The Tennessee Star has obtained a Metro Nashville Police Department (MNPD) internal document labeled “Vandy Psych” which appears to be notes taken by an MNPD officer tasked with reviewing documents obtained via
a search warrant granted for Vanderbilt Psychiatric Hospital, part of Vanderbilt University Medical Center (VUMC), on June 1, 2023.
The notes indicate that on page 38 of the documents retrieved from VUMC, the MNPD officer saw that Covenant killer Audrey Elizabeth Hale, who killed six people at Covenant School in Nashville on March 27, 2023, had “Thoughts of killing Dad in and struggles with mental health. Recent thoughts of going into a school and shooting a bunch of people.”
According to the document obtained by
The Star, the officer reviewed at least 75 pages of VUMC materials about Hale.
The document obtained by
The Star does not indicate the period of treatment for Hale covered in the VUMC notes, but
The Star has learned Hale left the care of her first psychologist in 2019 and began receiving care from other VUMC mental health professionals.
The complete contents of the document labeled “Vandy Psych” can be seen below:
Drugs on page 4
- Buspirone – Anxiety
- Escitalopram (Lexapro) – Depression
- Hydroxyzine – Anxiety
- Sodium Chloride – Nasal Spray
Page 36
- Parents concerned with her anger, sleep deprivation and increased depression. Several triggers. States she is angry with people. Denies SI, HI, and AVH.
Page 38
- Thoughts of killing Dad in and struggles with mental health. Recent thoughts of going into a school and shooting a bunch of people.
Page 48
- Homicidal thoughts with a plan. Misunderstood and felt like she needed to prove a point.
Page 58
- I have violent fantasies but wouldn’t do anything
Page 62
- SI and HI.
- “Thinking a lot about death, both Suicidal and homicidal
- Thinks about jumping off a bridge
- Has fantasies of being a school shooter
- Wrapped a cord around her neck
Page 72
- Worsening Depression, SI, HI
Page 73
- Has homicidal thoughts, such as shooting at a school
- Thoughts of jumping off a bridge or wrapping a cord around her neck
- Homicidal thoughts of killing her father. “Sometimes I get frustrated with him and have homicidal thoughts
Page 75
- Homicidal thoughts “That I would not act on”
- Worsening depression with intrusive ego-dystonic SI and HI
While the document suggests Hale was prescribed only four medications,
The Star has additionally
located a fifth medication prescribed to Hale. This drug is from the Benzodiazepine family of anti-anxiety medications the FDA warns is “associated with amnesia, hostility, irritability, and vivid or disturbing dreams.”
Based on VUMC materials retrieved by police, the notes appear to complement and corroborate additional details obtained by
The Star.
This includes information provided by a source familiar with the MNPD investigation, who told
The Star that MNPD Chief John Drake acknowledged to them that VUMC had knowledge that Hale expressed to mental health professionals there she had thoughts of killing her father and fantasized about committing a mass murder at a school, but failed its duty to warn potential victims.
The Star has learned that Drake acknowledged VUMC staff failed to adhere to Tennessee Code
33-3-206, which at the time of Hale’s
March 27, 2023 attack mandated mental health professionals and behavioral analysts “shall take reasonable care to predict, warn of, or take precautions to protect the identified victim from the service recipient’s violent behavior.”
Upon learning of a mental health patient’s threat, Tennessee Code
33-3-207 explains they are meant to inform identified victims, take steps to voluntarily or involuntarily commit the patient, and continue mental health treatment.
While there is no criminal penalty for mental health professionals who neglect their duty to warn, Tennessee Code
33-3-209 suggests mental health professionals who fail to warn could face monetary liability in court.
However, Tennessee Code
Title 28 appears to limit civil actions in personal injury to
just one year.
A scholarly journal article
presented by the National Library of Medicine explains that psychiatrists could face professional and civil consequences for failing to warn intended victims or targets of an individual, and specifically that a psychiatrist who releases a patient without gathering pertinent information about their capability to commit a violent attack could face civil liability.
