One of the victims’ family members filed a complaint with the Virginia Department of Health Professionals, asking that Roy Crouse, the independent clinical psychologist who assessed Cho on the morning of December 14, 2005, and Maisha Smith, one of the counselors at the Cook Counseling Center who triaged Cho, be investigated for possible professional wrongdoing. The investigation report, signed by Patricia Larimer, Deputy Director of the Virginia Board of Psychology, indicates there was not sufficient evidence to determine if a violation of law or regulations governing the practice of clinical psychology occurred.
But a simple reading of The Addendum indicates enough questionable, and possibly unprofessional, behavior on the part of medical professionals to warrant an investigation. Furthermore, if you read the regulations governing the practice of psychology put out by the Virginia Board of Psychology, it is fairly evident, even to a nonprofessional, that these regulations were broken. The regulations governing the practice of clinical psychology state the following:
“Testing and measuring” which consists of the psychological evaluation or assessment of personal characteristics such as intelligence, abilities, interests, aptitudes, achievements, motives, personality dynamics, psycho-educational processes, neuropsychological functioning, or other attributes of individuals or groups.
“Diagnosis and treatment of mental and emotional disorders” which consists of the appropriate diagnosis of mental disorders according to standards of the profession and the ordering or providing treatments according to need. Treatment includes “providing counseling, psychotherapy, marital/family therapy, group therapy, behavior therapy, psychoanalysis hypnosis, biofeedback, and other psychological interventions with the objective or personal goals, the treatment of alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, pain, injury, or disability.”
The problem is that nowhere in Cho’s medical records is there evidence that any part of the above was done. Indeed, medical professionals seemed content to handle Cho with brief phone calls, or at St. Albans with short, quarter-of-an-hour interviews. In fact, there is no way that Cho received any sort of diagnostic care at St. Albans. He was brought in late at night, given medication to treat insomnia, awakened at 6:30 a.m. and then given a 15-minute “evaluation.” He later met with a psychiatrist for a short time.
Ms. Larimer signed the investigative report knowing the standards of the profession, yet she found no evidence of wrongdoing. Cho’s medical history at Virginia Tech is riddled with sub-par care. The fact that so many documents and records dealing with Cho’s treatment were either never created in the first place, went missing, or are still missing, should be of utmost concern.
When I received a copy of the complaint filed by the victim’s family, I filed a Freedom of Information request with Virginia’ s Department of Health Professions for a copy of the investigation that was done on Smith and Crouse. My request was turned down. I received two letters from the Department of Health Professions. The first cited a Virginia law that any “reports, information, or records received or maintained in connection with possible disciplinary proceedings, including any material received or developed by a board during an investigation or disciplinary proceeding, shall remain confidential.” The second, signed by Patricia Larimer, the same Deputy Executive Director of the Virginia Board of Psychology who earlier had indicated there was not enough evidence to warrant an investigation, stated that she could “neither confirm nor deny the existence of complaints/investigations regarding Marisha Smith and Roy Crouse.”
Both letters are disturbing, but the second raises the question as to whether an investigation was seriously considered.
Memory loss, possible missing patient records, and sloppy bookkeeping apparently are the hallmarks of the Cook Counseling Center and its employees. Look at the facts:
1. Marisha Smith’s records of her triage of Cho were missing for months;
2. Dr. Betzel’s records of her triage of Cho were missing for months;
3. Cho’s Cook Counseling Center records were missing for months;
4. Dr. Betzel does not remember her conversation with Professor Roy about Cho, although Professor Roy remembers it quite well.
All these missing records are reminiscent of what happened at the Appalachian School of Law. Following that shooting, a school official went to one of the school offices and told a student working there to destroy records showing that the school was willing to “adjust” evidence relating to the law school’s enrollment—specifically regarding the student status of the killer, Peter Odighizuwa. The student made copies of all the records, destroyed the originals, and then offered the copies to the lawyers who were handling the lawsuit against the school.
I am not saying that any records were intentionally destroyed at the Cook Counseling Center, but the multiple instances of misplaced or lost documents, coupled with memory loss, are suspicious.
The specters of conflict of interest and cover-up once again raise their heads; this time it is the State Board of Psychiatry investigating a state-licensed psychiatrist and counselor. The question that persists is: Can a truly objective analysis of the facts surrounding Cho’s mental illness ever be produced and made public? The answer is, “Apparently not.”
