Thursday, April 19, 2007

Privacy laws need scrutinized

I really need to stop watching the news regarding the Virginia Tech shootings. Since I can't, I'll offer some commentary on what I watched this evening on the cable news shows and what I read in some of the online news articles with reference to privacy laws and medical records.

What is the role of the university if a student is diagnosed with a mental illness? In this article from today's New York Times, it states what we already know - That they are bound by the same federal laws that pretty much everyone else has to follow.
For the most part, universities cannot tell parents about their children’s problems without the student’s consent. They cannot release any information in a student’s medical record without consent. And they cannot put students on involuntary medical leave, just because they develop a serious mental illness.
The article goes on to say that universities have quite a problem here in trying to navigate through these privacy laws.
Universities can find themselves in a double bind. On the one hand, they may be liable if they fail to prevent a suicide or murder. After the death in 2000 of Elizabeth H. Shin, a student at the Massachusetts Institute of Technology who had written several suicide notes and used the university counseling service before setting herself on fire, the Massachusetts Superior Court allowed her parents, who had not been told of her deterioration, to sue administrators for $27.7 million. The case was settled for an undisclosed amount.

On the other hand, universities may be held liable if they do take action to remove a potentially suicidal student. In August, the City University of New York agreed to pay $65,000 to a student who sued after being barred from her dormitory room at Hunter College because she was hospitalized after a suicide attempt.
What is the role of government if a citizen is diagnosed with a mental illness and would like to purchase a firearm? There has been a lot talked about and written about how easy it was for Cho to purchase a gun in Virginia. In this article from the Associated Press, they talk with the gun store owner and his impressions of Cho during the transaction.
Roanoke Firearms owner John Markell said his shop sold the Glock to Cho in March. The serial number had been scratched off, but federal agents traced it to the store using a receipt found in Cho's backpack.

"It was a very unremarkable sale," said Markell, who did not handle the sale personally. "He was a nice, clean-cut college kid. We won't sell a gun if we have any idea at all that a purchase is suspicious."

Markell said it's not unusual for college students to make purchases at his shop as long as they are old enough. Cho held a green card, meaning he was a legal, permanent resident, according to federal officials. That meant he was eligible to buy a handgun unless he had been convicted of a felony.

It has been suggested in the media that if Cho's medical records, specifically his mental illness diagnosis, was somehow made available as part of the "background check," then, possibly, he would not have been able to purchase a gun at this place. I do realize that possibly no law could have prevented this kid from getting his gun.

However, this brings up an interesting point about privacy laws. Should certain medical diagnoses be made available in a law enforcement database? If so, which diagnoses? Just mental illness diagnoses? Who decides which medical information is placed into a database like this? Would that mean that if I am pulled over for speeding that my medical record would be accessed on a police cruiser computer?

These two articles bring in some new angles to the personal privacy verses public safety debate. Where is the line drawn between the two? Who decides where the line is drawn? What are the consequences if it goes too far one way or the other. I apologize for bringing up more questions, but I think the privacy laws in this country need to be placed under a microscope and analyzed. It is long overdue....

Update: Uh oh, this post got picked up this morning by RealClearPolitics.Com and by the FoxNews.Com Buzztracker - because of my quotes from the NYT story. Yeesh! Look out! I'm not a political commentator, just a doc! Oh well....

Update 4/24/07: There's now information that he should NOT have been sold a gun because he was seen as a danger to himself and others. But, the information was never entered into the National Instant Criminal Background Check System. Read more in this story.


N=1 said...

I believe Ohio does release medical records about mental illness as part of the "instant" background checking process.

However, this goes to the more general alarming trend of the courts inserting themselves into the exam room and interfering with the healthcare provider patient relationship.

Every patient should realistically assume that his or her medical records is not private in that release of information signatures and assent are demanded prior to treatment by all hospitals, healthcare insitutions and licensed healthcare providers, not to mention third party payers and third party benefits administrators. Patients have no real ability to control the privacy of their own healthcare information. Anytime, anywhere and under any circumstances.

coaster1robert said...

I think this subject,is worth the debate.

~*SilverNeurotic*~ said...

Even with those laws in place, Cho was outwardly showing warning signs that he had some serious issues that any intelligent individual could pick up on. You shouldn't need his medical information to have a good idea that he probably wasn't the stablest person and could possibly cause some type of violence in the future.

Dr. Deb said...

OMG, I couldn't read the post bc the profile picture distracted me.

