded. Diesel fuel spewed everywhere in a plume of fire. Marquez said he watched the driver scramble out screaming, flames leaping from his clothes.

Marquez and the others clambered into the dark street, rifles ready. Another bomb slammed them to the ground.

Then came a flurry of bullets spitting across the dirt. Marquez was hit four times in the leg.

As blood spurted from his femoral artery, Marquez said, he raised his grenade launcher to return fire and realized the storm of bullets had come from the heavy machine gun on the other Bradley, which had just come around the corner.

“They must have seen our Bradley on fire, figured it was an attack and thought we were all dead,” he said this spring, shaking his head, “then just started shooting.”

According to the Army, two soldiers died. Marquez said three others were wounded. Brigade commanders didn’t make anyone familiar with the incident available.

Marquez was flown to Walter Reed Army Medical Center in Washington, D.C.

He was still bleary on morphine on the Fourth of July weekend that he was told Bush was coming to award him a Purple Heart.

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ANTIDEPRESSANTS, ETC.: FT CARSON Soldier (Marquez) Murder

“We’re used to seeing people who are depressed and want to hurt themselves. We’re trained to deal with that,” she said. “But these soldiers were depressed and saying, ‘I’ve got this anger, I want to hurt somebody.’ We weren’t accustomed to that.”
MARQUEZ:

Marquez started destroying himself with the pills that were supposed to help him.

For his injuries, he said, doctors at Evans prescribed him 90 morphine pills, 90 Percocets, and five fentanyl patches every three weeks.

“They were for pain,” he said. “And I still had pain. But, mostly, I was using them to get high.”

He could not get Iraq out of his head. Doctors prescribed antidepressants and sleeping pills, but he said they didn’t help. He was saving up Percocet, then downing a handful on an empty stomach.

He said he started trading his morphine with other soldiers for an antipsychotic called quetiapine and an anti-anxiety drug called clonazepam. Improper use of either can cause psychotic reactions, anxiety, panic attacks, aggressiveness and suicidal behavior, but, Marquez said, injured soldiers traded them like children in a lunchroom swapping desserts.

“It was real common among the guys who were hurt,” Marquez said.

At one point, Marquez said, he ate his three-week supply of meds in half the time, then went back to Evans claiming he had lost his pills.

He started not showing up for duty. He took more pills. He bought more guns and kept them his in his car, he and other soldiers said.

It was no secret. Sergeants later told police that Marquez had showed off his stash of weapons.

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Casualties of War, Part I: The hell of war comes home

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July 26, 2009 3:30 PM
THE GAZETTE

Before the murders started, Anthony Marquez’s mom dialed his sergeant at Fort Carson to warn that her son was poised to kill.

It was February 2006, and the 21-year-old soldier had not been the same since being wounded and coming home from Iraqeight months before. He had violent outbursts and thrashing nightmares. He was devouring pain pills and drinking too much. He always packed a gun.

(A word of caution about the language and content of this story: Please see Editor’s Note)

“It was a dangerous combination. I told them he was a walking time bomb,” said his mother, Teresa Hernandez.

His sergeant told her there was nothing he could do. Then, she said, he started taunting her son, saying things like, “Your mommy called. She says you are going crazy.”

Eight months later, the time bomb exploded when her son used a stun gun to repeatedly shock a small-time drug dealer in Widefield over an ounce of marijuana, then shot him through the heart.

Marquez was the first infantry soldier in his brigade to murder someone after returning from Iraq. But he wasn’t the last.

Hear the prison interviews with Kenneth Eastridge.

Marquez’s 3,500-soldier unit — now called the 4th Infantry Division’s 4th Brigade Combat Team — fought in some of the bloodiest places in Iraq, taking the most casualties of any Fort Carson unit by far.

Back home, 10 of its infantrymen have been arrested and accused of murder, attempted murder or manslaughter since 2006. Others have committed suicide, or tried to.

Almost all those soldiers were kids, too young to buy a beer, when they volunteered for one of the most dangerous jobs in the world. Almost none had serious criminal backgrounds. Many were awarded medals for good conduct.

But in the vicious confusion of battle in Iraq and with no clear enemy, many said training went out the window. Slaughter became a part of life. Soldiers in body armor went back for round after round of battle that would have killed warriors a generation ago. Discipline deteriorated. Soldiers say the torture and killing of Iraqi civilians lurked in the ranks. And when these soldiers came home to Colorado Springs suffering the emotional wounds of combat, soldiers say, some were ignored, some were neglected, some were thrown away and some were punished.

Some kept killing — this time in Colorado Springs.

Many of those soldiers are now behind bars, but their troubles still reach well beyond the walls of their cells — and even beyond the Army. Their unit deployed again in May, this time to one of Afghanistan’s most dangerous regions, near Khyber Pass.

This month, Fort Carson released a 126-page report by a task force of behavioral-health and Army professionals who looked for common threads in the soldiers’ crimes. They concluded that the intensity of battle, the long-standing stigma against seeking help, and shortcomings in substance-abuse and mental-health treatment may have converged with “negative outcomes,” but more study was needed.

Marquez, who was arrested before the latest programs were created, said he would never have pulled the trigger if he had not gone to Iraq.

“If I was just a guy off the street, I might have hesitated to shoot,” Marquez said this spring as he sat in the Bent County Correctional Facility, where he is serving 30 years. “But after Iraq, it was just natural.”

More killing by more soldiers followed.

In August 2007, Louis Bressler, 24, robbed and shot a soldier he picked up on a street in Colorado Springs.

In December 2007, Bressler and fellow soldiers Bruce Bastien Jr., 21, and Kenneth Eastridge, 24, left the bullet-riddled body of a soldier from their unit on a west-side street.

In May and June 2008, police say Rudolfo Torres-Gandarilla, 20, and Jomar Falu-Vives, 23, drove around with an assault rifle, randomly shooting people.

In September 2008, police say John Needham, 25, beat a former girlfriend to death.

Most of the killers were from a single 500-soldier unit within the brigade called the 2nd Battalion, 12th Infantry Regiment, which nicknamed itself the “Lethal Warriors.”

Soldiers from other units at Fort Carson have committed crimes after deployments — military bookings at the El Paso County jail have tripled since the start of the Iraq war — but no other unit has a record as deadly as the soldiers of the 4th Brigade. The vast majority of the brigade’s soldiers have not committed crimes, but the number who have is far above the population at large. In a one-year period from the fall of 2007 to the fall of 2008, the murder rate for the 500 Lethal Warriors was 114 times the rate for Colorado Springs.

The battalion is overwhelmingly made up of young men, who, demographically, have the highest murder rate in the United States, but the brigade still has a murder rate 20 times that of young males as a whole.

The killings are only the headline-grabbing tip of a much broader pyramid of crime. Since 2005, the brigade’s returning soldiers have been involved in brawls, beatings, rapes, DUIs, drug deals, domestic violence, shootings, stabbings, kidnapping and suicides.

Like Marquez, most of the jailed soldiers struggled to adjust to life back home after combat. Like Marquez, many showed signs of growing trouble before they ended up behind bars. Like Marquez, all raise difficult questions about the cause of the violence.

Did the infantry turn some men into killers, or did killers seek out the infantry? Did the Army let in criminals, or did combat-tattered soldiers fall into criminal habits? Did Fort Carson fail to take care of soldiers, or did soldiers fail to take advantage of care they were offered?

And, most importantly, since the brigade is now in Afghanistan, is there a way to keep the violence from happening again?

Maj. Gen. Mark Graham, who took command of Fort Carson in the thick of the murders and ordered marked changes in how returning soldiers are treated, said he hopes so.

“When we see a problem, we try to identify it and really learn what we can do about it. That is what we are trying to do here,” Graham said in a June interview. “There is a culture and a stigma that need to change.”

Under his command, nearly everyone — from colonels to platoon sergeants — is now trained to help troops showing the signs of emotional stress. Fort Carson has doubled its number of behavioral-health counselors and tightened hospital regulations to the point where a soldier visiting an Army doctor for any reason, even a sprained ankle, can’t leave without a mental health evaluation. Graham has also volunteered Fort Carson as a testing ground for new Army programs to ease soldiers’ transition from war to home.

Eastridge, an infantry specialist now serving 10 years for accessory to murder, said it will take a lot to wipe away the stain of Iraq.

“The Army trains you to be this way. In bayonet training, the sergeant would yell, ‘What makes the grass grow?’ and we would yell, ‘Blood! Blood! Blood!’ as we stabbed the dummy. The Army pounds it into your head until it is instinct: Kill everybody, kill everybody. And you do. Then they just think you can just come home and turn it off. … If they don’t figure out how to take care of the soldiers they trained to kill, this is just going to keep happening.”

Satan’s throne

The violence started to take root in Iraq’s Sunni Triangle, where the brigade landed in September 2004.

“It was actually beautiful. There were lots of palm trees,” said Eastridge, who is a working-class kid from Kentucky who had never really been anywhere before he joined the Army.

But, he said, “the situation was ugly.”

It was a little more than a year after President George W. Bush had landed on an aircraft carrier in front of a “Mission Accomplished” banner to announce the end of major combat operations. But the situation was growing worse. Rival militias of Sunnis and Shiites were gaining strength. Looting had crippled cities. And in a war with no clear front or enemy, the average monthly body count for U.S. soldiers was up 25 percent from a year earlier.

The brigade was in the worst of it.

None of it bothered Marquez.

In high school, he had been a co-captain on the football team and had run track. After graduation, he joined the infantry because the Army commercials full of guns and helicopters looked like the coolest job in the world.

Eastridge felt the same way. He was the closest thing to a criminal in the group of soldiers later arrested for murder. He was trying to get his life together after growing up with a mother addicted to cocaine. He had been arrested for reckless homicide when he was 12, after he accidentally shot his best friend in the chest while playing with his father’s antique shotgun. He pleaded guilty and was sentenced to counseling. After that, his record had been clean.

Felons cannot join the Army unless they get a waiver from a recruiter. Eastridge said he called a dozen until one told him, “Son, it looks like you just need someone to give you a chance.”

Like Marquez, Eastridge wanted to join the infantry because, he said, “that’s where you get to do all the awesome stuff.”

