VIRGINIA BEACH, Va. — On the night of Nov. 11, 2010 — Veterans Day — Darla Grese cried herself to sleep.
She had a bad feeling about her identical twin sister, Kelli.
First thing the next morning, she left her son with a neighbor, telling her, "I have to go to Kelli's. She's dead."
She was so sure of it that she called the police on the way.
The officers went in first. They found Kelli Marie Grese, 37, dead of a self-administered prescription drug overdose. She had taken a massive quantity of the antipsychotic drug Seroquel.
She had tried to kill herself with the same drug three times in the previous eight months, but those doses weren't fatal.
This time, she made sure.
She persuaded her doctor at the Hampton VA Medical Center to prescribe a 120-day supply of Seroquel.
She took all or most of it, according to a pending lawsuit in U.S. District Court in Norfolk.
Her sister is suing the veterans hospital, alleging that by continuing to supply the drug in large quantities to the Navy veteran after three failed suicide attempts, the medical staff there caused her death. The lawsuit, set for trial in April, seeks $5 million in damages.
It will be a case of dueling medical experts exploring a provocative question: To what extent can doctors be held responsible for the drug-induced death of a psychotic, addicted, drug-seeking patient?
Among other side effects, Seroquel carries a risk of suicidal thoughts or actions, according to the U.S. Food and Drug Administration.
Spokesmen for the Hampton medical center and the U.S. attorney's office declined to comment on the case.
Government attorneys argue in court papers that Seroquel is not particularly lethal and was effective in treating Grese's psychosis when taken as directed. Despite her previous suicide attempts, they argue, the greater risk was that she would run out of the drug, which seemed to alleviate her bouts of depression and paranoia.
To Darla Grese, the issue is far less clinical. It's about accountability, she says. She blames the VA doctors — and in particular, their willingness to prescribe copious amounts of drugs — for enabling her sister's suicide.
"Her problems didn't start until she started going to the VA," she said in an interview.
The Grese twins were inseparable.
Born and raised in suburban Pittsburgh, they joined the Navy together after a recruiter visited their high school.
The Navy accommodated the sisters' desire to stay together. They went to boot camp on the buddy system, became hospital corpsmen, shared every deployment and made every promotion together.
While stationed at the Navy hospital in Naples, Italy, they shared a house off base.
On the last night of their tour in 1995, they were awakened by a burglar ransacking their bedroom. The sisters were unharmed, but both were traumatized by the incident, Darla Grese said.
As a result, Kelli Grese was diagnosed with post-traumatic stress disorder in 1996. On the basis of that and her frequent migraine headaches, she was found to have an 80 percent service-connected disability. The sisters left the Navy in 1997 after six years.
That began a 13-year downward spiral as Kelli Grese sought help from VA doctors for a variety of complaints, including insomnia, anxiety and depression.
Darla Grese watched her sister's deterioration with mounting alarm. There seemed to be no continuity of care at the Hampton medical center. Kelli was seen by a number of different doctors. Many prescribed various cocktails of drugs, her sister says.
Her medical records during that period show
she was treated by at least 12 VA doctors who prescribed as many as 25 drugs. She also consulted outside doctors in Hampton Roads and Pittsburgh who prescribed still more drugs.
Early on, Darla Grese said, she went to the chief of staff at the Hampton VA center and told him, "You're killing my sister with all these pills."
But nothing changed, she said; prescription drugs continued to arrive at Kelli Grese's door. She became increasingly paranoid. She thought her phone was tapped, her home was bugged, people were following her, setting her up, out to get her. She had nightmares and flashbacks. She heard voices in her head telling her to harm herself.
The diagnoses piled up: Major depressive disorder. Abuse of prescription drugs, alcohol, tobacco and marijuana. Bipolar disorder. With each diagnosis came more medications.
The psychotic episodes became more frequent. Several times, Darla Grese had her sister involuntarily committed for psychiatric treatment. Each time, she would go through the house and do a drug sweep, removing every pill she could find.
Eventually, she made the painful decision to sell the house they bought together in Portsmouth and move out.
"I felt like I was watching my sister die in front of me," she said. "And I was."
In March 2010, while waiting to see a doctor at the Hampton VA center, Kelli Grese took a whole bottle of Seroquel and was admitted to the intensive care unit with an acute overdose.
Two months later, she tried again. She was found in the back seat of her car on the side of the road, unresponsive. Rescue workers broke into the car and took her to the emergency room of Sentara Bayside Hospital.
The third overdose occurred two weeks after that, during a visit with her mother in Pittsburgh.
On Oct. 19, 2010, according to court papers, she told her VA doctor she was planning a return visit to Pittsburgh and didn't want to run out of Seroquel. At her request, he gave her a two-month prescription instead of the usual one-month quantity.
The next day, she went to the VA pharmacy to pick up the medicine but was told it was being mailed to her home. She then went back to the doctor and said she was headed straight for Pittsburgh and couldn't wait for the mail. Could she have another two-month prescription? The doctor complied.
She never made the trip to Pittsburgh. She now had a quadruple supply of Seroquel, most or all of which she ingested on Nov. 11 at her home in Virginia Beach.
"Kelli was very patriotic, which I think is why she killed herself on Veterans Day," her sister said.
When the police found her, the house was neat and tidy. She had left food and water out for her dog, Rocco. There was a half-smoked cigar next to the recliner, and an outfit facing outward from her closet, which Darla Grese took to mean her sister wanted to be buried in it.
There was also a diary, which Kelli Grese had labeled her "personal journal to recovery."
The entries encompassed "the good, the bad and the ugly," Darla Grese said — ranging from paranoid to hopeful.
On the inside back cover was a note to her sister, which read in part: "Dar:... if this can help just one person to never stop trying then my duty here is done!! Feel no guilt for anything you choose to do with it!... I will never leave you or that precious miracle of a baby! I will always be with you both even if I lose this battle!!"
That last part was a reference to Darla Grese's son, Brady, now 5. "Kelli worshipped him," his mother said. "He still talks about her almost every day."
For Darla Grese, the way ahead without her twin is uncertain. "My life became trying to save Kelli," she said. "I'm still trying to figure out how to live as an individual."
Her lifelong dream was to be an actress.
"My plan was to go to Los Angeles. But I would never leave Kelli. I gave up my dream. And I'm OK with that."
She works as a respiratory therapist at Sentara Norfolk General Hospital and takes acting jobs on the side. She has also written a screenplay, "Sister Surrendered," about her life with Kelli — a process that was painful but therapeutic, she says.
"Not one second have I ever been angry at her for what she did," she said. "Addiction is a disease — a disease that people don't want to talk about.
"But people need to talk about it."