Written by Amanda Coers – In the Land of the Free and the Home of the Brave, it is the bravest among us who are finding themselves enslaved to substance abuse and shackled by a system that fails to offer support for our veterans. Here in Brownwood, the recent trial of Joshua Stovall, a United States Army Veteran charged with a long list of drug related offenses, has put a face to the epidemic.
His story raises questions about the overprescription of painkillers for veterans, the lack of comprehensive treatment programs for PTSD, and a black-and-white criminal justice system dealing with the murky gray area of veterans struggling to integrate into society while battling the aftereffects of war.
MEDALS FOR VALOR COME WITH PTSD, TBI, AND ADDICTION
Josh graduated from Early High School in 2002 and attended Ranger College and Cisco Junior College. He, like many other young men and women, felt duty-bound to join the military in the wake of the September 11th Attacks as the United States entered into The War on Terror.
He told his mother, “I’ve got to go over there mom, because if I don’t then someone else in my family will.”
Josh went to Army basic training in 2005, and was almost immediately deployed to Iraq in early 2006, where he served for 11 months. Josh was a Calvary Scout, also known as 19 Delta. As a Cavalry Scout, he was responsible for being the “eyes and ears of the commander” during battle. Calvary Scouts engage the enemy in the field, track and report their activity and direct the employment of weapon systems to their locations.
On multiple occasions Josh was directly engaged with enemy combatants, with at least three separate incidents involving explosive devices. He sustained a back injury from a bullet hitting his body armor, causing chronic pain from blunt force trauma. Josh still carries shrapnel in his body. One – if not all – of the incidents involving explosive devices contributed to Josh sustaining a traumatic brain injury (TBI).
The traumatic brain injury may have affected the frontal lobe of his brain, considered the “emotional control center” and home to our personality. Frontal lobe injuries have been documented to cause changes in judgement, impulse control, and social behavior.
By 2007, Josh’s health was deteriorating with a Crohn’s Disease diagnosis, signs of PTSD, and issues with the shrapnel in his body. Around this time he was prescribed fentanyl and tramadol. Fentanyl, also known as fentanil, is an opioid pain medication 50 to 100 times more potent than morphine, and tramadol is also documented to be highly addictive.
Josh was referred to the Army’s Medical Evaluation Board in 2009. He was released from duty, according to military records, for injuries that were incurred as a direct result of armed conflict. His disabilities listed include PTSD, traumatic brain injury, Crohn’s Disease, and obstructed sleep apnea.
Sleep apnea — a common sleep disorder in which breathing frequently stops and starts — is potentially serious, and often linked with PTSD and TBI. In a recent study, researchers looked at almost 200 Iraq and Afghanistan veterans who visited a Veterans Affairs outpatient PTSD clinic for evaluation. Two-thirds were diagnosed with obstructed sleep apnea, with the frequency of the diagnosis increasing with PTSD symptom severity, according to the study authors.
In 2012, Josh was classified as permanently disabled. He received an Honorable Discharge and is considered a decorated war veteran, with medals and badges for his service. Along with the honors bestowed, he also exited the Army with a serious addiction to fentanyl.
“HE WASN’T JOSH ANYMORE”
His wife Jessica described their relationship as ideal at first. They met in 2006 when Josh was on leave and visiting his family in Brownwood. The pair continued a long distance relationship after he was deployed to Iraq. They married in 2007.
“He was everything a young girl wants in a husband. He was caring, loving, attentive. He made you feel special and beautiful,” she said.
But over the course of the next two years, the symptoms of his PTSD and TBI began manifesting in alarming ways, and Josh was different. His medication prescriptions kept increasing as doctors tried to ‘fix’ the issues.
“He became a walking pharmacy,” his mother, Shirley, remembered.
The once fun-loving young man, known to his family as a “teddy bear” and protector, was withdrawn and depressed. Often during family gatherings, Josh would need to excuse himself from the noise and commotion of celebrations. Family members instructed young children not to sneak up on Uncle Josh, as he was sensitive to quick movements behind him.
“He would sleep through most family functions,” Shirley said. “He also became more hyper vigilant. His behavior was becoming more erratic. You never knew which Josh you were going to get. You might get the really super cool Josh that everyone thinks the world of, or you might get this unfiltered person that you never knew what was going to come out of his mouth.”