After basic training, the Army sent both men to South Korea.

They were in different battalions of what became the 4th Brigade Combat Team. Marquez was in the 1st Battalion, 9th Infantry Regiment; Eastridge, the 1st Battalion, 506th Infantry Regiment. Both were foot soldiers. Both were surrounded by other young, gung-ho GIs with no battle experience. And both learned in the spring of 2004 that they were going to Iraq.

“We thought it would be cool. It was what we signed up for,” Marquez said.

It turned out not to be cool at all.

Ramadi, where Marquez landed, had a population the size of Colorado Springs but had no dependable electricity, let alone law and order. Sewage ran in rubble-choked streets. The temperature sometimes rose to 120 degrees.

And when roadside bombs blew civilians to bits, soldiers said, packs of feral dogs fought over the scraps.

Pat Dollard, a documentary filmmaker embedded in the area at the time, wrote that it looked like “Satan had punched a hole in the Earth’s surface, plopped down his throne, and set up shop.”

Marquez was assigned to hunt terrorists in the city. Eastridge patrolled the highway between Ramadi and Fallujah. With him was Bressler, a quiet, friendly gunner later arrested with Eastridge for murder.

Going on a mission usually meant tramping house to house in dust-colored camouflage, loaded down with rifles, pistols, body armor, ammo, grenades and water to fight the incessant heat.

Soldiers went out day and night, knocking on doors — sometimes kicking them in. They set up checkpoints. They seized weapons. They clapped hoods over suspected insurgents. They rarely found terrorists, but the terrorists found them.

A few days into the deployment, a sniper’s bullet killed Marquez’s lieutenant. Then another friend died in a car bombing. Then another.

Combat brigades always take higher casualties than the rest of the Army because they fight on the front lines, but, even by those standards, the 3,500-soldier brigade got pummeled. Sixty-four were killed and more than 400 were injured in the yearlong tour, according to Fort Carson — double the average for all Army brigades that have deployed to Iraq and Afghanistan.

As the insurgents learned their craft, attacks became more gruesome.

A truck loaded with explosives careened into Eastridge’s platoon, killing his squad leader, blowing fist-size holes in his platoon sergeant and pinning the burning engine against the baby of the unit, Jose Barco.

Bombs meant to kill soldiers shredded anyone in the area. Women had their arms ripped off. Old men along the road were reduced to meat.

“It just got sickening,” said David Nash, a then-19-year-old private and Eastridge’s best friend. “There was a massive amount of hate for us in the city.”

One of the jobs of the infantry was to bag Iraqi bodies tossed in the streets at night by sectarian murder squads.

“First thing in the morning, all we would do is bag bodies,” Eastridge said. “Guys with drill bits in their eyes. Guys with nails in their heads.”

Eastridge said he was targeted by snipers twice. Both bullets smashed against walls so close to his face that they peppered his eyes with grit. He laughed at his luck. He loved being a soldier.

In February 2005, Eastridge was in the gun turret of his Humvee when it drove over an anti-tank mine. A deafening flash tore off the front end. Eastridge woke up a few minutes later, several feet from the smoking crater.

He sucked it up. He was bandaged up and sent back on patrol. He said cerebral fluid was leaking out of his ear.

That was the job of the infantry. Eastridge’s battalion was created in World War II and became known as the “Band of Brothers.” It parachuted into Normandy on D-Day and fought in the Battle of the Bulge. In Vietnam, it helped turn back the Tet Offensive and take Hamburger Hill.

Men who heard the stories of past glory almost never got a chance for their own in Iraq. The enemy was invisible. The leading cause of death was hidden roadside bombs.

Sometimes, Marquez felt his only purpose was to drive up and down roads in an armored personnel carrier called a Bradley to clear away hidden bombs.

To unwind, soldiers spent hours playing shoot-’em-up video games. They even played one based on their own unit in Vietnam. They said it offered a release. They could confront a clearly defined enemy. They could shoot, knowing they had the right guy. They could win.

In Ramadi, Marquez and other soldiers said, it felt like they were losing.

“It just seemed like the longer we were there, the worse it got,” said Marquez’s friend in the 1st Battalion, 9th Infantry Regiment, Daniel Freeman.

Freeman was knocked unconscious by a roadside bomb, but the most rattling thing, he said, was driving through the eerie calm, knowing an improvised explosive device, or IED, could kill every soldier in a Humvee without warning, or maybe just smoke one guy in the truck, leaving the others to wonder how, and why, they survived.

Hatred and mistrust simmered between soldiers and locals. Locals who waved to them one day would watch silently as they drove toward an IED the next.

“I’m all about spreading freedom and democracy and everything,” said Josh Butler, another soldier in the 1st Battalion, 506th Infantry Regiment. “But it seems like the Iraqis didn’t even want it.”

Soldiers said discipline started to break down.

“Toward the end, we were so mad and tired and frustrated,” Freeman said. “You came too close, we lit you up. You didn’t stop, we ran your car over with the Bradley.”

If soldiers were hit by an IED, they would aim machine guns and grenade launchers in every direction, Marquez said, and “just light the whole area up. If anyone was around, that was their fault. We smoked ’em.”

Other soldiers said they shot random cars, killing civilians.

“It was just a free-for-all,” said Marcus Mifflin, 21, a friend of Eastridge who was medically discharged with PTSD after the tour. “You didn’t get blamed unless someone could be absolutely sure you did something wrong. And that was hard. So things happened. Taxi drivers got shot for no reason. Guys got kidnapped and taken to the bridge and interrogated and dropped off.”

Soldiers later told El Paso County sheriff’s deputies investigating Marquez for murder that, in Iraq, he got his hands on a stun gun similar to the one he later used on the Widefield drug dealer. They said he used it to “rough up” Iraqis.

Stun guns are banned by the Geneva Conventions. Using one is a war crime, but four soldiers interviewed by The Gazette said a number of soldiers ordered the stun guns over the Internet and carried them on raids. The brigade refused to make other soldiers who served during the tour available for interviews. The Army said it destroys disciplinary records after two years, so it has no knowledge of whether soldiers in the unit were punished.

After 10 months, Marquez said, all he wanted to do was go home.

In June 2005, with a month to go, his platoon was walking across a field when a sniper’s bullet smashed through his best friend’s skull under the helmet.

The platoon circled its guns and grenade launchers, Marquez said, and “tore that neighborhood up.”

That night, Marquez got hit. His squad had just finished hosing his friend’s blood out of their Bradley when they were called out on another mission. They loaded into two Bradleys and rolled toward downtown Ramadi.

Marquez was riding in the dark, cramped rear of the lead Bradley. In a flash, a blast tore through the floor. The engine exploded. Diesel fuel spewed everywhere in a plume of fire. Marquez said he watched the driver scramble out screaming, flames leaping from his clothes.

Marquez and the others clambered into the dark street, rifles ready. Another bomb slammed them to the ground.

Then came a flurry of bullets spitting across the dirt. Marquez was hit four times in the leg.

As blood spurted from his femoral artery, Marquez said, he raised his grenade launcher to return fire and realized the storm of bullets had come from the heavy machine gun on the other Bradley, which had just come around the corner.

“They must have seen our Bradley on fire, figured it was an attack and thought we were all dead,” he said this spring, shaking his head, “then just started shooting.”

According to the Army, two soldiers died. Marquez said three others were wounded. Brigade commanders didn’t make anyone familiar with the incident available.

Marquez was flown to Walter Reed Army Medical Center in Washington, D.C.

He was still bleary on morphine on the Fourth of July weekend that he was told Bush was coming to award him a Purple Heart.

Marquez’s sister, who was visiting, didn’t want to see the president because she was so angry about the war and her brother’s wounds, but Marquez was honored.

“I had gotten hurt, but it is part of the job. I wasn’t mad at nobody,” Marquez said.

He was in the hospital for three months and had 17 surgeries so he could keep his leg. Marquez was being medically discharged from the Army and could have stayed at the hospital, but he transferred to Fort Carson on Sept. 13, 2005, to spend his remaining months with his war buddies, who had just returned from Iraq.

He eventually learned to walk without a cane, but other wounds proved harder to heal. He started having nightmares about the war. He felt worthless and crippled, depressed and angry. On a visit home to California, he made his mom put away all his high school sports trophies.

The only things that made him feel better were the pain pills the doctors prescribed for him — and only if he took too many.

‘Kumbaya period’

Post-traumatic stress disorder is like a roadside bomb.

The symptoms can remain hidden for months, then explode. They can cripple some soldiers and leave others untouched. And just like bombs disguised as trash or ruts in the road, PTSD can look like something else.

In many cases, it looks like a bad soldier. In addition to flashbacks and nightmares, Army studies say, symptoms can include heavy drinking, drug use, domestic violence, slacking off at work or disobeying orders.

You can often see it coming, said the most recent commanding general of Fort Carson, if you know what to look for.

Soldiers usually go through a jubilant high for a few months after they come home, Graham said. He calls this time “the Kumbaya period.”

“Soldiers have served their country, they’ve made it back, they’re home. It’s all great. It’s later that problems start to surface,” Graham said.

Usually, problems don’t show up for three to six months, he said.

When the brigade landed in Colorado Springs, most soldiers had spent a year in Iraq and a year in South Korea. Most had saved several thousand dollars. Many were old enough to legally drink in the United States for the first time. They had survived the worst of Iraq, and they were jonesing to blow off steam.

All they had to do was go through a few post-deployment debriefings that Fort Carson still uses.

Soldiers sit through classes that warn them that troops often have unrealistically rosy notions of home. They are told to be understanding with spouses and loved ones. They are cautioned to be careful with drinking and driving, and they are warned that the time for carrying a gun everywhere ended in Iraq.

All personal guns must be stored in the post’s armory — not in soldiers’ barracks, not in their cars and not tucked in their belts.

Then Fort Carson screens every soldier for PTSD and other combat-related problems.

If there are no red flags, the soldier can go on leave. If there are, they are referred for further diagnosis, officials at Fort Carson’s Evans Army Community Hospital said.

The screening asks soldiers a long list of questions about the deployment: Do you have trouble sleeping? Are you depressed? Did you clear houses or bunkers? Were you shot at? Did you witness brutality toward detainees? Did you have friends who were killed?

