VIRGINIA TECH REPORT: EXCUSES, STATING THE OBVIOUS, LACK OF CLARITY--A WASTE OF MONEY

  

The TriData Corporation specializes in report writing—they knew exactly what they were doing. TriData may have been following instructions, or did not want to be too specific and alienate the state of Virginia, a state that might hire them again.

Then there are the excuses. While you are on pages 81-82 of the report checking Roy’s quote, look at the section on page 82 entitled “Decision Not To Cancel Classes or Lock Down:” 

 “…  Most police chiefs consulted in this review believe that a lockdown was not feasible.”

This statement is clearly intended to make excuses for a bad decision not to act. My questions are how many police chiefs were asked, and how many said the school should be locked down. This assertion that police chiefs consulted “believed a lockdown was not possible” clearly indicates the police chiefs were cherry picked to ensure responses favorable to the school’s inaction. In my talks with campus security representatives from colleges and universities, 100% said the school should have been locked down. The sentence also runs counter to the school’s own past practices—do I have to cite the Morva incident again? In that case, the school didn’t believe the killer was on the campus, yet it locked down.  

 On the next page (83) the excuses continue: “In the Morva incident, when the school was closed, it took over an hour and half for traffic to clear despite trying to stage the evacuation.”  An hour and a half is a small price to pay to save 30 lives.

The paragraphs on law enforcement records are especially disturbing.

 On pages 63 and 64 your will find, “Law enforcement agencies must disclose certain information to anyone who requests it. They must disclose basic information about felony crimes: the date, location, general description of the crime, and name of the investigating officer. Law enforcement agencies also have to release the name and address of anyone arrested and charged with any type of crime. All records about non-criminal incidents are available upon request. When they disclose non-criminal incident records, law enforcement agencies must withhold personally-identifying information such as names, addresses, and social security numbers. 

 “  … Most of the detailed information about criminal activity is contained in law enforcement investigative files. Under Virginia’s Freedom of Information Act, law enforcement agencies are allowed to keep these records confidential. The law also gives agencies the discretion to release the records. However, law enforcement agencies across the state typically have a policy against disclosing such records.”   

Many actions may be legal, such as withholding vital information in the nation’s worst school shooting, but to do so is morally and ethically repugnant. The panel should have made that point. Furthermore, the police, in order to remove any suspicion that they did not do their job in connection with Cho’s purchase of weapons, should have willingly released all documents.

 Chapter VI of the Addendum, “Gun Purchases And Campus Policies” is important and unfortunately, it is also a disappointment. Perhaps nowhere else in the report is it as evident as it is on these pages that the panel members did not want to address critically sensitive issues. 

Please take a look at page 71—“In investigating the role firearms played in the events of April 16, 2007, the panel encountered strong feelings and heated debate from the public. The panel’s investigation focused on two areas: Cho’s purchase of firearms and ammunition, and campus policies toward firearms. The panel recognized the deep divisions in American society regarding the ready availability of rapid fire weapons and high capacity magazines, but this issue was beyond the scope of this review.” This borders on stating the obvious; how does it help? This paragraph should be dropped.

 For example, on page 71 you will find, “Cho was not legally authorized to purchase his firearms, but was easily able to do so. Gun purchasers in Virginia must qualify to buy a firearm under both federal and state law. Federal law disqualified Cho from purchasing or possessing a firearm. The federal Gun Control Act, originally passed in 1968, prohibits gun purchases by anyone who has ‘been adjudicated as a mental defective or who has been committed to a mental institution.’ Federal regulations interpreting the act define ‘adjudicated as a mental defective’ as ‘(a) determination by a court, board, commission, or other lawful authority that a person, as a result of … mental illness…is a danger to himself or to others.’ Cho was found to be a danger to himself by a special justice of the Montgomery County General District Court on December 14, 2005. Therefore, under federal law, Cho could not purchase a firearm.

 “The legal status of Cho’s gun purchase under Virginia law is less clear. Like federal law, Virginia law also prohibits persons who have been adjudicated incompetent or committed to mental institutions from purchasing firearms. However, Virginia law defines the terms differently. It defines incompetency by referring to the section of Virginia Code for declaring a person incapable of caring for himself or herself. It does not specify that a person who had been found to be a danger to self or others is ‘incompetent.’ Because he had not been declared unable to care for himself, it does not appear that Cho was disqualified under this provision of Virginia law.” The report should have done a better job of reconciling Cho’s legal status to buy a gun. First the report says “under federal law, Cho could not have purchased firearms.” Then it implies that there are exceptions under Virginia law. When you read the following, perhaps the reason for this lack of clarity becomes clearer. 

