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Monday, April 23rd 2007

Does HIPPA Hinder Identifying Dangerous Individuals?

One of the author’s of Point of Law has an op/ed in The Times pointing out how HIPPA’s patient privacy regulations hinder identifying the mentally ill who might be a threat to the community (h/t Kevin, MD).

Under HIPAA, it would have been unlawful for the psychiatric hospital that treated student Cho Seung-Hui, who shot 32 people at Virginia Tech university this week, to compare notes on his therapeutic progress, or lack thereof, with his counselors or dean. So effectively did the various privacy laws bottle up information that even a Virginia Tech official tasked with the monitoring of problem students is said to have known little or nothing about Cho’s lurid history of psychotic symptoms until after the fact.

First, I’m a strong supporter of privacy rights. Sometimes those need to be explicitly ennumerated – as with privacy concerning your health care with HIPPA.

Second, I’m not sure that HIPPA played a real role in the Virginia Tech horror. The loosely defined federal handgun rules concerning mental illness should’ve prohibited Cho from buying a handgun. But it wasn’t access to Cho’s history of mental illness that was a problem. It is really a question of how Virginia, and the gun dealer he purchased from in particular, enforced federal law.

Nor do I think, beyond limiting his access to weapons, that pundits can come up with what the Virginia Tech administration or local authorities could’ve done differently if they had had access to Cho’s mental health records. There’s a lot of talk of suicidal ideation, but the stuff being leaked out specifically from his time under evaluation (not including his creative writing endeavors) speaks nothing that he was a risk to others. The stalking, which got him his brief psychiatric evaluation to begin with, apparently involved no threats and no aggressive behavior.

Identifying those with the potential to carry out horrors like what happened on April 16th is incredibly difficult I imagine. I don’t think we can assign HIPPA or patient privacy concerns any real role in Cho “slipping through the cracks.”

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