LEGAL ACCESS TO MEDICATION ENDS
Between 2010 and 2015, the number of veterans addicted to opioids rose over 50 percent, according to a VA Office of Inspector General’s report. In response to the growing concern, the VA began cutting back on painkiller prescriptions in an effort to curb addiction.
Also read: www.pbs.org/wgbh/frontline/article/veterans-face-greater-risks-amid-opioid-crisis/
In 2014, Josh was one of hundreds of thousands of veterans no longer receiving a prescription for painkillers. He did some “doctor shopping,” hoping to get relief, but eventually, he was left completely without legal access to the medication he had been taking in abundance for years.
Josh became increasingly desperate. His mother’s elderly neighbor had been prescribed fentanyl patches and the temptation was too great. He had grown up next door, and knew the family well. They had always welcomed him and his family into their home, with a ‘knock and enter’ policy.
On May 14, 2014, Josh entered the neighbor’s house and took a box of fentanyl patches. The woman’s daughter noticed the box missing, and immediately contacted Josh’s mother. Confronted with his actions, Josh agreed to his family’s insistence that he seek treatment at River Crest, a facility in San Angelo for drug addiction.
He stayed at River Crest for three days to stabilize, then sought help at the VA clinic in Temple but immediate admission for drug rehabilitation was not offered to him at that time.
Josh continued to battle addiction and depression and his homelife began to unravel. In 2015 Jessica filed for a divorce.
“I thought it would help him,” she explained. “I thought if he lost his family, and hit rock bottom, then he would wake up. But it just made it worse.”
Josh sank deeper into depression and addiction, and criminal acts followed. By 2016 he was often homeless, sleeping in parks, or getting cheap rooms in motels. His addiction now included methamphetamine.
Looking to find help, Josh was admitted into a program at Camp Hope in Houston, a facility that specializes in treating veterans with combat related PTSD. The program is normally a minimum of six weeks, but after completing two weeks of treatment, Josh felt compelled to leave the program in order to attend a custody hearing regarding his daughter. Attempts were made to find treatment at facilities in San Antonio and Fort Sam Houston, but time was running out as Josh racked up 12 felony drug charges.
FACING SERIOUS CONSEQUENCES IN COURT
On October 13, 2017, Josh appeared in the 35th District Court before Judge Steve Ellis with his lawyer for a docket call. He was facing 10 indictments. His lawyer at the time was woefully unprepared for the case and requested a continuance. The request was denied, with the judge explaining the case had been already set for trial for a considerable amount of time. Josh’s family became extremely worried.
Present in the courtroom for the docket call was Aaron Seymour, a local attorney who had been recommended to Josh because he was also a U.S. Army combat veteran. Seeing Aaron, Josh spoke to him briefly in passing, and asked him to take his case, fearing his lawyer at the time was not fully committed. Aaron met with Josh’s family, and spent over 20 hours throughout the weekend reviewing the case and meeting further with Josh.
On the morning of the scheduled trial three days later, Aaron was present to represent Josh. His previous lawyer was absent from the courtroom. Aaron informed the court he had been retained by Josh, and requested approval for the substitution, as well as a continuance in order to prepare. The judge was less than pleased.
However, he was not coming to court empty handed. After speaking with Josh and his family, Aaron negotiated an Open Plea, meaning Josh agreed he was guilty, and would present his case to the court for the purpose of punishment and sentencing. His new lawyer asked the court for more time to prepare their case.
After some consideration, Judge Ellis granted the continuance and the trial was rescheduled for November 14, 2017.
With less than a month to prepare, Aaron and his staff worked nearly around the clock, day and night, to construct their defense strategy, which included an expert witness: Dr. Harold D. Scott, a forensic psychiatrist with unique insight into the world of PTSD, traumatic brain injury, and addiction.
“ADDICTS AREN’T BAD PEOPLE BUT THEY DAMN SURE DO BAD STUFF”
Dr. Scott testified he had thoroughly reviewed Josh’s military and medical records, and had also conducted two interviews with Josh, as well as with his family members.
He was particularly interested in Josh’s experience with methamphetamine. In court, Dr. Scott explained Josh had admitted to trying meth once when he was 19 years old, prior to his military service. Josh said he didn’t like how it made him feel, very jittery, overly excited, and unsettled. But after combat left him with a traumatic brain injury, meth had a very different effect. Now the drug was calming, and according to Josh, it helped him feel focused, and able to calm the chaos he was battling within.
