The Police Meet With Cho Again
On December 13th, the campus police, for the second time in a month, met with Cho and instructed him not to have contact with a young woman who had filed a complaint about him. No charges were filed. The young woman later told the Review Panel that no one informed her of her rights to file a complaint with Judicial Affairs.
St. Albans Behavioral Health Center for the Carilion New River Valley Medical Center
Police returned the same day, around 7:00 p.m. to interview Cho. This time, the officers took Cho to the campus police headquarters for further assessment and around 8:15 p.m. a licensed clinical social worker for the New River Valley Community Services Board conducted a pre-screen evaluation.
The social worker interviewed Cho and a police officer then spoke with both of Cho’s roommates. She filled out a five-page Uniform Pre-Admission Screening Form. She checked the boxes indicating that Cho was mentally ill, was an imminent danger to self or others, and was not willing to be treated voluntarily. The social worker found a bed at the St. Albans Behavioral Health Center of the Carilion New River Valley Medical Center and contacted the magistrate to request a temporary detention order.
The detention order was issued and at 10:12 p.m. the police transported Cho to St. Albans, where he was admitted at 11:00 p.m. Upon admission, Cho was diagnosed with mood disorder, “NOS,” meaning non-specific. Cho denied any past history of violence but did volunteer that he had access to firearms. He was not on any medication, but was given Ativan for anxiety.
The next morning, December 14, 2005, Cho met with a Clinical Support Representative, at 6:30 a.m. The representative informed him about his upcoming hearing to determine the state of his mental stability. There is no record that anyone at St. Albans contacted the social worker who had diagnosed Cho as a danger to himself or others.
At 7:00 a.m. Cho was taken to a meeting with Roy Crouse, a licensed clinical psychologist, who conducted an independent evaluation. Crouse did not have access to Cho’s medical records. Crouse, however, did have access to the prescreening report containing information from people who knew Cho well and assessed him to be a danger to himself and others. The psychologist reviewed the prescreening report, but because of the early hour, no hospital records were available. Furthermore, he did not speak with—or apparently try to speak to—the attending psychiatrist who had not yet seen Cho. Crouse’s meeting with Cho lasted a quarter of an hour.
Based on this fragmentary information, Crouse then completed the evaluation form certifying that Cho “is mentally ill; that he does not represent a danger to himself or others.” There is nothing in the records that we can find to explain why the St. Albans psychologist, who spent less time with Cho than the pre-screener, disagreed with the initial diagnosis that Cho was a danger. But, in a scant 15 minutes, and without getting further explanation of the initial findings, he overrode the pre-screener and indicated Cho was not a threat. Curiously, knowing that the pre-screener had described Cho as a threat, Crouse checked the box on the form indicating Cho had access to guns.
The checked box for access to guns was later described as having been in done in error and therefore was discarded as a mistake. But, there is no evidence that the checked box was a mistake and the psychiatrist certainly had no evidence of a mistake when he interviewed Cho. That checked box, coupled with the diagnosis that Cho was a threat to himself and others, should have been a huge red flag signaling the seriousness of the situation at hand. But instead, the warning signs were ignored. Why ignore that one entry? Why discredit just one entry? If one entry is wrong, what made the psychiatrist think there were not other errors on the report? The so-called “mistake” excuse appears to be a Monday-morning cover-your-rear-end, for a colossal error in judgment.
Cho was then taken to a commitment hearing. Shortly before the hearing the attending psychiatrist (The Addendum does not specifically give a name, but presumably it was Dr. Jasdeep Miglani, MD) evaluated Cho. The psychiatrist later said he found nothing remarkable about Cho and did not “discern dangerousness” in him. He apparently did not seek to resolve the discrepancy between the pre-screener and the psychologist over whether or not Cho was a threat. His assessment was that Cho was not a threat to himself or others, and he suggested that Cho be treated as an outpatient. The psychiatrist later told the Review Panel that his conclusion was based on Cho’s denying drug or alcohol problems, or any previous mental health treatment.
The psychiatrist acknowledged that he did not gather any collateral information or any information to refute the pre-screeners contention that Cho was a threat. In other words, he made his decision without taking the time to consult the person who probably knew the most about the true depth of Cho’s illness. He also accepted, without question, Cho’s denial of any previous mental health care.
St. Albans’s handling of Cho raises serious questions about professionalism. Nowhere is there any reference about a detailed tool used to evaluate Cho’s mental status. Cho came in with a diagnosis of mood disorder and left with no new diagnosis and no prescribed medication. In sum, Cho was admitted at night, had an initial history and physical (there is no mention of a psychological examination), was medicated with Ativan, and then was briefly evaluated the next morning by Roy Crouse, who did not have access to the information gathered the night before. Crouse apparently did not speak with Dr. Miglani, the attending psychiatrist.
The evidence at hand in the early morning of December 14, 2005, was that a dangerously mentally ill young man had been brought into St. Albans. The handling of Cho at St. Albans raises serious questions about the competency and quality of care and attention given Cho. There was no depth to what was done in examining Cho at St. Albans. He was not given a thorough evaluation, there was no extensive gathering of information, nor was there the development of a solid treatment plan for him. And, there was no follow-up to ensure that he got treatment—at that facility or elsewhere.
The psychiatrist indicated that he did not gather collateral information or information to refute the data obtained by the pre-screener on the basis of which the commitment was obtained, because what he did is standard practice and that privacy laws impede the gathering of collateral information. This is simply not true. If a person is a threat to himself or others, the laws do not impede gathering more information; the laws do not prevent a psychologist or psychiatrist from consulting parents when confronted with a student who is a threat to himself or others.
Some have said that “the system” let Cho down. But what is “the system?” The system is made up of the people who run it. There is no getting away from the reality that the medical professionals who saw Cho at St. Albans failed—they failed miserably and there is no way to sugar-coat that fact by calling it “a system failure.”
To call what happened at St. Albans “a system failure” is purely a way of protecting people who did not do their jobs and preventing them from being held accountable. (To be continued)