An Air Force veteran who told Tripler Army Medical Center personnel that he intended to jump to his death from a top floor of the hospital and then did so days later would still be alive if Tripler heeded his pleas to be admitted for severe depression, his widow believes.

Twice before Robert Roth, 50, jumped to his death Jan. 2, he went to Tripler's emergency room seeking to be admitted, even telling medical personnel the day after Christmas that he planned to commit suicide by jumping from the top floor of the hospital, according to an April 4 Army investigative report into his death. During his other visit, on Dec. 16, he told medical personnel he planned to jump off a cliff in Makapu'u, the records show.

The Roth case may add to an ongoing national controversy on the quality of mental-healthcare for military members and their families.

The military's mental-healthcare network is under tremendous strain because of the Iraq war — many soldiers are returning with psychological problems — and because of a shortage of professionals to treat them.

Roth, who suffered from a bipolar mood disorder, had a long history of depression and was on antidepressant medication at the time of his death. He jumped from a 10th-floor balcony not far from where he worked as a ward clerk at Tripler. He served 20 years in the Air Force as a medic and paramedic and retired in 2002, suffering from post-traumatic stress syndrome.

On his first ER visit, he waited more than five hours and never saw a psychiatrist, only a physician training to be one, and on his second visit, he waited about three hours and left angry — and against the wishes of medical personnel — because he hadn't been seen yet by a physician, according to his medical records, the investigative report and attorney Rick Fried, who represents the widow.

The reason for the long wait on Dec. 26 was related to staffing: Roth was told that because of the holiday, only one doctor was on duty in the ER.

"Patient feels he's been blown off and wants to get admitted to hospital," an ER nurse wrote in Roth's records.

Although Roth had been seeing a Tripler psychiatrist since 2005, going every two or three weeks, his medical records provide no indication that ER personnel consulted with the psychiatrist on either visit, nor do the records indicate she was aware that he had been speaking about committing suicide when she saw him a day or two after each visit.

The records and investigative report also hint at other gaps in the system. Medical personnel, for instance, could not explain to investigators why Roth was able to drive away Dec. 26 because, the report said, his car keys should have been held by the ER staff. The investigators also were told that Tripler's ER did not have any written standard operating procedures for handling patients with suicidal intentions.

On both visits, Roth brought a small bag packed with personal belongings because he expected to be admitted, Fried said.

Fried said his client, Satsuki Roth, 47, blames Tripler for her husband's death.

"There were a lot of chances to save this guy," Fried said. "She feels had Tripler done their job, her husband would be alive today."

Fried said she did not want to speak to reporters about the case.

NOT UP TO JOB

Tripler officials did not respond to repeated phone messages yesterday afternoon seeking comment. It normally does not comment on pending cases.

Satsuki Roth has filed an administrative claim seeking damages for what she considers medical negligence on Tripler's part. If the case isn't settled by late November, the end of a required six-month waiting period for resolving administrative claims, the widow is free to file a malpractice lawsuit against the federal government.

In late September, a mental-health task force visited Tripler as part of a worldwide tour of 38 U.S. military hospitals.

The panel concluded that the military's network of mental-health professionals was "woefully inadequate" to meet the growing needs of service members, not sufficiently accessible to them and was inadequately trained. The panel did not specifically mention Tripler in its findings.

'THEY SCREWED UP'

Fried said the Roth case was a prime example of the system's shortcomings — a sentiment echoed by Arizona resident Leslie Roth, the 53-year-old brother of the suicide victim.

Leslie Roth said Tripler botched his brother's care despite his pleas for help.

"I blame them completely," Leslie Roth said in a phone interview. "He asked for help, he begged for help, and they screwed up."

Roth first informed The Advertiser about his brother's case in late April — before many of the details were known to the family. Once Fried obtained the investigative report this week, he provided a copy to the newspaper yesterday.

According to the report and Fried, on the day of Roth's suicide, he put on his favorite shirt, told his wife he loved her and went to work, bringing a packed bag of personal belongings. Roth, still suffering from severe depression, apparently believed he had an appointment with his psychiatrist that day and was expecting to be hospitalized — even though his appointment actually was the next day, Fried and the records indicate.

CRIED FOR HELP

When Roth showed up at his psychiatrist's office, it was closed because of a federal holiday — former President Ford's funeral was that day — so he then went to the psychiatric ward, which also was closed.

From there, Roth went to the 10th floor about 11 a.m. and jumped off a balcony walkway outside an emergency exit that was accessible because a maintenance crew had deactivated the alarm earlier that day to do some work, according to the report.

His body was found by landscape workers who had heard a loud thud near some air-conditioning pipes on a third-floor roof. Roth, fatally injured, was crying for help. Although medical personnel quickly attended to him, he was pronounced dead a short time later. His black overnight bag was found on the 10th floor.

Roth, who served 20 years in the Air Force, had been hospitalized in 1999 at Tripler because of his severe depression, according to Fried, who said Roth's problem tended to flare up every five to eight years.

Tripler's ER personnel apparently were sufficiently alarmed by his suicide talk on Dec. 26 to try to force him to stay at the hospital.

When he fled the ER after refusing to sign agreements that he was leaving against medical advice and that he would not attempt to commit suicide and would see a professional the next day, two staff members ran after him and tried to block his car from leaving the parking structure, according to investigators.

But Roth swerved his car to get around them and headed for Tripler's front gate.

ROTH WAS GONE

Informed about what happened, a police officer at the hospital attempted numerous times to call the front gate to alert the guard, but the phone was repeatedly busy, the report said. By the time the officer got through, Roth already was gone.

The following day, a Tripler staffer called the Roth home to check on him, but neither he nor the wife were there, the report said. At that point, the staffer checked the medical records and learned that Roth had seen his psychiatrist that day, leaving the staffer satisfied Roth was getting appropriate care, according to the records.

Throughout his treatment, the Tripler psychiatrist said Roth never expressed suicidal ideas and indicated he never would take his own life, the documents say. When the psychiatrist saw Roth on Dec. 27, she noted that he showed "no suicidal tendency, no suicidal ideation, no suicidal plans, no suicidal intent," according to his records.

Fried, who has handled other Tripler cases, said they all had a common thread. "That's been one of my problems with my Tripler cases — a failure to have communication between doctors, nurses and so forth," he said.

Reach Rob Perez at rperez@honoluluadvertiser.com.