Dr. Scott then explained to the court that Ritalin (methylphenidate) is often a treatment for traumatic brain injury. Methamphetamine and methylphenidate share a similar impact on brain function.
In a sense, Josh was attempting to self medicate.
“It’s not just to get high,” the doctor said. “It was to regain control.”
Dr. Scott also testified Josh’s frontal lobe injury likely caused personality changes, including loss of impulse control, which would give insight into Josh’s descent into criminal activity. He also testified that in his opinion Josh was over exposed to prescription medications while serving in the military, leading to addiction. The combination of addiction and the effects of the brain injury were certainly important to consider in this case.
“Addicts aren’t bad people, but they damn sure do bad stuff,” Dr. Scott told the court.
Dr. Scott testified that consequences for Josh’s illegal actions were definitely warranted and necessary, but he also advised the court to consider prescribing treatment to specifically address Josh’s PTSD and traumatic brain injury.
In the end, the judge agreed. Josh’s crimes demanded consequences, and yet the circumstances that led to the crimes needed consideration.
“If I speak the words today, you will be sent to prison for life. Let that just set in on you. All I have to do is say that,” Judge Ellis began in his address to Josh before pronouncing the sentence.
“In many ways that would be the easiest thing for me to do,” the judge continued. “It’s not just that you used drugs, you were actively involved in the sale and distribution. That’s a lot of poison to spread. I appreciate your service, but that can not be an excuse for your criminality.”
“Now there is a cause and effect here, and I understand that,” Judge Ellis said. “Addiction is certainly a big part of what has happened here. But there are consequences that you brought on yourself. The issue that I’m grappling with is what is best for you, but also what is best for society.”
Joshua Stovall was sentenced by the 35th Judicial District Court to six years in prison, to be followed by 10 years’ probation, which includes court-ordered treatment for substance abuse, PTSD, and traumatic brain injury.
VETERANS TREATMENT COURTS: A PATH TO JUSTICE AND REDEMPTION
For Josh, it could have been a much harsher sentence. But perhaps Judge Ellis’ pronouncement signifies a shift in how courts view the individual circumstances of veterans who are still paying a price for their service.
In 2008, the Center for Mental Health Service wanted to look at ways to decrease the involvement of veterans in the justice system and provide them with mental health treatment instead. It was the desire to serve those who had been of service that led to the establishment of Veterans Treatment Court.
Veterans Treatment Courts are based on the Drug Courts and Mental Health Courts begun in the 1990s. The goal of these courts is to keep those with mental health issues out of the traditional justice system. Instead, the courts offer a chance for treatment. Each Veterans Treatment Court established is part of a community’s local justice system, and also partner with local VAs and Veterans’ organizations. Since the first Veterans Treatment Court in 2008, the number of courts has been growing. By 2010, there were over 40 Veterans Treatment Courts in the United States.
Through a treatment court, veterans accepted into the program could have their criminal charges placed on hold while the court helps them address underlying issues: homelessness, unemployment, substance abuse and PTSD treatment.
In April 2016 the Brown County Commissioners Court heard a proposal for a local Veterans Treatment Court to be established in this area. The initial presentation needed some additional work and the proposal was tabled to allow for more research. Currently two local veterans Larry Pullian and Eddie Gomez plan to present the idea again to the county commissioners in early 2018.
“Wars don’t go away and neither do warriors, unless you send them to prison, and nobody learns anything like that,” Gomez told KTXS in a recent interview.
Certainly with the establishment of more comprehensive services for our veterans that include a better understanding of PTSD, traumatic brain injuries (and the symptom overlap of the two that can often lead to misdiagnosis), substance abuse programs, and Veterans Treatment Courts, communities can see fallen heroes get back on their feet.
Author’s note: I had contacted Dr. Harold Scott regarding Josh’s story and asked whether or not the over-prescription of opioids had contributed to his path to jail, and if alternative pain management methods would have resulted in a different outcome for Josh. Dr. Scott was gracious to write a response which I’m including here.