“Did you shoot people? Did you kill people? Did you see dead civilians? Did you see dead Americans? Did you see dead babies? No. No. No. No.” Eastridge said, mimicking how he answered the questionnaire.

“I had seen and done all that stuff, but you just lie to get it over with.”

Several soldiers said the same: They lied because they didn’t want the hassle of more screening.

When the young infantrymen were set free in Colorado Springs, many packed Tejon Street bars such as Rendezvous Lounge and Rum Bay. When the bars closed, soldiers said, they often picked fights in the street.

By 2006, the police were being called to break up bar brawls almost every night. Extra police were assigned to the area.

The Colorado Springs Police Department doesn’t track the crime statistics of individual units, but according to the El Paso County Sheriff’s Office, jail bookings of military personnel as a whole increased 66 percent in the 12 months after the brigade returned.

The “Kumbaya period” lasted about six months, soldiers said.

Eastridge said he blew through almost $27,000, mostly drinking at bars, but the first thing he did was buy guns: pistols, shotguns and an assault rifle similar to the one he carried in Iraq.

“After being in Iraq, it feels like everyone is the enemy,” he said. “You feel like you need a gun so they don’t come to get you.”

His friends all felt the same way.

Nash slept with a loaded .45 under his pillow.

Butler kept a Glock .40-caliber with him all the time, even when he rocked his newborn baby.

Marquez bought three pistols, a riot-style shotgun and an assault rifle like the one he carried in Iraq. He carried a pistol constantly, he said, even when he went to church.

His buddy, Freeman, said he bought himself a “big, scary” snub-nose .357 revolver.

“I couldn’t go anywhere without it,” he said. “I took it to the mall. I took it to the bank. I even had it right next to me when I took a shower. It makes you feel powerful, less scared. You have to have it with you every second of every day.”

Some returning soldiers, especially those with family members to notice their behavior, went into counseling.

More than 200 Fort Carson soldiers have been referred to First Choice Counseling Center, a private counseling service in Colorado Springs. Davida Hoffman, the director, said her counselors were unprepared for what they heard.

“We’re used to seeing people who are depressed and want to hurt themselves. We’re trained to deal with that,” she said. “But these soldiers were depressed and saying, ‘I’ve got this anger, I want to hurt somebody.’ We weren’t accustomed to that.”

In units that have seen the toughest combat in

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ZOLOFT: FT CARSON – Soldier (Needham) Sucide Attempt, Murder

In March 2007, Needham went to the battalion’s doctor, saying he was “losing it” and needed a break, according to a summary of his service that he wrote. He was prescribed the antidepressant Zoloft and sent back to work. In May, Needham said, he went back to the doctor and was again sent back to work. In June, according to medical records, he went again. And in September. Commanders always sent him back out on patrol, he said.

Around that time, he posted a note on his MySpace page: “I’m falling apart by the seams it seems the days here bleed into each other I have to find the will to live man I miss my brothers. These walls are caving in my despair wraps me in its web, I feel I’m sinking in, throw me a lifesaver throw me a life worth living. I’m a part of death I am death this is hard to admit but this shits getting old.”

A few nights later, on Sept. 18, Needham and a fellow soldier bought a contraband can of whiskey and tried to drink away their sorrows. Then Needham took out a gun and fired a shot at his head, his father said. The bullet missed. Needham was detained by his commanders for illegally discharging a firearm. After a few weeks of arguing by phone and e-mail, Needham’s father convinced the unit to let his son see a doctor. The soldier was diagnosed with severe PTSD and flown to Walter Reed Army Medical Center.

“What led him to the point of such deep despair that he would attempt suicide?” his father, a retired Army officer, asked. “I understand it. He was trained as a soldier. He was a good soldier, and his group was doing things he knew was wrong. And he was in this prolonged combat situation where they have all this armor and lifesaving technology to keep them alive, but mentally, they are in pieces.”

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Casualties of War, Part I: The hell of war comes home

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July 26, 2009 3:30 PM
THE GAZETTE

Before the murders started, Anthony Marquez’s mom dialed his sergeant at Fort Carson to warn that her son was poised to kill.

It was February 2006, and the 21-year-old soldier had not been the same since being wounded and coming home from Iraqeight months before. He had violent outbursts and thrashing nightmares. He was devouring pain pills and drinking too much. He always packed a gun.

(A word of caution about the language and content of this story: Please see Editor’s Note)

“It was a dangerous combination. I told them he was a walking time bomb,” said his mother, Teresa Hernandez.

His sergeant told her there was nothing he could do. Then, she said, he started taunting her son, saying things like, “Your mommy called. She says you are going crazy.”

Eight months later, the time bomb exploded when her son used a stun gun to repeatedly shock a small-time drug dealer in Widefield over an ounce of marijuana, then shot him through the heart.

Marquez was the first infantry soldier in his brigade to murder someone after returning from Iraq. But he wasn’t the last.

Hear the prison interviews with Kenneth Eastridge.

Marquez’s 3,500-soldier unit — now called the 4th Infantry Division’s 4th Brigade Combat Team — fought in some of the bloodiest places in Iraq, taking the most casualties of any Fort Carson unit by far.

Back home, 10 of its infantrymen have been arrested and accused of murder, attempted murder or manslaughter since 2006. Others have committed suicide, or tried to.

Almost all those soldiers were kids, too young to buy a beer, when they volunteered for one of the most dangerous jobs in the world. Almost none had serious criminal backgrounds. Many were awarded medals for good conduct.

But in the vicious confusion of battle in Iraq and with no clear enemy, many said training went out the window. Slaughter became a part of life. Soldiers in body armor went back for round after round of battle that would have killed warriors a generation ago. Discipline deteriorated. Soldiers say the torture and killing of Iraqi civilians lurked in the ranks. And when these soldiers came home to Colorado Springs suffering the emotional wounds of combat, soldiers say, some were ignored, some were neglected, some were thrown away and some were punished.

Some kept killing — this time in Colorado Springs.

Many of those soldiers are now behind bars, but their troubles still reach well beyond the walls of their cells — and even beyond the Army. Their unit deployed again in May, this time to one of Afghanistan’s most dangerous regions, near Khyber Pass.

This month, Fort Carson released a 126-page report by a task force of behavioral-health and Army professionals who looked for common threads in the soldiers’ crimes. They concluded that the intensity of battle, the long-standing stigma against seeking help, and shortcomings in substance-abuse and mental-health treatment may have converged with “negative outcomes,” but more study was needed.

Marquez, who was arrested before the latest programs were created, said he would never have pulled the trigger if he had not gone to Iraq.

“If I was just a guy off the street, I might have hesitated to shoot,” Marquez said this spring as he sat in the Bent County Correctional Facility, where he is serving 30 years. “But after Iraq, it was just natural.”

More killing by more soldiers followed.

In August 2007, Louis Bressler, 24, robbed and shot a soldier he picked up on a street in Colorado Springs.

In December 2007, Bressler and fellow soldiers Bruce Bastien Jr., 21, and Kenneth Eastridge, 24, left the bullet-riddled body of a soldier from their unit on a west-side street.

In May and June 2008, police say Rudolfo Torres-Gandarilla, 20, and Jomar Falu-Vives, 23, drove around with an assault rifle, randomly shooting people.

In September 2008, police say John Needham, 25, beat a former girlfriend to death.

Most of the killers were from a single 500-soldier unit within the brigade called the 2nd Battalion, 12th Infantry Regiment, which nicknamed itself the “Lethal Warriors.”

Soldiers from other units at Fort Carson have committed crimes after deployments — military bookings at the El Paso County jail have tripled since the start of the Iraq war — but no other unit has a record as deadly as the soldiers of the 4th Brigade. The vast majority of the brigade’s soldiers have not committed crimes, but the number who have is far above the population at large. In a one-year period from the fall of 2007 to the fall of 2008, the murder rate for the 500 Lethal Warriors was 114 times the rate for Colorado Springs.

The battalion is overwhelmingly made up of young men, who, demographically, have the highest murder rate in the United States, but the brigade still has a murder rate 20 times that of young males as a whole.

The killings are only the headline-grabbing tip of a much broader pyramid of crime. Since 2005, the brigade’s returning soldiers have been involved in brawls, beatings, rapes, DUIs, drug deals, domestic violence, shootings, stabbings, kidnapping and suicides.

Like Marquez, most of the jailed soldiers struggled to adjust to life back home after combat. Like Marquez, many showed signs of growing trouble before they ended up behind bars. Like Marquez, all raise difficult questions about the cause of the violence.

Did the infantry turn some men into killers, or did killers seek out the infantry? Did the Army let in criminals, or did combat-tattered soldiers fall into criminal habits? Did Fort Carson fail to take care of soldiers, or did soldiers fail to take advantage of care they were offered?

And, most importantly, since the brigade is now in Afghanistan, is there a way to keep the violence from happening again?

Maj. Gen. Mark Graham, who took command of Fort Carson in the thick of the murders and ordered marked changes in how returning soldiers are treated, said he hopes so.

“When we see a problem, we try to identify it and really learn what we can do about it. That is what we are trying to do here,” Graham said in a June interview. “There is a culture and a stigma that need to change.”

Under his command, nearly everyone — from colonels to platoon sergeants — is now trained to help troops showing the signs of emotional stress. Fort Carson has doubled its number of behavioral-health counselors and tightened hospital regulations to the point where a soldier visiting an Army doctor for any reason, even a sprained ankle, can’t leave without a mental health evaluation. Graham has also volunteered Fort Carson as a testing ground for new Army programs to ease soldiers’ transition from war to home.

Eastridge, an infantry specialist now serving 10 years for accessory to murder, said it will take a lot to wipe away the stain of Iraq.

“The Army trains you to be this way. In bayonet training, the sergeant would yell, ‘What makes the grass grow?’ and we would yell, ‘Blood! Blood! Blood!’ as we stabbed the dummy. The Army pounds it into your head until it is instinct: Kill everybody, kill everybody. And you do. Then they just think you can just come home and turn it off. … If they don’t figure out how to take care of the soldiers they trained to kill, this is just going to keep happening.”

