Phillip H. Crews spent his last moments of life in a place he knew well: a room on the first floor of the sprawling John Cochran VA Hospital at 915 North Grand Avenue, just north of downtown St. Louis.
The hospital's first-floor waiting room is officially titled "the Ambassador's Suite." A gently sloping ramp leads upward from the south visitor parking lot through sliding doors to the suite, which can accommodate dozens of patients and visitors at a time.
Crews, 62, a Marine Corps veteran who had served during the waning days of the Vietnam War, had been a frequent visitor to the John Cochran VA hospital for many years.
A self-employed handyman from the city's south side, Crews suffered from severe stomach pains that eluded a medical diagnosis. VA doctors prescribed Crews powerful opioid painkillers, to which he became addicted in his later years, according to his family and friends.
As his stomach pains worsened with no end in sight, Crews grew increasingly frustrated with the hospital, says his nephew, Tim Harrison, of Herculaneum.
"He just got worse and worse," Harrison says. "And then in the last three to four months he looked really, really bad."
Crews earned a precarious living as a handyman and from occasional work rehabbing houses. His financial situation deteriorated in his last years of life as his health declined. The bank that held his mortgage sought to take possession of his home, while Crews found it increasingly difficult to make ends meet on the $1,200 he earned each month from Social Security.
In late March, Crews told his nephew he was going to kill himself. "He said, 'Tim, I can't take it no more,'" Harrison recalls.
Harrison asked his uncle if he was serious about taking his own life.
Yes, Crews replied.
"When I do it, I'm going to do it at the VA because these are the guys who failed me," Harrison recalls his uncle saying.
Crews made his final visit to the hospital in the pre-dawn hours of March 26, 2018.
He left his modest house at 4472 Beck Avenue and drove his 1996 maroon-colored Buick Regal sedan the five miles north to the hospital.
It was just after 4 a.m. when Crews parked the Buick and walked the last few hundred feet into the Ambassador's Suite.
In his right hand he held a pistol. All six chambers were loaded.
When he entered the Ambassador's Suite, it was empty. He lowered his body onto a couch near the entrance.
Crews inserted the barrel of the gun, a Herman Weihrauch .38-caliber Special revolver with black polymer grip, into his mouth. The time was 4:19 a.m., according to security cameras.
Crews angled the barrel upward so that it touched the roof of his mouth. Then he squeezed the trigger. The bullet exploded out the left side of his skull, according to the St. Louis medical examiner's report.
Apparently no one inside the hospital heard Crews' gun go off. More than an hour elapsed before a man walked into the Ambassador's Suite to buy a soft drink from one of its vending machines. There the man "observed a white male subject seated on the couch, unconscious, and bleeding from the head," according to an incident report prepared by a St. Louis police officer.
The man ran into the nearby emergency room and alerted staff to the situation. Crews was rushed to the emergency room on-site.
But it was too late. A VA physician pronounced Crews dead at 5:33 a.m., according to the police report.
An estimated twenty military veterans take their lives each day in the United States. But Crews' decision to end his life at the VA hospital put him in a smaller subset of those deaths, that of veterans committing suicide at VA facilities or on public grounds. The phenomenon even has a name: parking lot suicides.
From October 2017 to June 2018, fifteen on-campus suicides occurred at VA facilities nationwide, according to figures released to the Riverfront Times by the VA headquarters in Washington.
The reasons for the phenomenon range from veterans protesting poor and long-delayed treatment to their desire to spare family members the shock of discovering their corpses.
The phenomenon of parking lot suicides gained the attention of Dr. David Shulkin, who, in early 2017, was still serving as the VA secretary. He described these suicides as part of a growing, if tragic, trend.
"As some of you may know, veterans tend to come to a VA — either drive a car or come to the VA — and actually commit suicide on our property," Shulkin said in a speech at Georgetown University. "There are a number of reasons, not all of which I completely understand, but one of them being they don't want their families to have to discover them."
These veterans know that "if they're discovered at a VA, that we will handle it in an appropriate way and take care of them," including the handling of paperwork for military burials and benefits for survivors, Shulkin said.
Shulkin made the reduction of veteran suicides his top clinical priority when he took the VA's reins. At the time, he said he didn't know how many parking lot suicides had occurred at VA facilities. "But every day I am notified of more and more of these that happen. So we just have to do more, we have to do better, we have to innovate," Shulkin said.
On March 28, 2018, two days after Crews' suicide, Shulkin was fired by President Donald Trump as part of a dispute over the privatization of VA health care.