On page 72 the issue of whether Cho should have been able to buy a gun is blurred. “This uncertainty in Virginia law carries over into the system for conducting a firearms background check. In general, nationally, before purchasing a gun from a dealer a person must go through a background check. A government agency (which government agency?) runs the name of the potential buyer through the databases of people who are disqualified from purchasing guns. If the potential purchaser is in the databases, the transaction is stopped. If not, the dealer is instructed to proceed with the sale. The agency performing the check varies by state. Some states rely on the federal government to conduct the checks. In other states, such as Virginia, the state conducts the check of both federal and state databases. In Virginia the task is given to the state police.” Did the police not do their job? The report never even attempts to address that point. 

Again, on page 72—“In Virginia, the Central Criminal Records Exchange (CCRE), a division of the state police is tasked with gathering criminal records and other court information that is used for the background checks. Information on mental health commitments orders ‘for involuntary admission to a facility’ is supposed to be sent to the CCRE by the court clerk (Was this done?) who must send all copies of the orders along with a copy of form SP 237 that provides basic information about the person who is the subject of the court order. (Was this done?) As currently drafted, the law only requires a clerk to certify a form and does not specify who should complete the form. Because of the lack of clarity in some jurisdictions (Which jurisdictions—the one where Cho bought his firearms?) it was reported to the panel that clerks in some jurisdictions do not send the information unless they receive a completed form. Recommendations to improve this aspect of the law were given in Chapter IV.” 

The lack of clarity continues on page 73, “The state police did not permit the panel to view copies of the forms in their investigation but indicated that Cho answered “no” to this question (Have you ever been adjudicated mentally defective, which includes having been adjudicated incompetent to manage your own affairs?) or have you ever been committed to a mental institution? It is impossible to know whether Cho understood the proper response was “yes” and whether his answers were mistakes or deliberate falsifications. In any event, the fact remains that Cho, a person disqualified from purchasing firearms, was readily able to obtain them.”

Then on page 74 the reader is told, “Federal law prohibited Cho from purchasing ammunition.”  So, was the law broken? If so, why was no one held accountable?

  The Key Findings on gun ownership and gun rights are weak and clearly represent the timidity of the panel when confronting a politically sensitive issue: gun ownership and guns rights. Indeed, the Key Findings are so weak as to be meaningless. (To be continued)

VIRGINIA TECH REPORT: STRUCTURAL AND OTHER FLAWS

           

The report, then, falls short of what it needed to do: make clear that everyone in a position of responsibility must be held to the highest standards of safety, and that failure to meet those standards will result in stiff penalties. Instead, the reader is left wandering from page to page in an effort to tie ends together and make his or her own conclusions. 

There are structural flaws in the report centering on the Key Findings and Recommendations. Most people who look at a report this size will only read those two parts. Professional writers are taught to put one or both of these sections at the beginning of the chapters or the report itself because it is a well-known principle among professional writers that the Key Findings and Recommendations are the meat. By placing them at the end, and by watering them down, the writers are weakening the significance of the key findings and recommendations. In other words, the report is written more as an on-going investigative report, rather than an analysis of a major crime. TriData Corporation employs professional writers who presumably know this.

Now, let’s take a look at the specifics that typify errors found throughout the report. A major concern is the apparent selection of words in the report to downplay failings and mistakes. For example, the topic sentence on page 18 in the paragraph in the middle of the page needs to be replaced: 

Original Sentence	Reasons for Replacing	My Replacement Sentences
“Shootings at universities are rare events, an average of 16 a year across 4,000 institutions.”	Reason: To correct the report’s downplaying of the seriousness of the threat and to be factually correct.  Site: The Journal of College and University Law, a peer-reviewed journal published by the Notre Dame Law School, Professor Helen de Haven, “The Elephant in the Ivory Tower: Rampages in Higher Education and the Case for Institutional Liability,” —the citation for the article is 35 JC&UL 503, 2009.	“Shootings at universities are becoming more and more frequent and now average 16 a year across 4,000 institutions. Even before the rampage at Virginia Tech, a growing body of legal opinion held that the nation’s colleges and universities have a legal and moral responsibility to protect students, faculty and staff.”