Satan’s throne

The violence started to take root in Iraq’s Sunni Triangle, where the brigade landed in September 2004.

“It was actually beautiful. There were lots of palm trees,” said Eastridge, who is a working-class kid from Kentucky who had never really been anywhere before he joined the Army.

But, he said, “the situation was ugly.”

It was a little more than a year after President George W. Bush had landed on an aircraft carrier in front of a “Mission Accomplished” banner to announce the end of major combat operations. But the situation was growing worse. Rival militias of Sunnis and Shiites were gaining strength. Looting had crippled cities. And in a war with no clear front or enemy, the average monthly body count for U.S. soldiers was up 25 percent from a year earlier.

The brigade was in the worst of it.

None of it bothered Marquez.

In high school, he had been a co-captain on the football team and had run track. After graduation, he joined the infantry because the Army commercials full of guns and helicopters looked like the coolest job in the world.

Eastridge felt the same way. He was the closest thing to a criminal in the group of soldiers later arrested for murder. He was trying to get his life together after growing up with a mother addicted to cocaine. He had been arrested for reckless homicide when he was 12, after he accidentally shot his best friend in the chest while playing with his father’s antique shotgun. He pleaded guilty and was sentenced to counseling. After that, his record had been clean.

Felons cannot join the Army unless they get a waiver from a recruiter. Eastridge said he called a dozen until one told him, “Son, it looks like you just need someone to give you a chance.”

Like Marquez, Eastridge wanted to join the infantry because, he said, “that’s where you get to do all the awesome stuff.”

After basic training, the Army sent both men to South Korea.

They were in different battalions of what became the 4th Brigade Combat Team. Marquez was in the 1st Battalion, 9th Infantry Regiment; Eastridge, the 1st Battalion, 506th Infantry Regiment. Both were foot soldiers. Both were surrounded by other young, gung-ho GIs with no battle experience. And both learned in the spring of 2004 that they were going to Iraq.

“We thought it would be cool. It was what we signed up for,” Marquez said.

It turned out not to be cool at all.

Ramadi, where Marquez landed, had a population the size of Colorado Springs but had no dependable electricity, let alone law and order. Sewage ran in rubble-choked streets. The temperature sometimes rose to 120 degrees.

And when roadside bombs blew civilians to bits, soldiers said, packs of feral dogs fought over the scraps.

Pat Dollard, a documentary filmmaker embedded in the area at the time, wrote that it looked like “Satan had punched a hole in the Earth’s surface, plopped down his throne, and set up shop.”

Marquez was assigned to hunt terrorists in the city. Eastridge patrolled the highway between Ramadi and Fallujah. With him was Bressler, a quiet, friendly gunner later arrested with Eastridge for murder.

Going on a mission usually meant tramping house to house in dust-colored camouflage, loaded down with rifles, pistols, body armor, ammo, grenades and water to fight the incessant heat.

Soldiers went out day and night, knocking on doors — sometimes kicking them in. They set up checkpoints. They seized weapons. They clapped hoods over suspected insurgents. They rarely found terrorists, but the terrorists found them.

A few days into the deployment, a sniper’s bullet killed Marquez’s lieutenant. Then another friend died in a car bombing. Then another.

Combat brigades always take higher casualties than the rest of the Army because they fight on the front lines, but, even by those standards, the 3,500-soldier brigade got pummeled. Sixty-four were killed and more than 400 were injured in the yearlong tour, according to Fort Carson — double the average for all Army brigades that have deployed to Iraq and Afghanistan.

As the insurgents learned their craft, attacks became more gruesome.

A truck loaded with explosives careened into Eastridge’s platoon, killing his squad leader, blowing fist-size holes in his platoon sergeant and pinning the burning engine against the baby of the unit, Jose Barco.

Bombs meant to kill soldiers shredded anyone in the area. Women had their arms ripped off. Old men along the road were reduced to meat.

“It just got sickening,” said David Nash, a then-19-year-old private and Eastridge’s best friend. “There was a massive amount of hate for us in the city.”

One of the jobs of the infantry was to bag Iraqi bodies tossed in the streets at night by sectarian murder squads.

“First thing in the morning, all we would do is bag bodies,” Eastridge said. “Guys with drill bits in their eyes. Guys with nails in their heads.”

Eastridge said he was targeted by snipers twice. Both bullets smashed against walls so close to his face that they peppered his eyes with grit. He laughed at his luck. He loved being a soldier.

In February 2005, Eastridge was in the gun turret of his Humvee when it drove over an anti-tank mine. A deafening flash tore off the front end. Eastridge woke up a few minutes later, several feet from the smoking crater.

He sucked it up. He was bandaged up and sent back on patrol. He said cerebral fluid was leaking out of his ear.

That was the job of the infantry. Eastridge’s battalion was created in World War II and became known as the “Band of Brothers.” It parachuted into Normandy on D-Day and fought in the Battle of the Bulge. In Vietnam, it helped turn back the Tet Offensive and take Hamburger Hill.

Men who heard the stories of past glory almost never got a chance for their own in Iraq. The enemy was invisible. The leading cause of death was hidden roadside bombs.

Sometimes, Marquez felt his only purpose was to drive up and down roads in an armored personnel carrier called a Bradley to clear away hidden bombs.

To unwind, soldiers spent hours playing shoot-’em-up video games. They even played one based on their own unit in Vietnam. They said it offered a release. They could confront a clearly defined enemy. They could shoot, knowing they had the right guy. They could win.

In Ramadi, Marquez and other soldiers said, it felt like they were losing.

“It just seemed like the longer we were there, the worse it got,” said Marquez’s friend in the 1st Battalion, 9th Infantry Regiment, Daniel Freeman.

Freeman was knocked unconscious by a roadside bomb, but the most rattling thing, he said, was driving through the eerie calm, knowing an improvised explosive device, or IED, could kill every soldier in a Humvee without warning, or maybe just smoke one guy in the truck, leaving the others to wonder how, and why, they survived.

Hatred and mistrust simmered between soldiers and locals. Locals who waved to them one day would watch silently as they drove toward an IED the next.

“I’m all about spreading freedom and democracy and everything,” said Josh Butler, another soldier in the 1st Battalion, 506th Infantry Regiment. “But it seems like the Iraqis didn’t even want it.”

Soldiers said discipline started to break down.

“Toward the end, we were so mad and tired and frustrated,” Freeman said. “You came too close, we lit you up. You didn’t stop, we ran your car over with the Bradley.”

If soldiers were hit by an IED, they would aim machine guns and grenade launchers in every direction, Marquez said, and “just light the whole area up. If anyone was around, that was their fault. We smoked ’em.”

Other soldiers said they shot random cars, killing civilians.

“It was just a free-for-all,” said Marcus Mifflin, 21, a friend of Eastridge who was medically discharged with PTSD after the tour. “You didn’t get blamed unless someone could be absolutely sure you did something wrong. And that was hard. So things happened. Taxi drivers got shot for no reason. Guys got kidnapped and taken to the bridge and interrogated and dropped off.”

Soldiers later told El Paso County sheriff’s deputies investigating Marquez for murder that, in Iraq, he got his hands on a stun gun similar to the one he later used on the Widefield drug dealer. They said he used it to “rough up” Iraqis.

Stun guns are banned by the Geneva Conventions. Using one is a war crime, but four soldiers interviewed by The Gazette said a number of soldiers ordered the stun guns over the Internet and carried them on raids. The brigade refused to make other soldiers who served during the tour available for interviews. The Army said it destroys disciplinary records after two years, so it has no knowledge of whether soldiers in the unit were punished.

After 10 months, Marquez said, all he wanted to do was go home.

In June 2005, with a month to go, his platoon was walking across a field when a sniper’s bullet smashed through his best friend’s skull under the helmet.

The platoon circled its guns and grenade launchers, Marquez said, and “tore that neighborhood up.”

That night, Marquez got hit. His squad had just finished hosing his friend’s blood out of their Bradley when they were called out on another mission. They loaded into two Bradleys and rolled toward downtown Ramadi.

Marquez was riding in the dark, cramped rear of the lead Bradley. In a flash, a blast tore through the floor. The engine exploded. Diesel fuel spewed everywhere in a plume of fire. Marquez said he watched the driver scramble out screaming, flames leaping from his clothes.

Marquez and the others clambered into the dark street, rifles ready. Another bomb slammed them to the ground.

Then came a flurry of bullets spitting across the dirt. Marquez was hit four times in the leg.

As blood spurted from his femoral artery, Marquez said, he raised his grenade launcher to return fire and realized the storm of bullets had come from the heavy machine gun on the other Bradley, which had just come around the corner.

“They must have seen our Bradley on fire, figured it was an attack and thought we were all dead,” he said this spring, shaking his head, “then just started shooting.”

According to the Army, two soldiers died. Marquez said three others were wounded. Brigade commanders didn’t make anyone familiar with the incident available.

Marquez was flown to Walter Reed Army Medical Center in Washington, D.C.

He was still bleary on morphine on the Fourth of July weekend that he was told Bush was coming to award him a Purple Heart.

Marquez’s sister, who was visiting, didn’t want to see the president because she was so angry about the war and her brother’s wounds, but Marquez was honored.

“I had gotten hurt, but it is part of the job. I wasn’t mad at nobody,” Marquez said.

He was in the hospital for three months and had 17 surgeries so he could keep his leg. Marquez was being medically discharged from the Army and could have stayed at the hospital, but he transferred to Fort Carson on Sept. 13, 2005, to spend his remaining months with his war buddies, who had just returned from Iraq.

He eventually learned to walk without a cane, but other wounds proved harder to heal. He started having nightmares about the war. He felt worthless and crippled, depressed and angry. On a visit home to California, he made his mom put away all his high school sports trophies.

The only things that made him feel better were the pain pills the doctors prescribed for him — and only if he took too many.

‘Kumbaya period’

Post-traumatic stress disorder is like a roadside bomb.

The symptoms can remain hidden for months, then explode. They can cripple some soldiers and leave others untouched. And just like bombs disguised as trash or ruts in the road, PTSD can look like something else.