One veteran’s case … a commentary from Dr. Harold Scott
Amanda,
I apologize for my non-response yesterday when you approached me for my comments about opioid addiction, and specifically its impact on combat-veterans such as Josh Stovall. I appreciate your understanding that I could not comment further about Josh (beyond my court-testimony) without his expressed permission to do so… subsequently retrieved from someone with his Power of Attorney.
You asked if a non-opioid approach in treating Josh’s pain while still on active-duty might have circumvented Josh’s eventual legal predicament. Upon my first weighing the authenticity of pain-related complaints, it is likely that Josh’s pain originated with blast-induced (IED) injuries, which culminated in documented “mild TBI” (traumatic brain injury). Further, his “plate” (i.e., body-armor) served to prevent a penetrating gunshot wound. However, upon absorbing the impact of a projectile fired from close range, that energy is necessarily distributed by the plate, rendering the soldier vulnerable to secondary musculoskeletal injury (and pain) not uncommonly affecting the neck, shoulders, and lower back.
As matters unfolded, it is doubtlessly true that access to excessive doses of narcotic analgesics (“opioids”) did not translate to a service to this patient. Undeniably, the medical profession is absolutely contributory to our national, opioid epidemic. In my scrutiny of Josh’s record, including over 500 pages from the VA, I discovered one instance where he was supplied enough Tramadol (a narcotic analgesic) to average 17 a day!
But Josh’s difficulty was not limited to opioids. With his severe PTSD-related anxiety came access to benzodiazepines and subsequent abuse, thereby presenting an additional problem which itself required attention. Eventually, meth came to be abused and, alongside addiction, criminal acts predictably followed, with recidivistic misconduct until incarcerated.
What does our common-sense tell us about addiction? First, some substances are more addicting than others. As demonstrated by Josh, benzodiazepines, opiates, and amphetamines all fall into that category. Also, certain substances in each class can impose a greater risk (For example, the shorter-acting benzodiazepine Xanax, as compared to the longer-acting Klonopin). Next, some individuals are more susceptible to addiction than others. Other, untidy variables intrude, such as the fact that many victims of mild TBI have their agitation alleviated, and their cognition improved, by agents (such as meth) which enhance the effect of the neurotransmitter dopamine. So, as we denounce someone for trying “to just get high”, do we still feel so smug if that person was instead seeking simply to feel normal and in control, with a brief respite from an endless storm of torment and emotions which most of us will never encounter?
Not everything about Josh’s case is negative. The citizens of Brown County are fortunate to have on its judicial bench Steve Ellis to administer justice, tempered by compassion whenever warranted. I believe he meted out firm consequences to Josh, while imposing a structured opportunity for meaningful treatment and rehabilitation. My own role was simply to share some relevant truths (about diagnosis, treatment, etc.), and never intended to insulate Josh from consequences which are themselves actually therapeutic. Attorney Aaron Seymour presented his client’s case conscientiously, bolstered by an empathy which unintentionally revealed that he himself had not emerged totally unscathed from his own combat experiences. Prosecutor Chris Brown is a no-nonsense, law-and-order guy, who dutifully reminded all of us in the courtroom (to paraphrase): “Ultimately, doctor, doesn’t it all come down to our choices?”
Notwithstanding my ample respect for Chris Brown, I believe we are well-served to acknowledge that, by allowing complex human experience to be reduced to our mere choices, we might in fact be making a choice …a choice to be dismissive of those realities which can erode our very capacity to make adaptive choices. The capacity to make good choices can be undermined by the compelling forces of addiction which (appropriately) is hardly a get-out-of-jail-free card in our culture. In Josh’s case, the capacity to make choices has been further eroded by TBI-induced loss of judgment and those feedback-circuits necessary to censor thoughts, emotions, impulses, and behaviors. Importantly, these acknowledgments are included to impart a truthful understanding, not a lingering excuse.
I absolutely concur with Chris Brown that the prognosis will be determined by Josh’s future choices. We are all relatively powerless to ensure that Josh will thrive, or even survive. But even those future choices to be faced by Josh are impacted by other human forces, not the least of which are hope, resiliency, perseverance, and a baseline sense of self-worth bolstered by love from his family and from whatever few friendships which might have survived. The future will reveal whether a happy ending can be realized, or merely further acts of this all-too-familiar contemporary play. Sadly, other actors, many with similar scripts, await my attention.
Harold D. Scott, M.D.
11/17/17