            Another example is found on page 52—here, The Key Findings need to be rewritten to accurately reflect the magnitude of the school’s failings. These failings are documented on pages 46 through 52:  

Original Sentence	Reasons for Replacing	My Replacement Sentences
“The lack of information sharing among academic, administrative, and public safety entities at Virginia Tech and the students who had raised concerns about Cho, contributed to the failure to see the big picture.”	Reason: vague language, inaccurate reflection of the magnitude of the failings and over use of platitudes such as “big picture.”	The numerous failings of Virginia Tech to respond to warning signs that Cho was a serious threat to himself and others should not, and cannot, be glossed over. Members of the school administration and campus police failed to heed the warnings and take the initiative to head-off what became the nation’s worst school shooting. There were at least five complaints about Cho’s threatening behavior that reached the ears of campus police and or school administrators. Overly strict, and at times incorrect, interpretations of federal and state privacy laws combined with bureaucratic ineptitude to make the shooting rampage possible.

            There are also discrepancies in logic and reasoning that need to be reconciled. For example on page 43 the reader will no doubt be confused over what constitutes a threat. In the left hand column, first full paragraph, third sentence through the end of the paragraph reads: “She (Dr. Giovanni) contacted the head of the English Department, Dr. Roy, about Cho and warned that if he were not removed from her class, she would resign. He was not just a difficult student, she related, he was not working at all. Dr. Giovanni was offered security, but declined saying she did not want him back in class period. She saw him once on campus after that and he just stared at the ground.” Here is the problem: if a professor is threatening to resign because she feels threatened, then Frances Keene, Judicial Affairs director, needs to give a better explanation of why Cho’s threatening behavior was not actionable under the abusive conduct-threats. 

In fact, all of page 43 is confusing and is intellectual mumbo-jumbo—it may have been intentionally written that way to hide the shortcomings and failures of the school to act.                

                  The report’s excessive use of passive voice sentences appears to be intentional and meant to obscure. Passive voice sentences are the preferred sentences of members of the legal profession because they allow for greater courtroom interpretation and argumentation. In an historical document such as this, passive voice sentences should not be used, unless the writer has no other choice.  

                  Let’s take a look at a couple of examples. Look at page 43 and how the passive voice is intended to hide who knew what: “However, it is known that the university did not contact the family to ascertain the veracity of home town follow-up for counseling and medication management.”  Known by whom? Was the individual or department responsible for this failure ever questioned?

                  Professor Lucinda Roy, in her book “No Right to Remain Silent,” gives an excellent example of passive voice sentences obscuring information. When referring to Vice Provost of Student Affairs David Ford’s statement to the panel on May 21, 2007, she writes, “As Ford revealed in his prepared statement, the president and the Policy Group were advised by the police that a suspect was being tracked—slain student Emily Hilscher’s boyfriend.” The prepared statement reads:  

 “Information continued to be received through frequent telephone conversations with Virginia Tech police on the scene. The Policy Group was informed that the residence hall was being secured by Virginia Tech police, and students within the hall were notified and asked to remain in their rooms for their safety. We were further informed that the room containing the gunshot victims was immediately secured for evidence collection, and Virginia Tech police began questioning hall residents and identifying potential witnesses. In the preliminary stages of the investigation, it appeared to be an isolated incident, possibly domestic in nature.” (Pages 81and 82 of the Review Panel Report.)  

            In commenting on the above, Roy writes, “It’s difficult to know why this last assumption was made, though there is little doubt that the term ‘domestic violence’ has connotations which can lead people to assume that the violence has somehow been contained within the domestic sphere and is therefore less likely to be visited upon those outside it.” 

                  Roy then adds, “When the passive voice is used in sentence construction it is hard to pin down who the subject is. In the first sentence of the above quote, for example, we would normally say ‘So-and-so continued to receive information,’ but instead we have ‘Information continued to be received,’ which makes it hard to know who was actually receiving it. Although this description begins as what appears to be a first-person, eyewitness narrative, it seems to dissolve into an account of an event viewed at a considerable distance. The phrase ‘The Policy Group was informed,’ for example, raises the question of who did the informing. It seems by the end of the paragraph as though everyone is receiving all the information at the same time, but given how chaotic the situation must have been, this seems somewhat unlikely. Usually teachers of writing try to dissuade students from using the passive voice construction because it tends to result in accounts that lack specificity and removes a subject from his or her own action, as it does in this case.” (To be continued)

THE VIRGINIA TECH REPORT: ONE FLAW AFTER ANOTHER

Many of the original flaws of the report on the Virginia Tech shooting stem from decisions made before a word of it was written. In the first place, the idea of a state-sponsored panel investigating a state institution is a conflict of interest—I have said that before, but it bears repeating. That conflict of interest probably explains why the report does not hold anyone accountable for anything. Furthermore, from the outset, the credibility of the Review Panel and their report was undermined because of the failure of the review panel to have subpoena power (just as in the case of Colorado) and the inability of the panel to have people interviewed under oath. The justification for hiring TriData was their experience with the Columbine shooting, so surely someone should have been aware enough to learn the lessons that the Columbine report stated so clearly that in the wake of tragedy, people will try to protect themselves from blame. Without the power to subpoena, the review panel simply had no teeth.

