August 2, 2012

The psychiatrists could have done more to stop the Aurora theater murderer.

Dr. Lynne Fenton did contact the University of Colorado Behavioral Evaluation and Threat Assessment team, but it "never came together."
"It takes more than just statements,” said one source, explaining that Holmes would have had to tell Fenton “something specific" before she would have to report it to law enforcement.

“He would have to tell her he had taken steps to make it happen,” said another source....

One source [said] that the team may not have been convened because while Fenton had “serious concerns, there may not have been an immediate threat.”
Maybe these standards and procedures need to be changed.

82 comments:

wyo sis said...

This seems to be one of those cases where everything was done that could be done and it happened anyway. Nothing in all of our civil precautions worked.
We can take this to mean that sometimes things can't be prevented, or to mean that we all have to give up more freedoms in the vain hope that something could have prevented this thing.
People are unpredictable. They don't behave in ways that can be forced by outside influences.

LoafingOaf said...

So, it seems the warning signs were there, yet he was still able to rush order assault rifles, thousands of rounds of ammo, gas mask, tear gas, body armor, etc etc etc, from internet vendors with no problem whatsoever and no triggering of an alert to law enforcement.

deborah said...

When I first heard the Aurora shooter was a student, I thought of Virginia Tech. From that timeline:

2005

Fall
Andy Koch, Cho's suitemate, took Cho out to some parties at the start of the fall semester in 2005. At one party, Cho got "tipsy" enough that he opened up and began talking about his virtual love life. He said he had an imaginary girlfriend named Jelly, and that she was "a supermodel that lived in space." Jelly had a nickname for Cho—Spanky.[5]
Andy Koch along with John Eide snooped in Cho's belongings and "found nothing more threatening than a pocket knife."[6]

Fall poetry class
Professor Nikki Giovanni requested that Cho either change the sinister content of his poems or drop the class. Cho responded, "You can't make me."[7]

Removed from poetry class
Lucinda Roy, co-director of the creative writing program removed Cho from Professor Giovanni's class and tutored him one-on-one. When Cho refused to go to counseling, Roy notified the Division of Student Affairs, the Cook Counseling Center, the Schiffert Health Center, the Virginia Tech police and the College of Liberal Arts and Human Sciences.[7]

Fall writing class
Professor Lisa Norris, who had Cho in her class, alerted the associate dean of students, Mary Ann Lewis, who could find "no mention of mental health issues or police reports" on Cho.[7]

Sunday, November 27
A female student filed a report with the Virginia Tech campus police indicating that Cho had made "annoying" contact with her on the internet,[5] by phone and in person. The investigating officer referred Cho to the school's disciplinary system, the office of judicial affairs,[8] which is separate from the police department.[9]

Monday, December 12
Another female student, a friend of Andy Koch,[5] filed a report with the Virginia Tech campus police complaining of "disturbing" instant messages from Cho. She requested that Cho "have no further contact with her."[10][11][12]

Tuesday, December 13
Virginia Tech campus police notified Cho that he was to have no further contact with the female student.
After Virginia Tech campus police left, Andy Koch, Cho's roommate, received an instant message from Cho stating, "I might as well kill myself now."[5][13]
In response to receiving the instant message from Cho, Andy Koch, Cho's roommate, notified the resident advisor and phoned Cho's father.[14] Both Koch and Cho's father alerted Virginia Tech campus police that Cho had sent Koch a suicidal instant message.
Virginia Tech campus police took Cho off campus to a voluntary counseling evaluation at New River Community Services,[10] where he was examined by Kathy Goodbey. Goodbey determined that he was "mentally ill and in need of hospitalization."[15]
Cho's paperwork, declaring Cho "an imminent danger to self or others," was sent to court.
Cho was transported to Carilion St. Albans Psychiatric Hospital where psychologist Roy Crouse determined that Cho "presents an imminent danger to himself as a result of mental illness."

Wednesday, December 14
Cho was released from Carilion St. Albans Psychiatric Hospital after his examination by Roy Crouse.[16]
Cho's paperwork was sent to special Justice Paul M. Barnett, who certified the finding and ordered follow-up treatment.[17][18]
Neither the court, the university nor community services officials followed up on the judge's order, according to dozens of interviews. Cho never got the treatment, according to authorities who have seen his medical files.[15]


http://en.wikipedia.
org/wiki/Virginia_
Tech_massacre_timeline

The shooting occurred in April 2007.

Salamandyr said...

Maybe these standards and procedures need to be changed.

I don't think so. Maybe it would have helped in this case. Maybe.

However, I see a lot more common outcome being overzealous psychiatrist siccing law enforcement on someone for otherwise innocent admissions.

rhhardin said...

