Colleges bound by privacy law, medical ethics


Virginia Tech Shootings

April 19, 2007|By Gadi Dechter and Frank D. Roylance | Gadi Dechter and Frank D. Roylance,SUN REPORTERS

Even with early warning signs and multiple campus interventions - as in the case of Virginia Tech gunman Cho Seung-Hui - a university's options for dealing with mentally ill students are limited by privacy laws and medical ethics.

Despite two encounters with campus police in 2005 after harassment complaints by female students, and a brief commitment at a psychiatric hospital because of fears that he was suicidal, Cho remained a Hokie in good standing even as he plotted the massacre of 32 students and faculty Monday in Blacksburg, Va., authorities said yesterday.

Those and other revelations, such as the 23-year-old's twisted writings and sullen behavior, have caused many to wonder why Virginia Tech officials did not alert others to Cho's condition or ensure that he got as much psychiatric treatment as he apparently needed.

"We're upset the school system did not let us know this kid had problems," said Wayne Aust of Westminster, whose son Joe, 19, shared a room with the gunman. "Nobody knew nothing."

The depth of Cho's disturbance was underscored yesterday when NBC aired a package of DVDs showing Cho brandishing his guns and uttering threats and accusations. The package, sent to the network, was postmarked at 9:01 a.m. Monday, after the first two shootings but before the slaughter at Norris Hall.

Under federal law, universities must keep private, even from parents, most of an adult student's nonviolent disciplinary records, experts said. And medical records are protected by doctor-patient confidentiality.

But in the aftermath of the killings at Virginia Tech, there is a natural tendency to look for missed opportunities where officials might have intervened.

"We are really looking for, presumably, a living source to put some blame on," said Dr. Jack Vaeth, an Annapolis physician who specializes in college psychiatry. But "often it's really not preventable, or barely preventable."

Campus counseling centers across the country deal with disturbing or merely odd student behavior all the time, said Rick Hanson, president-elect of the American College Counseling Association and director of the center at Rockhurst University in Kansas City, Mo.

"Every semester, students, ... faculty or staff raise red flags around behaviors they're seeing as odd, bizarre or unusual," he said. "They're not sure whether they're potentially harmful or just kind of weird."

In most cases at public colleges, there's nothing to be done, because the U.S. legal system has long recognized the right of adults in society to be odd. But colleges and universities have a sometimes-competing obligation to provide an environment for students and faculty that is conducive to safety and learning.

Increasingly, schools are establishing a variety of "early alert systems." Two years ago, the University of Maryland, College Park established the Behavior Evaluation & Threat Assessment Resource Group, said John Zacker, director of student conduct.

The task force of campus police, student affairs and mental health counselors meets at least once a month to evaluate any complaints of student behavior that might constitute a threat to the university community, Zacker said.

Even with such initiatives, experts say that college administrators can only respond to the behaviors they are presented with.

In the Virginia Tech case, the two women who complained said they considered Cho's calls and computer messages "annoying" but not threatening, Wendell Flinchum, the campus police chief, said yesterday. A court-ordered medical examination conducted Dec. 14, 2005, found that Cho's "affect is flat. ... He denies suicidal ideations. He does not acknowledge symptoms of a thought disorder. His insight and judgment are normal."

Reports that Cho wrote disturbing plays and other items would not necessarily signal that he posed a threat, Vaeth said.

"I've seen a lot of strange writing from kids," he said, and creepy artwork, too. "Adolescents do have a tendency to reflect on life and death."

When students break a university's code of conduct, administrators sometimes compel them to undergo a medical evaluation when an underlying mental health problem is suspected.

"If we think someone is a threat to themselves or others ... we do have ability to require them to participate in a psychological assessment that would help find an appropriate solution for that student and the community," said Jim Osteen, UM's vice president for student affairs.

But absent a continuing imminent threat of violence, any diagnosis of mental illness would be shielded by doctor-patient confidentiality rules. Ethical codes and federal privacy laws prevent the disclosure of student medical information even to their parents, unless the student has given explicit permission.

That changes when the patient says something that, in the care provider's judgment, constitutes a direct threat to commit a violent act such as homicide, suicide or child molestation.

"This is one of the few ways we do break confidentiality," Vaeth said.

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