The systemic flaws in the panel itself play out in the Virginia Tech report. There appear to be eight major failings: 

        First, the report did not address issues such as identifying mistakes in judgment and the individuals who should be held accountable for their actions or inactions. Indeed, the report is an exercise in avoiding accountability and legal liability. 

       Second, the panel itself, which investigated the tragedy and wrote the report, is a prime example of conflict of interest. A state panel examining the behavior of state employees and a state organization cannot be completely objective. To even suggest that the panel was completely objective is sheer folly—particularly when the state was so well represented and not one member of the victims’ families was a panel member. Instead, there is the state-selected family representative and spokesperson on the panel—again, a conflict of interest that is not conducive to impartiality. 

       Third, several key players did not fully cooperate with the review panel. This lack of cooperation is both disheartening and puzzling.  Specifically, the Virginia State Police, the ATF, and the gun dealers “declined to provide the panel with copies of the applications” Seung Hui Cho completed when he bought the weapons that would eventually kill over thirty innocent people. The report notes that “the Virginia State Police … did describe the contents of Cho’s gun purchase applications to members of the panel and its staff.” The state police’s willingness to “describe” is a limp attempt to explain their failure to fully cooperate and provide the panel with documents related to the shootings and is a major flaw in the report—it is inexcusable. 

       Fourth, the report repeatedly falls back on passive voice sentences that obscure who did what and when; who knew what and when; and who acted and didn’t act. The authors of the report carefully chose their words in order not to identify any individual by name. 

       Fifth, the panel was impeded in its work by the FOIA rules that did not allow more than two members to meet together or speak by phone without it being considered a public meeting. This is bureaucracy at its worst. The report needs to be more specific in detailing the problems this bureaucratic obstacle presented.  

       Sixth, the report sugar-coats glaring errors and problems: for example, on page 10, the report talks about its findings and recommendations being of two different kinds: “What was done well,” and “what could have been done better.” The report should talk about people in positions of authority failing to do their jobs.

       Seventh, the report appears to make excuses for the decision of the university’s Policy Group not to put out a campus-wide alert following the discovery of the first two bodies. But the previous August, the university had put out an alert that a convict named William Morva had escaped from a nearby prison and killed a law enforcement officer and a guard. The alert indicated that the murderer was on the loose and could be on campus. The university set its own standard in August of 2006 by issuing that alert, and then violated that standard in April 2007.The report skirts this critical point.  

       Eighth, a former head of the state police should not have chaired the panel. Here again is another example of a conflict of interest. The result appears to have been a downplaying of the mistakes made by the police on the day of the shooting—and probably mistakes they made in not placing Cho’s name on the list of those people prohibited from buying guns.  

In connection with systemic flaw eight, the report says that the police may have made an error in reaching the premature conclusion that their initial lead (following the discovery of the first two shooting victims) was a good one and that the person of interest was probably not on campus. May have made an error? They did make a very serious error by jumping to a premature conclusion and giving the wrong impression to school officials. Michael and I have examined in detail this fatal mistake earlier.

In sum, the report fails to do its job in critical areas; it is bland, and raises no real red flags. The report is the equivalent of reading a book with no thesis. The recommendations indicate this or that “should” be done.  The “shoulds” relate to such things as analyzing, training, complying with this or that act, police being members of panels, and so on and so forth. Yes, these “shoulds” need to be done. But, nowhere does the report say that individuals must (or even should) be held accountable for their actions or inactions; that organizations and individuals must be held accountable when they break their own standards and it results in over 30 lives being lost. (To be continued)

VIRGINIA TECH: WHY WERE THEY SILENT

The Governor’s Review Panel Report on the Virginia Tech massacre, The Addendum, never really addresses the question of responsibility and accountability. Indeed, TriData makes just enough revisions to give them the fig leaf of being able to say, “We listened to the families; we made revisions.” Did they really? Ok, let’s lift up the fig leaf and take a look at one of the revisions.

In fact, the panel seemed to go off on tangents and interviewed at least one expert who added little insight to gun violence on campuses and school grounds. Dr. Jerald Kay is a case in point. Here is the explanation for including Dr. Kay in the report:

“The panel heard a presentation from Dr. Jerald Kay, the chair of the committee on college mental health of the American Psychiatric Association about the large percentage of college students who binge drink each year (about 44 percent), and the surprisingly large percentage of students who claim they thought about suicide (10 percent). College years are full of academic and social stress. The probability of dying from a shooting on campus is smaller than the probability of dying from auto accidents, falls, or alcohol and drug overdoses.”

