​Detach strings from student health care

In October 2014, Duke announced plans for a new Student Health and Wellness Center. The 72,000-square-foot structure brings Student Health, Case Management and other health resources together under one roof. While the new building will greatly improve student health care on campus, it fails to address a striking problem with how health care is administered on campus. Many campus providers—including the Women’s Center, Counseling and Psychological Services, and the Center for Sexual and Gender Diversity—answer to and are budgeted under the Division of Student Affairs.

This chain of command leaves room for potential conflicts of interest where the interests of the University may not align with the medical best interests of the student. For example at Princeton and several other universities, students have fought universities advising suicidal students to voluntarily withdraw or else be involuntarily withdrawn when many medical professionals say withdrawing can be detrimental and inappropriate for some depressed students. A healthcare provider should counsel the student based on their medical case without pressure from the university’s administrators.

Further consider a student looking for counseling after a sexual assault. While the student might desire to pursue legal action against the alleged perpetrator, a department like Student Affairs may very well be interested in avoiding costly lawsuits that could blow into public relations disasters. Pressuring counselors to emphasize forgiveness resolution to survivors is not an unlikely possibility but may not be the path an independent provider would take.

These potential conflicts of interest are further compounded by privacy issues with student medical records. In cases of litigation between a student and their University, the student’s medical records are essentially unprotected by HIPAA privacy regulations according to the Department of Education, allowing for the public exposure of counseling records. This risks compromising the integrity of the professionals providing care and the privacy of students in their health care, who may no longer feel able to litigate given the exposure risk.

In 2015, administrators at the University of Oregon released a student’s private counseling session records after she sued the school. A few months later at Yale University, holding medical records under FERPAled to a student’s parents being notified of mental health treatment despite a rocky relationship that the medical professionals were aware of and being cautious not to upset.

Resolving these loopholes and risks for conflicts of interest and confidentiality is not easily done but requires transforming how student health care is administered on campus. If the Duke Hospital and not Student Affairs oversaw the on-campus resources that students go to so often for counseling, the process of health care from start to finish would be managed by professionals with much less non-medical stake in what treatments were given to students. The vulnerability of records to exposure would also be mitigated. Otherwise, these centers could transition towards a referral-based system, in which trained staff review student cases and suggest appropriate medical professionals within the Duke University Health System or in the Durham area. Current medical professionals on campus could move to private practice or be incorporated into DUHS and the referral system.

While Duke’s medical professionals care very much about the students they treat and there is no reason to suspect anybody wishes vulnerable students ill, it cannot be denied that the current organization of student health care providers on campus needs changes. Students cannot be left open to these plausible conflicts of interest and unwanted privacy breaches. Duke students ought to be able to seek health treatment on campus without any trepidation that Student Affairs or non-medical considerations will interfere in their best road to recovery.