It's the great scapegoat hunt, expert against expert.

The truth is that they're not experts, which must be prevented from coming out.

rhhardin said...

Stanley Cavell has a category he calls the village explainer.

Everybody will fall into it, but some have talent and others don't.

Joe said...

Hindsight is 20-20. There are many disturbed individuals who end up physically harming nobody.

This is another case where if we rush to make laws, we'll end up with more abuses of police power, not less.

tiger said...

This will certainly lead to the doctor and the school being opened to lawsuits by people looking to cash-in.

What happened in Aurora is the fault of Holmes' - no one else.

EMD said...

So, it seems the warning signs were there, yet he was still able to rush order assault rifles, thousands of rounds of ammo, gas mask, tear gas, body armor, etc etc etc, from internet vendors with no problem whatsoever and no triggering of an alert to law enforcement.

Constantly monitor the populace ... they might do something bad!

Jay said...

LoafingOaf said...
So, it seems the warning signs were there, yet he was still able to rush order assault rifles, thousands of rounds of ammo, gas mask


Nice talking point.

Notice you are entirely unaware of the sequence of events here.

Notice you can't get past the bumpersticker level of "raise red flags"

There is an adjective for such thoughts which immediately comes to mind...

Lem said...

Maybe these standards and procedures need to be changed.

I assume the standards on a blog commenter (for example) are such that we have to wait for garage to say something specific... because while we may express serious concerns, there is no immediate threat ;)

LoafingOaf said...

wyo sis: This guy was going completely off the rails and sending red flags up, yet in a very short period of time he was able to receive rush orders for a whole arsenal of assault weaponry, ammo, and accessories without raising an eyebrow anywhere. That's nuts!

Bill Harshaw said...

Not sure we want to discourage people from going to shrinks. It's a fine line where judgment is required and nobody, repeat nobody, is going to judge correctly all the time.

wyo sis said...

LoafingOaf
No.
He's nuts.

Jay said...

LoafingOaf said...
wyo sis: This guy was going completely off the rails and sending red flags up, yet in a very short period of time he was able to receive rush orders for a whole arsenal of assault weaponry, ammo, and accessories without raising an eyebrow anywhere.


Er, did the "red flags" come before or after the firearms were purchased?

Tim said...

Its good to keep in mind that laws that would put everyone who "act strange" through lengthy tests, etc will not improve our situation.

deborah said...

In _Games People Play_, Berne had a similar category to Village Explainer.

Lem said...

This guy was going completely off the rails and sending red flags up...

That's a poor analogy because despite the hundreds of years in tech advancements.. trains still go off the rails.. so by the standard posed in your analogy we should expect people to go postal at least as often as trains go off the rails.

I'm going to go off the rails and assume trains go off the rails more often than university students go postal.

I believe going postal is a better analogy..

TMink said...

For the record, mentally ill people are less likely to assault or kill other people than are people who are not mentally ill. The person who is ill enough to conceive and plan such an attack but can still function well enough to carry it out is rare.

Since Tasasoff, there is a duty to warn in mental health. I think that is a good rule, and it is one I follow. It sounds like the psychiatrist followed the rule.

Tragedy is often beyond our control or influence.

Trey

Roman said...

Looking for "scapegoats" is in full force. I think this reflects badly on the so called "mental health professionals". This madman had close enough contact with the shrink, she should have known and did nothing, or didn't know and couldn't do anything. Both senarios are unacceptable.

TMink said...

LoafingOaf, the so called assault weapons you mention are not in fact assault rifles. A bona fide assault rifle is an automatic weapon and with it the ill man could have killed the entire theater in 30 seconds.

The so called assault weapons are legal firearms that are made to resemble actual assault weapons. They are only cosmetically assault weapons.

I can put racing stripes on my PT cruiser, but it will remain a little putt putt despite what it looks like.

Obviously, he killed folks with actual, legal weapons. But the point is not what those weapons looked like, and the "assault weapon ban" just banned cosmetics.

Trey

Lem said...

... and another thing.

Why should we be expected to recognize red flags... while at the same time we are all about encouraging color blindness.

This is very confusing.

Geoff Matthews said...

The problem here are the false positives. The individuals that people believe may be a danger but never act out on it. How often are we willing to let people be hassled just because someone (a psychiatrist, a counselor, an English teacher, a friend) had a concern that they may be a danger to others?
And if a significant proportion of these people turn out to be minorities, will that be a problem?

Tibore said...

"Maybe these standards and procedures need to be changed."

I sort of think that myself, but with the caveat that it can't be just any change.

