I cant say exactly what is going on in the case of the Colorado movie theater sho oter I just do not

t have all the knowledge and all the facts. I am happy this you ng man was able to find the psychiatric services at his local institute of high er education. Many students cannot. Sometimes I even have to alert my patient s who are eligible for such services that such services exist. Psychiatrist Lynn e Fentons past as an acupuncturist is colorful, at least. I have been to so many places and done so many things, that I do not think anyone should be condemned by their past. In the past, Dr. Fenton has been disciplined by her medical board for prescribin g rather strong drugs to herself and family. I suppose people are sometimes ove rcome in circumstances such as the death of a relative like Mom. She is back pr acticing with not more than a slap on the wrist and a mark on her record. Appr opriate for this level of wrongdoing I think, if there are really no other circu mstances. As for the accused shooters notebook with the stick figures and the sh ooters, I have seen many such notebooks but never from a patient. I saw them in 2nd, 3rd or more rarely in 4th grade on the desks of male classmates who fantas ized about such things. The operative word here is fantasize. If the psychiatrist believed this represented a fantasy or better yet, had not s een the drawings and had no knowledge then there is no reason to report. If sh e thought this guy was actually going to do this, she was under the obligation t o do some kind of warning to authorities or potential victims. This is standard practice and required in most if not all states due to the Tarasoff case. We u sually just say it like a verb we have to Tarasoff someone. The best summary Ive found on the web is a 2006 lecture from a Stanford Universit y seminar on psychiatry and the law. Basically, if Dr. Fenton knew about his th reats and took him seriously but took no steps to protect potential victims (fo r here is an example of a really good reason to break medical confidentiality) t hen she is in very deep doo-doo. Me, I had a case like this on one of my early r otations in county mental health. I informed a supervisor, who agreed with me and agreed I should Tarasoff a schizophrenics girlfriend. I did the whole bit tel ephone with follow-up letter. She laughed on the phone, she basically told me t hat saying he wanted to kill her was some kind of sex play. She didnt want to ta ke any protective action then. The last I heard when I left that August berg o f California, she was very much alive. When on the public payroll, cover-your-a ss medicine is a way of life. As for our theater shooter, we can only stay tune d and try to understand why this tragedy happens and how to keep similar ones fr om happening.