For David Barbash, who runs a website that raises money to help family members of veterans who commit suicide, the motivation behind these parking lot suicides makes a certain kind of sense. "They obviously want to make a statement, a political statement," he says.
But committing suicide at a VA hospital can also signal another message.
"It's a cry for help," Barbash says. "And they don't want their families to clean up the mess, so to speak."
Although the problem of parking lot suicides was an issue of special concern for former VA director Shulkin, the VA does not keep comprehensive figures on suicides at agency facilities nationwide, according Gina Jackson, an agency spokeswoman.
The agency provided the tally of fifteen suicides in nine months at the Riverfront Times' request, but offered little additional information.
"That information is available at each individual facility, but is not something we have compiled (other than what we have provided to you)," Jackson wrote in an email in August.
The Riverfront Times reached out repeatedly to the VA to determine how the agency had arrived at its figures, as well as to determine the dates and locations of each veteran suicide. The agency, however, declined to provide the information.
"Due to the low total number of on-campus suicides, we are unable to provide further detail as doing so could jeopardize patient privacy," Curt Cashour, press secretary for the Department of Veterans Affairs, wrote.
News accounts, however, abound of VA patients taking their lives at VA facilities or other public property over the past two years. These cases include:
• An unidentified 76-year-old Navy veteran who killed himself in August 2016 in the parking lot of the Northport Veterans Affairs Medical Center on Long Island, New York, where he had been a patient.
• Peter A. Kaisen, of Islip, Long Island, a former police officer, died after he shot himself at the Long Island VA center. The veteran had reportedly been frustrated that he was unable to see an emergency-room physician for reasons related to his mental health.
• In November 2016, the body of John Toombs, a former Army sergeant and Afghanistan veteran, was discovered in a vacant building on the campus of the Alvin C. York VA Medical Center in Murfreesboro, Tennessee. Toombs, who hanged himself, left behind a video in which he stated, "Earlier today, I was discharged for trivial reasons. They knew the extent of my problems. When I asked for help, they opened up a Pandora's box inside of me and kicked me out the door."
• In February 2017, the body of 63-year-old Navy veteran Paul Shuping was found in the parking garage of the Durham Veterans Affairs Medical Center in North Carolina, six days after he took his own life. Police announced that Shuping had used a .22-caliber rifle to kill himself inside a parked car.
• In March 2017, Hank Brandon Lee, 35, a former U.S. Marine lance corporal who served tours in Iraq and Afghanistan, fatally overdosed on fentanyl while under lockdown at the Department of Veterans Affairs psychiatric facility in Brockton, Massachusetts.
Fitting the pattern, but not happening on site, in June 2018, an Air Force veteran upset with the VA set himself on fire outside the Georgia state capitol in Atlanta. He died soon afterward. "He was strapped with some homemade incendiary devices, some firecrackers and doused himself with some kind of flammable liquid and attempted to set himself on fire," an Atlanta fire department captain told reporters.
A major aspect to veterans' on-campus suicides is the fact their health is deteriorating, says Barbash, who runs the website to help survivors of veteran suicide.
"Whether it's physical, emotional or spiritual, they're convinced they're done," Barbash says. "So this is their last kind of service to their country. And that breaks my heart."
On a warm September afternoon, Sherry Crews Harvel sits in her house in Oakdale, Illinois, a tiny farm community about 65 miles southeast of St. Louis. Nearly six months have passed since Harvel's older brother Phillip took his life.
In Harvel's hands is a copy of the St. Louis Metropolitan Police Department report on her brother's suicide.
After several minutes reading the report, Harvel sets down the document. She leans back in her chair, then takes out a pack of cigarettes and lighter. She lights up, takes a few thoughtful drags and stares through the swirls of smoke that twist and float toward the ceiling.
What concerns her, Harvel says, are the contradictions between what hospital staff told her on the morning of her brother's death and the information in the police report.
Harvel recalls a conversation with her brother's hospital-assigned physician a few hours after his death.
"I talked to his doctor that morning and I was furious," Harvel recalls. "I said, 'I want to know how in the hell you can walk through there and he shot himself and nobody heard anything?' She says, 'We have a "no firearms in the building" sign.' I said, 'What the hell is the good in that? What good is a sign going to do if you can still walk in there?' I said, 'You all knew he had mental problems. Why didn't you do something about it?'"
