By Brigid Schulte and Tom Jackman
Washington Post Staff Writers
Thursday, August 20, 2009
The missing mental health records of Seung Hui Cho, released Wednesday afternoon, provide more evidence that Virginia Tech's counseling center and the state's mental health system failed to recognize, communicate and treat the gunman's increasingly erratic behavior.
But the triage forms, e-mails and Post-It notes provide no window into Cho's tortured mind.
The records indicate that Cho sought help at the university's Cook Counseling Center three times in November and December 2005, twice on the phone and once in person. Each time, he was assessed but not treated.
On Dec. 14, 2005, the day Cho was released from a psychiatric hospital, was declared a danger for threatening to kill himself and was ordered by a judge to receive involuntary outpatient treatment at Cook, the therapist who saw him there did not evaluate his mood. Instead, she drew an "X" through the preprinted triage form.
"Did not assess," therapist Sherry Lynch Conrad wrote. "Student has 2 previous triages in past 2 weeks. Last 2 days ago."
At the psychiatric hospital, just hours before, Cho had been given Ativan for anxiety and was assessed as having a mood disorder, the newly released records show.
"Patient very non-verbal, very quiet, sits in the chair looking down at the floor, does not blink," the records say. "No smile, no laughter, no crying."
Cho had been temporarily detained at the hospital, Carilion St. Albans in Christiansburg, after telling a roommate that he had "blades" in the room and that he might as well kill himself after a female student reported his harassing behavior to campus police in 2005.
In the records, Conrad dismissed the incident. "Said the comment he made was a joke. Says he has no reason to harm self and would never do it," she wrote.
Counselors at Cook have long maintained that they were never informed that Cho was ordered to undergo treatment with them. Instead, Conrad noted that Cho was in her office for a "follow-up." Conrad ended the 30-minute session by encouraging Cho to return in January. She did not schedule an appointment, and Cho never returned. About 15 months later, he would kill 32 students and teachers before killing himself.
On Dec. 14, 2005, at 4:32 p.m., center director Robert Miller forwarded an e-mail -- also released Wednesday -- that he had received about 11 a.m. about Cho's temporary detention order and examples of his bizarre, troubling behavior. "Fyi in the event this student is seen here," he wrote. Cho, who arrived at 3 p.m., had already come and gone by then.
On Dec. 12, a different counselor triaged Cho over the phone and noted that Cho was depressed, had episodes of panic and anxiety and was engaging in self-destructive behavior. When therapist Cathye Betzel, who specializes in women's issues and couples therapy, asked whether Cho was able to interact with friends, classmates and family, Cho responded "No." A pre-doctoral student intern likewise triaged Cho by phone Nov. 30 and concluded much the same thing, labeling him "troubled."
Officials at Virginia Tech said the records show that the counseling center staff "acted appropriately" in evaluating Cho.
"The absence and belated discovery of these missing files have caused pain, further grief, and anxiety for families of the April 16  victims and survivors, as well as for the Cook Counseling Center professionals who interacted with Cho and created and maintained appropriate departmental records," Virginia Tech spokesman Mark Owczarski said in a statement.
But Suzanne Grimes, whose son was shot and seriously wounded by Cho, said the university "completely blew it."
"You can't have a person walking around who can't communicate with family and friends and think he's all right," she said. "Especially when he talks about killing himself and nothing happens. Nothing. They just sloughed it off."
All three Cook Counseling Center triage forms noted that Cho had neither suicidal nor homicidal thoughts.
Cho's family agreed Aug. 4 that the records should be released. "My mother, father and I all agree that it is the correct thing to do to release the newly discovered medical records of my brother," Cho's sister, Sun Cho, wrote to the family attorney.
A panel created by Gov. Timothy M. Kaine (D) to investigate the state and local systems that allowed Cho to fall through the cracks already had criticized the Cook staff for failing to "connect the dots" about Cho, as well as for losing his records. "The system failed for lack of resources, incorrect interpretation of privacy laws, and passivity," the panel wrote.
With the release of Cho's records, what emerges is a counseling center in disarray in the fall of 2005, at just the time when an increasingly erratic Cho was finally persuaded to seek help.
That fall, the center's one staff psychiatrist had taken a leave of absence and never returned. Articles published in the student newspaper, the Collegiate Times, warned that the center was understaffed and that students in need of mental health prescription medications were often required to drive as far as 45 miles to have them filled.
In court papers released Tuesday, Miller, who was director of the counseling center from 2002 to 2006 and had worked there since 1988, acknowledged that he was fired shortly after calling for an independent consultant's review in December 2005.
The staff at Cook told investigators after the massacre that they never accepted students who had been involuntarily ordered into outpatient treatment, as Cho was. However, local lawyers said that as a matter of practice, they did it all the time.
"I ordered a few people to Cook," said Joe Painter, a Blacksburg attorney who used to serve as special magistrate overseeing mental health commitment proceedings. "And they did take them."
Miller "inadvertently" packed Cho's records, along with those of fewer than five other students, with his belongings when he cleaned out his office in late February 2006. Miller did not treat Cho.
After years of assuming that the records were missing or destroyed, Miller discovered them in his home in July after he had been named in a lawsuit filed by the parents of two of Cho's victims and he was required to thoroughly search his home.
Staff researcher Meg Smith contributed to this report.