All of us here recall those utterly vacuous arguments from psychologists denigrating conservatism? Such as the University of Tampa paper actually alleging psychopathy? (Disclosure: The researcher did state that specific point within the context of opposition to gay marriage, but the author still tagged it as a trait of conservatism, and that is indeed a published paper, not just some pop column in a magazine.) There's Amodio's 2007 paper that doesn't outright call conservatism a syndrome, but does attempt to associate it with negative behaviors (a small step from calling conservatism pathological). And then there's the Barry X. Kuhle article in Psychology Today making the explicit argument that conservatism was a mental illness. There are more. Well anyway, my point is that if we don't take care in how we build different standards and procedures, how close can we come to political affiliation being considered a psychological threat?

No, that's not likely. But at the same time, I'd still be worried about the erosion of opposition to such attitudes. The point is that it's not impossible for such attitudes to influence standards, and therefore threaten liberties.

Anyway, that's what I mean by taking care. We all can acknowledge the possibility that standards and practices need to be changed, but we must remember to be vigilant about not letting basic freedoms and tolerances be eroded. Liberals have already laid the first few feet of the road to making conservatism something to be treated. We can't count on any sense of fair play from them to keep the road from being further built.

FloridaSteve said...

Crazy is often like porn. you can't always define it but you definitely know it when you see it. So yes they need to reevaluate the standards.

leslyn said...

"Maybe these standards and procedures need to be changed."

It would be interesting to know if their "procedures" were in accordance with Tarasoff. When a therapist determines, or should determine, that his patient presents a serious danger of violence to another, he incurs an obligation to use reasonable care to protect the intended victim from danger. (Tarasoff II)

Did the psychiatrist know that there were intended victims? Was there a present danger of serious violence to another? The specificity that was stated as lacking--must there be a named victim, or specific act?

It seems that at least a review of the concerns, to inquire into these things, would be warranted. The psychiatrist had already done a balancing of the patients confidentiality interest against the protection of victims, and decided on protection of victims. That's not an easy decision to arrive at, and should carry some weight.

edutcher said...

Thanks to the ACLU and the Federal judiciary, nothing could have been done until he shot somebody.

Ya wanna place the blame, that's right where it begins and ends.

Lem said...

People can take on the appearance of a need for confinement while under the influence of what we now call road rage.

They seem to come out of it, once they remove themselves from a vehicle... while others let that rage carry them over a tipping point.

We have no way of knowing...

Does that mean we have to change current standards and procedures.. to accommodate the possibility that some drivers are more prone to road rage and therefore...

traditionalguy said...

This Psychiatrist is not doing her job. But she doesn't want anyone to know that.

Mr Genius was a game player that was clearly disassociated from reality and living in his own games. He was about to take a dangerous actions in his hero script, and I am sure he shared those thoughts with her.

If no one ever told her that such men are very, very dangerous, then she needs to get a better education.

Just managing the patient's decline to bill more time is not medical care. Medical care takes an action based upon a diagnosis.

Peter said...

Behavioral Evaluation and Threat Assessment ... it has a fitting acronym, I'd say.

traditionalguy said...

If we want computer Dx medicine, then by all means change some rules in the program, but if we train and pay humans to understand people 1000 times better than computers can do, and to act in concert with a cadre of other trained men and women, then we just need to get better ones.

Rob said...

I reckon the University of Colorado, like Penn State, had better get out its checkbook. The search for deep pockets just struck paydirt.

leslyn said...

edutcher said...
Thanks to the ACLU and the Federal judiciary, nothing could have been done until he shot somebody.

Ya wanna place the blame, that's right where it begins and ends.


Bullshit. Again. Come up with something rational rather than knee-jerk bile.

leslyn said...

traditionalguy said...
This Psychiatrist is not doing her job. But she doesn't want anyone to know that.

Mr Genius was a game player that was clearly disassociated from reality and living in his own games. He was about to take a dangerous actions in his hero script, and I am sure he shared those thoughts with her.

If no one ever told her that such men are very, very dangerous, then she needs to get a better education.

Just managing the patient's decline to bill more time is not medical care. Medical care takes an action based upon a diagnosis.


Since when did you put a listening device in her office, and do a mindmeld with her brain?

Wally Kalbacken said...

Tarasoff - what a classic! Of all the cases I read in law school (20+ years ago), that is one of the most memorable, if only for the names. Victim: Tatania Tarasoff, murderer: a guy named Prosenjit Poddar.
It just rolls off the tongue.

jimbino said...

If the rules were changed so that a shrink would have a heightened responsibility to rat out his patient, you would have to be insane to consult a shrink.

Hagar said...

If you call the cops on someone before he or she goes off the rails, it is 50/50 whether you and your institution will be sued for defamation, false arrest, and whatever else plaintiff's lawyer can dream up.
And the suit is obviously justified since nothing happened.