YOu sure have a wonderful sense of humor, Dr. A.


Hi Dr. A. Good post. Thanks for visiting.

patientanonymous said...

I think it's very unfortunate when tragic events like suicides and homicides happen like this but really, I am a huge advocate of privacy and patients' medical records should not be released. Not unless there is a patently valid reason for it.

Things are a little different here in Canada re: firearms etc... We don't sell them on street corners and they are actually pretty hard to obtain "legally." Well, maybe not but you need to have a hunting license or something...I don't really know but you can't just walk in to *wherever* they sell rifles and buy one! I wouldn't even know how to go about getting something like a hand gun illegally!

But no. Once you start to open the floodgates, pretty soon nothing will be sacred and you will have so many people being mistreated for their illnesses and...ugh, I just don't even want to go there. There's already enough discrimination as it is. And there's already enough information floating around out there already.

Anonymous said...

i have always assumed that it was a general rule (insert proper term here) that a mental problem..diagnosis..illness...even one inpatient hospitalization would be cause to not be able to pass a back ground check to buy a gun.
i have never attempted to buy one, so i don't know if i could... but honestly, some people just should not be allowed to purchase a gun. mainly unstable people.
i do NOT agree with anyone's right to bear arms being infringed upon. i don't mean to say that people should not be allowed to own guns or hunt or do whatever it is people do with guns. but people who are proven to be a danger to themself or someone else, in my opinion.. should not be sold a gun. period.
btw... i have this type of diagnosis... chronic suicidal thoughts / behavior, etc. so yeah, i find it in my best interest,and those who care about me, to just go on beleiving, that i can't just waltz into "wherever" and buy me a gun.

The Angry Medic said...

What I thought was the most disturbing was that that depression went for so long untreated. No one should be that lonely...Mother Teresa said that loneliness and being unloved were the diseases of the future.

People have joked that with the pressure-cooker atmosphere here at Cambridge, it's a wonder someone here hasn't gone kooky and done the same, but with the nervous laughter that followed, I'm not sure if I can post that on my blog just yet...

And well done on the RCP pick-up, old bean! Fox seems to really love you too. This young admirer wonders, "how DO you do it?"

Anonymous said...

I value my privacy, freedoms and privileges as much as anyone in this country...but I wonder...

At what point does someone's private life/problems cross the line where they become a community's problem? Somewhere along the line, this guy's did as his mental illness affected many that day (and continues to).

Wouldnt this be like the guy mentioned a few weeks ago on your blog that was put in jail because he refused to wear a mask to protect the public from illness? If the TB guy is in jail...shouldnt this guy have been/be too?

At what point does someone who has a mental illness cross the line and become a community threat/problem? (and not all are or will what is the breaking point where something should be done to protect the community?) Im not advocating locking all with a mental illness up (by no means!!!) Im just posing questions that have come to me as I've listened and read this week. Muddy

SOULMANGE: said...

excuse me? anonymous. good LORD. you think that CHO..HE did have a name ya know. he was just as human as anybody else. he was diagnosed and medicated for depression. depression. YOU beleive that he should have been put in prison... BEFORE the (for lack of a better word) tragedy... at VT... ?????
can you honestly say that, and beleive it to be the majority vote or beleif in this country that a person diagnosed with a mental illness should be JAILED?????
MY GOD YOU need to read a fuckin book !
the guy was obviously misdiagnosed, and his ILLNESS?DIAGNOSIS was much more severe than depression. perhaps he was schitzophrenic, or maybe even bi-polar. but regardless. did you ever think that maybe he was NOT taking his meds? that happens A LOT more than people know. and the consequences can be serious. many times it is not the meds...but NOT taking the meds that cause problems such as this. just wait... after the results..if made public...of CHOS" autopsy reprt... they will say if he had a theraputic level of his meds in his system at the time of the shootings...or even perhaps if he was high on something else...crack? heroine? nobody knows this yet.
man. i could go on and on about this. jail! that is just the most outrageos statement that ii have read or heard since the day this happened.
you better study up, and pray to God that YOU never get depression, or bi-polar... or perhaps PTSD. got kids? a spouse? what if they died suddenly or tragically? PTSD is real and long lasting. sometimes disabling.
should the spouses and children of 9/11 be JAILED because they suffer PTSD for their losses and trauma? should our united states war vets be JAILED because they come home depressed or having flashbacks because they lost their legs or their best friend...or worse..maybe killed people?
oooooohhhhhhhh. it's people like you, that make people like CHO... AFRAID to SPEAK
i hope you're happy with yourself.
but..apparently you are not...or you would have identified yourself wouldn't you???