The Health Insurance and Portability and Accountability Act of 1996
And the Family Educational Rights and Privacy Act of 1974
As already noted, patient privacy and privacy laws have been cited numerous times as the reason for not sharing information about Cho. In fact, privacy laws contain many provisions that allow the sharing of information. The Health Insurance and Portability and Accountability Act of 1996 (HIPPA) and the Virginia law on medical information privacy is found in the Virginia Health Records Privacy Act (VHRPA). Both laws have provisions to share information. Specifically:
“Situations where privacy is out-weighed by certain other interests. For example, providers may sometimes disclose information about a person who presents an imminent threat to the health and safety of individuals and public safety. Providers can also disclose information to law enforcement in order to locate a fugitive or suspect. Providers also are authorized to disclose information when state law requires it.”
Let’s look at Cho’s commitment hearing for involuntary admission. A judicial officer made the determination that Cho would be committed to a mental institution for involuntary treatment. The records of the hearing were sealed but information about the hearing, including the patient’s name as well as the time and place of the hearing, are publicly available. Therefore, there was no legal reason why Virginia Tech or its Police Department did not notify Cho’s parents of their son’s involuntary admission to a mental health facility.
For medical, school, or law enforcement officials to say that privacy laws stood in their way of notifying the Cho family is simply not true and represents ignorance of the law or incompetence—or both.
Now, look at the confusion surrounding school records. Privacy of educational records is mainly governed by the Family Educational Rights and Privacy Act of 1974 (FERPA). FERPA’s rules favor privacy, but it contains special regulations for law enforcement and medical records. FERPA and state law govern restrictions on medical records. FERPA laws apply only to information in student records. Personal observations and conversations with students fall outside the law’s purview. That means that professors and anyone else, who observed Cho’s behavior and raised concerns, could have notified his parents.
Many other records fall outside the restrictions of FERPA. For example, when, in the fall of 2005, campus police received complaints from fellow student Jennifer Nelson about Cho’s behavior, their records were part of the investigation of a potential crime. The police would have been within the law to notify Cho’s parents.
A wide variety of law enforcement duties are not covered by privacy laws. For example, when transporting an individual, who is under temporary detention orders, to a mental health facility, the police were under no restrictions and could have reported what was going on to school officials and Cho’s parents.
Finally, there is an emergency provision in FERPA that allows for the disclosure of educational records. “If the knowledge of such information is necessary to protect the health or safety of the student or other persons,” then the information is releasable. HIPPA also contains a similar emergency provision. This is not just law; it is common sense.
It is surprising that before Cho’s rampage school, medical, and law enforcement officials appear to have been obsessed with privacy. But, when Robert Miller, the head of the Cook Counseling Center, violated patient privacy by taking Cho’s files home, these same officials just looked the other way.
When Cho’s medical records were discovered in mid-July 2009 in Miller’s home, then-Governor Timothy Kaine said he was perplexed over how Cho's mental-health files ended up in the personal files of the former director of Tech's Cook Counseling Center.
"Every bit of the lawyer in me . . . and the common sense in me, says nobody should have been able to walk out of a counseling center with these kind of mental-health records," Kaine said. "They should have stayed right there." The records were critical to the investigation of Cho’s crime. "Certainly that aspect of the investigation -- the discussion, what happened, … that is really critical," Kaine said.
Kaine added, " …I think the other critical piece is how he could remove those records. These are confidential records, that by my understanding cannot be legally removed -- certainly not by someone who is a former employee." In other words, Miller apparently broke the law, and no one has ever followed up on that crime.
An editorial in The Richmond Times-Dispatch on July 26, 2009 put the fiasco surrounding Cho’s medical records clearly and succinctly when the paper wrote:
“It strains credulity to think that files relating to the worst campus massacre in American history might simply have slipped the mind of the very person who had counseled the gunman. Not since the Rose law-firm billing records went unfound [sic] for two years in the Clinton White House has there been such a remarkable lapse of memory.
“The performance of the Virginia Tech administration throughout this entire affair has not always inspired confidence, either. That university officials received Cho's miraculously rediscovered records late last Thursday, but did not inform the State Police and the governor until the following Monday, adds to a widespread sense that the Tech administration has been less than completely forthcoming.”
* * *
Time and time again, faculty and staff at Virginia Tech raised concerns about Cho, but to no avail. Professor Lucinda Roy alone voiced her concerns about Cho with the Division of Student Affairs, the Cook Counseling Center, The Schiffert Health Center, the Virginia Tech Police, Department, and the College of Liberal Arts and Human Services—all for naught. The warning signs were numerous and glaring, Cho could have done little more than he did to alert people of his pending rampage—practically the only more obvious thing he could have done to alert people was to put up a neon sign announcing his intentions. The excuses are equally as numerous and just as glaring in the covering up of ignorance of the law, mediocre and incompetent medical care, and an astonishingly incredible lack of common sense. (To be continued)