A System in Need of a Dose of Common Sense

By Marc Fisher
Sunday, June 17, 2007

We can all breathe easy now: When Seung Hui Cho passed all too fleetingly through Virginia's mental health system, "everyone did everything that was required by Virginia code." So concludes Kent McDaniel, consulting psychiatrist to the state inspector general's investigation into what authorities did about Cho before he shot 56 people, killing 32, at Virginia Tech.

As the probes into the horrific events of April 16 start to come in, we're learning that Cho's rapidly escalating bizarre behavior was known to even more people than was first reported and that lots of those people tried to get someone to take action -- to no avail.

But we're also learning that when governments investigate themselves, they tend to conclude that everyone did a marvelous job; that there are gaping holes in our mental health system (We're paying people to rediscover this?); and that we've let privacy zealots run amok, rewriting our laws to make it much harder to find the truth about even a massive crime such as Cho's, let alone about ordinary doings in American health care. Just about every investigation into the Tech shootings is running into walls. Until Cho's family authorized Virginia Tech last week to give Gov. Tim Kaine's commission the shooter's medical records, privacy laws had prevented investigators from finding out essential facts, such as whether Cho ever got the outpatient treatment that a court ordered for him four months before the shooting .

Check that: Some investigators do know the truth; they just aren't saying.

At a recent public meeting in Fairfax County, when a member of Kaine's commission asked whether the state court got to see a psychiatrist's evaluation of Cho, McDaniel answered, "I can answer the question -- I know the answer -- but because of issues of confidentiality, I'm constrained."

"It's really rather remarkable," said a visibly frustrated Tom Ridge, the former homeland security secretary who serves on Kaine's panel. "We're talking about a deceased individual who's responsible for all kinds of carnage, and you as a professional are still encumbered by the law."

When I asked James Stewart, Virginia's inspector general for mental health, whether Kaine's commission will be able to gain a full understanding of the Cho case, he replied, "I can't speak to that."

The tangle of privacy laws is so maddening that even the Bush administration, not exactly a big booster of the free flow of information between government and the people, concluded last week in a report to the president that "confusion and differing interpretations about state and federal privacy laws and regulations impede appropriate information sharing" that could identify dangerous students and save lives.

The report by three Cabinet members said concern about liability at colleges is preventing the exchange of information needed to focus attention on potentially dangerous students. The report recommended looking at easing legal restrictions to create a better balance between privacy and security.

In Cho's case, an overemphasis on privacy inhibited efforts to do something about the threat he posed while he was alive. After roommates, neighbors, classmates and professors alerted officials that something was deeply wrong, Tech deans, counselors and police spoke to Cho, removed him from a class and, eventually, took him into emergency custody to see if he should be hospitalized.

But because of privacy laws, the university had no procedure for notifying Cho's family that he'd been taken in for observation, university police were not informed when Cho returned to campus and Tech's counseling center never told the state whether Cho showed up for his court-ordered treatment.

Faculty at Tech express frustration about a system that holds information too tightly. When Kerry Redican, president of Tech's faculty senate, had a student whose wild, paranoid, aggressive scrawls on a test sheet raised major alarms, he called the counseling center. But he was never told what happened. "That's where communication stops because of confidentiality -- need-to-know," he said. For the sake of the student, he said, faculty who see kids every day need to be in the loop.

Some schools take a less legalistic attitude. Peter McDonough, Princeton's general counsel, told the school's alumni magazine that he often asks counselors which "would we rather deal with: a contention or claim of a privacy violation, or a death? I think it's fair to say that, being as respectful as we possibly can be to the various laws, at the end of the day, we're going to try to preserve life."

No system can identify every Cho before disaster strikes. But any system that lets rigid laws take precedence over common sense, human caring and the free flow of information is destined to fail.

"We keep head-injured patients, trauma patients, involuntarily all the time," said Marcus Martin, an emergency room physician who is on Kaine's commission. "We don't rely on the legal system. It should be the same for mental health."


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