Anonymous said...

If they can lock up someone with TB for not wearing a mask because he is a public threat...then if the signs are there(as they supposedly were with this guy)...why wasnt this guy locked up too? Im just sayn' Muddy

(BTW-I did identify just missed it)

SOULMANGE: said...

my apologies "muddy"
i haven't even read about thi TB guy you're so hung up on.
but the thing is... i suppose THAT situation would be similar to the laws of the people who kNOW that they have HIV or AIDS and they continue to expose other people to the risk without telling them beforehand.
THAT.. i have NO problem with. i have a young daughter.... i would surely hope that someone would never knowingly infect her with aids without her knowledge. not that she or anyone else would be so gullable to go further after they were informed. at least not without precaution.
anyhow. yes, i suppose that is similar. TB is highly contageous, and airborne, and deadly. would you want to stand in the bank line and have a simle sneeze from the guy next to you KILL you.. or your child? IF he could have prevented it by wearing a simple dust mask? i doubt it.
BUT c'mon.... JAIL????? for being sick? NOBODY KNEW the severity of CHOS' condition. everyone chose to ignore him. NOW EVERYONE wants someone to blame. so YOU instead of "blaming" the man, or the illness, YOU want to blame our LAWS? our RIGHTS? our FREEDOM ?
perhaps it is YOU who needs some meds. you just are not thinking straight.

Anonymous said...

Soulmange, the TB story I reference was a post a few weeks ago also on this blog. Here is the URL in case you'd like to read it.

I think you are reading too much into what I am saying here. I am trying to make a link that IF they can put someone in jail for being a harm to society because they have TB and are not taking precautions (in this case a mask) to protect those they come in contact it really a far jump for them to put someone in jail that is showing signs of perhaps snapping where they could be a danger to themselves or society. It is my understanding that this IS done. I am not condoning a universal locking up of people suffering from mental illness. (I said that in my first comment, maybe you missed it.) There is a point sometimes however where someone suffering from mental illness crosses the line and becomes a threat. It seems that situations like this are never dealt with in time...but after the fact...after people are hurt or dead. I was mearly posing some questions and the TB case came to my mind. In those comments, I didnt feel like jail was the place for a TB patient (as you might see if you read the post and the comments by folks) but he did need to be somewhere if he wasnt going to take precautions. He was a threat to the community. Same thing with this from what we have learned. I still say the shooter is ultimately responsible for his actions. He pulled the trigger...but I also think that somewhere along the way, people that should have intervened, didnt and 32 families are now paying the price. I ask it again, when does someone cross the line to where it goes from being just his personal problem with his own mental illness to where it becomes the community's problem because this person is now a threat? Are we failing as a society in this regard too? And if this crosses over to being a community problem...then going back to Dr A's privacy laws cease to pertain?

Soulmange, Im sorry if any of my comments bothered you. My intent was not to stir the waters, but to ask some questions and add to the conversation. God bless and take care. Muddy

SOULMANGE: said...