Lem said...

Insurance companies are going to ask for a psychiatric evaluation as as a prerequisite to matriculation.

Wont that 'change in the culture' (I dont know what else to call it) encourage an expectation of these kinds of acts rather than discourage them?

traditionalguy said...

Leslyn...Do you always want proof? At this stage when the facts are only guessable and may never all come out.

But the Post wants a discussion of Psychiatrists Rules to prevent... prevent what?

So I am positing some probable facts for discussion of solutions.

Your turn.

JAL said...

One of the news blips I saw a week or so later involved the university post office, which notified the police they had a suspicious package.

It turned out to be nothing, but in the process, another package / large envelope apparently from the shooter, addressed to a UC psychiatrist (unnamed in the story) was found and taken by the police. The article said they weren't sure how long it had been in the PO there, but apparently from before the shooting (the Monday before?) and it *had not been delivered* to the psychiatrist (whatever that involved).

Haven't seen anything about it since, but that and the fact that the shooter told the police that the apartment was booby-trapped might indicate that at some level in his mentally ill mind there was a call for help.

I have had some extended family related exposure to people who are in desperate need of help, but because of HIPPA and other confidentiality laws even related adults are not allowed access to medical information or able to take any kind of control over the sick person's choices and treatment.

The mentally ill person would have to be 1) diagnosed and then 2) declared mentally incompetent (which is another whole ball of wax and not a simple deal)) or 3) have communicated something indicating they were a threat to themselves or another.

In the meantime there can be behaviors and activities which create very serious legal problems which take precedent over the mentally ill person's health issues.

There is always Monday morning quarterbacking. It is an extremely difficult position to be in.

I had a client whose separated husband had her picked up for involuntary commitment -- the day she got a temporary 50B (domestic violence) order on him. It hadn't been served on him so the other cops, being unaware, went ahead and picked her up on his say so and delivered her to the local psych ward. (She got out the next day.)

Ugly. And HER insurance company got billed -- which since it was Medicare Advantage program means all the taxpayers {waves to Althousians} got to participate in his harassment and abuse of the system.

The magistrate who issued it was completely nonplussed when we went to complain to her about her lack of careful interrogation and fact checking and his perjury. Didn't wrinkle her botoxed face one single bit.

As for Aurora, he was a young man in the age range for the appearance of schizophrenia. But without specifics about violence, who could know?

It isn't like the Minority Report exists. Yet.

Allowing concealed carry in the theater would have been more effective in this case, I believe.

edutcher said...

leslyn said...

Thanks to the ACLU and the Federal judiciary, nothing could have been done until he shot somebody.

Ya wanna place the blame, that's right where it begins and ends.


Bullshit. Again. Come up with something rational rather than knee-jerk bile.


no, that's exactly where the problem lies.

leslyn and the Lefties got what they wanted 40 years ago and now they have to explain why nobody like OrangeHair can be committed.

So they just yell a lot and try to create as much misdirection as they can.

Rabel said...

I wasn't going to comment but my WV is "psycoo" so I know that Google is telling me that I must.

That the psychiatrist considered him a potential violent threat makes me even more skeptical about the story of the assault plan being left to sit in the mailroom.

Marshal said...

"That's not an easy decision to arrive at, and should carry some weight."

Note how the lefties are perfectly accepting of limitations which result in death. Then compare to their inability to admit there are any limitations to our ability to eradicate poverty. It seems their willingness to accept limitations is inverse to the seriousness of the matter.

I think they accept the limitations here (or in anti-terrorism efforts) because they can understand the difficulty, whereas they are economically illiterate. But it seems strange their willingness to trample civil rights wanes as the stakes increase.

Peter said...

IF Holmes had mailed the warning letter to the psychiatrist well in advance of the shootings but it sat in the university mailroom for days without being delivered, that's a whole new basis for lawsuits against the university.

My prediction is that by the time the dust settles, the university (meaning, of course, Colorado taxpayers) will be shelling out hundreds of millions of dollars in damages, and Lynne Fenton's professional reputation will be completely destroyed.

Cedarford said...

nk said...
For the record, mentally ill people are less likely to assault or kill other people than are people who are not mentally ill. The person who is ill enough to conceive and plan such an attack but can still function well enough to carry it out is rare.

Since Tasasoff, there is a duty to warn in mental health. I think that is a good rule, and it is one I follow. It sounds like the psychiatrist followed the rule.

Tragedy is often beyond our control or influence
========================
Trey is a shrink, so I definitely defer to his experience.....
BUT...
My understanding is while overall, you have mentally ill people crippled from active engagement by depression so the overall "less likely to do violent acts" IS TRUE of the aggregate population of mentally ill --
There IS A SMALL PORTION OF THAT POPULATION THAT IS AGITATED, ACTIVE PSYCHOTICS WITH internal "Narratives" playing all the time about revenge, payback for being ostracized, showing POWER and CONTROL via acts of violence.