In many cases, it looks like a bad soldier. In addition to flashbacks and nightmares, Army studies say, symptoms can include heavy drinking, drug use, domestic violence, slacking off at work or disobeying orders.

You can often see it coming, said the most recent commanding general of Fort Carson, if you know what to look for.

Soldiers usually go through a jubilant high for a few months after they come home, Graham said. He calls this time “the Kumbaya period.”

“Soldiers have served their country, they’ve made it back, they’re home. It’s all great. It’s later that problems start to surface,” Graham said.

Usually, problems don’t show up for three to six months, he said.

When the brigade landed in Colorado Springs, most soldiers had spent a year in Iraq and a year in South Korea. Most had saved several thousand dollars. Many were old enough to legally drink in the United States for the first time. They had survived the worst of Iraq, and they were jonesing to blow off steam.

All they had to do was go through a few post-deployment debriefings that Fort Carson still uses.

Soldiers sit through classes that warn them that troops often have unrealistically rosy notions of home. They are told to be understanding with spouses and loved ones. They are cautioned to be careful with drinking and driving, and they are warned that the time for carrying a gun everywhere ended in Iraq.

All personal guns must be stored in the post’s armory — not in soldiers’ barracks, not in their cars and not tucked in their belts.

Then Fort Carson screens every soldier for PTSD and other combat-related problems.

If there are no red flags, the soldier can go on leave. If there are, they are referred for further diagnosis, officials at Fort Carson’s Evans Army Community Hospital said.

The screening asks soldiers a long list of questions about the deployment: Do you have trouble sleeping? Are you depressed? Did you clear houses or bunkers? Were you shot at? Did you witness brutality toward detainees? Did you have friends who were killed?

“Did you shoot people? Did you kill people? Did you see dead civilians? Did you see dead Americans? Did you see dead babies? No. No. No. No.” Eastridge said, mimicking how he answered the questionnaire.

“I had seen and done all that stuff, but you just lie to get it over with.”

Several soldiers said the same: They lied because they didn’t want the hassle of more screening.

When the young infantrymen were set free in Colorado Springs, many packed Tejon Street bars such as Rendezvous Lounge and Rum Bay. When the bars closed, soldiers said, they often picked fights in the street.

By 2006, the police were being called to break up bar brawls almost every night. Extra police were assigned to the area.

The Colorado Springs Police Department doesn’t track the crime statistics of individual units, but according to the El Paso County Sheriff’s Office, jail bookings of military personnel as a whole increased 66 percent in the 12 months after the brigade returned.

The “Kumbaya period” lasted about six months, soldiers said.

Eastridge said he blew through almost $27,000, mostly drinking at bars, but the first thing he did was buy guns: pistols, shotguns and an assault rifle similar to the one he carried in Iraq.

“After being in Iraq, it feels like everyone is the enemy,” he said. “You feel like you need a gun so they don’t come to get you.”

His friends all felt the same way.

Nash slept with a loaded .45 under his pillow.

Butler kept a Glock .40-caliber with him all the time, even when he rocked his newborn baby.

Marquez bought three pistols, a riot-style shotgun and an assault rifle like the one he carried in Iraq. He carried a pistol constantly, he said, even when he went to church.

His buddy, Freeman, said he bought himself a “big, scary” snub-nose .357 revolver.

“I couldn’t go anywhere without it,” he said. “I took it to the mall. I took it to the bank. I even had it right next to me when I took a shower. It makes you feel powerful, less scared. You have to have it with you every second of every day.”

Some returning soldiers, especially those with family members to notice their behavior, went into counseling.

More than 200 Fort Carson soldiers have been referred to First Choice Counseling Center, a private counseling service in Colorado Springs. Davida Hoffman, the director, said her counselors were unprepared for what they heard.

“We’re used to seeing people who are depressed and want to hurt themselves. We’re trained to deal with that,” she said. “But these soldiers were depressed and saying, ‘I’ve got this anger, I want to hurt somebody.’ We weren’t accustomed to that.”

In units that have seen the toughest combat in Iraq, one in four soldiers can screen positive for PTSD, the director of psychiatry at Walter Reed, Dr. Charles Hoge, said in an e-mail interview.

“Many soldiers continue to be able to perform their duties very well despite having significant symptoms,” Hoge wrote. But others show what he called “serious impairment,” and the worse the combat and the longer units are exposed, the worse the effects.

The affliction is as old as war itself.

Eric Dean, an author in Connecticut who specializes in war’s psychological toll, reviewed records from the Civil War for his 1997 book, “Shook Over Hell,” and found the same surge of crime and suicide that Fort Carson has seen.

“They have been in every war,” he said. “They never readjusted. They ended up living alone, drinking too much.”

They were “the lost generation” of World War I. They are the veterans of Vietnam who disproportionately populate homeless shelters and prisons today.

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CELEXA: Youth in India Dies During Clinical Trial

Paragraph 10 reads: “Concerns about the ethics of clinical trials do not exist merely in the realm of speculation. The GVK exposés are not unusual. An increasing number of reports are coming to light of unethical and illegal practices that exploit people’s social and economic vulnerability, subject them to serious risks without their knowledge and consent, and do not even assure them of access to the drugs developed from the trials. Certain types of trials depend on paid volunteers who desperately need money. In Gujarat, unemployed diamond workers and migrants from Uttar Pradesh and Bihar get paid between INR 5000 and INR 20,000 to take part in bioequivalence trials – sums large enough for them to put money over personal safety. Indeed, trial participants may be both financially and socially vulnerable. It is reported that Surender, who died in the Hyderabad felodipine trial, was one of a number of Dalit students being recruited for clinical trials in that city. Likewise, some years ago, a 22-year-old Adivasi youth died in a bioequivalence trial of the antidepressant citalopram [Celexa] by the Sun Pharma Advanced Research Centre in Vadodara. ”

http://www.himalmag.com/Bodies-for-hire;-The-outsourcing-of-clinical-trials_nw3213.html

Bodies for hire; The outsourcing of clinical trials August 2009
By: Sandhya Srinivasan

Medical testing by Western countries is having a staggering impact on India, if only we were to care to pay attention. And the government’s own policies are encouraging this.

Karen Haydock
In November 2008, the Hindustan Times’ LiveMint broke the story of an infant in Bangalore having died after being administered a vaccine in a drugs trial. The Drugs Controller-General of India (DCGI), Dr Surinder Singh, halted the testing, reportedly the first time that the office of the DCGI had taken such action. The trial, for a new pneumonia vaccine, was being conducted by a Hyderabad-based contracted research organisation, GVK Biotech, for the US-based multinational Wyeth Pharmaceuticals. The infant had been recruited from St. John’s Medical College, a reputed private medical institution in Bangalore.

GVK’s spokesperson claimed that the vaccine had nothing to do with the death, as the child had received an approved and widely used vaccine – not the experimental product. However, the DCGI’s investigation revealed that the infant had a heart condition, and that the trial had been meant to be conducted only on healthy babies. According to C M Gulhati, editor of the Monthly Index of Medical Specialities, India and a Delhi-based expert on clinical-trial regulations, the investigation revealed a number of other irregularities as well: the informed-consent document had not been signed before the child was recruited; and the St John’s ethics committee had not been properly constituted, as it was not chaired by an external member to ensure independent functioning.

Yet the infant’s death was not an aberration. In December 2008, 25-year-old K Surender, of Hyderabad, died in a ‘bioequivalence’ trial of a blood-pressure drug, felodipine. Bioequivalence trials test generic versions of drugs to ensure that they are as effective as the original, and involve administering the drug and then monitoring the individual through blood tests and other investigations. These tests are conducted on healthy people who are paid for their participation. The Hyderabad trial also happened to be run by GVK Biotech, which subsequently issued a statement that Surender had simultaneously been part of many bioequivalence studies, with GVK as well as other contracted research organisations. This multiple trial participation could have accounted for his death, argued the company.

Such an explanation is unconvincing. If Surender had taken part in many trials, it would only have been for the money, which would amount to an inducement according to national and international ethical guidelines for research – an inducement that might have made him overlook the risks of the trials. And, in any case, why did the company let him take part in the felodipine trial when it was aware that he had taken part in many others? The answer to this question lies in the compulsions of the global pharmaceutical industry. The GVK trials are among the increasing number of international clinical trials that are taking place in India – and the concerns that they raise will come up increasingly frequently in the future. The reports of various government and private bodies put the potential of the clinical-trial industry into billions of dollars, though the method of calculating these numbers is not available. One market-research company, Frost and Sullivan, reportedly estimates a USD two billion turnover by 2010.

Marcin Bondarowicz
The growth of the outsourced clinical-trial industry in India followed changes in the law in January 2005 that encourage clinical research in India. The most important of these was an amendment to the Drugs and Cosmetics Rules, permitting clinical trials in India to be carried out at the same time that they are done in other countries, rather than waiting until the results of drug trials in other countries were made public. Previously, this ‘phase lag’ had ensured that India was of no interest to big pharmaceutical companies to test their drugs. At that time, Phase II trials were permitted in India only after the results of a Phase III trial abroad were declared. And Phase I trials of foreign drugs were simply not permitted. (Phase I or safety trials are done on healthy ‘volunteers’, Phase II trials look at the drug’s safety and effectiveness on patients, and Phase III trials also look at safety and effectiveness, but in large numbers of patients.) It should be noted, though, that an exception was made for drugs deemed of importance to India. While the Drugs and Cosmetics Rules do not specify, such drugs would probably include the HIV vaccine.

This changed in January 2005, and India is now prominently on the radar screen of the international pharmaceutical industry in terms of clinical trials, given its vast population of potential trial subjects. As of today, the bulk of clinical trials are still located in rich countries. To illustrate, as of 19 July 2009, the US government clinical-trial database lists a total of 76,018 trials, of which 44,758 have sites in North America and 17,878 have sites in Europe – accounting for the bulk of trials. In contrast, only 1021 clinical trials have sites in India, in addition to 122 in Pakistan, 61 in Bangladesh and 12 each in Nepal and Sri Lanka.

