My new column in the Times (U.K.) is on the many costs of HIPAA, the federal law which even now prevents institutions from releasing the Virginia Tech psychopath’s health records (privacy rights extend after death) and played a notable role (along with the Buckley Amendment/FERPA) in restricting the chances for relevant actors to compare notes on his symptoms of madness before it was too late (Walter Olson, “Could less rigid privacy laws have prevented the Virginia tragedy?”, Apr. 20).
More: Dr. Wes has some additional HIPAA thoughts, as does Jeff Drummond at HIPAA Blog.
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Good article, Walter. At the risk of being called a “moron”, more of my thoughts are here:
http://drjshousecalls.blogspot.com/2007/04/imperfect-connection.html#links
The system, culture, whatever you call it, did recognize Cho as disturbed, and many tried to work with him, although most were concerned with just isolating a nut from their other students.
I ask children who I know to tell me about their best friends. My simple test would have gotten to Mr. Cho’s illness, his inability to connect to other human beings.
Maybe Dr. Johnson can help us out. Are there any proven techniques to help people with this sickness? Why didn’t anybody see that Cho was getting worse over time despite their efforts? Supposedly he didn’t talk to his suite mates for nine months.
There is a tradeoff between unnecessarily hospitalizing people and violating people’s privacy versus providing proper treatment for seriously ill persons. I agree with Mr. Olson that decency was sacrificed to the activists.
Cho should not have been sold the guns – and those guns had large clips. Better still would have been helping him cope with his torment.
As the N&O article I cite indicates, the system failed, Mr. Nuesslein. And I believe it failed because privacy & confidentiality laws have everyone running scared of doing what needs to be done to protect/help people . . . be it the individual or society as a whole. There are many “disconnects”, and I’m not just talking about HIPAA.
If that’s because these laws are badly written or hard to understand or contradictory or impossible to implement without STILL worrying about getting sued, then that’s something that needs to be debated and fixed.
The very sad thing is that the debate – and the fixing – never happens until a tragedy like this takes place. People have to die to get anyone to give it a second thought.
It is not just that the laws are badly written. That of course is part of the problem. The other part is that an organization does not want to get sued. As has being pointed out time and time again on this blog, the cost of the lawsuit itself, independent of whether or not you are found liable for damages, is a strong disincentive to act. I was just involved with a request for special treatment from a student. The University checked to see if the student had requested at the beginning of the term that accommodations be made as is required by the University’s own rules for complying with ADA. The student had not done so. However, the University still acquiesced to his request because they were fearful of being sued irrespective of the fact that he had not followed the required procedures.
Dr. Johnson,
The system failed to hospitalize Cho and to keep guns from him. Bad law and the fear of lawsuits were components in that failure. It was known to the court and in the University that Cho was very sick, the system did recognize him.
I questioned whether Cho’s illness was correctly diagnosed. I also wondered why the various parties involved did not see the progression of the illness, especially the court. Most judges have a thither when their orders are not fully carried out.
“Cho should not have been sold the guns – and those guns had large clips.”
Th clip size is irrelevant (in this case) to anyone without an agenda regarding guns: Cho reloaded MULTIPLE times. If the clips had been smaller (and they were actually standard sized clips for the weapon in question, last I heard), he could simply have reloaded more times, as there was no time pressure.
And yes, it usually does take a body count to gt pople to bother with things like this. Unfortunately, that seems to be the nature of humanity.
Over the past few years I have been taking classes at a local University. From what I have seen of the different rallys and protests that take place on campus, I have to ask one question. If Cho had been removed from the Virginia Tech because of mental illness, how many of the students would have shown up at a protest demanding that he be reinstated and that Virgina Tech not discriminate against the mentally challenged?
“Most judges have a thither when their orders are not fully carried out.”
That is not my experience.
I have not practiced in Virginia in a while, but please consider (Mr. Nuesslein) that I live and work in a state (NC) where mental health services are a sad joke (and the fact that they’re a joke is making all the headlines).
You can diagnose things all day long (and or refer the most desperate/awful things to DSS), but it does not matter when the system in place allows so much and so many to fall through the cracks.
Psychiatric diagnoses just aren’t that accurate – especially when you get patients who don’t want to be properly classified. A system that would lock Cho up would also lock up hundreds of non-dangerous mentally ill people for every dangerous one, and it would still miss many really dangerous ones. Psycho/sociopaths are quite often misdiagnosed as schizophrenic; there’s not much in common between the two diseases (sociopaths may be perfectly sane, aside from their lack of a conscience), but they tend to be master actors, and if they get caught in a serious crime, their best chance of ever getting free again to wreak more havoc is often playing a schizophrenic…
markm,
Your point is well taken that a more aggressive mental health policy might be too costly in terms of number of people hospitalized – too many false positives. But you focused on separating Mr. Cho from society, as did most people.
I saw Mr. Cho as a tormented soul, and I wondered if something could have been done for him. The judge ordered treatment for him, but there seemed to be no followup, even though he was getting worse all the time.
A few joints might have done the trick in his case.