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Cho's Case Spelled Out

June 19, 2007

By Bill McKelway

Virginia's mental-health system may be understaffed, underfunded and under fire, but learning to read might help get things pointed in the right direction.

That was the view yesterday from key legislators who told mental-health officials that state laws may not be as murky as some have alleged; nor are they solely to blame for the breakdowns in procedure that allowed troubled Virginia Tech gunman Seung-Hui Cho to slip through the cracks of the state's mental-health system.

After state mental-health Inspector General James W. Stewart III recently spelled out findings about Cho's muddled care in December 2005, some lawmakers said state law simply wasn't being followed. And they recoiled at any notion that state laws leave gray areas about treatment plans and monitoring outpatient care.

"I don't see them as lacking in clarity," said a frustrated Del. Robert B. Bell, R-Charlottesville, referring to code sections that specifically assign responsibility for outpatient-treatment plans to the local mental-health agency. "It seems as clear as day that they are supposed to do something."

Cho was declared mentally ill and a danger to himself and ordered to undergo involuntary outpatient care by a special justice in December 2005.

But a hospital clerk arranged the care, not the New River Valley Community Services Board, and no one was directed by the justice to monitor what care was provided. State law leaves that up to the local community services board or the treatment provider.

In Cho's case, however, Cho was supposed to see someone at Virginia Tech's counseling center. But the head of that center has said publicly that it does not accept court-ordered patients or patients who are mentally ill and dangerous.

Cho, in other words, was directed to receive care that he had to arrange himself through a clerk and that could not have been monitored because it was not available.

What care Cho may or may not have received has not been made public but has been disclosed to Stewart and other investigators.

In Washington yesterday, a lawyer for some 20 families of Virginia Tech victims said progress is being made about allowing the families to have a more direct role in the investigation of Cho's April 16 shooting rampage that left five faculty members and 28 students, including Cho, dead.

Gov. Timothy M. Kaine will meet privately with the families on Saturday, and the issue of representation on Kaine's handpicked investigative panel will be a top item on the agenda, said the lawyer, Thomas J. Fadoul Jr.

Fadoul indicated that the families may accept an existing panel member to represent their interests instead of the appointment of a new panel member.

While Fadoul did not rule out the possibility that the families are interested in some sort of financial recovery from the deaths, he said families now want to know what happened and why their loved ones died.

In Richmond yesterday, the House Committee on Health, Welfare and Institutions heard Stewart detail findings of broad shortcomings in mental-health care, most of them reiterations of studies years ago.

While Chairman Del. Phillip A. Hamilton, R-Newport News, promised broad reform efforts next year at a time when new state funds will be lacking, others stumped for closer adherence to current law.

"I don't know how you can be a whole lot clearer," said Del. Clarke N. Hogan, R-South Boston, also referring to outpatient-treatment plans and monitoring requirements.

But Stewart pointed out important problems, including Virginia's tight time frame for assessing a mental patient, the lack of requirements for specificity in determining background profiles, and the failure of state law to require that conflicting statements about a patient be reconciled.

Local mental-health agencies are short about 230 case managers; 60 percent of the 40 regional agencies have two staff members or less per 50,000 people; the average wait for outpatient treatment is 35 days; and almost 60 percent of the agencies have seen a decrease in outpatient-treatment capacity in the past decade at a time when pressure for that service is increasing.

If legislators see the law as unequivocal, the reality is something else, Stewart said.

While community services boards are required by law to devise an outpatient-treatment plan for a patient, only half of those boards reported even being able to attend commitment hearings more than 76 percent of the time, Stewart said. There is not enough staff.

Contact Bill McKelway at bmckelway@timesdispatch.com or (804) 649-6601.