Thursday, May 24, 2007
Agency reviews how Cho fell through gap
The agency's board is working to restore its state law compliance.
It was December 2005 and Seung-Hui Cho was in the hearing room at Carilion St. Albans Behavioral Health, about to learn if a special justice would commit him to a mental facility.
No one from New River Valley Community Services, the regional agency that coordinates a variety of mental health programs, was present -- even though a community services counselor had determined just a day earlier that Cho was an imminent danger and should be hospitalized, and even though Virginia law requires the community services board to direct any care that was ordered.
Sixteen months later, of course, Cho would become the deadliest lone gunman in U.S. history, perpetrating the April 16 shootings at Virginia Tech that took 33 lives, including Cho's own. Whether any decision at St. Albans could have altered the course of events is impossible to know.
But New River Community Services Board Executive Director Les Saltzberg hopes a meeting Friday will point the way toward bringing his agency back into compliance with the state law that governs competency decisions such as Cho's. The meeting between community services staff and Special Justice Paul Barnett, an attorney who oversees mental health cases and who decided on Cho's treatment, also will go over new processes required by Gov. Tim Kaine's executive order last month.
Among other items, the order closes a legal loophole that let Cho purchase firearms.
Cho's hearing highlighted the gap between state law and what has become the community service board's practice. In the 1990s, the agency had staff on hand at every competency hearing. That shifted sometime earlier this decade, said Barnett and Saltzberg, who became executive director last summer.
"It's been several years since we've been able to afford to have someone there every day just in case," Saltzberg said Wednesday.
Cho ended up at the intersection of the legal and medical systems after a roommate reported that the Tech student might be suicidal. On Dec. 13, 2005, a community services worker evaluated Cho and decided that he was mentally ill, that he posed an imminent danger and that he should be hospitalized. He was held in St. Albans overnight.
The next day, a standard independent evaluation by a private doctor agreed Cho was mentally ill -- but concluded he did not present an imminent danger and did not require hospitalization.
Such disagreement is not uncommon, Saltzberg said. In cases where a patient is not blatantly psychotic, "when someone's had 24 hours to pull themselves together, it can look quite different," he said.
After the independent evaluation, no one from community services went to Cho's hearing, held Dec. 14, 2005.
"I think the general thought was he was going to get released" without a treatment order, Saltzberg said.
But Barnett decided Cho met Virginia's imminent danger threshold for compelling treatment. He ruled that Cho was a danger to himself and ordered him to get outpatient care, a step for which Cho or his insurance company would have to pay. Someone from St. Albans would have referred patients like Cho to a service provider, Barnett said last month. A Carilion spokesman has declined to comment on Cho's case.
Such outpatient commitments are rare, and in the New River Valley, most go to the community services board. But Cho's did not, community services spokesman Mike Wade said last month.
A state review commission looking into the Tech shootings is trying to find out if Cho ever received treatment. The director of the university's Cook Counseling Center has said that to his knowledge, the center was never notified about Barnett's order for Cho.
But a professor who tutored Cho in late 2005 has said that she urged Cho to seek counseling -- separately from the legal process -- and that he told her he did. A Virginia State Police search warrant served on the university health services last month indicates that Cho had medical and counseling files there.
Mark Bodner, a special justice in Fairfax County who heads the commitment task force on the state Commission on Mental Health Law Reform, said his group has not yet looked at how treatment plans are drawn up across the state. But Bodner said he expects the same "great variations" seen in other aspects of the commitment process.
In Fairfax County, for example, competency hearings mirror criminal court cases, with presentations of evidence and attorneys arguing for and against commitment, he said.
In the New River Valley, the immediate goal is just figuring "how do we get the communication loop better so no one falls through the cracks," Saltzberg said.
Barnett, who said he hears about 50 or so mental health cases per month, said Wednesday that he'll welcome an increased community services presence.
"Any input like that is appreciated," Barnett said.