However, the number of trials in India is growing fast. Figures given by the DCGI’s office show that the number of newly approved trials every year went from 100 in 2005, when the new rules kicked in, to about 500 in 2008. What is of concern here is that many of the trials that come to countries such as India are likely to be those rejected as unethical in Western countries. As trials shift to countries such as India, there has been an international debate on ethical concerns of the outsourcing boom. This debate has been partly responsible for amendments in the World Medical Association’s Declaration of Helsinki, “Ethical Principles for Medical Research Involving Human Subjects” in 1996, 2000 and in October 2008. Drug regulators in Europe and the US require that clinical trials submitted to them adhere to the Declaration.

Some of these changes have dealt with placebos or ‘sugar pills’. The October 2008 revision took a strong stance against the use of a placebo in a trial when a treatment exists. Clinical trials compare the effect of an experimental drug to an existing drug. If there is no drug for the condition, the experimental drug may be compared to a placebo. Using a placebo when a treatment exists deprives the trial participant of effective treatment. The ethical guidelines of the Indian Council of Medical Research and the World Medical Association’s Declaration of Helsinki both forbid the use of a placebo when an effective treatment exists, with certain specific exceptions. While both of these documents have been a bit ambiguous in the past, the 2008 revision of the Helsinki Declaration is clear: placebos can be used only when absolutely methodologically necessary, and when the risk to the participant is low. This revision was reportedly preceded by behind-the-scenes lobbying by the drug industry to permit greater use of placebo controls.

In the same month that the revised Declaration was announced, the US Food and Drug Administration (FDA) amended its own requirements for clinical trials. While placebos are rarely necessary, regulatory bodies such as the FDA require placebo-controlled trials to give marketing approval to new drugs. Yet as of October 2008, trials conducted for FDA approval no longer had to adhere to the Declaration of Helsinki – an internationally accepted document, but not binding unless incorporated into national regulations. The FDA would continue to require placebo controls, and no one was going to tell them otherwise.

Concerns about the ethics of clinical trials do not exist merely in the realm of speculation. The GVK exposés are not unusual. An increasing number of reports are coming to light of unethical and illegal practices that exploit people’s social and economic vulnerability, subject them to serious risks without their knowledge and consent, and do not even assure them of access to the drugs developed from the trials. Certain types of trials depend on paid volunteers who desperately need money. In Gujarat, unemployed diamond workers and migrants from Uttar Pradesh and Bihar get paid between INR 5000 and INR 20,000 to take part in bioequivalence trials – sums large enough for them to put money over personal safety. Indeed, trial participants may be both financially and socially vulnerable. It is reported that Surender, who died in the Hyderabad felodipine trial, was one of a number of Dalit students being recruited for clinical trials in that city. Likewise, some years ago, a 22-year-old Adivasi youth died in a bioequivalence trial of the antidepressant citalopram by the Sun Pharma Advanced Research Centre in Vadodara.

Certain types of trials are more likely to be conducted in India and other countries where regulatory and monitoring mechanisms are weak, or regulators are too willing to please drug companies. The use of placebos is a good example, as it is not difficult to conduct placebo trials in India. In 2005-06, Indian patients with schizophrenia were taken off their regular medication and given either a new, ‘extended-release’ formulation of an approved drug (quetiapine, marketed by AstraZeneca) or a placebo, to compare the time it took for people in each group to have a relapse attack of schizophrenia. The trial was conducted by a Contract Research Organisation (CRO) called Quintiles, in India as well as a number of countries in Eastern Europe. One patient (not in India) who was on the placebo committed suicide. Experts are unanimous in their view that a placebo was methodologically unnecessary in that trial, as the new formulation could have been compared to the existing ‘immediate-release’ drug. But the European regulators required a placebo-controlled trial, noted Irene Schipper and Francis Weyzig of the Dutch research organisation Centre for Research on Multinational Corporations, in a 2008 report. They also argued that placebo-controlled trials for severe conditions, which put the participants at greater risk, are more likely to be conducted in developing countries.

Trials in government hospitals in India can also be of special concern. In one trial, 290 people who had been hospitalised because they were having a severe attack of acute mania were given either a drug (risperidone, marketed by Johnson & Johnson) or a placebo. The idea, of course, was to examine how many people recovered with the drug, and how many with the placebo. This subjected seriously ill people to harm. The majority of patients in this India-only trial, also conducted by Quintiles, were recruited from government hospitals where, according to the principal investigator of the trial, the most seriously ill patients could be found. It is also where patients can be recruited easily, because trial participation ensures a hospital bed and free, quality treatment.

Another concern about trials in government hospitals is that they are conducted on poor people who may have no access to the drugs tested on them after the trial is over. In August 2008, the media reported that 49 children died in 42 clinical trials that were conducted over two and a half years in the Department of Paediatrics at the All India Institute of Medical Sciences (AIIMS) in Delhi. An investigation ordered by the National Human Rights Commission concluded that the trials were conducted properly: the children in the trials were seriously ill, and all the deaths occurred because of the serious illnesses, not the treatments. However, the committee’s report left many questions unanswered. What, for instance, was the purpose of these trials? Would they help other poor children in India?

One of these trials tested the blood-pressure drug valsartan, supplied by its manufacturer Novartis. Paediatric hypertension is indeed a serious condition, but companies conduct paediatric trials for various reasons, including to get information for the benefit of doctors who prescribe the drug to children. Another reason is because the US FDA extends a drug’s exclusive marketing rights when it is tested on children; this provision is meant to encourage research on children who are otherwise prescribed drugs based on the results of research on adults. However, companies also use this clause to maximise their profits. Another trial was linked to gene-activated human glucocerebrosidase, a treatment for Gaucher’s disease, a serious genetic condition in which a fatty substance (lipid) gets deposited in cells and specific organs. The drug for this trial was provided by the US-based Shire Human Genetic Therapies. Will the drug be made available in India once it is proved effective? Both the Helsinki Declaration and the ICMR’s guidelines emphasise that a community on which a drug is tested should have access to the drugs, if proven effective, once the trial is over. Unfortunately, this is rarely the case. Although all of the new drugs being tested in India will indeed be available in India, this will be at prices unaffordable to the very people who agree to have them tested on their bodies.

More generally, but of no less concern, AIIMS has stated that the trials did not “target” children from poor backgrounds. But there is no need to target poor people at AIIMS – they constitute the majority of patients at this government referral hospital. The simple fact is that the vast majority of people seeking care at the AIIMS centre would be there because they cannot afford treatment elsewhere.

Body market
The pharmaceutical industry depends on constantly getting new drugs into the market. New drugs include new uses for old drugs (a cancer drug that can also be used for infertility?) or ‘improved’ or ‘me-too’ versions of older drugs (all those antacids, blood-pressure and cholesterol-lowering drugs, anti-depressants or antibiotics). These drugs must be tested on human beings before they can go into the market. Permission has to be obtained, patients have to be recruited, trials carried out and the results filed – all at top speed, because time is money.

This is where the Contract Research Organisation – the CRO, such as GVK Biotech referred to earlier – steps in. The CRO undertakes all aspects of the process involved in getting regulatory clearance: getting the necessary permissions, tying up with doctors and hospitals to recruit patients on whom the drugs are to be tested, analysing the data that emerges from the trials, monitoring the trial to make sure that the information collected meets standards, putting together reports and even ghostwriting articles for publication in medical journals. Of course, the most important aspects of all this is the recruitment of patients. The best place to recruit patients for, say, a diabetes-drug trial, is a country with a large diabetic population. And diabetics who have not received treatment make better trial subjects, as the results of drugs tested on them will not be ‘contaminated’ with the results of drugs that they have already used.

Clinical trials in developing countries depend not only on physical infrastructure – hospitals and laboratories – and trained human power. They also depend on drug companies getting access to bodies on which they can test their drugs. So, CROs in India market Indian bodies. In a 2006 advertisement on their website (which has since been removed), a CRO named Igate advertised the ‘India advantage’ as “40 million asthmatics, about 34 million diabetics, 8-10 million people HIV positive, 8 million epileptic patients, 3 million cancer patients.”

CROs in India all claim to have ‘access’ to patients with various health problems for which drugs can be tested. For instance, a research group called Veeda claims to have “access to vast patient populations and has specific expertise in recruiting patients with cardiovascular disease, oncology, diabetes, renal disease”. The CRO Quintiles India once boasted that, for a paediatric-flu-vaccine trial, it recruited 201 one- to three-year-olds from three sites in India in just six days. What kind of network does Quintiles have, and what kind of influence does it have with the medical profession, that it can round up 200 children and convince their parents to let them get an experimental flu shot – all in just six days flat?

It seems that at least some of this is able to take place through wilful misinformation. Spectrum Clinical Research specialises in recruiting patients, collecting patients through networks of private clinics, hospitals, specialists and family physicians. It also runs ‘awareness campaigns’ – for instance, a “white ribbon initiative” on osteoporosis, co-organised with the women’s magazine Femina of the Times of India stable, collected data on 2000 patients with osteoporosis. Another campaign, this time to “defeat diabetes”, collected data on 1000 patients with diabetes. In these ways, people who think they are joining patient-support groups are actually being tracked so they can potentially be put on a trial.

Behind a veil
Other than the boasts of CROs, there is little information available on the hundreds of clinical trials being conducted in India. This is despite the evidence that many of these trials are conducted for the benefit of international drug companies, at unacceptable cost to the local population; that trial subjects could be put at risk; that subjects often have not given their informed consent to participate; that they might be provided care that is of lower quality than if they had been recruited for a trial in the West; that injuries during a trial might not be investigated thoroughly, and that those injured may not receive treatment of the highest standard, or even compensation; and that drugs that are tested are often too expensive for people who need them in India.

The only institution to have direct power over the conduct of a trial is the ethics committee (EC). Research institutions appoint their own institutional ethics committee to conduct an ethics review of all research proposals from within the institution. Independent or freelance ethics committees undertake ethics review for a fee, from anyone who applies – usually the CRO or drug company who coordinates the trial at a number of small nursing homes or private clinics, which don’t have their own ethics committee. The EC is a collection of specialists from various fields who review trial documents, including the trial design, the manner in which subjects are recruited, the patient information sheet and the informed-consent form, and approve or reject the application. These committees also have the authority to investigate a trial, and even to stop it if they feel that something is not right.