Even with this explanation, the relevancy of the testimony of Dr. Jerald Kay on the frequency of shootings on campus is especially puzzling. What was the purpose of interviewing him? Were his words an attempt to downplay the seriousness of the Virginia Tech shootings in light of other dangers to students such as drunk driving? Here is TriData’s excuse for including Kay’s words:

“The Review Panel invited Dr. Kay’s presentation for two reasons: First to consider the risk from guns as part of the larger picture of campus emergency planning. The Review Panel wanted colleges and universities to consider, as part of emergency planning, the whole range of threats and their likelihood, not just guns. Second, this testimony was of interest as part of the discussion of whether guns should be allowed to be carried on campuses. The frequency and nature of shootings on campus was very relevant to the deliberations of the Review Panel in making recommendations regarding these issues. It also was relevant in understanding the risk of a further shooting faced by the Policy Group after the double homicide.”

1.     Nowhere does the report state that Dr. Kay says anything about guns as part of emergency planning.

2.     If the frequency and nature of shootings on campus was relevant to the Review Panel deliberations, why is Dr. Kay not quoted on the subject?

3.     What insight did Dr. Kay provide on understanding the risk of a further shooting faced by the Policy Group after the double homicide?

Is TriData trying to tell us that binge drinking played a role in the killings at Virginia Tech? As for the sentence: “The probability of dying from a shooting on a campus is smaller than the probability of dying from auto accidents, falls, or alcohol and drug overdose.” What possible reason could there be for this sentence in the report other than to downplay the significance of gun violence on campuses? 

TriData’s response is that they wanted colleges and universities to examine the whole range of threats. Fine, but that was not the Panel’s overwhelming priority and responsibility, nor was it the duty to emphasize those threats at the expense of analyzing the Virginia Tech shootings. There is nothing in the Panel’s mission statement telling them to go into a broader range of campus threats. Here is the Review Panel’s Mission Statement:

“The Panel’s mission is to provide an independent, thorough, and objective incident review of this tragic event, including a review of educational laws, policies, and institutions, the public safety and health care procedures and responses and the mental health delivery system. With respect to these areas of review, the Panel should focus on what went right, what went wrong, what practices should be considered best practices, and what practices are in need of improvement. This review should include examination of information contained in academic, health and court records and by information obtained through interviews with knowledgeable individuals. Once that factual narrative is in place and questions have been answered, the Panel should offer recommendations for improvement in light of those facts and circumstances.”

Are we saying the interview was worthless? Not necessarily, although it is hard to tell when exact quotes are not included in the text. What we are saying is that the inclusion of Dr. Kay was a misplaced band aid attempting to cover the massive gaps left by some notable absences. The Panel interviewed Dr. Jerald Kay, but look at the list of key individuals they did not interview:

1.     Dr. Robert Miller, the director of the Cook Counseling Center at the time Cho was taken to Carilion St. Albans Psychiatric Hospital. He was the man who “accidently” took Cho’s medical records home, meaning those records were not available to the Review Panel nor to the families before they settled with the state.

2.     Kim O’Rourke and Lisa Wilkes, both of  whom took notes at the Policy Group meeting the morning of April 16, 2007. Those notes indicate the police on the scene at West Ambler Johnston Hall advised there was no need to warn the campus. The police liaison with the Policy Group during this time was Virginia Tech Police Chief Wendell Flinchum.

3.     Heather Haugh, the roommate of murdered student Emily Hilscher. Haugh was the one who identified Hilsher’s boyfriend, Karl Thornhill. An interview of Haugh would have pinned down the time Thornhill was identified as a person of interest.

4.     Karl Thornhill, Emily Hilscher’s boyfriend, was never interviewed by the panel.

5.     Ralph Byers, a participant in the Policy Group, who at 8:45 am sent an email to Laura Fornash in Richmond telling her not to release details of the shooting.

For those who say the families should now move on, we ask, “How can anyone move on when their child has been gunned down and there is a cover-up? How can anyone move on when he or she knows that there are lies of omission dealing with the death of a child?” We want to ask then-Governor Kaine, then-Attorney General McDonnell, Virginia Tech President Charles Steger, Virginia Tech Chief of Police Wendell Flinchum,  and members of the Virginia Tech school administration, the review panel, and the people at TriData, “Did you really read the Review Panel’s Report? If you did, why did you remain silent about this incredibly flawed document?” (To be continued)