you're right, i did miss some things you had said in earlier comments. i don't know if you've seen it, but there is an e-mail that goes around sometimes, and it contains a paragraph or two in which all of the letters in all of the words are jumbled... but , it is read smoothly if you actually just "read" it. i think this is because a person's mind, sees what it recognizes, and it processes it THAT way. so, many times such as in blogs for instance, someone will forget a letter in a word, or misspell it, but most people know what it was "supposed " to be, and can make sense of it. point here? while i read your earlier post (s)... my mind saw what it recognized..... (reject the mentally ill/they are not safe/ put them ALL in jail/ Before they snap)
well... obviously..that is what my mind saw.
sooo... why did i get so defensive? because I would be one of those people that you implied should be imprisoned. that is why. WAS i , in the past, a threat to myself or someone else? yes, i was. mainly to myself. the other people part was less than 3 times in my life... did i follow thru..NO. i got help. I was still able to remain coherent enough in even that state of mind to know that neither was right, nor an option, and would solve nothing.
as far as the hurting someone else thing... that is not a problem for me...there were "circumstances"...that's why i think i understand Cho's side of this. the pressure and angst that he was feeling. the isolation, and loneliness. the rage. i hate the way he dealt with all of it.
the thing is... this is a country that reserves their "resources", for certain people.
do you realize that a couple years ago in Dallas.. The MAYOR of all people... the mayor! in an attempt to "clean up the streets of Dallas... to get rid of the homeless, and street people. she had a team of police men... who MANY did not want to do it, but only followed orders. it was even in the winter time. the mayor sent these teams out to certain places and if there was anyones belongings.. such as blankets, coats, make-shift shelters, etc..but MOST importantly... they even took these peoples medications. most of these people were blessed to even have meds... she (the mayor of dallas...) had ALL of these things removed, and disposed of. !!!
you think your little statement got me should have seen me then! THAT was CRUEL, and INHUMANE. to do that to already homeless, and many ill people. these meds were not only psych meds, but also cancer meds, pain meds, allergy name it. these people were already suffering..without homes, food or shelter...and she took what little they had...including their medication, and threw it all away...NONE of it was returned to them. NONE.
some mental illness derives from genetics. others appear after trauma of whatever sort. it can be can be life-long. depending on the severity. either way it is terribly difficult to live with on a daily basis. paralyzing, isolating.
some states do have laws in place to "protect the community...AND the patient... by involuntary hospitalization...not jail ), but others don't.
the thing is that just TOO MANY people with thought like Cho .... remain silent... until they "snap" and do something like this.
or other times... they do seek help, but are turned away, because they don't have insurance or money for the help that they need.
Cho, for example... mAY have been a different story if he would have spoken out to someone..anyone.. about his true feeling and thoughts. he obviously didn't do that. and he obviously was mis-diagnosed because he didn't voice his true "problems."

i'm sorry that i made such a big deal about this whole thing. it's just the need to blame... that everyone seems to have. and the total lack of understanding that even doctors have about mental illness... of seemingly every type.

so what does it ALL boil down to NOW???
apparently money. resources. understanding. humanity. NOT blame. blame only allows the rage to continue in this country.
if my sister, brother, daughter, mother , father, son... had been one of the victims at VT.. would i be so "understanding" right now? i don't know. i honestly do not know. but if i were able to direct my rage and pain in a positive, rather than destructive manner...such as John Walsh...after his son was so brutally and tragically murdered. that type of response is what makes good things come from bad. Not blame. rage. or attacking an entire group of people because :they just might someday be like Cho".
the worst part of all of this, past and future... is that... nobody can help someone... unless that person SPEAKS out honestly of their "symptoms". and sadly, most mentally ill .. have NO trust with that kind of knowledge being let out of their own mind. "people will think i'm crazy" "no one will like me" "i'll lose my kids" "people will be afraid of me"
ya...that is why people get as sick and snap and go to the extreme that some do in school shootings, or office spaces.
it's just something that we have to live with. i think that the mental health providers should pick up on these symptoms earlier on. i know nobody can read minds... but there is a pattern of behavior that leads up to a breaking point. sad thing... few know that pattern. and few no how to handle it.
and that is sad... but that is life .
anyhow. sorry i blew up on ya, but really, i did miss A lot that you said. mainly that you were NOT speaking of ALL ill patients. i really didn't see that.
so anyhow. take it ez.
sorry for writing a book here. (dr A)

Roy said...

I deal with these situations all the time. Many inpatient psychiatrists do. You just don't hear about it because it doesn't usually get to this extreme. How many thousands are treated and released, without any bad outcome, for each one like Cho who does have a bad outcome?

And, these people, who might be a danger to self or others, don't go to jail unless they have already committed a crime. They go to a hospital for treatment.

What was the Tom Cruise movie where they locked people up who were likely about to commit a crime? Is that where folks want to go? God help us if that is so.

SOULMANGE: said...

i remember the movie...not the i feel the need to find out! perfect example!
i will get back here on this.

SOULMANGE: said...

it was "Minority Report"

Anonymous said...

And, these people, who might be a danger to self or others, don't go to jail unless they have already committed a crime. They go to a hospital for treatment.

Perhaps so, but they do also put people in jail (with or without a mental illness) who they find is planning to commit a crime. (whether it is to the extent of last week's tragedy or something less) Through that they will often do a psychiatric evaluation, but people are put in jail before a crime happens if there is proof they are planning one. muddy

daedalus2u said...

So what kind of "diagnosis" would be necessary to bar someone from purchasing guns? Would being in a delusional state enough of a mental illness? Who would get to "diagnose" that person? Could they be diagnosed against their will? Again, by who?

I can think of plenty of political leaders who are delusional about lots and lots of things. They may call their delusional beliefs "religious", but that doesn't make them any less delusional.