The doctor claimed that Crews "was in a wing that nobody goes to and nobody is ever around there," Harvel recalls. "I said, 'Well, it had to echo, and nobody heard it.'"
But the St. Louis police report states that Crews killed himself in the Ambassador's Suite, the hospital's main waiting room, which was under 24/7 video surveillance, Harvel says.
"How could his body just sit there for over an hour with no one noticing?" she says.
From across the room, Harvel's husband Tim announces his theory.
"They was blowing smoke up your ass when you were talking to them," Tim Harvel says to his wife. "If security had been there like there should have been, he couldn't get in the door with the pistol to begin with. Something else would've happened instead of him committing suicide. If security had been there at that front desk, at least he wouldn't have killed himself that night."
Marcena Gunter, a St. Louis VA hospital system spokeswoman, declines to address Crews' family's concerns about the quality of his treatment and the hospital's lack of security.
"Our deepest sympathies go out to Mr. Crews' family and loved ones," Gunter writes. Gunter adds that Crews' death "has prompted changes in our facility security plan, which now has an additional level of security at our emergency entrance and patient waiting areas."
Gunter declined to identify the extra security measures now in place. And when an RFT writer visited in both August and early October, we encountered no metal detectors, no front desk personnel and no security officers.
Gunter acknowledges that the Ambassador's Suite area "is typically unoccupied at that hour of the morning and he was not discovered for approximately 50 minutes."
She says the VA St. Louis Health Care system has three providers on its suicide prevention team and is working to hire a fourth.
"Patients can come here to get the care they need that day," Gunter wrote. "We want veterans and their loved ones to know we stand ready to help whenever possible."
The John Cochran St. Louis VA Hospital, named for the late Missouri congressman, is one of the largest VA hospitals in the Midwest. With 355 beds, it is a full-service health-care facility providing in-patient and ambulatory care in medicine, surgery, psychiatry, neurology and rehabilitation, plus more than 65 subspecialty areas. A two-division facility, it serves veterans and their families in east central Missouri and southwestern Illinois.
The St. Louis VA Hospital system has been the subject of complaints over the years regarding the timeliness and quality of medical care provided to patients.
In 2012, a federal review of Cochran and its sister facility, Jefferson Barracks, reported that staff at both hospitals failed to conduct follow-up checks as required with mental-health patients, including those assessed as "high risk" for suicide.
Dr. Jose Mathews, the former psychiatric chief for the St. Louis VA system, has complained for years about the quality of mental health care provided to patients. Long a thorn in the side of other VA officials, Mathews quit his job at the hospital in early 2018.
Five years earlier, in 2013, Mathews had filed a whistleblower complaint with the federal Office of Special Counsel. Mathews alleged in the complaint that mental health-care staff at the hospital treated patients only a few hours a day and exaggerated their work hours.
In July 2014, Mathews testified before a congressional panel that he suffered reprisals from superiors after disclosing that psychiatrists at the St. Louis VA hospital were seeing patients fewer than four hours a day.
Mathews told the U.S. House Veterans Affairs Committee that "it was as if there was an agreement amongst all the clinic employees to only work for less than half the time they are paid to work."
Two major metrics in mental health care are "engagement and care" and the drop-out rate of patients, Mathews testified. More than 60 percent of veterans showing up at the St. Louis VA hospital "were not coming back for their visits in the outpatient setting. So there was 60 percent attrition rate," he said.
Gunter, in her email statement, discounts Mathews' allegations, calling them "several years old" and deriding them as "largely unsubstantiated after being thoroughly investigated four years ago by two separate Office of Inspector General inquiries."
"These largely unsubstantiated allegations have absolutely no relation to Mr. Crews' suicide," Gunter writes. "There was no evidence found of artificial inflating the work hours or productivity, or manipulation of wait-time data ..."
Phillip Crews lived in a small, crumbling house at the end of a cul-du-sac off South Kingshighway.
As of early August, the house was as he left it on the morning he took his life nearly five months before. The only difference was a cut-off notice from gas utility Spire, hanging from the front door knob.
In a handwritten scrawl, a sign posted in the house's front window warns visitors, "If you are not the mailman or a parcel delivery guy, do not come on my property By law!! You will be shot!!!! Survivors will be shot Again!!"
Other crudely drawn signs warn of video and audio surveillance. A side window, its curtains open, shows a house jammed with the detritus of Crews' 62 years on Earth: old power drills and weed whackers, a tool box, a kid's lunch box, car jumper cables, a corner piled high with dirty clothes.
