• The Washington Post


Aaron Alexis’ erratic and violent behavior was ignored, overlooked or dismissed for nine years by police, the military, the Department of Veterans Affairs and his employer, creating a series of missed opportunities that might have stopped the Washington Navy Yard gunman, according to records and interviews with officials close to the investigation.

The warning signs were stark but never detected or communicated among agencies, allowing Alexis to move freely around military bases with a secret-level security clearance.

Alexis was arrested three times in three states for acts of rash, inexplicable violence. He told Seattle police in 2004, for example, that he had had an anger blackout so intense that he could not recall shooting three rounds from the .45-caliber Glock he usually kept strapped tightly to his waist.

An upstairs neighbor in Texas in 2010 told police she was terrified of him after a gunshot came through the floor close to where she was sitting. Three other times, in other states, he was cited in police reports for acts of aggression or hallucinations.

Twice, medical staffers at swamped Veterans Health Administration emergency rooms in Providence, Rhode Island, and the District of Columbia failed to pick up on Alexis’ deteriorating mental stability, despite new protocols designed to screen for it, the records and interviews show.

Navy security officials, warned in August by police in Rhode Island that Alexis was hearing voices, a key indicator of a mental break, failed to notify the technology company where he worked, a navy official said, nor did they appear to pass the information up the chain of command.

Alexis’ employer, an IT company called The Experts, was so concerned about his increasingly agitated state over the summer that they called his mother and sent him home to rest, but they say they did not share their concerns with the navy.

His outbursts never made it into a national database that would have notified police among different jurisdictions and turned up in background checks for gun purchases, enlisting in the military or obtaining a mid-level secret security clearance. That system is designed to catch Cold War-era spies intent on selling national secrets, not monitor people for mental health problems.

In fact, some experts said, his security clearance, rather than acting as an early warning system, actually helped Alexis avoid greater scrutiny. His clearance was an indication for many that Alexis could be trusted.

The VA staff, trained to catch and treat such mental instability, often are so overworked and understaffed that they fail to do so, the records and interviews indicate. And military and company officials failed to act on clear warning signals that Alexis was spiraling dangerously out of control.

And so on Sept. 16, about 8:15 a.m., Alexis, who was known for his explosive temper and smoldering grudges, who sought refuge from his jangled thoughts at Buddhist temples and in meditation, and who had been estranged from his family for years, quietly slipped onto the Washington Navy Yard base with a sawed-down Remington 870 shotgun hidden in a bag. He emerged from a bathroom and killed 12 people before police shot him dead.

“The fact is, the VA missed the diagnosis. Twice,” said retired general Stephen Xenakis, a military psychiatrist and former adviser to the Joint Chiefs of Staff. “And that’s not the only shortfall.”

On Aug. 23, and again five days later, Alexis sought help for insomnia at the emergency rooms of two Veterans Affairs medical facilities. In each case, VA officials say, he was asked if he was depressed or anxious or had thoughts of harming himself or others. Those questions became standard after a 2007 lawsuit forced the VA to adopt better mental health screening because of a disturbing rise in veteran suicides.

Alexis denied such negative thoughts and appeared “alert and oriented,” according to a memo that the Department of Veterans Affairs sent to Congress.

Each time, he was prescribed what law enforcement officials confirmed was trazodone, one of the early antidepressants now more commonly used as a sleep aid. Each time, he was told to follow up with a primary care physician. And each time, he was released.

The insomnia complaint, said Barbara Van Dahlen, a psychiatrist who works with military families, should have been a warning. “A sleep disturbance, unless it’s a physical issue, that you’ve got pain and can’t sleep, is pretty much about some kind of internal agitation, depression, anxiety,” she said.

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