*Eric Harris of Columbine was a angry, at times violent mentally ill young man under treatment, on drugs. Rejected by the AF because of his mental ills, notably his expressions of welcoming violence, infatuation with violent games, and suicidal feelings.

* Cho, of VT, was a disaster waiting to happen.

* Major Nidal Hasan of FT Hood, besides his radical Islamism, also had many warning signs he was mentally not all there and was full of advocacy of violence.

************
I believe society has to move past the SACRED HIPAA...that sees certain psychotics of very dangerous potential potential as "Patients needing full legal privacy". That the medical community needs to get societal sanction and more societal expectation that they will collaborate with police - not "we will deal with the Chos, Hasans, Harris, and Holmes types on our own".

This is akin to 9/11. Various "authorities" guard their sphere by witholding info from others...and without information shared...the (dots don't get connected).

leslyn said...

leslyn and the Lefties got what they wanted 40 years ago and now they have to explain why nobody like OrangeHair can be committed.

Misdirection. Again.

What happened 40 years ago?

The Libertarian enclave Minerva on a platform in the South Pacific, sponsored by the Phoenix Foundation, declares independence. Soon neighboring Tonga annexes the area and dismantles the platform.

Japanese soldier Shoichi Yokoi is discovered in Guam; he had spent 28 years in the jungle.

U.S. airlines begin mandatory inspection of passengers and baggage.

Richard Nixon visits China.

The last episode of "Bewitched" is aired.

The Watergate Burglars are arrested.

George Carlin is arrested for saying "Seven Words You Can Never Say on Television."

The Munich Massacre at the Summer Olympics occurred.

The first female FBI agents are hired.

U.S. troop levels in the VietNam war drop to 27,000.

Apollo 17 lands on the moon.


Mind telling me what that has to do with a crazy man shooting up a theater in Aurora?

JAL said...

I did not see anything else on the "letter" and there was no speculation about its contents in what I read.

Anyone else see anything about it?

Cedarford said...

Peter said...
IF Holmes had mailed the warning letter to the psychiatrist well in advance of the shootings but it sat in the university mailroom for days without being delivered, that's a whole new basis for lawsuits against the university.


===================
Good fucking luck with that.

Care to make it so you can be sued for negligence by not opening any mail or package addressed to you in a timely manner..???
For "failing to read all email and text messages" on a daily basis??

ed said...

@ LoafingOaf

"So, it seems the warning signs were there, yet he was still able to rush order assault rifles, thousands of rounds of ammo, gas mask, tear gas, body armor, etc etc etc, from internet vendors with no problem whatsoever and no triggering of an alert to law enforcement."

Amazingly enough unless someone actually does something entirely legal transactions remain astonishingly legal.

Paul said...

No no no... don't infringe on the nuts... don't infringe on the psychiatrist.

Instead BAN GUNS and infringe on everyone else!

The nuts have rights... you don't!

leslyn said...

Marshal said...
"That's not an easy decision to arrive at, and should carry some weight."

Note how the lefties are perfectly accepting of limitations which result in death.

I don't know where your brain went today Marshal, but then I can never figure that out from your comments.

My comment advocated paying more attention to the warning.

How do you come up with that as "perfectly accepting of limitations which result in death?"

The rest of your comment just went...waaaaayyy out there.

Do you have a psychiatrist?

Scott said...

"One source [said] that the team may not have been convened because while Fenton had 'serious concerns, there may not have been an immediate threat.'"

There is never an immediate threat until they have a gun in their hands.

Scott said...
This comment has been removed by the author.
khesanh0802 said...

At least it is no longer the gun's fault!
It is a real puzzle, though, at what point a psychiatrist who becomes aware that he/she has a dangerous patient has a responsibility to the general public to force treatment or advise restriction. If a counselor is talented enough to recognize the danger aren't they then responsible? My first - cynical -reaction was that it was term end and that it would have been too much effort to follow up. I hope that is not true.

edutcher said...

leslyn said...

leslyn and the Lefties got what they wanted 40 years ago and now they have to explain why nobody like OrangeHair can be committed.

Misdirection. Again.


No, fact - again, which leslyn can't rebut.

Heaven and earth has to be moved to commit somebody before they kill someone else and the Lefties engineered it.

That's the real issue here - not the "system" not catching him or anything else that's a blind to justify ObamaTax.

PS Think it's cute leslyn goes straight for the Soviet option in response to Marshal.

lgv said...

