Aug 032012
 
 August 3, 2012  Misc

Like many, I’ve been watching and reading the media for insights as to what happened and whether a tragedy could have been avoided. And as a privacy advocate, I’ve spent some time mulling over whether federal privacy laws such as FERPA and HIPAA may have become obstacles to the shooter’s psychiatrist preventing this tragedy.

Sadly, the level of interviews I’ve seen on TV has been pretty abysmal.  The worse was a CNN interview involving Dr. Drew Pinsky who seemed to have no knowledge of relevant federal and state laws as they might interact in this case.

If you’re going to interview people, how about finding someone who actually has expertise on HIPAA, FERPA,  Colorado law, and medical ethics?  Or if you can’t find one professional with all those qualifications, bring two people together and let them interact.

In any event, here are the questions I wish the media would ask of knowledgeable experts:

1.  Dr. Fenton reportedly referred her concerns to the university’s threat assessment team in June. Might she have been more likely to notify authorities, his parents, or arrange for an involuntary commitment if she hadn’t sought the opinions of others? And doesn’t the treating psychiatrist still have an ethical and legal obligation to pursue her concerns via notification and/or involuntary commitment even if the threat assessment team does not agree?

2.  If the threat assessment team did not conclude there was a serious or imminent threat in June, did the psychiatrist contact them again in July?

3.  Do we know if the psychiatrist attempted to persuade Holmes to admit himself for psychiatric treatment?

4. Do we know if the psychiatrist sought Holmes’ permission for her to talk to his parents?

5. Did the psychiatrist (incorrectly) believe that her obligations were moot because the student resigned from the university? Did she ever discuss termination or transfer of care with Holmes?

6. Many universities now have threat assessment teams. Is it possible that their use creates a “diffusion of responsibility” problem whereby the original referrer feels less pressure to take action to protect the patient and community?

7. Do we know if Holmes saw the psychiatrist in the week preceding the murders?

8. Did the psychiatrist consult with CU’s lawyer or her own attorney as to her ethical and legal obligations in this case?

Psychiatry is not a hard science, and practitioners will make mistakes. Was a mistake or mistakes made in this case? It is easy to conclude that they were, but without more facts and analysis, we really don’t know whether the relevant laws hampered the psychiatrist or whether the psychiatrist felt – correctly or incorrectly – constrained by the law(s) and wanted to take further steps consistent with her ethical obligations to protect the safety of the patient and the community.

I doubt we’ll get answers to most of these questions in the near future, but they are important questions to ask if we want to learn any lessons from this terrible situation.

Update 1:  ABC reports that the psychiatrist did make contact with a university police officer about her concerns in the weeks before the massacre. This confirms my point that there are a lot of facts we do not yet know about this case and we should withhold judgement until the facts are revealed.

  4 Responses to “Memo to MSM: Please ask these questions about the Holmes case”

  1. A Randi Weingarten ah ha moment.

    Now I see why you questioned my FERPA attack. The questionable actions are psychiatric related.

    Perhaps not even HIPAA.

    • Well, to be clear, that doesn’t mean that FERPA doesn’t come into play at all. It well might. But yes, the important questions I see are psychiatry related.

  2. Unfortunate that a mistake may have been made by a doctor. One would think the psychiatrist knew what to do. It’s common knowledge at this point & there is no hiding the fact that FERPA isn’t understand however as stated previously, this situation is complex.

    It would have been a mistake. Not an intentional harm however the consequences are still too raw to break down & I would imagine the answers to questions will emerge, one way or another. I don’t watch television & not tracking the story. Just seeing headlines & this thread.

    • Mistakes happen all of the time. Years ago, my friend’s parents were murdered and she was shot by a relative who never should have been released from a psychiatric facility. But the doctors felt that there was no real evidence of any risk to warrant keeping him institutionalized. Were they negligent? Not necessarily, but as I said, psychiatry is not hard science.

      I’m not saying a mistake was made in this case, but if it was, we need to know where things broke down so we can hopefully avoid a repeat.

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