Additional analysis by the McCain Institute
explains, “Importantly, even if a threat doesn’t constitute a duty to warn, it should be taken seriously and handled appropriately internally,” because a [f]ailure to act or provide appropriate support in light of a threat may lead to harm or to an unintentional breach of duty of care obligations, providing grounds for a civil action lawsuit.”
The Star previously reported it has learned the identity of
the original psychologist who treated Hale. More recently,
The Star has
learned the identities of a psychiatric nurse practitioner and psychiatrist who both treated Hale and prescribed at least five medications prior to her death.
In an affidavit
submitted by an MNPD detective in order to obtain the search warrant for VUMC,
published by The Star, it was additionally revealed that Hale received treatment at VUMC or from mental health professionals affiliated with VUMC from April 2001 until her death.
Upon searching the Hale family home, detectives discovered a VUMC folder “with a portion of Audrey Hale’s medical history from Vanderbilt Psychiatric Hospital.”
The Star additionally obtained photographs which depict both the front of this folder as police found it as well as some of its contents.
Titled Vanderbilt University Medical Center Partial Hospitalization Program, the label and handwriting on the front of the folder’s label indicate it contained “Discharge Information” and other data related to a VUMC Intensive Outpatient Program (IOP) in which Hale participated in 2019.
Inside the folder was a partially visible page titled “After Visit Summary” that contained Hale’s name. The document is dated August 26, 2019, and confirms Hale was seen by VUMC staff on that day.
Two handwritten notes on the page included the name of an individual and instructions to “follow up with primary care” after the VUMC visit.
On the other side of the folder was a second partially visible document which appears to contain advice about self-soothing techniques that can “help calm and relax our mind and body” when “feeling anxious or overwhelmed.”
While the exact title of the VUMC program Hale joined in 2019 is unclear from the photographs obtained by
The Star, a VUMC
web page explains, “Our Adult Partial Hospitalization program is designed to help adults struggling with mental health concerns whose symptoms are not responding to current outpatient therapy and/or medications.”
This program is “personalized to each client’s needs and symptoms, which may include anger or irritability, inability, inability to regulate emotions, interpersonal conflicts, isolation, mood-related sleep disturbances or recurring suicidal thoughts,” according to VUMC.
After Hale’s attack, Representative Jason Zachary (R-Knoxville) successfully passed legislation that additionally required mental health providers to
report to law enforcement in addition to their patient’s the intended victim.
Both
Star News Digital Media, Inc. (SNDM), which owns and operates
The Star, and editor-in-chief Michael Patrick Leahy are
suing to compel the full release of Hale’s writings, including those some call a manifesto, from MNPD. Leahy and SNDM are similarly plaintiffs in the
federal lawsuit to compel the FBI to release Hale’s writings.
The Star recently published
an FBI memo, addressed to Drake and sent in May 2023, which “strongly” advised against the release of “legacy tokens” from individuals like Hale. Such “legacy tokens” appear to include all of Hale’s writings, including those obtained by
The Star and those sought in the lawsuits.
Last week, the FBI
declined to confirm it sent the memo in a statement to
The Star, but confirmed it sends such “products” to local law enforcement partners.
Since obtaining a tranche of documents related to the Covenant case, as well as
about 80 pages from the journal recovered from Hale’s vehicle,
The Star has published
dozens of articles reporting new information about the killer, including excerpts of her own words in the days before March 27, 2023.
MNPD submitted a Friday legal filing that
confirmed the authenticity of the materials obtained by
The Star.
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Tom Pappert is the lead reporter for The Tennessee Star, and also reports for The Pennsylvania Daily Star and The Arizona Sun Times. Follow Tom on X/Twitter. Email tips to pappert.tom@proton.me.
Image “Audrey Elizabeth Hale” by Nossi School of Fine Art and “Vanderbilt Health Campus” by Vanderbilt Health.
