The Philadelphia Inquirer Helen Ubiñas column

May 20--THIS WASN'T the first email that Rilma Scott sent colleagues at Pathways to Housing PA alerting them that one of their clients had died.

It was always sad to lose someone with whom she and her team members at the homeless housing group had worked. The emails were her way of offering a final remembrance of someone often forgotten in life.

Last month, Scott sent an email about Mark Wilkins, 59, an Army veteran with PTSD and a long history of drug and alcohol addiction. But in addition to expressing sadness over the loss of a man they had come to know as a gentle giant, Scott's message was filled with a nagging sense of "what if?"

Months earlier, on the very day the city announced that it had "functionally ended" homelessness among veterans, word came that the Philadelphia Veterans Affairs Medical Center was ending its contract with Pathways to house chronically homeless vets. Wilkins was one of them.

The 126 veterans whom Pathways served under that contract were among the most difficult to reach, which was why the VA worked with Pathways. Many had serious psychiatric and medical issues, and had lived on the streets for decades. Others refused services from the VA. They needed the kind of support, attention, and hand-holding that a bigger bureaucracy just couldn't offer.

I met with some caseworkers and veterans in January as they were preparing the transfers. The vets, some of whom cried, feared losing their safety nets. The caseworkers dreaded the day veterans fell through the cracks of a much bigger bureaucracy.

They'd never be able to prove it when it happened, they told me. But they'd know it in her hearts.

A couple of weeks ago, I sat with Scott, a nurse manager, in an empty room where she and team members once met with veterans like Wilkins. Scott had volunteered to be laid off so that some of her younger colleagues could keep their jobs. But she recently had been called back.

Wilkins had been discharged from Pathways on March 31. He died 26 days later in his apartment.

Scott didn't blame the VA. Wilkins was a challenging client. The medical examiner ruled his death as "hypertensive cardiovascular disease-related," Scott said.

"But I think he got his pension check and smoked his drug of choice until his heart couldn't take it anymore," she said.

Even with the members of a committed Pathways team, Wilkins sometimes refused care. But he also knew that they were available to him 24/7, that they'd come running when he called. They often did.

"I'm going to be OK," Scott remembers Wilkins often telling them.

Did he try to call anyone at the VA when he realized he wasn't? Scott wondered.

Could things have turned out differently if he had stayed in the care of Pathways?

There is no way to know for sure. Maybe not. Probably not. But Scott can't help but wonder:

"What if?"

Fern Billet, a spokeswoman for the VA, said she couldn't comment specifically about Wilkins, but said in an email: "The transition of Veterans from Pathways to VA consisted of warm hand-off meetings with VA staff and Pathways staff. All the veterans were already known to VA since they were receiving health care through the VA."

Still, there is no denying that caseloads at the VA are larger than at Pathways, and that the agency has some major issues. During a congressional hearing last year, Assistant Inspector General Linda Halliday called Philadelphia'sVA offices "the most problematic" in the nation. In November, a disabled veteran jumped to his death from a parking garage at the Philadelphia VA Medical Center. He reportedly had been seeking psychiatric treatment.

The veterans I talked to in January said they felt like numbers at the VA but like people at Pathways.

The day before Wilkins was to be transferred to the VA, Scott was supposed to take him to a long-term substance-abuse program. She and other team members had finally persuaded him to get care when a bed was available. But when they went to pick him up, he was gone.

If Wilkins had remained a client at Pathways, she and others would have gone back the next day and the day after to try to find him. But they had to walk away.

"It just seemed like we were on the brink of pulling him back over that bridge he was dangling over," Wilkins said, sighing. "But then we had to just let go of his hand."

She was left to hope that the man who always said he'd be OK actually would be.

Then she got a message from his landlord. Did she know of any relatives? he asked.

Scott's heart sank. She sat at her computer and wrote the email.

"The work we do is hard and often unrequited," she wrote. "But our diligence and dedication to our participants is real. It can be the difference between life and an untimely death for many of the folks under our care.

"Rest in peace, Mark."

ubinas@phillynews.com

215-854-5943 @NotesFromHel

Helen.Ubinas

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