Ethicist Amar Jesani points out that ethics committees have a lot of power, as the DCGI requires that all trials be passed by such an appointed group. In fact, the DCGI only requires approval by an ethics committee, since it does not monitor the actual conduct of the trial – it does not check that informed consent is taken, that the investigators do their job correctly, that subjects are not harmed, and so on. Thus, says Jesani, it is the ethics committee, not the DCGI, that is the real regulator of clinical trials.

Yet the effectiveness of an ethics committee depends entirely on the setting in which it functions. Important factors, for instance, include the institution that funds the committee’s work or that determines its level of independence, the training of its members, and their competence in terms of doing a proper ethics review. Likewise ‘independent’ or freelance ethics committees are more accountable to the companies that pay for their services. Even the patient information sheet and informed-consent document are treated as confidential documents by the ethics committee – and, of course, the trial’s sponsor. These contain the information on the purpose of the trial, its risks and benefits, and an assurance that a patient’s treatment will not be jeopardised by refusal to participate, or withdrawal from a trial. There is nothing here of proprietary value – on the contrary, everything in these documents is of public interest, and they should be available to the public. Ethics committees are also often poorly educated in their responsibilities.

The reports of people dying in trials are likely to be merely the tip of the proverbial iceberg. And many more are likely to suffer an injury related to the trial drug, injuries that require treatment and that could result in temporary or permanent disability. Indian guidelines require that trial participants be compensated for injuries suffered during research. However, a study by Urmila Thatte and others in a 2009 issue of the UK-based Journal of Medical Ethics found that many trial investigators as well as ethics committee members are not even aware of this requirement. The guidelines of trial sponsors – such as drug companies – provide for medical treatment of any participant who suffers a trial-related injury, or reimbursement of their medical costs. However, Thatte and her colleagues found that none of the companies sponsoring trials, or ethics committees reviewing their trials, had a policy of compensation for trial-related disability or death. Yet for ethics committees to be a law unto themselves is hardly surprising, given the overall environment of lax regulation and monitoring.

Now, the FDA’s decision to do away with the Declaration of Helsinki will create a dilemma for the DCGI. If CROs in India are to follow the FDA requirements – such as using a placebo even when it is not absolutely necessary, and when it might put subjects at risk – they will be violating Indian regulations, which require that the Declaration of Helsinki be followed. The latest revision of the Declaration is quite clear that the placebo may be used in very few circumstances. At the moment, however, the DCGI’s record – permitting a number of unethical trials – suggests that his office places greater value on the potential financial returns of clinical trial outsourcing than on protecting the people who take part in drug trials in India.

Sandhya Srinivasan is a Bombay-based journalist specialising in public health and development issues. She is executive editor of the Indian Journal of Medical Ethics.

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ZOLOFT, PROZAC, Adderall & Ritalin: 18 Year Old Shoots Deputy: Critcal …

WHEN ARE DOCTORS EVER GOING TO REALIZE THAT THEY CANNOT GIVE ALL OF THESE DRUGS TOGETHER?!!!!!!! THERE IS NO CLINICAL DATA TO PROVE THE SAFETY OF EVEN TWO OF THEM GIVEN IN COMBINATION!!!!!!!!!!!!!!!!!!!

Paragraphs 11 though 14 read: “To combat attention disorders and other conditions, the teen took Ritalin, Zoloft, Prozac and Adero, among other drugs, Bryce said, toting the various prescriptions with him in a pill sorter.”

“The medicine sedated Adrian for hours. He was often unresponsive and seemingly unaware of people talking to him while on the medication, Bryce said.”

“The assortment of pills ‘took a toll on him,’ he said.”

“Other times Adrian displayed anger he seemed unable to control, Bryce said. Some of it was typical teen behavior, but sometimes Adrian “blacked out” and later forgot about the episodes, Bryce said.”

http://www.dailycomet.com/article/20090731/ARTICLES/907319905/-1/SPORTS12?Title=Dad-says-There-s-something-wrong-with-him –

Dad says, ‘There’s something wrong with him’

Father grieves for son suspected of shooting deputy.
By Matthew Pleasant
Staff Writer

Published: Friday, July 31, 2009 at 12:24 p.m.
Last Modified: Friday, July 31, 2009 at 12:24 p.m.

BOURG ­ To understand what happened, Bryce Broussard sifts through memories of his son.
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He cries as he remembers an 18-year-old boy who struggled to read, who needed help filling out job applications and had an unpredictable and explosive temper, he said.

The same young man earned money by cutting Hope Street yards, who welded his own workout bench in school and sometimes fell asleep wearing headphones.

The teen, Adrian Broussard, is now charged with attempted first-degree murder, accused of shooting Terrebonne deputy David Bourg three times Tuesday and leaving him in critical condition.

Still reeling over the arrest, Bryce, 36, said he and his wife, Amy, plan to support his son. He finds it hard to comprehend Adrian committing the crime, he said, but recognizes the behavior problems that may have contributed to the shooting.

“He was a good kid, but there’s something wrong with him,” said Bryce, an offshore worker. “He would blow up over nothing.”

Adrian Broussard’s last steady home was 128 Hope St. in Bourg, where his father said Adrian lived for two years before moving to live with a relative in Montegut.

He struggled through school at South Terrebonne High to earn a technical-skill degree, Bryce said. Rusting in the yard is a workout bench and frames for four-wheelers ­ all of it Adrian’s work.

Often unable to concentrate, Adrian took a slew of medications, his father said. But he never seemed more focused or content than when welding or dissembling a motor.

“He wanted to make different things that nobody else had,” Bryce said.

To combat attention disorders and other conditions, the teen took Ritalin, Zoloft, Prozac and Adero, among other drugs, Bryce said, toting the various prescriptions with him in a pill sorter.

The medicine sedated Adrian for hours. He was often unresponsive and seemingly unaware of people talking to him while on the medication, Bryce said.

The assortment of pills “took a toll on him,” he said.

Other times Adrian displayed anger he seemed unable to control, Bryce said. Some of it was typical teen behavior, but sometimes Adrian “blacked out” and later forgot about the episodes, Bryce said.

His unwieldy behavior and penchant for mechanic work followed the family to Disney World last summer, where the teen preferred to stay at the hotel rather than visit the parks, they said. When the family truck broke down, he worked on it without hesitation.

The father and son bought parts and repaired the truck in the hotel parking lot, he said.

“He helped me piece by piece, tearing it down,” he said.

Bryce said the family tried to help him find a job after graduation. The family ate at Golden Corral during one trip into Houma, and Adrian’s temper flared at servers who told him the restaurant wasn’t serving steak.

He berated the kitchen staff, telling them none knew how to cook, Bryce said. He also threw his cup in the dining room, sending drink all over surrounding tables.

“It was nothing nice,” he said.

Neighbors said the Broussard family seemed to have a troubled home life, citing fights and police visits to the trailer. Bryce and Amy Broussard said they were close despite the incidents.

“We’re not saying we’re perfect,” Amy Broussard said.

Adrian Broussard left the Hope Street trailer several months ago to stay with cousins in Montegut and only occasionally spent time with his father after that, Bryce said.

Just before midnight Tuesday, Adrian allegedly gunned down a deputy investigating reports of a suspicious person outside the Montegut Post Office.

By 1 a.m. Wednesday, deputies were at the Broussard’s trailer demanding to know where Adrian was, Bryce said. He said he spent much of the morning handcuffed inside a police cruiser that drove through Montegut in search of the teen.

The elder Broussard was charged that day with simple criminal damage to property and theft of goods over $500, according to jail records. Broussard said the arrest stemmed from outstanding warrants.

Adrian was arrested about 12 hours after the shooting when a resident found him inside an abandoned home, police have said. He is being held at the Terrebonne Parish jail in lieu of a $2 million bond on the attempted first-degree-murder charge. He is also charged with simple burglary, trespassing, possession of marijuana and illegal carrying a weapon, deputies said.

Deputies had searched for Adrian Broussard earlier Tuesday to arrest him on warrants for felony theft and criminal damage. His bond for the warrant charges is $20,000.

Deputy Bourg, a five-year veteran of the Sheriff’s Office who is married with children, remains in stable condition in the critical care unit at Terrebonne General Medical Center.

While Bryce is hoping for the best outcome for his son, he says he also hopes Bourg is able to heal.

“We are praying for a full recovery,” Bryce said. “We apologize to the family, and we’re very sorry for what happened.”

Staff Writer Matthew Pleasant can be reached at 857-2202 or matthew.pleasant@houmatoday.com.

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DEPRESSION MED: Suicide Attempt: Story on The Gap: Australia

Paragraph 11 reads: “Years later, Mr Ritchie encouraged a ‘‘nervous and confused’’ woman, sitting on a ledge, shoes by her side, to follow him home. Over tea and toast, she revealed she was unhappy with medication she had been prescribed for depression. Mr Ritchie’s wife suggested she seek a second opinion. ‘‘A couple of months later she came up the path with a bottle of French champagne. We later got a Christmas card from her, and a postcard. It said ‘I’ll never forget your important intervention in my life. I am well’.’’

http://www.smh.com.au/national/an-angel-walking-among-us-at-the-gap-20090731-e4f2.html

An angel walking among us at The Gap

’’People will always come here. I don’t think it will ever stop’’ … Don Ritchie. Photo: Marco del Grande

Kate Benson Medical Reporter
August 1, 2009

HE IS the watchman of The Gap. A former life insurance salesman who in 45 years has officially rescued about 160 people intent on jumping from the cliffs at Watsons Bay, mostly from Gap Park, opposite his home high on Old South Head Road. Unofficially, that figure is closer to 400.

Some, at his urging, quietly gathered their shoes and wallets, neatly laid out on the rocks, and followed him home for breakfast. Others, tragically, struggled as he grabbed at their clothes before they slipped over the edge.

Still others later sent tokens of thanks, a magnum of champagne or an anonymous drawing slipped into his letter box, labelling him ‘‘an angel walking among us’’.

Don Ritchie, 82, spends much of his time reading newspapers, books and scanning the glistening expanse of ocean laid out before him. His days of climbing fences are gone and he admits some relief that most visitors now carry mobile phones and are quick to contact the police if they see a lone figure standing too close to the edge, too deep in contemplation.