Nineteen-year-old Keith Boyd, who lives nearby, says Crews could get easily upset, Boyd says.
"If he's working on something and he didn't get it correctly, he'll say all these violent words," he recalls. "Like one day there was somebody that threw a can. Phil said, 'Pick it up.' He said, 'Motherfucker, pick that up.' And the guy wouldn't pick it up. So Phil started going off on the guy. And the guy just kept on walking."
John Noecker, Crews' friend and occasional employer, described him as a troubled man of many moods. He could be easy-going and friendly one moment, but thin-skinned and irritable the next.
"I liked Phil. He was a fun guy to be around most of the time," Noecker says. "When he was feeling good he was generous, and he'd help. He'd lend you a hand or a hand-out."
Crews, Noecker adds, was "somewhat of a protector of his neighbors. He wouldn't take any guff from anybody, particularly the police."
Yet Crews suffered from depression and stomach pains, and he relied on painkillers and anti-anxiety medications to deal with his health problems, Noecker says.
"He had to have them all the time," Noecker says. "He finally admitted to me he was addicted to those things. I guess he didn't know what to do about it. He needed them, I guess."
Eating became a painful challenge for him, Noecker says.
"It seemed likely any time he tried to eat something, he'd throw up," Noecker says. "And sometimes they'd give him something that would make him feel better for 24 hours at the most, then, bang, he'd be right back."
In his last few years, Crews talked a lot about suicide, Noecker says.
"It was kind of something we thought he was joking about it at first," Noecker says. "But then in the last few months, we knew it was something that was on his mind. I'd ask him if he was ever thinking about suicide, and he'd say, 'Well, how can I not think about it? You ask me about it every time I come here, you know.' Yeah, he was definitely thinking about it."
Noecker downplayed the threats.
"We just sort of thought, 'Well, that's not going to happen,'" Noecker says. "I couldn't get inside of his head."
Crews and his three siblings — two sisters and a brother — actually grew up in the house on Beck. Their father worked at a local printing plant, and their mother worked in nursing homes and at a coat factory. It wasn't an easy childhood; their father could be a tough disciplinarian, according to Sherry Crews Harvel.
"My dad was very strong," she says, declining to elaborate further.
Phillip Crews had a daughter with a girlfriend after his time in the service, Harvel says, but father and daughter became estranged. Crews, however, became very close to his daughter's daughter, a gifted student who is now fifteen, Harvel says.
Harvel points to a series of photos of her late brother. Several show him posing with his granddaughter.
"As you can tell from the pictures, him holding her, that little girl was everything to him," Harvel says. "He lived and died for that little granddaughter there."
In his last year of life, Crews began talking more often about taking his life, Harvel says.
"He was hurting so bad, he said, 'Man, I'm sick of this. I'm not going to live like my mom,'" Harvel says, noting their mother suffered immense pain as a result of the colon cancer that eventually claimed her life.
After years of complaining to the VA, Crews was finally allowed to see a private physician, who diagnosed an inflamed stomach lining. But the VA would not pay for subsequent visits to the private physician, Harvel says.
By this point, Crews was dealing with after-effects from a heart attack, worsening diabetes and depression. His medical problems made it difficult to work, so his financial situation also spiraled downward, Harvel says.
Then, about a year ago, the VA cut him off from his supply of opiates and antidepressants, touching off a new round of threats of suicide, Harvel says.
"At the time we all thought he was blowing off steam," she says. "We never thought he'd really do it. But then, towards the end, when he was getting all his stuff in order, we knew then he was going to do it."
Crews belonged to three groups of Americans especially susceptible to suicide: He was a military veteran, he was a white and middle-aged male, and he owned a handgun. Suicide rates for all three groups have been soaring in recent years.
Last year more than 45,000 Americans took their lives, a staggering statistic reflecting the fact that America's suicide rate has increased by almost 30 percent in less than two decades, the Centers for Disease Control and Prevention reported June 7.
The rate for white Americans ages 35 to 64 jumped 40 percent from 1999 to 2010, with men more than 3.5 times more likely to kill themselves than women.
Experts cite a wide range of reasons for the sharp jump, including easily accessible painkillers, the lingering effects of the last decade's mortgage crisis and the challenges of an economy in which wages are stagnant and job security is increasingly rare.
Missouri's suicide rate rose 36.4 percent, while Illinois' climbed 22.8 percent. Missouri's suicide rate is now thirteenth highest in the nation.