Ultimately it comes to which type of error you prefer. We can choose to be more aggressive with prevention and end up investigating and detaining those who would have never committed any crime, or we can choose to err on the other side, a real threat is not detained.

It's no different than our legal system. Better more guilty go free than innocent go to jail.

It's easy to second guess.

We've seen the same in issue in Child Protective Services.

Ironclad said...

I am seriously afraid of the "law of unintended consequences" should more action be taken to "prevent" such people from doing anything. Unless the person makes a specific threat to someone, the idea of "preemptively" acting against people could quickly turn into something more sinister. (Think of the soviets putting people into psychiatric hospitals for "anti social behavior").

If TSA is not an experience you wish to repeat (remember - it was to "protect us") then try to make the existing system work better. Don't make a bigger problem by "preventing" something

The Godfather said...

Based on op-eds and letters to the editor, there are a lot of people out there who are willing to violate or at least bend the Second Amendment in hopes that this will stop a mass killing. But maybe it would be more effective to violate or bend the Fifth Amendment and whichever one it is that contains the Right Of Privacy to identify potentially-violent paranoid schizophrenics, so that they can be locked up before they do any harm. I understand that this condition usually appears in early adulthood, and is almost entirely seen in males. So require every young man to have an annual mental exam starting at age 18, and commit him as soon as danger signs are detected.

Wouldn't that make us all feel safer?

Calypso Facto said...

Maybe these standards and procedures need to be changed.

Maybe the slogan of your cause can be: "Guns don't kill people, people who tell their shrinks they're gonna kill people kill people."

I Callahan said...

people who tell their shrinks they're gonna kill people kill people

Here's the ironi part: what if they don't tell their shrinks, and it still happens?

Cedarford said...

Sort of OT, but some other huge failings of the US medical system, besides failing to alert authorities of dangerous psychotics that do need to be checked up on (Hey, would you cops mind seeing if this crazy person has made large purchases of guns, ammo, bomb making supplies...and let us know so we can better assess the degree of danger this character poses to the general public???)

Is obscene stuff like this:

1. Only in America, do people sweat being ruined financially with medical bills if they survive violent criminal or deranged psychotic people's assault. Aurora is the latest..and the only thing those shot up survivors have going for them is the high public profile will force "charitable donations".
Someone shot up by a black thug may still have their lives...but could lose their home and life savings. Charity from "Freedom Lovers" coming to the rescue?? HAhaHAha!!

2. A 17-year old lifeguard from Vancouver Washington visiting friends in Oregon saves a kid drowning in heavy surf. After the rescue, exhausted and beat up, he listens to the Hero firefighters who tell him he must go by ambulance along with the drowning victim - to the hospital for observation.

When the bill arrived a few weeks later, Clark was in for a surprise: about $450 for the emergency room, $230 for the doctor bill and $1,900 for the 15-mile ambulance ride.

The Washington Park&Rec Dept he worked for, or their insurer, said the healthcare policy he has as a lifeguard doesn't cover stuff "he decided to do on his own, in a different state.

3. Hero EMT firefighters in Arkansas watched a man drown in a reservoir. Upon arriving, they found they were out of their jurisdiction and were not covered for healthcare, line of duty expenses, or liability without someone from the town jurisdiction they were in requesting help. For several minutes, they tried contacting the small towns cops, hero firefighters, or town officials to get the "formal invite".
Without luck.
By the time some official said "yes, save the man!" - he had already sunk. They then heroically retrieved the body, but despite heroic measures, were unable to resusitate the man.

Marshal said...

leslyn,

"Do you have a psychiatrist?"

I realize you have trouble responding since you can't crib from your lefty approved talking points briefing. But really, this is the best you have? Does this work in the drum circle?

Michael K said...

"
For the record, mentally ill people are less likely to assault or kill other people than are people who are not mentally ill. The person who is ill enough to conceive and plan such an attack but can still function well enough to carry it out is rare."

This is actually not true, especially for those schizophrenics with paranoid delusions. The Tarasoff standard applies to cases in which a specific individual has been named by the patient. That is unusual. Attacks are often random.

If you want to know a lot about this subject, read My Brother Ron, by Clayton Cramer. It is excellent and the Kindle version is two bucks.

DADvocate said...

You can bet there's a lot of CYA going on. Mental health professionals have notoriously bad judgement. It can go either way, but, this time, it went the wrong way.

Calypso Facto said...

Here's the ironi part: what if they don't tell their shrinks, and it still happens?

Don't get me wrong, I'm not a supporter of the idea of jailing people for pre-crime. Just trying to help Althouse out.

Wally Kalbacken said...

My only encounter with medical privacy issues, personally, not professionally, was from before the implementation of HIPPA.