For its part, Woollahra Council has been campaigning for $2.5 million to install higher fences, motion-sensitive lights, emergency phones and closed-circuit television cameras, but Mr Ritchie is ambivalent.

‘‘People will always come here. I don’t think it will ever stop,’’ he says, with a shrug.

Some deaths have been recorded in his diary, others are eternally etched in his mind.

One summer evening he spotted a young man perched on a thin ledge, beyond the fence.

‘‘I went over and I tried to talk to him, asking him questions about where he was from. He wouldn’t talk much, just kept looking straight ahead. I was talking to him for about half an hour … thinking I was making headway. I said ‘why don’t you come over for a cup of tea, or a

beer, if you’d like one?’ He said ‘no’ and stepped straight off the side … his hat blew up and I caught it in my hand.’’ Later, Mr Ritchie discovered the 19-year-old had grown up next door, playing with his grandchildren.

Years later, Mr Ritchie encouraged a ‘‘nervous and confused’’ woman, sitting on a ledge, shoes by her side, to follow him home. Over tea and toast, she revealed she was unhappy with medication she had been prescribed for depression. Mr Ritchie’s wife suggested she seek a second opinion. ‘‘A couple of months later she came up the path with a bottle of French champagne. We later got a Christmas card from her, and a postcard. It said ‘I’ll never forget your important intervention in my life. I am well’.’’

Despite his bravery and compassion, Mr Ritchie has steered clear of the limelight. He was awarded a Medal of the Order of Australia in 2006 for his services to suicide prevention but is all too aware that any publicity attracts more depressed and disturbed people.

In the weeks after the Channel 10 newsreader Charmaine Dragun jumped to her death outside his house in November 2007, Mr Ritchie’s wife is adamant six more followed.

‘‘But what do you do? Not talk about it?’’ he asks. ‘‘It’s the truth. It’s what goes on here.’’

It has long been a haunting dichotomy for rescuers, families and media. To speak out in a bid to have the area made safer, risking more people becoming aware of it, or to keep quiet, letting the deaths go on.

But for an anti-suicide campaigner, Dianne Gaddin, whose daughter Tracy jumped from The Gap in 2005, the answer is easy. If the issue is not aired, the problem will never be solved.

She has written four letters in the past month to the Prime Minister, Kevin Rudd, urging him to act. While her pleas go unanswered, her desperation balloons. She knows Mr Ritchie will not be standing guard forever.

‘‘Sometimes just a smile and a greeting is all it takes to change the mind of the would-be suicider. I don’t believe people want to die, but living is just too hard. To me, Don is a guardian angel.’’

Lifeline: 131 114; Salvo Crisis Line 93312000; Beyond Blue 1300224 636.

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ANTIDEPRESSANT & ALCOHOL: In Pink Pajamas Woman Slashes Neighbor’s Tires: UK

Third paragraph from the end reads: “Stephen Constantine, defending, said: ‘Ms Fergus suffers from depression and this offending was a result of combining drink with her prescribed medication’.”

http://www.sunderlandecho.com/news/Easington-tyreslasher-wore-pink-pyjamas.5509772.jp

Easington tyre-slasher wore pink pyjamas
Published Date:
30 July 2009
By Rob Freeth

A drunken woman dressed herself in pink pyjamas before going out at the dead of night to slash car tyres.

Joanne Fergus did not know the owners of the vehicles she damaged, Durham Crown Court heard.

Fergus, 25, of Glenhurst Road, Easington Village, admitted three charges of criminal damage on January 23 this year.

She has no previous convictions, but has police caustions for a public order offence and possessing a small quantity of amphetamine, and she received a penalty notice for being drunk and disorderly.

Judge Esmond Faulks sentenced Fergus to a nine-month supervision order, and ordered her to pay £282 compensation.

“You slashed the tyres of cars belonging to neighbours who had done nothing to you,” the judge told Fergus.

“It was a disgraceful thing to do and I hope you are ashamed of yourself.”

“A neighbour in Easington saw a figure crouched down beside a Jaguar car,” said David Wilkinson, prosecuting.

“He then saw a flash of metal, which was later confirmed to be a kitchen knife.

“The neighbour was able to tell police the person with the knife was a woman dressed in pink pyjamas.

“Officers cruised around the immediate area and the only house with a downstairs light on belonged to Fergus.

“She was wearing the pink pyjamas when she answered the door.”

The court heard Fergus admitted she had been out slashing tyres, but could not say why she had done it.

“She had been drinking and was upset due to an argument with her boyfriend,” added Mr Wilkinson.

“One tyre on the Jaguar was found to be slashed, as well as two tyres on a Peugeot, and another two tyres on a Vauxhall Astra.”

Stephen Constantine, defending, said: “Ms Fergus suffers from depression and this offending was a result of combining drink with her prescribed medication.

“The incident was also borne out of a domestic argument with her boyfriend at the time.

“She can pay compensation, although her income from benefits is £120 a week, from which she has to look after herself and her young daughter.”

* Last Updated: 30 July 2009 12:44 PM
* Source: n/a
* Location: Sunderland

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ANTIDEPESSANTS: Death: 21 Year Old: Florida

Paragraph 20 reads: “Mr. Mott was discharged July 14. He went home with three prescriptions to treat depression, his family said ­ and a companion.”

Paragraphs 27 through 29 read: “In the wake of his death, his family searches for answers. Kathy Mott said she does not believe her son relapsed. She wonders if the antidepressants played a role in his death.”

“Now she wants others to be careful.”

“‘Just because it’s prescription drugs, doesn’t mean you can’t OD,’ she said.”

http://www.tampabay.com/news/obituaries/article1023489.ece

Track star Matthew Mott had started rehab
By Andrew Meacham, Times Staff Writer
In Print: Friday, July 31, 2009
[LARA CERRI | Times]

ST. PETERSBURG ­ At a gathering held in his honor Wednesday at Northeast High School, Matthew Mott’s family and peers recalled the good times.

A former teammate showed off a large pink stuffed bunny rabbit, the unofficial mascot of the Northeast High track team, led by Mr. Mott and his twin brother, Jonathan. Others reminisced about late-night scavenger hunts and mud-wrestling in Mr. Mott’s back yard.

But it wasn’t good times that brought more than 140 people to Northeast’s cafeteria Wednesday ­ it was an unexpected death. Mr. Mott died of unknown causes early July 23, nine days after leaving an addiction treatment center. He was 22.

Mr. Mott literally ran through most of his life, competing with and against his brother. The brothers anchored a previously unremarkable Northeast track team, each earning second-team all-county honors in 2005. The next year, they helped take Northeast to its first state finals in more than two decades.

They trained together, worked out together. Jonathan won many races just a second or so ahead of Matthew, though sometimes it was the other way around.

“I don’t think they were competing against anybody else,” said Patty Parker, the boys’ aunt. “The competition was between those two.”

The boys took separate paths after their graduation in 2006. Jonathan Mott got a full track scholarship to Webber International University, where he remains.

Matthew Mott did not get the same offer. He enrolled in the Orlando Culinary Academy.

In the fall of 2006, after less than two weeks at the school, he called his aunt.

“He called in a panic,” said Parker, 40. He didn’t like it there, she said. Parker and her husband drove Mr. Mott back to St. Petersburg.

It is around this same time that friends began noticing changes in Mr. Mott’s behavior. Suddenly, the happy-go-lucky man with bleached blond locks had grown quieter, more reserved.

“He was the most upbeat, happy person,” said Ian Upson, 21. “He was always saying, ‘Let’s do this’ or ‘Let’s do that.’ Afterward, he just wanted to sit back and do nothing.”

Some of his friends and family members knew that Mr. Mott was taking the painkiller OxyContin. But they, like everyone else, were powerless to stop him.

“If you were around him, you knew,” said older brother Sam Mott.

Mr. Mott got a series of cooking jobs at places like the Don CeSar, the TradeWinds, Bascom’s Chop House and Derby Lane, his family said.

“He lost all of those jobs due to his addiction,” said his mother, Kathy Mott, 53.

With less money to buy OxyContin illegally, Mr. Mott resorted to Coricidin Cough and Cold medicine ­ or “Triple C” ­ an over-the-counter antihistamine that can be used as an intoxicant.

In June, Mr. Mott told his family he had had enough. His mother entered him in Fairwinds Treatment Center in Clearwater.

During a family visit to the facility, Mr. Mott seemed to have improved. He had gained weight. He was his old, animated self.

Mr. Mott was discharged July 14. He went home with three prescriptions to treat depression, his family said  and a companion.

Mr. Mott had met Genny Perry in treatment, and the two had formed an attraction. Perry and Mr. Mott lived with Kathy Mott. The two went to 12-step meetings together and separately.

Mr. Mott had gone to an AA meeting the night of July 22, then talked to his AA sponsor, his mother said. They stayed close to home the rest of the evening, Perry said, and fell asleep together at 3:30 a.m.

She awoke at 4 a.m. sensing something was wrong.

“He felt sweaty,” said Perry, 32.

Mr. Mott was snoring ­something he did not normally do, his mother said. Foam bubbled around his lips, his mother and Perry said.

Paramedics were unable to revive him, and he died at 4:40 a.m.

In the wake of his death, his family searches for answers. Kathy Mott said she does not believe her son relapsed. She wonders if the antidepressants played a role in his death.

Now she wants others to be careful.

“Just because it’s prescription drugs, doesn’t mean you can’t OD,” she said.

Learning the cause of death could take months, as the Pinellas County medical examiner awaits toxicology results.

At his celebration service Wednesday, family and friends spoke of Mr. Mott’s zest for life. A friend strummed a ukulele and sang a song. A priest extolled the value of Mr. Mott’s life and called it complete.

The audience listened in respectful silence.

Andrew Meacham can be reached at (727) 892-2248 or ameacham@sptimes.com.

.Biography

Matthew

David Mott

Born: Feb. 20, 1987.

Died: July 23, 2009.

Survivors: brothers, Jonathan and Sam; parents, Kathy and Sam; aunts, Patty Parker and Barbara DuFault; extended family.

[Last modified: Jul 30, 2009 10:29 PM]

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