Fort Hood opens debate about secrecy of medical records

Fort Hood opens debate about secrecy of medical records
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Army officials say one thing that could have helped prevent last week’s shooting at Fort Hood is better information sharing with commanders about the mental and behavioral health histories of incoming soldiers.

The shooter, Spc. Ivan Lopez, 34, had arrived at Fort Hood, Texas, in February after being stationed for four years at Fort Bliss, Texas. By the time of his transfer, Lopez had a history of mental health issues, including anxiety and depression, and was prescribed a number of prescription drugs, including Ambien.

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But receiving commanders at Fort Hood would not have been privy to Lopez’s health history.

“Here's the biggest problem we have. … It’s a dilemma,” said Army Chief of Staff Gen. Ray Odierno. “The problem is sharing information and how you protect an individual's rights with sharing information, so the commanders and the people at the lower level understand that, maybe, there was a previous problem.”

Under the Health Insurance Portability and Accountability Act (HIPAA), a soldier’s mental and behavioral health record is kept private from his or her new commander. Thus, while physicians at a new base would have access to soldiers’ health records, a commander would not.

“If a soldier has mental health counseling at Fort Bragg, N.C., and he moves to Fort Carson, Colo., sometimes we have difficulty moving that information with them, because of patient HIPAA, frankly. And so, that's the concern. And so, we are trying to develop systems that enable us to do some of that, but it is difficult,” Odierno said at a Senate Armed Services Committee hearing on Wednesday.

Army officials say they have developed a new software program called "Commander's Risk Reduction Dashboard," which allows commanders to consolidate information from multiple Army databases on which soldiers in their units have been involved with "at-risk behaviors," but it is not known whether it was used to consolidate information on Lopez.

The only circumstances where a commander would be alerted by a mental health professional about a solider is if there were signs the solider would act in violence against him or herself, or others, a Pentagon spokeswoman said. That step is required under the Duty to Warn Act. 

Although an Army psychiatrist had “fully examined” Lopez the month before last Tuesday’s shooting rampage, there was no sign he was a threat to himself or others, Army officials said.

Lopez also had a clean “behavioral” record, Army Secretary John McHugh said at the hearing. “No outstanding bad marks for any kinds of major misbehaviors that we are yet aware of.” 

Army officials said they faced the same issue with Maj. Nidal Hasan, who opened fire at Fort Hood in 2009, killing 13 and injuring more than 30. 

“We had a flavor of that with Maj. Nidal Hasan in that the receiving commander was not aware of some of the disciplinary issues that he had, some of the academic issues that he had that, over time, added to his challenges,” McHugh said.

“So, part of the problem is HIPAA and who has access to what kind of medical records, behavioral health records,” McHugh said.

Army officials say extensive background screening takes place before a soldier is accepted into the service.

"Applicants with a history of conduct that shows that they have views that are inconsistent with Army values are denied entry based on questionable moral character," said Army spokesman George Wright. 

However, after that, mandatory behavioral health screening is done once a year, according to McHugh.

“So, we're trying to keep as close a watch on our soldiers as we can. But clearly, we believe there are more things we can do to identify problems in the more discreet stages of their development, try to get soldiers added help where, under our current toolkit, it may not be so obvious," he said.

McHugh said another part of the lack of information sharing is the “age-old culture of the military… that you’re given a new start with every permanent change of station.”

“We've made a lot of progress in making the relevant information aware and available to receiving commanders, but we still have some challenges on what we're allowed to do legally,” McHugh said.

The gap in information comes at precisely the same time of a period of high-stress for the service member, according to military mental health professionals.

“Changing locations, changing duty stations, changing jobs — things of that nature is going to bring upon stress,” said retired Navy Master Chief Petty Officer Maurice Wilson, president and executive director of Reboot, a nonprofit that helps veterans transition to civilian life.

Currently, there is a mental health program, “inTransition,” that can help a service member adjust to his or her new base, but it is voluntary, the Pentagon spokeswoman said.

Warrior Transition Units help injured soldiers transition back to work if they are unable to do their job, but Lopez’s mental and behavioral issues never rose to that level, she said.

Wilson said offering more mental health services during a transition from one base to another could help with the stress.

“You don’t know what anxieties people are bringing in, and what they’re accumulating,” he said. 

Army officials also acknowledge the stigma against seeking mental health assistance contributes to keeping problems from one’s commander.

"The challenge we face, particularly as we look at what occurred just yesterday at Fort Hood, is that we are doing everything we can to destigmatize … reaching out for help, before it becomes a larger problem," McHugh said.