Elizabeth Matoushek, crisis intervention chief for St. Louis-based Provident Inc., says the increase in suicides in Missouri could be caused by a myriad of factors, including financial stress, retirement uncertainty, family struggles and a lack of connection with other people. "All those things can come together into a perfect storm for some people that could lead them to believe that suicide is the only option for them right now," Matoushek says.
It doesn't help that gun ownership is widespread in the Show Me State, where hunting is a popular pasttime.
"Any home that has a firearm in it has a much higher risk that somebody in that home will die by suicide, no matter what the person could do to secure or separate the ammunition from a gun," Matoushek says. "Seventy percent of people who think about suicide act on it within one hour."
Missouri also exceeds the national average when it comes to the suicide rate for military veterans. In Missouri, it's 47.2 per 100,000 people, compared to 38.4 nationally, according to a recent Veterans Administration report.
Even when mental health care is available, veterans are often reluctant to access it because of the stigma that attaches to mental illness, Matoushek says.
"They're lacking that connection, that brotherhood the military can give them," she says. "Sometimes men struggle to know, 'Who am I? What is my purpose in being here if I'm not part of this brotherhood?'"
Crews joined the U.S. Marine Corps at age seventeen after dropping out of Cleveland High School on the city's south side. He served as a Marine for more than two years, training as a surveyor, before receiving an early discharge under "honorable conditions" in 1974, according to his military records.
Crews blamed the VA for his physical problems, Noecker says.
"He said, 'I don't know what good it does to go,'" Noecker recalls. "Sometimes they'd keep him in the waiting room until nine o'clock at night."
The hospital staff would admit him and allow him to stay overnight. "Then the next morning they'd kick him out to free up the room for someone else," Noecker says.
Like Crews' sister, his nephew Harrison recalls the trouble that followed the VA's decision to cut off his prescriptions.
The first time was ten years ago. "They pulled his medication out from under him," Harrison says. "Well, he was doing fine with the opioids, working every day, dealing with the pain, having no problems, and then they pulled it out from under him, so all he had from then on was just pain, until like the last year." (Gunter, the spokeswoman, does not address allegations that Crews originally became addicted to opioids thanks to prescriptions he received at the VA.)
After that, the VA started giving him opioids again, "but they didn't do him any good," Harrison says. "He still had all the pain, and he kept telling them, 'Look, they're not doing me any good. I need something to get rid of the pain. You need to find out what's causing it. I need something for the pain, but I want to know why I'm hurting so damn bad all the time.'"
About a year ago, the VA again decided to cut him off, according to Harrison.
"'That's why you're hurting,'" Harrison says VA doctors told his uncle. "He's like, 'Fine, I guess I'm hooked on them.' And then they started telling him the reason he was having so much pain is because he's hooked on them and he was trying to cut back off of them. I think it was all bullshit."
In Crews' last month, things took a turn for the worse.
"He was in so much pain. He couldn't eat, he couldn't sleep," Harrison says. "He was in so much pain for the last month or so, maybe two months, he couldn't eat anything, he couldn't keep it down. He was shitting all over himself. He couldn't go to sleep. He couldn't lay down in bed. He couldn't sleep at all. He'd get very little sleep, if any. He couldn't work."
Finally, Crews reached a breaking point, telling Harrison, "Look, I can't live like this. I'm not going to live like this. And I can't pay my bills if I can't work."
Crews' remains are buried at Jefferson Barracks National Cemetery in south county.
Harrison helped arrange Crews' burial, as well as the subsequent family reception at a nearby sports bar. Harrison recalls a rifle salute and a bugler playing "Taps." "It was a nice funeral, I can say that," he says.
Harrison still thinks about the night his uncle called him just before taking his life.
Harrison was on vacation, and Crews' phone call woke him up at 3:30 a.m.
"And he said he was going to the VA and doing it then," Harrison says. "I told him, 'I'm on vacation' and 'Don't do anything until I get home.'"
"He said, 'I ain't waiting no more.'"
Months later, in early September, Ameren cut the power to Crews' house on Beck Avenue. The outdoor lights that had provided some measure of security went dark.
On the same night the power went out, thieves kicked in the house's back door and cleaned out everything, Harvel says.
"As soon as they seen the lights were out they were in there," she says. "There was nothing left. They took it all. Everything."
For those struggling with suicidal thoughts, the National Suicide Prevention Lifeline is available 24/7. It is free and confidential. Its number is 1-800-273-8255.
RFT contributing writer Mike Fitzgerald can be reached at [email protected].