Paragraphs 12 through 15 read: "Bianchi's notes from a July 3, 2002, session, for example, detail Gardner's mental health. He was worried, depressed and having difficulty sleeping."
"There were also ''feelings of guilt, a decrease in excitability and hostility (with) homicidal ideation (without) plan,'' according to Bianchi's progress notes."
"She ordered an increase in his prescription for Zoloft."
"'Dr. Bianchi did not refer Patient 1 to a psychiatrist immediately as she should have done upon being notified of a patient's homicidal ideation,' the letter states."
VA pharmacist treated troubled man
By ROB JOHNSON
The deputy U.S. marshals rolled the hulking Michael Gardner and his wheelchair out of a federal judge's hushed Nashville courtroom and straight toward an eight-year prison sentence for a terrifying shooting spree at the Alvin York VA Medical Center in Murfreesboro two years ago.
While the criminal case against the former Veterans Affairs janitorial supervisor mostly ended at that moment last week, a federal tort claim against his old employer continues to rage because of new allegations that the man known as ''Big Mike'' had sought VA counseling in the months before his rampage and was treated with psychoactive drugs administered by a staff member who isn't a doctor.
VA records show that Gardner was exhibiting ''homicidal ideations'' more than a year before he stalked the hallways of the hospital Oct. 7, 2003, firing birdshot at co-workers and police officers. He dropped his shotgun and surrendered before anyone was injured.
His accumulating mental-health troubles, though, were well known to Vicki Bianchi, a clinical pharmacist at the center. Records show that she had been treating him with antidepressants, administering drugs without the oversight of VA psychiatrists.
A close Gardner friend said she watched his physical and mental health decline precipitously in the months after an equal-opportunity dispute with the VA. So the veteran asked for counseling.
''There was a combination of things that were taking a toll on him,'' Gardner's close friend Donna Primm said last week. ''And I know that he thought he was getting qualified help from the woman who was counseling him.''
What caused her friend to walk into his workplace and start shooting, Primm does not really know.
''But I know this. Every man has his breaking point,'' Primm said. ''And at the VA, I think Mike went well past his.''
VA care questioned
While she doesn't condone what he did that October day, she seriously questions whether Gardner got the right help ? and whether the care he got worsened his rapidly declining mental health.
Meantime, VA officials have written Bianchi a letter informing her of their decision to remove her from the staff for a laundry list of alleged procedural violations, including practicing outside the scope of her duties.
Bianchi did not return a message left with a woman answering the telephone at her Nashville home.
Citing pending litigation, Alvin York officials would not comment about procedures at the Murfreesboro facility as they related to the Gardner case.
Nor would VA public affairs officer Molly Reynolds answer questions about how a pharmacist would come to be handling the task of counseling a VA client.
Ron Dooley, regional counsel for the VA, also declined to answer specific questions about the Gardner-Bianchi case, citing civil legal actions filed against the VA by Nashville attorneys David Raybin and David Randolph Smith on Gardner's behalf.
A letter from the VA to Bianchi, though, spells out the administrative allegations against the pharmacist, who remains a licensed professional in Tennessee.
The letter shows an ongoing counseling relationship between Gardner and Bianchi.
Bianchi's notes from a July 3, 2002, session, for example, detail Gardner's mental health. He was worried, depressed and having difficulty sleeping.
There were also ''feelings of guilt, a decrease in excitability and hostility (with) homicidal ideation (without) plan,'' according to Bianchi's progress notes.
She ordered an increase in his prescription for Zoloft.
''Dr. Bianchi did not refer Patient 1 to a psychiatrist immediately as she should have done upon being notified of a patient's homicidal ideation,'' the letter states.
The documents filed with the federal court show that again and again, Bianchi was tracking Gardner's mental health.
She wrote recommendations about how the janitor's shift shouldn't be changed lest the added stress aggravate his state of mind.
She wrote notes to excuse him from his work duties.
On Feb. 12, 2003, she entered another progress note, the VA document states:
'''He is willing to try a sleeping aid at this time because the chronic lack of sleep is causing mood changes and regression of his symptoms. Will add trazadone.'
''Trazodone is an antidepressant used in treating major depression. There was no countersignature by the managing physician,'' the VA document states.
In June, she diagnosed Gardner with post-traumatic stress disorder, citing events from his military service in Korea.
The VA document notes that Bianchi ''has no authority or training to diagnose such a medical and psychiatric condition. There was no countersignature by the managing physician.''
After a series of employment-related disputes at the VA, Gardner arrived one day with his shotgun.
He strolled into an office, restrained one woman and pointed a shotgun at another man, according to assistant U.S. Attorney Trey Hester.
Gardner fired the gun at the desk where the man had been sitting and behind which he'd taken cover.
He left that office and fired through the closed door of an empty office.
He went outside and fired a blast into the windshield of a responding VA police cruiser. He surrendered when the officers returned fire, Hester said.
Gardner told the officers he had only intended to scare people.
He eventually pleaded guilty to assaulting federal employees with a shotgun and agreed to the eight-year prison sentence, a deal which U.S. District Judge Aleta Trauger affirmed last week.
Some of his victims sat on one side of the courtroom at the sentencing hearing. They declined afterward to talk about the case with a reporter.
At the same time, Gardner smiled and waved to relatives and friends who had arrived to lend him their support.
''I love you all,'' he said.
''We love you, too,'' they answered.
Then the marshals took the 53-year-old man away. He probably will be assigned to a prison medical facility because of his diabetes, heart troubles and breathing difficulties, which force him to use a wheelchair.
His friend Primm knows he faces a difficult eight years behind bars.
''When Mike would go dove hunting with my husband and my boys, he would go to one corner of the field with one of my sons,'' Primm said. ''I trust him that much. And if he were somehow able to go hunting again with them tomorrow, I'd still trust him with my sons.''
Rob Johnson can be reached at 664-2162 or at