In the mid-1980's my first wife became psychotic and had a very bizarre episode which ended up with her being admitted to the lock down ward (i.e., the acute psychiatric care unit at the UW Hospital and Clinics.) She was in the middle of something that the psychiatrists initially treated as a bi-polar illness, but after some further evaluation the diagnosis was refined to schizophrenia.

After she was admitted, I went to see her for the first time and the nurse who was at the front desk asked my name, and after I identified myself, she said " Oh, you're her estranged husband." To which I replied "not lately." The nurses had processed her in, and they wrote down a lot of admitting information based on what this clearly psychotic person had told them. That became the reality from which they addressed others, such as myself and her father (she had accused him of conspiring with others to have her killed, in a statement to the Madison Police before she was admitted to the hospital.) I was not in any way estranged from her before her abrupt departure in behavior. Her father never had anything to do with any threat to her. But that was what she said when she was admitted, it was duly recorded, and that was that. I can't imagine how much more frustrating it would have been post-HIPPA.

PatCA said...

Yes, the standards should be changed, but there is an inertia in a bureaucracy that stymies any attempt to deal with a deranged student.

I came across this while in academia. The student was clearly mentally ill, almost incoherent. The admin, campus police, department all agreed on that but nothing was done. I said, graduate him if that's what he wants, and they refused b/c he was a couple units short.

So far he hasn't killed anyone, so I guess they were correct.

David said...

Hey, it looked good on their cv.

Until now.

Credentials without responsibility, this time with big time consequences.

traditionalguy said...

The imprisonment of persons thought to be dangerous to themselves or others is not our system anymore. we really have no where to keep them.

But doctors can issue detention orders so Sherrifs can arrest them and bring them before a panel hearing with their own MDs, Family Representatives and an appointed attorney.

Most times they are medicated and released wth threats of re-arrest if they don't take their meds.

The reason that is valuable is the memory created by the experience of being arrested by strong, no-nonsense men in uniform carrying guns. It is a needed learning experience that a real authority exists.

Mary Beth said...

Reading the comments on whether or not one can tell if someone is a danger and how much, if anything, can be done to prevent it made me think of the Twilight Zone episode "A Penny for Your Thoughts".

In it a man (Dick York), who works at a bank, suddenly has the ability to read minds. He "hears" another employee thinking about robbing the bank and reports it to the manager. The thoughts he overheard were just the other man's fantasy, not something he was actually planning.

Predicting what another person will do isn't that easy, even if you think you know what they're thinking.

furious_a said...

If the rules were changed so that a shrink would have a heightened responsibility to rat out his patient, you would have to be insane to consult a shrink.

"Clinically insane" and "high-functioning" aren't mutually exclusive. Patients have fooled their shrinks before. Bias against "False positives" and "prior restraint" mean that the occasional mad shooter will evade detection/prevention.

grackle said...

… he was still able to rush order assault rifles, thousands of rounds of ammo, gas mask, tear gas, body armor …

This keeps popping up in the comments. Please keep the facts straight. There was no "assault rifle" or "body armor." Assault rifles, that is to say fully automatic rifles, are not available to the general public.

Although bullet proof vests are available to the public apparently the shooter instead wore a vest designed to carry items such as ammo. Bullets go right through them. But what the hell, he could be reasonably certain of no return fire since the premises were 'gun free'(which rhymes with 'killing spree').

Chuck said...

Dear Ann,
I live in Michigan, but having spent a fair bit of time in Madison, and coicidentally in the neighborhood west of Camp Randall that you know so well, I'd actually be a lot more comfortable living there if I knew that there were no "Threat Assessment Team" composed of UW academics, than if there were such a team.

R. Chatt said...

If the "threat assessment team" had decided to do something about Holmes what would have been their next step? Does anybody know the laws in CO?

What was it that caused his psychiatrist to become so concerned?

What I'm thinking here is that Holmes, like Jarad Loughner was severely troubled psychologically for quite a long time, much different than a person with temporary road rage etc.

Finally, a person with chest pain visiting a medical doctor found to be on the verge of a heart attack would be immediately taken to a hospital for treatment. But someone on the verge of a psychotic break is left on their own?

Fr Martin Fox said...

Cedarford:

Your point is made--i.e., about people being totally crazy aren't so likely to be able to plan it. It takes someone maybe, I dunno, only partly crazy?

And...I'm sorry, but--when I read your posts, I think, how can someone be so clear-headed so often, and then believe all that crazy stuff about the JOOOOZE?

Good God, man, they're God's Chosen People! Don't mess with them!

OK, sorry, don't mean you any ill. Just had to get that out.

Fr Martin Fox said...

RE: this whole post...

Sounds like some folks are revving up for a big-ole lawsuit.

This week, I was talking to one of our human resources guys at the Archdiocese. He's the guy who sends out "policies" that drive everyone nuts--such as a notice that everyone who does any work, whatsoever, that gets remuneration, has to be on the payroll.

So we're having to put folks who teach Catechism on the payroll--because we give them a few bucks three times a year.

No, seriously--you can't just hand them cash or a check as a thank you. If you give them a gift card, it has to be $49 or less. Seriously.

And, why, you ask?

Because of lawyers. And bureaucrats and politicians. It's all about complying with tax laws, 401(k) laws, and...wait for it...avoiding lawsuits.

Lawsuits? How, I asked?

Because if they get hurt while teaching the catechism class, they claim workers comp. Only they aren't employees. So workers comp. doesn't apply. So guess who pays? The Archdiocese.

So it's "easier" to put 'em all on the payroll.

Lawyers. They (with lots of help) are wrecking this country.

Sorry, genial hostess.

a psychiatrist who learned from veterans said...

I guess somewhat like the psychiatrist in question I can't quite make up my mind. I suppose my first impression is that I'm kind of jealous of Ann. The comments here seem capable of coming to a conclusion on the basis of extremely limited data. I mean like 'is heaven pink of blue?' The answer awaits. OTOH, the University of Colorado as represented by the Behavioral etc, does come across like the football program at Penn State. Like 'Is there any reason to change our world? We're big; we're grand; everybody kisses our ass and will continue to. Think, be responsible? You didn't come here for that.'

Unknown said...

The premier legal precedent on the issue of psychiatric duty upon discovery of the possibility of violence from the treater's patient has been referenced, too briefly, above:

Tarasoff v. Regents of the University of California, 17 Cal. 3d 425, 551 P.2d 334, 131 Cal. Rptr. 14 (Cal. 1976).

The Wikipedia summary is over simplistic, but a good starting point:

"The Supreme Court of California held that mental health professionals have a duty to protect individuals who are being threatened with bodily harm by a patient. The original 1974 decision mandated warning the threatened individual, but a 1976 rehearing of the case by the California Supreme Court called for a "duty to protect" the intended victim. The professional may discharge the duty in several ways, including notifying police, warning the intended victim, and/or taking other reasonable steps to protect the threatened individual."

As with any legal precedent "THE DEVIL IS IN THE DETAILS"--the particular and unique facts which must be scrutinized in light of both past law and present social policies.

EXPECT "CLASH OF TITANS" LAWSUITS ENDING IN THE U.S. SUPREME COURT AND INVOLVING LEGIONS OF LAWYERS AND "FRIENDS OF THE COURT" BRIEFS.

So far? I'd put down some money on the plaintiffs. Again, however, the SPECIFIC FACTS will control the outcome. THIS IS THE VICE OF "TRIAL BY MEDIA"--the talking heads come to conclusions without knowing the facts or conducting a rigorous analysis of the law.

Unknown said...

Some years ago, I obtained a Master's Degree in Counseling Psychology. We studied the Tarasoff decision, albeit in a psychological context, and concluded: ANY POSSIBLE RISK OF HARM TO OTHERS COMPELLED SWIFT DISCLOSURE "WITH HIGHER AUTHORITY". This CYA approach can alternatively be phrased: "IF IN DOUBT, SPREAD THE LIABILITY BY HAVING SOMEONE ELSE TO POINT THE FINGER AT"

THIS WAS NOT DONE HERE. The school is going to pay "big time".

Bryan C said...

"So, it seems the warning signs were there..."

Are you comfortable with law enforcement being "alerted" and your rights being curtailed because of "warning signs"?

Consider that "warning signs" in the past few decades would have included so-called deviant sexual behavior, political affiliation, race and ethnicity, recent travel, military background, medical conditions, family medical history, religious beliefs, etc.

From the contemporary perspective, those were all considered valid proxies for an inclination to dangerous behavior.

Of course, we're much more enlightened now, and no one would ever be so stupid as to publicly label someone a mass-murderer based on factors as trivial as political party membership. Right?

Bryan C said...

FWIW, I think the current situation is balanced as well as it can be. It's not a matter of criminal responsibility.

Psychiatrists, lawyers, etc. have a first and higher obligation than the one they adopt upon joining a particular profession.

If they break confidentiality and they're right, then they may save lives. If they break confidentiality and they're wrong, they may lose their professional standing. Which can they defend to their licensing boards? Which position will save them from a civil lawsuit? Which outcome can they live with?

In other words, they've got exactly the same choices every other ethical human being would be faced with.

Lyle said...

They couldn't have done more. There is no fast tracking interdiction. This is America.